Our guest this episode was Bill Winkenwerder, M.D.. Dr. Winkenwerder is a nationally known health care strategist with extensive leadership experience in the US Department of Defense and the private health sector. He is Chairman at CitiusTech and Chairman and CEO of Winkenwerder Strategies, LLC, a health care advisory and investment firm. He is an expert in health care finance, health insurance operations, federal health policy, and new technologies.
Dr. Winkenwerder joined Reuben Hall to discuss his experiences and knowledge of the digital healthcare sector, and his perspectives on the future of digital healthcare.
“The use of technology already has in the last ten to fifteen years accelerated the pace of our knowledge. So we are learning more and learning faster because of all the data.” Bill Winkenwerder
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Welcome to the MindSea podcast series, Moving Digital Health. Our guest today is Bill Winkenwerder. Bill is a physician and prominent American healthcare industry leader. Currently, he is the chairman and CEO of Winkenwerder Strategies, where he works with global private equity firms such as Bain Capital, EQT, Carlyle Group, and Partners Group, and healthcare companies such as CitiusTech and Confluent Health to transform the trajectory of healthcare nationwide. Thank you for joining us today, Bill.
Bill Winkenwerder (00:36.95)
Reuben, great to be with you.
Could you start off by telling us a bit about your background?
Bill Winkenwerder (00:44.43)
Happy to do that. I trained initially as a primary care physician, attended medical school at the University of North Carolina, Chapel Hill, where I grew up in the state of North Carolina. Did a residency in internal medicine that sort of prepares you for general medicine. And then I went beyond that after all those years of training and had an interest in what we now call population health, epidemiology, biostatistics, sort of the looking at the broader picture instead of just a one-on-one patient care. And that led me to apply and then attend at the University of Pennsylvania, the Wharton School of Business, and also a fellowship program there that was focused on that very topic of epidemiology, biostatistics, clinical health research, that kind of thing.
And that was a key pivot point early in my career because it was pretty different than just taking care of patients, which I liked to do. But it pointed me in a different direction. And I spent three years there, two two-year programs. And I combined them, did it three years. And then immediately after that, I had an opportunity to kind of jump into the policy world and was offered a job to work as the assistant to what we now call CMS, the big federal agency that runs Medicare and Medicaid. And spent a couple years there, running or working with the leadership and introducing some ideas that I had picked up in those last few years about population health and measuring health outcomes and so on and so forth.
I then pivoted back into clinical practice and a primary care physician became a medical director, the chief medical officer, and I was in Atlanta, Georgia at the time with Kaiser Permanente, and also Emory University Health System. That led to another opportunity to sort of move up the ladder, so to speak, with a health plan, which was Blue Cross Blue Shield of Massachusetts, where I was recruited in to become the chief operating officer there and be at that interface dealing with between the health insurer and large health care provider systems. And that was a very interesting, great experience, some very leading minds in health care there in the Boston area during those years, and certainly still today.
I then left there and had an opportunity to return to government and took on the responsibility of running all the healthcare, leading the healthcare for the US military health system. And that was right after 9-11. So that was not something I expected. I actually joined or was asked to sign on and work as an appointee of then President George W. Bush was sort of waiting to hear about being confirmed by Congress to take on that job when 9-11 happened. So it really changed my career yet again to jump into the middle of military and national security issues and global healthcare and so on and so forth. And I spent six years there, had quite an experience, all kinds of things. We could talk just about that.
But it immersed me at that time, as I had in the years prior to that, in digital health, because there was a lot of resources there to introduce at that time the early electronic health record systems. And so I was involved in that at the Department of Defense, and we coordinated our efforts with the VA, which is a different agency, different department, and also help sort of establish a foothold in the federal government for investment and policy in digital health care with the stand-up of the office of the national coordinator for health information technology. It’s now, you know, short name now is ONC. But that was the agency that after I left government appropriated $30 billion to promulgate and accelerate the adoption of electronic health records. That was right in the 2010, 2011, 2012 time period. That was also the time of the introduction of Obamacare.
By that point in time, I had left the Department of Defense. and then took on a role as CEO of Highmark Health, which is one of the 10 largest health systems, sort of combined health insurance and healthcare delivery. I Took that organization through a lot of changes and restructuring and acquisitions and so forth, ultimately left there and then pivoted yet again for the final phase of my career. I think it’s final now.
uh, still doing it, but working with those private equity firms and, uh, investing in healthcare, investing in innovative healthcare organizations that I think are, you know, changing the landscape, improving how healthcare is delivered using information, technology, software, et cetera, to improve healthcare. So that’s what I do today. And, uh, so I chair the board at CitiusTech and very involved in that company and lead director at Confluent Health. I’m also involved at the university back at my alma mater, UNC Health Care, as they’re one of their board members and a couple of other companies as well. So I’m very active, very engaged as much as I’ve ever been, but it’s kind of in a different capacity than being either a clinician or an executive It’s really more on the governance side and on the investment side.
Okay, so yeah, so many roles and so much experience to dive into. Obviously, you’re still very engaged and passionate. I’m wondering what really drives you about the healthcare and digital health space? What gets you excited to keep on working with these companies every day?
Bill Winkenwerder (07:54.334)
Yeah, Well, I get excited by seeing solutions, that is technology solutions, that make health care better, make it easier, improve it for the patient, improve that, actually improve the outcome and the satisfaction that people have with the care that they’re getting.
And I think it’s also the use of technology already has in the last 10 or 15 years accelerated the pace of our knowledge. So we’re learning more and learning faster because of all the data. And so that kind of supercharges my passion. And I just see lots of different places, lots of different areas that the digitization of healthcare can improve healthcare.
Now, not everything obviously is a net improvement. There are things that happen that are mistakes and there are complications and sometimes it doesn’t work out the intended way. But all in all, I have no doubt that we’re on a pathway that is improving healthcare and making it better. And so I wanna keep doing that. Now, I’ll say this, apart from that, it’s interesting that we’ve had along the same timeline trends that tell us pretty clearly that the actual health of people has not improved. In fact, in the US and in the other countries, the health status has declined.
So I think it’s important to separate the fact that our healthcare system, I think is working in many ways better than it ever has, even though it’s very complex. And the health of people is not so great. One might ask, why is that? And I think I’ve come to the belief that we can work forever and work really hard, even smartly on improving the care process. But we have to ensure that people themselves are educated they’re eating the right foods, that they’re not getting obese, that they’re not getting onto drugs and fentanyl and all kinds of other things, opioids, that really destroy people’s health. And you can help people get better from some of those things, but the best approach is to not have them happen in the first place.
Yeah, it’s a really good point that the healthcare system can get better quality of care, more efficient, but if you’re feeding more sick people and sicker people into the system, that’s not really solving the problem.
Bill Winkenwerder (11:07.566)
It’s not, yeah, it’s costing more money. And so I’m hopeful that we will spend more time in the next decade or two talking about that and not using it as a whipping stick or whatever to try to denigrate people or their, but it’s really about education and helping people understand that they can be healthier if they do certain things and that they should do that, we need to teach that, we need to reinforce it. And we’ve gotten, I think, gotten away from that. And so that’s another thing that, whether it’s schools or public education, things that educate people.
But I’d also say there’s a role for corporations because sometimes corporations make, you know, they make a lot of money incentivizing people into sometimes bad habits, whether it’s the food industry, alcohol, previously cigarettes and tobacco. That’s less of a market.
Yeah, I’d say that mobile phones and technology are right up there too. Yeah, certainly there’s a lot of power in having those devices in your pockets. And they can make your life more efficient in terms of all the tools and scheduling and communication, but they can be also a massive time waster with people spending hours flipping through social media when they could be, you know, out doing other things.
Bill Winkenwerder (12:57.046)
Exactly, exactly. And that’s gonna be a tough challenge, getting those habits changed so that they’re healthier habits that people adopt and that they adopt early on and it becomes part of their lifestyle for most of the rest of their life.
Yeah, for sure. So I’m wondering, what are some of the biggest lessons you’ve taken away from working directly with healthcare leaders over your career?
Bill Winkenwerder (13:32.107)
Yeah, I think it’s important no matter what kind of organization you’re part of or what aspect of healthcare you’re involved in as a leader to identify clearly the vision and sort of where you’re going and to have a strategy for that and to pursue it.
very diligently, very persistently to get your team, your people engaged in that. You have to start with that. If you’re not starting with some passion and excitement and vision, it’s just not going to be motivating. Secondly, after that, you have to ensure that what you’re doing or trying to introduce the new thing, the new solution, the new software, etc. that it fits into the system right now as it exists. Sometimes I think people get a little bit too carried away with massive transformation and that’s really hard to do massive transformation or you know I mean you can wail away and criticize until the cows come home you know the complexity or the problems of the health care system but you’re better off to focus on something that you can change that you can improve and get that into place and work with you know the providers, the business people, the users, the patients, the members, work with the people that are using the system to introduce that and build on that.
And so that’s another thing that I’ve learned and I think companies that do that you know, have a much better chance of being successful. So it’s not, you know, it’s not easy. Most of the people that I’ve worked with that are like CEOs or founders, they’re super smart and very passionate. And I like working with them for that reason. You know, you just got a lot of energy, want to change the end, but you know, another element to not making this.
you’re always going to make mistakes, but the making fewer mistakes is to gather around you and take the advice of people who have more experience so that you don’t make so many mistakes. And I think that’s a really wise thing. I think the companies that tend to grow and succeed and go to that next stage and the stage after that, that’s what they do.
They really find the help and support and guidance from, you know, smart, experienced people. And that’s where private equity can come in with not only the money to grow, but bringing in people that really have great experience and can help advise, you know, the existing management team.
Yeah, we work with a lot of founders at MindSea, and especially founders who are experts in their field, maybe a medical doctor, but they don’t really know software and technology. So, you know, we spend a lot of time, you know, talking people out of, you know, building the everything, building the vision right off the bat, and say, okay, let’s scale it back. So it’s lean it out. What’s the smallest thing we can do to test your concept? to see if that works, get it done as cheaply and quickly as possible, and then iterate from there.
Because you’re right, founders are visionary. They see a few years into the future of the fully-fledged, mature solution and that massive change, but it’s one step at a time. And trying to get founders to walk that back is always a tough conversation.
Bill Winkenwerder (17:42.498)
It is. It’s a balancing act because you don’t want to destroy the passion or, you know energy But at the same time, you know, it’s like driving a car and driving it really fast, you know, you’re likely to crash You know unless you really know what you’re doing or you slow down and learn
Yeah, it’s a conversation about that risk. How confident are you in your solution or your bet that you’re willing to take that risk? And some people are okay with their risk and say, no, I feel 100%, this is the way to go. Or some people say, no, let’s test it out first. Let’s get some feedback. Let’s try and de-risk the technology before building the everything.
Bill Winkenwerder (18:31.978)
Yeah, absolutely. For sure. Makes sense.
And so with your experience there, any kind of specific examples or case studies you’d like to share.
Bill Winkenwerder (18:51.671)
Sure, I’ll give a couple and I’ll go back to my Department of Defense days and one of the things, for example, that we did while I was there, we did several things. But with respect to just the way that system was organized, we went through a process to try to consolidate different facilities because in that system there was the army, the navy, the air force that each had their own you know systems and their own facilities and that may have made sense you know 50 years ago but it wasn’t the way to do it now and or at that time
and so we wanted to consolidate some of the big hospitals, especially in the Washington, D.C. area. And the Army and the Navy each had a big facility, the Navy at Bethesda, the Army at what was then called Walter Reed. But through a series of pretty intense discussions and efforts, and also there was a process that was going on at the time called base realignment and closure that was mandated by Congress, which tells the Department of Defense, you take this period of time for the next couple, two, three years, and come back with a plan of things you wanna close, things you wanna open, things you wanna restructure, because it’s so hard to do it in the normal course of business.
And what we did was we put the healthcare system changes into that process, which gave us the leverage and the authority to make those big changes.
And what came out of that was a consolidated idea of combining the Army and the Navy and the Air Force into a single hospital system that is now the system that’s there today, the Walter Reed National Military Medical Center. That’s where all the presidents and congressional leaders and so forth get their care.
And it’s a world-class, you know, it’s the best military hospital in the world. And so that would be an example of being strategic, but also being aware of the politics and how that can get in the way of making transformation.
Yeah, and how long did that take roughly? Because that sounds like quite a big change.
Bill Winkenwerder (21:39.302)
It was and just to get the decisions teed up and made and approved and so forth was about a two year process. And then there was like a three, four year timeline after that for all the construction and tear down and build up and all that stuff. It followed.
So it all in. It was probably, you know, six or seven years long time, but that’s how you make big, big changes. And then I would say, you know, in the area of digital health, we introduced at that time, one of the early versions of electronic health records, as did the VA. And I think it was what we were doing at that time, got the notice of people in Washington and the president and the White House and various other people. And they said, Should we do more as a government?
And we advised yes, you should. So a new office was established to promulgate electronic health records and digital health. That was the office of the national coordinator. And that actually had bipartisan support. And then after the Bush administration, the Obama administration took that up and put all that money behind it, behind the adoption.
And that’s made it, you know, obviously this made a huge change in healthcare in the United States, really probably in the world. And it was, you know, $30 billion, a lot of money, but in the grand scheme of things, not that much to incentivize.
Somebody asked me recently, was there any mistake that they made? And I said, yeah, I think they did make some mistakes on that even though we got the good outcome from that. But what was not in that legislation and those policies was the establishment of things like interoperability and systems talking to each other and creating common standards. So unfortunately, there was a lot of adoption of different systems and they couldn’t talk to each other.
And now we’re only beginning to solve that problem. you know, the last few years, still not solved. But we’re doing that, you know, with cloud infrastructure and with interoperability standards and mandates on interoperability. And then now, of course, we’re going to be driven, I think, by generative AI and chat GPT and these things that are going to get introduced that will, you know, bring even more change. to the future of healthcare.
Yeah, certainly you highlighted interoperability as being a big challenge still to overcome and understanding that’s progressing and taking time. Are there any other big gaps in the digital health you see in the US that still need to be crossed?
Bill Winkenwerder (24:58.238)
Yeah, absolutely. A couple of the areas that I see that are really still problematic is the workflow inside of hospitals and even inside of clinics. There’s still a lot of paper, a lot of reliance on facts and phone and machines. Now, I’m not an anti-phone person, I think.
People talking to each other is a good thing. But there is a lot that can be done to automate many of those processes in the supply chain, all kinds of stuff. And that’s where a lot of labor costs are. And so, yeah, that would probably eliminate some jobs, but that would make things more efficient.
I think that another area is the documentation. There’s sort of an imperative that’s been established to document everything. And because we can, we don’t always use all that information. There’s a ton of it that gets collected. But the collection part is, you know, that consumes time and it consumes energy, especially on the front end with clinicians spending a lot of their time.
So I’m hopeful again that generative AI and some of the new technology there can help reduce that workload because it’s kind of mundane work that’s really not, it prevents the clinicians from working at their full grade level, so to speak.
So I think that, and then thirdly, I’d say on the patient and consumer side, I think there’s a lot more that can be done to give the patient, the consumer, the health plan member the option, the flexibility, the ability to do things like make appointments, track and move their records, engage to get guidance for care, all of that. I think that you’re going to see more of that happening online.
And I think that’s a good thing. It can take time. But I think that’s another area that I see a gap and opportunity. And then finally, I’d say in the area of analytics and just data that can help accelerate the research on new care pathways and new care approaches and new drugs, new devices, all that can be done more quickly and more efficiently using information technology.
Mm-hmm. Yeah, a lot of the work we’ve been doing recently is on the research side as well. So think mobile phones and specifically connected to wearables like watches are gathering a whole bunch of health data, including heart rate, activity, and being able to collect accurate data for research purposes is a great way to get insights on population behavior and health.
Bill Winkenwerder (28:34.514)
Yeah, absolutely. And it does come back to, again, individuals having the ability to use that information to adjust and change what they’re doing and better self-care protocols and better self-care activity.
But again, it goes back to the idea that we talked about earlier which is individuals can have a huge impact on their own health you know but they need to do certain things in order to do that and it doesn’t all you know doesn’t have to be like you know you’re being instructed by your third grade teacher you know to do this I mean it’s like you know just do what makes sense and what’s good and stay away from the bad stuff, you know, and it’ll make a big difference in your life and the quality of your life. And more people need to know that. They can have an impact by following these better approaches for healthy living.
Yeah, and digital health tools can really help support them doing that. But you know, you’re right, there needs to be that, you know, that motivation to, to improve your health, to start off with. And the whole, you know, you can lead a horse to water. And I think to your point before, the education plays a big part in, you know, understanding that, you know, it’s important to take that role in your own health.
Bill Winkenwerder (30:26.166)
Yeah, absolutely, absolutely. So it’s been a really fun and interesting career. For me, it’s obviously not over, but I’ve met so many brilliant people, people that are doing really interesting things, helping to change healthcare, helping to change you know, society. So a long list of really accomplished and interesting and game-changing people and that’s been another aspect of all of this. It’s been just, you know, very rewarding to be engaged with.
Yeah, and you mentioned being able to be part of the team that brought about the Walter Reed Hospital. Certainly you can feel really good about that. Is there anything else you can look back on and think about where your biggest impact has been?
Bill Winkenwerder (31:35.678)
Well, there are a few different things, you know, at least in my own mind. I, you know, the things I’m engaged with right now are still growing. I mean, they’re still in a full growth flowering growth stage.
CitiusTech for example when I got involved with the company, totally focused on healthcare, software services company. So think of them as a company that supplies the people to help healthcare institutions build their technology, their technology stack and helps in the areas of whether it’s, you know, their existing systems or new systems or changing. So software engineering, data analytics.
AI, ML, performance, metrics, all that. And we work with all sectors of healthcare, payers, providers, life sciences, med tech companies. But when I got involved with the company eight years ago, we were about 60 million in revenue and we’ll be over half a billion this year. And so it’s a fast growing company and backed by two of the biggest private equity firms in the world.
And, You know, so you just feel like you’re riding a fast running horse that’s, you know, going to keep going. So that’s very exciting. And then I work with another company that’s a physical therapy company that’s, I think, really changing the definition of physical therapy to think of it more as a musculoskeletal service platform.
So whether it’s not just the rehab, it’s the prehab, it’s the prevention at workplaces, it’s digital physical therapy, it’s a bunch of different things. When you put them together, the idea is that you can create a, you know, more of a value-based care approach instead of just, you know,
get a referral from a doctor, go see a physical therapist. It’s really an expanded view. And with the idea that our customers or our company itself might be in a position to take some financial risk for a population of people because you can do all those things for them and deliver better services and better outcomes at a lower cost.
That’s, so those are just a couple of examples that are exciting to me that I see as being, game changing companies for the next 5 to 10 years.
Yeah, we did a mobile app that’s currently in a research study with the Sunnybrook Research Institute about physiotherapy and specifically rehab exercises. The app gives the patient videos and detailed instructions, you know, walking them through those exercises, which really helps with adherence because a big part of the challenge there.
We’re also collecting a lot of the data off a smartwatch as they’re doing the exercises to give the clinicians information about how they’re performing against their baselines. So some really interesting opportunities there in the physiotherapy space for sure.
Bill Winkenwerder (35:26.43)
Yeah, you got it. So yeah, so that’s kind of a quick summary of things and appreciate the opportunity to talk and field your questions. And you’re obviously very, very knowledgeable about this whole space. So.
Yeah, well, it’s been a pleasure chatting with you, Bill. And thanks for joining me on the podcast. Thanks, everyone, for listening as well to Moving Digital Health. If you enjoyed the conversation, please go to movingdigitalhealth.com to subscribe to the MindSea newsletter and be notified about future episodes.