Deborah Lafer Scher Spills the Tea on the VA's Mission and Reimagining Veteran Care, Support, & Collaboration

[00:00:04] Welcome to the High Tea with Grace podcast where we spill the tea on HIT. Today I'm honored to welcome Deborah Lafer Scher, advisory board member of numerous healthcare organizations, including EnableComp. Thanks for joining us, Deborah. Deborah Lafer Scher, Oh, I'm so delighted to be here, Grace. Thank you for having me. Deborah Lafer Scher, Well, we're so thrilled to learn from you. So thanks for that. Can you tell us a little bit about your career path that brought you to your role as executive advisor at the VA and now the board of EnableComp?

[00:00:32] Deborah Lafer Scher, I thought it might be interesting to start with just a little vignette of my earliest memory. I was five years old and in a car with my father. The car was equipped with a huge megaphone and he let me use my voice to say, today is election day, don't forget to vote. From then on, I really grew up in a family where it was important to give back and to give back to the country. My father's parents were both immigrants, came with nothing and

[00:01:02] Deborah Lafer Scher, We're all so grateful to be Americans. And healthcare really became a way to lead a mission driven life, to wake up every day and think about how do we make the world better for patients, for providers and for payers to be able to support the healthcare that patients so desperately need and have it be outcomes driven.

[00:01:23] Really grew up in a family that valued education, went to college, went to business school and then started a career that began first in information and technology and then led to healthcare. I'm happy to speak more about how I got to the VA, but Grace really turning it back to you so you can focus this on what your listeners really want to hear.

[00:01:45] Oh yeah, I love it. I love it. And it's just so critical to be mission driven. It's like, why do technology when I can do technology that saves lives, right? And impact the world through it. So I'm wondering in terms of the VA and the work that you were doing there, what are some of the most significant challenges that veterans are facing to access timely care? And, you know, in terms of like, how are these hurdles really impacting veterans and healthcare providers?

[00:02:11] The VA takes care of 9 million veterans and they take care of them from the time they leave their service and transition out of the military really until the time they leave this earth. And so they have a healthcare system. Veterans have access to a healthcare system that is data driven, is prevention driven, is outcomes driven because of the longitudinal care.

[00:02:37] Most Americans would find that envious, right? Because we get our care in silos. We go to a GP, we go to a surgeon, we go to a gynecologist, we go to a cardiologist. They mostly don't talk to each other. They don't have the background. That's very, very different at the VA. Now, when the VA first built its facilities, veterans lived in very different geographic places than they do now, just like other Americans.

[00:03:07] You know, they've moved from the Northeast to the South, to the Southeast, to the Southwest. And the facilities haven't been able to keep up with the changes in population. The Mission Act was passed, which allowed veterans to seek care in the private sector if they lived a certain distance from a VA facility or the wait times were too long. And this opened up a whole new world for veterans.

[00:03:32] And it opened up for the private sector, a whole new world of patients. Veterans had to understand how to navigate the private sector of healthcare, the commercial world where people didn't know them. Their electronic medical records were sometimes available, sometimes not. They certainly didn't talk to each other. And providers were faced with a patient population that had experiences they hadn't seen before and combinations of experiences they hadn't seen before.

[00:04:01] So I think it's been a learning curve. I think we're in a much better place now. And I think that's because there's been a new understanding of some of those issues and a willingness to try to find different ways to work through them, including leveraging technology. What are some of the challenges and issues that they're facing that may be a little bit different for providers and things that they have to understand?

[00:04:24] Well, there's the physical and there is the mental health issues that veterans present as healthcare patients. The physical is that, you know, they've been in extremely dangerous situations. They've had physical trauma that most Americans never experienced before. And the VA has built up centers of excellence around that.

[00:04:51] For example, traumatic brain injury or what we call TBI. In fact, it's interesting, Grace. When I was at the VA, we would periodically get calls from parents of teenagers who would say, my son was in a motorcycle accident. My son had a terrible skiing accident. They have a TBI. We know that the VA has centers of excellence around this. Can we bring our child to the VA?

[00:05:18] Now, the regulations don't allow that to happen, but perhaps one day they will, where not only can veterans access the private sector, but non-veterans should be able to access the VA and the knowledge and the centers of excellence that have been created. On the mental health side, obviously, veterans have been in situations that most of us cannot even imagine. And many of them start with this sense of stoicism, right?

[00:05:47] That they are there to serve. And truly, they are there to serve America and keep America safe. And that they should not be weak. And sometimes mental health issues are considered a sign of weakness to themselves and their families. We know mental health needs to be treated the same way as any other condition. But it requires expertise. And since the VA has seen more of that, they also have centers of excellence around some of these issues.

[00:06:17] And so veterans expect to interact with providers who have that kind of training when they go to the commercial sector. And that's not always the case. Very interesting. And so interesting to learn about this reality that I think a lot of us may not know a lot about. I'm wondering, you know, how are the claims different on the back end in terms of veterans to affairs? How do people keep track of the health?

[00:06:41] Is there like a longitudinal record or is there a difference in reimbursement for them? Tell us a little bit about that. Sure. So way before there were electronic medical records in the commercial sector, the VA created their own. And it was called Vista. And so they have been able to track for decades, you know, comorbidities, different interventions and what the impact has been.

[00:07:08] The outcomes data that's at the VA is incredibly valuable. In fact, while I was there, the Prostate Cancer Foundation committed $50 million in a public-private partnership with the VA to stand up centers of excellence around prostate cancer so that they could get access to that data and better understand not only the journey that patients go through,

[00:07:34] but patients who are more diverse than is typically available in the general population. And once you see that, then you can hopefully, the goal was to accelerate cures for the general population. Right. And so I think that's very, very different than what we see in the commercial sector.

[00:07:56] Now, EnableComp, in processing claims, has developed some specialty knowledge around reimbursement, around the process, around tracking, around the different kinds of diagnosis codes. And in fact, Grace, when we talk about AI, you know, and claims processing is one of the first places people say, oh, AI should just be able to do this.

[00:08:19] You know, I think what we're learning about AI is that it's not enough for machines to just churn data, that they need context for the data so that they're giving us back meaningful, insightful information. And I've just learned that there's a new term in the AI world called CAG, context augmented generation. And really, this is something that fits beautifully with companies like EnableComp because they have the context for these claims.

[00:08:49] They have been processing so many more of them than any of their individual health system clients, that they have the insights and the knowledge that all of us get when we drill down and focus on an area of expertise. And so I just think it's a fascinating time to be leveraging data and technology to develop insights. Now, in your work at the VA and now at EnableComp, can you tell me some of those lessons that you've learned in the process of creating some of these public-private partnerships?

[00:09:19] What can people learn they're hoping to do to work with the VA? And what are some of the lessons that might be helpful for people to learn about? Sure. So I think in any kind of partnership, public-private or private-private, right? Two companies coming together. The most important thing to find is alignment around both organizations' highest strategic priorities. If it's important to me and it's important to you, Grace, we're going to make it happen.

[00:09:49] If it's just important to me and it's like, you know, number 15 on your list, it's probably not going to happen. And these partnerships require a fair amount of time and energy. So pick something that's really important to you and really important to the other organization. And then when it comes to a government partnership, it's helpful to understand how the organization might work differently than the world you've been immersed in.

[00:10:16] I found when I came to the VA, it was the first government experience I had. And it was such a different mindset than the private sector that, you know, we talk about red, yellow, green lights going off. I didn't even have a yellow light when I was in red territory. I needed people to tell me, oh, no, you can't do that. Or you need to do that a different way. Or that will get all of us in trouble.

[00:10:39] So I think understanding how organizations work, what flexibility they have, how people are rewarded. For example, in the private sector, when priorities change, you just move resources around. It doesn't really matter what somebody was working on yesterday. There's a new priority. They're going to work on that today. In the government, people's offices are determined by regulations that Congress passed. Congress says this is what this office will do.

[00:11:07] And so in the early days, when I was meeting leaders for the first time, some of them would say, my work is authorized around regulation, you know, 24, 55, 67. And I would say, why are they telling me that? Like, I don't care. The answer is that they were showing me the confines of what they could do and couldn't do. And so it's not so easy to find people to take on new initiatives.

[00:11:34] But I think if it's presented as part of the mission and how it will help them accomplish what they come to work to try to do every day, which is help veterans, then you can certainly find a large number of people that are motivated to make it happen.

[00:11:50] So I think picking something that's very important to you and very important to the partner and then understanding how your partner organization works and how to best accomplish moving that mission forward will serve everyone better. So insightful. So insightful. And it's so interesting because I'm sure people have been talking with the VA and have thought something was a closed door when, in fact, they were just talking to the wrong person the whole time or the wrong department.

[00:12:16] And so really making sure you're mission driven and you're talking to the right people is critical. So, you know, looking ahead, what innovative solutions or policies do you think could further enhance? What's 10 steps ahead for them? Yeah, so I think the world is moving very quickly in leveraging technology in health care. One of the challenges in America are the people who live in rural communities far from a health system.

[00:12:41] We all discovered the VA was using telehealth way before COVID, but the rest of America discovered telehealth during COVID. I think that that's a platform where you can collect more and more data for patients without them having to leave their home. The ability to diagnose a wider variety of conditions remotely will help veterans living in rural communities and Americans living in rural communities.

[00:13:09] So I think the continued leverage of technology to collect more data, to make health care providers be able to act smarter and quicker without jamming up the appointment schedule will be very helpful in the future. You know, for our listeners who really want to make a difference and they want to help veterans, what can policymakers or even just you or I do to support initiatives that are improving access for veterans and improving things for the lives of veterans?

[00:13:38] Do you know of any organizations or projects or innovations that could really help support? Well, I think the first thing is understanding, taking the time to understand who they are, who veterans are and what they need. I remember I was at the Milk and Global Conference three years ago and a member of a panel said, well, we should just take the entire VA and give it to, you know, Google to run health care. And I'm thinking Google is not a health care organization like they wouldn't even know where to begin.

[00:14:08] I understand the desire to have efficiencies in government, but, you know, be thoughtful, ask good questions and think about it. Look, there are thousands of veteran service organizations and they're all trying to help veterans, whether it's the Disabled Veterans of America or an organization around women's veterans called To Serve Together. There are so many, the American Legion, the veterans of the foreign war.

[00:14:34] There's even an organization for veterans who are students and who have served and are now going back to school on the GI Bill. So I think, you know, whatever is going on in your community, taking the time to go visit and ask what they need and get to know the people there is really, you know, then it becomes driven by the people you're trying to help. Thank you so much. I'm going to look into all of those, especially the one supporting women veterans.

[00:15:02] That's an amazing organization and all of them sound great. So I want to get to know you more as a leader. I loved learning about the industry from you, but I'd also love to hear about what drives you as just a woman powerhouse in this space. So what are some things that you have done in your life to work your best and make a difference and stay on top of your game? Well, thank you for your interest. I appreciate that.

[00:15:26] You know, I've always been driven by how you make an impact and how to make the biggest impact possible. And some of that just comes from listening and then thinking about, OK, what am I hearing? What are the unmet needs? What are people frustrated about? And what's really missing that would make a huge difference? And then being willing to be the person in the room asking questions, being the person who has the most to learn.

[00:15:54] I think that's very difficult early on in your career. You want to feel like you're showing up and you're competent and you know more, not know more than everybody else, but can certainly hold your own in any conversation. And in your area of expertise, you want to be somebody that other people look to. I think as you progress in your career, you realize that you're not you're never going to know everything and you certainly can't do everything by yourself.

[00:16:20] And so for me, it's been so much about connecting people with other people who can give them leverage to have an even bigger impact. And the work I've enjoyed the most has been building coalitions so that we can get work done on a bigger platform. I'll give you one example during because my role was public private partnerships.

[00:16:43] I was one of the few people at the senior level of the VA who talked to the private sector on a regular basis and brought with them to this role, a whole Rolodex of private sector contacts. The secretary called me early on in covid and said, we are about to run out of PPE. None of our regular suppliers can deliver. You know, people in the private sector, can you find some for us? And I thought I had no supply chain background at all.

[00:17:13] I really had no idea where to begin, Grace. And so I started just calling people, everybody I knew saying, do you know anybody in this field? Do you know anybody who can help? And of all things, out of the blue, I got a call from a hedge fund manager who said, there are CEOs who want to help. And I said, great, here's what I need. Massive amounts of PPE.

[00:17:37] And through a series of introductions, I got to Dean Kamen, who's a private, very successful entrepreneur in New Hampshire, who was flying in plane loads of PPE from China for the state of New Hampshire. And I called him and I said, could you do this for the VA? And he was silent for a minute.

[00:17:59] And he said, I'm a little guy in New Hampshire and you are a massive billion dollar agency and you need me to help you get PPE? And I was embarrassed. But I said, yes. And he said, and probably like the state of New Hampshire, the VA also cannot put up the money in advance to pay for PPE because that's what China and the rest of Asia was requiring. And I was also chagrined and said, no, we cannot do that.

[00:18:29] And why couldn't we do that, Grace? Was because if we put up the money and these boxes showed up empty or had like toy fire trucks in them, then we would be stuck and it would be a total waste of taxpayer money. Right. We couldn't do that.

[00:18:42] So anyway, between the secretary, Dean Kamen, the governor of New Hampshire and a lot of flexibility on the part of key leaders at the VA in the procurement and legal departments, we flew in about 25 plane loads of masks and gowns and gloves.

[00:19:02] And the trucks, these huge trucks were waiting at the New Hampshire airport and then driving them right out to the health care systems across the country at the VA. So that was a time where I felt like we could really make a difference on a national scale and save people's lives. I mean, the resilience in you to just keep going after it until you figured it out is just incredible and inspiring. So like, where do you get that strength to just figure it out?

[00:19:31] What do you do to get that? Oh, that's such a good question. And I've not been asked it before. You know, I think if I had to do it for myself, I would never be able to do it. But I was just channeling like, we need to do something for the health care providers who are on the front line and for their veteran patients to save their lives. And this is not like curing cancer. There should be a way to do it. If I make enough phone calls, involve enough people, we are going to figure this out.

[00:19:59] And it's not an opportunity that I can take six months to figure it out. I got to figure it out now and I should be able to do it. And so there we were off and running. I don't know, Grace. No question, no hesitation because you had no other choice. No other choice. If you could give your younger self a piece of advice, what would that be? Stop trying to be perfect. You have enough positive attributes and qualities to make a difference.

[00:20:28] Just go out and conquer the world. Well, thank you so much. Where can our listeners find you online to get some more great insights like that one? Oh, I would encourage them to please reach out to me on LinkedIn. That's terrific. And now before I forget, did you happen to bring tea with you today? I brought my tea. Tell me about your mug. So my mug is from Banff, Canada, where I went this past summer. I'm a huge hiker and a huge skier. Two of my favorite activities come together in Banff.

[00:20:56] But even more important than that, the reason I was there was for the wedding of the daughter of my best friend from business school. It just symbolizes to me the importance of these friendships we have, which go on for decades and evolve. And the people who have been in our lives telling us the truth, cheering us on, providing consolation when we need it, and making us laugh along the way.

[00:21:24] It's just a reminder to invest that time as busy as we are. Those friendships really are so special and meaningful to all of us. Thank you so much for joining us today and for sharing your great insights with us. Thank you, Grace. Check out the High Tea with Grace podcast for more great interviews with esteemed guests like Debra today. Cheers! Like a Girl Media is more than a media network. It's a community.

[00:21:49] We want to meet you and amplify your voice and the voices of outstanding women innovating in healthcare. Interested in starting your own podcast or hosting an event near you? Connect with us online or in person. We're here to support and empower you.