Wrangling Medicare: A New Vision

“The Doctor’s Art” is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

With around 63 million beneficiaries, Medicare is the single largest provider of health insurance in the U.S. serving Americans ages 65 and older, as well as some younger patients who have certain disabilities. Directing this massive program is Meena Seshamani, MD, PhD, an otolaryngologist and former vice president of Clinical Care Transformation at MedStar Health, a large healthcare organization primarily operating in the Baltimore-Washington metropolitan area. There, she led initiatives in palliative care, geriatrics, and community health. She has also served as director of the Office of Health Reform at the U.S. Department of Health and Human Services.

In this episode, Seshamani discusses her path from surgeon to health policy leader, what draws her to caring for older adults, and her vision for better, more sustainable, healthcare in the future, with hosts Henry Bair and Tyler Johnson, MD.

In this episode, you will hear about:

• 2:08 Seshamani’s enthusiasm for medicine at a young age and the diverse career trajectory that followed
• 6:27 A discussion of Seshamani’s past leadership roles, including those at the Office of Health Reform under the Obama administration and at MedStar Health
• 10:20 Balancing the need for clinicians to work collaboratively and the inclination of physicians to value autonomy
• 14:51 An explanation of Medicare’s role in the U.S. healthcare ecosystem
• 17:39 What draws Seshamani to focus on the care of older adults
• 21:00 The crisis of burnout in the medical profession and Seshamani’s vision for how this can be addressed
• 25:33 The fee-for-service mechanism of healthcare reimbursement, accountable care relationships, and the value of preventive care
• 30:40 The pay disparity between specialists and primary care physicians, and the role Medicare can play
• 38:41 How the growing population of aging Americans impacts the future sustainability of the Medicare program
• 42:02 How Medicare is reforming its allocation of resources to promote health equity
• 48:24 Seshamani’s advice to students and clinicians on engaging in meaningful work as they advance in their careers

Following is a partial transcript (note errors are possible):

Bair: You’re listening to “The Doctor’s Art,” a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor-patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?

Johnson: In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives. Those who have collected a career’s worth of hard-earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life’s biggest questions.

Bair: With more than 60 million beneficiaries, Medicare is the single largest provider of health insurance in the United States, serving Americans age 65 or older, as well as some younger patients who have certain disabilities. Today, we are delighted to be joined by Dr. Meena Seshamani, an otolaryngologist and head and neck surgeon, who is the director of Medicare. Prior to her current position, Dr. Seshamani was the vice president of Clinical Care Transformation at MedStar Health, a large healthcare organization primarily operating in the Baltimore-Washington metropolitan area. There she led initiatives in palliative care, geriatrics, and community health. She has also served as director of the Office of Health Reform at the U.S. Department of Health and Human Services.

In this episode, Dr. Seshamani discusses her diverse medical career, what draws her to caring for older adults, lessons learned on healthcare leadership, and her vision for a better, more sustainable, healthcare of the future. Dr. Seshamani, welcome to the show and thanks for being here.

Seshamani: It’s great to be here. Thank you for having me.

Bair: So your career has spanned academia, public service, and being an executive at a large health organization. But can you take us all the way back to the start and tell us what first drew you to a medical career?

Seshamani: Well, when I was six years old, I thought that if you took care of people who are sick, you wouldn’t get sick yourself. So that’s really where it all started. Clearly, I was wrong, but in all seriousness, I think during middle school, high school, I did my volunteer work at a local hospital and just really enjoyed that ability to interact with people and to be able to care for people. And that carried through my undergraduate and ultimately led me to want to be in healthcare and to be in an area where you can take care of others as part of your job.

Bair: And what drew you in particular to being an ENT surgeon?

Seshamani: Well, when I started medical school, I thought that I was going to be a full-time practicing pediatrician. Clearly, that is not what happened. Then I had developed an interest in economics, ended up doing an economics graduate degree. I thought, okay, the people who do health policy work, who are physicians, tend to be in internal medicine. So I will go into internal medicine. And I planned my medical school rotations. Right? So I did kind of surgery first. So then I would really knock it out of the park with my internal medicine rotation. And I did my surgery rotation and I really enjoyed it. I loved being in the OR, I loved interacting with patients in that way, pre-op through the OR and post-op. And I thought, oh my gosh, if I’m having this much fun on my surgery rotation, my internal medicine rotation is just going to be incredible.

For the full transcript, visit The Doctor’s Art.

If you know of a doctor, patient, or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to [email protected].

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