Ep. 3 Judith Kunisch: Understanding How Healthcare Works from an Industry Insider

Understanding How Healthcare Works from an Industry Insider

Vinny welcomed author Judith Kunisch to discuss her book "The Center of the Star," which offers insights into the healthcare industry. Drawing from her extensive career, Judith explained how healthcare, the world's second-largest industry, operates through five interconnected sectors that often work independently, creating confusion for consumers navigating pricing and care.

Judith introduced her "star" model framework, covering 100 years of healthcare history and addressing critical issues including population health, costs, the consumer-patient distinction, and AI's impact. She discussed the Triple Aim framework and revealed the "Hidden Triple Aim": power, control, and money as key drivers often overlooked in healthcare discussions.

The conversation explored the Health Industrial Complex, the role of brokers and consultants, and future predictions. Judith anticipates improvements in population health and access over the next decade, while noting ongoing cost challenges. She emphasized shifting from a "patient" to "consumer" mindset and AI's potential in reducing costs.

Vinny closed by highlighting his commitment to balanced, informative healthcare discussions and mentioned Judith's book is available on Amazon.

Disclaimer: This content is for educational purposes only. Please discuss your specific situation with your health benefits administrator or insurance provider for personalized guidance.

Transcript

Vinny Catalano: Welcome, everybody, and so excited to be with you today. I have such a great guest.

Vinny Catalano: Um, she's someone I've known for, uh, for many, many years, and, um…

Vinny Catalano: Um, her introduction, uh, is just great. Uh, she's, uh, her name's Judy Kunis, she's an author of a great new book.

Vinny Catalano: on the world of healthcare, called, uh, The Center of the Star, and it's published by Advantage Books.

Vinny Catalano: And I've known Judy, like I say, a long time, and went to college with her sister, Suzanne. Shout out, Suze, how are ya?

Vinny Catalano: Um, Judy is a healthcare strategist and executive leader and educator with decades of experience across.

Vinny Catalano: Many sectors. A former Fortune 500 vice president and Yale faculty member.

Vinny Catalano: She specializes in healthcare operations, economics, and reform.

Vinny Catalano: She's a passionate advocate for system change, blending expertise with actionable insights to drive impactful solutions. Welcome, Judy!

Judith Kunisch: Hi, Vinny. So nice to see you, and thank you for the opportunity to talk about my book.

Vinny Catalano: Absolutely. Your book is, like I said in the preamble, really an amazing book. I, um…

Vinny Catalano: I thought I knew something about healthcare, and as having been a broker for 22 years, but when I read this book, there were insights literally on every page.

Vinny Catalano: And so, uh, it was, uh, a master's degree in, in healthcare, uh, in about a, uh, you know, 10-hour read. So, uh, I really, I really enjoyed it.

Vinny Catalano: So, let's start with it, you know, why did you write the book, and who did you write it for?

Judith Kunisch: Well, good questions. Um, first of all.

Judith Kunisch: I did have a fabulous career, and, um, I am a nurse. I started at the bedside taking care of patients.

Judith Kunisch: Um, I realized that I wanted to do more, and so I got a Master's of Business Administration, an MBA, and, um, stepped over into some management roles and leadership roles.

Judith Kunisch: And had a very interesting career, and, um, I was very fortunate.

Judith Kunisch: I, near the end of my career, I started teaching people who were in grad school to become healthcare executives, and I was teaching them about the business of this huge industry.

Judith Kunisch: And they were fascinated.

Judith Kunisch: And I realized that I really did know a lot of stuff.

Judith Kunisch: So I started writing it down, and um…

Judith Kunisch: I said, I want to tell people what I learned, quote-unquote, in the School of Hard Knocks.

Judith Kunisch: And because I learn stuff on the front lines in lots of different positions.

Judith Kunisch: And so, that's… that's why I wrote the book. And then I decided.

Judith Kunisch: well, I need to write this down and publish it, and I did, and I'm very happy about it.

Judith Kunisch: And I do want to say one thing right up front.

Judith Kunisch: The book is 210 pages.

Judith Kunisch: You can either write about the healthcare industry and write thousands of pages, or I tried to keep it.

Judith Kunisch: Readable, so that people would, would learn.

Vinny Catalano: No, it's utterly, it's utterly readable, and I think, you know, there were a few moments where I got, like, lost in the weeds, but I'd say on the whole, it was, you know, imminently readable, and I think your point is well taken about.

Vinny Catalano: You know, people who are training to be physicians, nurses, anybody in healthcare.

Vinny Catalano: I think the number of folks that actually are trained on the business end of healthcare is, uh, it's not part of the core curriculum, right?

Judith Kunisch: Well, that's absolutely correct.

Judith Kunisch: At the same time, people who… well, let me say this right up front.

Judith Kunisch: It's the second largest industry and the largest economy in the world.

Judith Kunisch: So there's a whole lot of people that are involved in it who are not healthcare providers.

Judith Kunisch: And yet, they're very much involved with it. They pay for healthcare, they write policies around healthcare.

Judith Kunisch: And I wrote it for them, too. It's not just for people in the healthcare system. It's…

Judith Kunisch: truly for everybody. And I also wrote it for users of the system. People, you know, who…

Vinny Catalano: Right.

Judith Kunisch: are using it and say, oh, wow, this is interesting. Is that what's going on?

Vinny Catalano: No, no, no, absolutely. I feel as though, um, in my career, having talked to, you know, senior HR leaders and CFOs and organizations and CEOs.

Judith Kunisch: So…

Vinny Catalano: This is the thing that is truly mystifying to everyone, you know? I mean, even though they… the second that they go to the doctor, they park their brains at the door, and all of a sudden, they're in this system that, um, you know, is designed to lead them down this path.

Judith Kunisch: Yeah, sure.

Vinny Catalano: And they don't even know where they're going, so they get very confused very quickly, and I took a lot of…

Vinny Catalano: you know, great comfort in at least feeling like I understood some of what was in the book, but there was other bits that I really, really enjoyed.

Vinny Catalano: So, what should someone expect from reading the book? I mean, what is the value to all the folks you just mentioned? Consumers, insurers, doctors, insurance brokers, and anyone in healthcare? I mean, give me the high level.

Judith Kunisch: Well, I'll tell you. First of all, have a basic understanding of.

Judith Kunisch: how the parts are. And I divide the system into 5 parts, and that's where I got the star.

Judith Kunisch: It's got 5 arms. And so each of the parts has a… has a role, a major role in it.

Judith Kunisch: But a lot of them don't talk to one another very often, and a lot of them don't know what each other are doing, and yet, when we want to make change, we need to get them all at the table.

Judith Kunisch: So that was basically what I did, is I said, let me give you an overview of how all these things work. So when you're.

Judith Kunisch: Working on it, or thinking about it, or…

Judith Kunisch: listening to television or the news and hearing about it, you have a few… you have more insight into what this major system is all about.

Judith Kunisch: Make sense?

Vinny Catalano: Yeah, no, it makes total… makes total… makes total sense. I mean…

Vinny Catalano: And I think, like, you said, you hit it right on the head, a lot of, you know.

Vinny Catalano: Instead of talking to each other, a lot of these segments talk at each other.

Judith Kunisch: Correct.

Vinny Catalano: Um, you know, when you have a provider on the one side and a payer on the other side, and they're negotiating their annual contracts.

Vinny Catalano: You know, they're trying to work toward a number that makes them all happy.

Vinny Catalano: But are they really talking about.

Vinny Catalano: what is gonna make the customer happy? I mean, this is…

Judith Kunisch: Yeah.

Vinny Catalano: the one industry… one thing we buy and consume in America that no one knows the price before they go ahead and buy it.

Judith Kunisch: Correct, correct, correct. And the price is different.

Judith Kunisch: Depending on who's paying for it.

Vinny Catalano: No, no, exactly. The price is different within the same facility, depending on who they have the contract with.

Judith Kunisch: Exactly, exactly, exactly.

Vinny Catalano: No, it's, it's, it's, it's, it's pretty crazy.

Vinny Catalano: So, um, let's talk about, you know, the book itself. So, so, you know, you…

Vinny Catalano: I was wondering, you know, what was actually…

Vinny Catalano: center of the story. What was… I mean, that you just looked at, you just sort of named it from the perspective that that was.

Vinny Catalano: point of view.

Judith Kunisch: Well, no, what I did is, um, I developed the star years ago, um, and what I did, and here's my little graphic.

Judith Kunisch: I took those 5 sectors, and I had laid them out, and I started drawing arrows in between them.

Judith Kunisch: That's where I came up with the star. I went.

Judith Kunisch: They all are interconnected, and son of a gun, we have a star here. So that's where I got the idea.

Vinny Catalano: Gotcha.

Judith Kunisch: And then I said, you need to stand in the center of the star, no matter where you're coming from, whether you're a patient, or a consumer, or you're a healthcare provider, or you're a payer, or you're working in the government, and you're working for the Department of Health and Human Services, or…

Judith Kunisch: the infamous CDC, or, you know, down here in the industry.

Vinny Catalano: Right.

Judith Kunisch: You need to, when you're doing things, talk to people from these other sectors.

Judith Kunisch: Um, and so that's how I got started on the STAR. And then…

Judith Kunisch: I really said, well, what is the purpose of this sector, and how do they get the job done?

Judith Kunisch: And so that's part of what I write for each of the sectors. So the book is set up.

Judith Kunisch: I give a background on how we got to the health system that we have today.

Judith Kunisch: And really about the last 100 years. There were major changes.

Vinny Catalano: And that was great, by the way, from a historical perspective, I really, really enjoyed that part of the book.

Judith Kunisch: And…

Judith Kunisch: Yeah, I'm glad you liked it, I'm glad you liked it. And I enjoyed writing it, because it goes back to, you know.

Judith Kunisch: The 20th century, in the beginning, sort of, of the 20th century, and we get into.

Judith Kunisch: Drugs, and building the system, and building hospitals, and changing it.

Judith Kunisch: And, um, it responded to changes in science, and it responded to changes in the population.

Judith Kunisch: So, it's very interesting. And then I take each of the five sectors, and I explain how they're set up, and how they basically work.

Judith Kunisch: I don't get out in the weeds, I will try hard not to.

Judith Kunisch: And then, in the third part of the book.

Judith Kunisch: I identify what I call four paramount issues.

Judith Kunisch: And that we have to address. And the first one of those is.

Judith Kunisch: The health of the general population.

Judith Kunisch: Um, I… I'm very fortunate because there's a lot of data out there.

Judith Kunisch: And I was able to get my hands on it, but I also had a colleague.

Judith Kunisch: who's a librarian at Yale, who did all of my footnotes and checking all my data points to make sure they were legitimate.

Vinny Catalano: Right.

Judith Kunisch: Because it's a big issue, you've got to have legitimate data.

Judith Kunisch: The second one is the high cost of care. Everybody's got issues around it, so I explain.

Judith Kunisch: Behind the curtain, what's going on.

Judith Kunisch: The third one is this whole concept of a consumer versus a patient.

Judith Kunisch: And at the top of the star, I have the consumers and patients, but they're not the same thing.

Judith Kunisch: And we can be one of those at all times, it just depends on where we are.

Judith Kunisch: And then I address AI.

Judith Kunisch: And, um, I write about 8 pages around AI.

Judith Kunisch: And what it means to the health system, because you bet, it's out there, and it's just gonna be there, and be there, and be there.

Vinny Catalano: No, I was super impressed by that inclusion in the book as well. I thought that was super, super-duper insightful.

Judith Kunisch: So…

Vinny Catalano: The one thing that I want to start with, though, with you, were, uh…

Vinny Catalano: It was the triple aim and the hidden triple aim. You know, to me, those two things were…

Vinny Catalano: like, the light bulb went off, and I'm like, why have I never heard of these things before? If you, you know, and you state in the book that this is, you know, what health systems and others.

Vinny Catalano: you know, work toward, why don't we talk about what that is? And, um…

Judith Kunisch: Good boy, good boy.

Vinny Catalano: you know, start there. Start with the triple aim, and then the hidden triple aim.

Judith Kunisch: Okay, so the Triple Aim was developed in about 2004, and it came out of a group in Boston called the Institute for Healthcare Improvement.

Judith Kunisch: Very esteemed organization, very esteemed organization.

Judith Kunisch: And they said that they…

Judith Kunisch: Purpose of the U.S. health system. It has three aims.

Judith Kunisch: And one of them is quality of care.

Judith Kunisch: One of them is the population, and one of them is the costs.

Judith Kunisch: And when they first came, they wanted it to be cost-effective, and when it first came out, people were like.

Judith Kunisch: what? What are you even talking about? We're delivering healthcare, or a patient… I'm getting healthcare, I… you know, those things aren't important.

Judith Kunisch: But as time started to go by.

Judith Kunisch: the overall system, and I mean overall, all 5 of those sectors said.

Judith Kunisch: Oh, yeah, we are interested in the population. We are interested in quality of care. We are interested in the costs.

Judith Kunisch: So, it has become… and unfortunately, you're right, people don't talk about it all the time, but it's… they're drivers of what the system's about.

Judith Kunisch: In my book, and in my work, I created something called the Hidden Triple Aim.

Judith Kunisch: Which is power, control, and money.

Judith Kunisch: And those items are very much a part of the U.S. health system.

Judith Kunisch: And…

Vinny Catalano: Oh, for sure, for sure, I want to add that. I mean, one of my favorite classes.

Judith Kunisch: Oh, interesting.

Vinny Catalano: in my MBA was a class called Power and Influence. And so when you start talking about that in.

Vinny Catalano: Um, in the book, I was just, like, amazed that that was just, like… you hit it right on the head, because.

Vinny Catalano: It's really… and all of the notes I left grad school with, I threw all those notes away eventually, but I kept one piece of paper, and that was the one from my Power and Influence class.

Judith Kunisch: Oh, interesting.

Vinny Catalano: Which was all about, you know, the way, you know, power and influence is managed, and direct power and indirect power.

Judith Kunisch: You're, you're absolutely right.

Vinny Catalano: And I really thought that you hit it right on the head with the…

Vinny Catalano: Shouldn't triple aim.

Judith Kunisch: Well, and it's there, and… and don't kid yourself, it's… it's there big time.

Judith Kunisch: And again, I go back to second largest industry and the largest economy in the world. The money is incredible.

Judith Kunisch: And the power, and, um…

Judith Kunisch: You know, it starts with how many letters you have after your name, but it also starts with who you work for, it starts with the position you have.

Judith Kunisch: It's very much… and then who's controlling things?

Judith Kunisch: And, you know, one of the things that I've experienced in my career is.

Judith Kunisch: I've seen some fabulous ideas that have come from.

Judith Kunisch: People who are on the front lines doing the work.

Judith Kunisch: And it never really makes it beyond where they're working. And a lot of it has to do with power, money, and control, because they're…

Vinny Catalano: Yeah.

Judith Kunisch: They're not, you know, they're not powerful themselves.

Judith Kunisch: And people aren't listening to them. And so…

Vinny Catalano: No, no, absolutely. I mean, I, I, you know, it strikes me as, you know, the triple aim.

Vinny Catalano: You know, and you and I, I think I talked about this in our phone call, but I don't think I've ever heard a healthcare executive stand up and talk about all the things they're gonna do to reduce costs.

Vinny Catalano: You know, you just… they talk about quality, they talk about patient care, they talk about the new hospital they want to build, they talk about the new Gamma Knife they bought.

Vinny Catalano: But they don't talk about what they're doing to lower the cost of healthcare, and or, by extension, health insurance.

Judith Kunisch: Well, that's… that is a very interesting observation, and I'm listening to you, and I'm going.

Judith Kunisch: And I think he's right. I don't think I've heard that either.

Judith Kunisch: I think people are sensitive.

Judith Kunisch: To the costs, particularly if they're addressing the users of the system.

Judith Kunisch: And… and the cost. And… and I… I do write a lot about the media. I don't…

Judith Kunisch: make the media one arm of the star. I probably should, because the media is so involved.

Judith Kunisch: And… because the media.

Judith Kunisch: Brings a huge amount of attention to it.

Judith Kunisch: But it also is one and done. You know, they put something out there, and then they move on to the next thing.

Judith Kunisch: And as I write in the book, making change is very much possible.

Judith Kunisch: People are trying to do it all… ARE doing it, not trying to, are doing it all the time.

Judith Kunisch: But it doesn't get the attention.

Judith Kunisch: That, you know, the hot button items do the things that people really want to hear about.

Judith Kunisch: And, um, so the media is not…

Judith Kunisch: I mean, they're important, they're very important, but I think you have to listen to them, sort of, you know.

Judith Kunisch: Not with a screen, but you have to stop and say, okay, this is one opinion, this is one part of it.

Judith Kunisch: This is not the whole thing. And if you're really interested, I need to learn more about it, because I need to learn more about what they're talking about.

Judith Kunisch: Make sense?

Vinny Catalano: I think that the key… what I've noticed about.

Judith Kunisch: Right.

Vinny Catalano: the media, um…

Vinny Catalano: And by extension, anybody doing communications around healthcare is… no one understands it.

Judith Kunisch: Right. They ought to read my book!

Vinny Catalano: I mean, they don't understand, let alone.

Vinny Catalano: one chapter in your book, let alone the whole book, you know, so it's interesting to hear the angles that the media take. So let's give a real high-level look at.

Judith Kunisch: Yeah, yeah.

Vinny Catalano: the points in the star. Let's have you talk through the different points in the star, kind of, you know, how you define them.

Judith Kunisch: I know you.

Vinny Catalano: And, um, and then, you know, one of the things I want to ask you is, you know, which is your favorite? You know, do you have a favorite, or, you know, or not? So, uh, why don't you go ahead and talk about those points in the star from your perspective?

Judith Kunisch: I would think of them all.

Judith Kunisch: Okay, well, the five points, I start, and I put them at the top, because they're the absolute most important, consumers and patients.

Judith Kunisch: And, um, I use the word consumer as opposed to customer.

Judith Kunisch: Because we have an obligation.

Judith Kunisch: when we're using healthcare, and even when we're not actively using it, to take care of ourselves. And, um…

Judith Kunisch: I write about things like diet and exercise, not a whole lot. This is not a, you know, a how-to do it.

Judith Kunisch: But the concept that not everybody is a patient all the time.

Judith Kunisch: And that patients tend to be acutely ill.

Judith Kunisch: If you are… if you have a long-term illness, and you're on meds, and you're doing perfectly fine, you're still… you're a consumer.

Judith Kunisch: you're, you're, you're a consumer, so I write about that.

Judith Kunisch: The next one I get to right away is the hot button item payers.

Judith Kunisch: And because I worked for a, um, insurance company.

Judith Kunisch: And, boy, did I learn a lot. Um…

Judith Kunisch: I learned about how private health insurance works. I learned a lot about, over my career.

Judith Kunisch: public payments, Medicaid, Medicare, uh, all those different kinds of programs.

Judith Kunisch: And so I write about how they're set up, I write about how they're structured, the difference between the government and private industry.

Judith Kunisch: And I have some good numbers in there for people to get a sense of what's going on.

Judith Kunisch: I then moved down to the healthcare providers.

Judith Kunisch: And I talk about the healthcare… I write about… not talk…

Judith Kunisch: I can talk. Um…

Judith Kunisch: I write about… I divide the providers into two segments. One is.

Judith Kunisch: The individual healthcare provider who's giving you healthcare and you're working with.

Judith Kunisch: And the second one is the institutions, the hospital systems.

Judith Kunisch: big hospital systems.

Judith Kunisch: The health systems, the healthcare delivery systems.

Judith Kunisch: The huge industry, huge industry.

Judith Kunisch: And some of these hospital systems, they're multi-state.

Judith Kunisch: They're… they're… they're all over the place. As a broker, you obviously know that kind of thing, because you're addressing them.

Judith Kunisch: So I write about that and explain that.

Judith Kunisch: I then hop up here to the policy makers.

Judith Kunisch: Government is very much involved.

Judith Kunisch: And I discriminate between the federal government and the state governments.

Judith Kunisch: Because the feds write a lot of the rules, they do the licensing, but the states execute on it, and then the states will write their own pieces into it.

Judith Kunisch: So, I give examples of, for instance.

Judith Kunisch: I happen to use nurse practitioner, so I'm not a nurse practitioner. They do a good job.

Judith Kunisch: But in some states, they can practice independently. In other states, they can't practice independently. Now, the feds…

Judith Kunisch: license them, write the licenses, write the exams, and approve them, but the feds don't say how they can execute their practice, so that's what I talk about.

Judith Kunisch: on the policy side. And then, of course, the payments and…

Judith Kunisch: Medicare, Medicaid, etc, etc. And I dive into Health and Human Services and CDC and just…

Judith Kunisch: a little bit about them, who they are, and what they do. But they add a lot.

Judith Kunisch: to the system. They add a lot to the system.

Judith Kunisch: Okay, and then I get down to…

Vinny Catalano: Well, let me just, let me just stop you there for a sec on HHS and CDC. I mean, that's a whole other podcast. I mean, we, you know, given what's been going on.

Judith Kunisch: It's a hot item right now.

Vinny Catalano: current political climate, um, you know, we can have a field day on that conversation at some point.

Judith Kunisch: Well, and I'm trying hard to stay away from it, because you can imagine it's captured my attention, and I have opinions on it.

Judith Kunisch: And, um, so I'm trying to stay away from it, but it's…

Judith Kunisch: It's pretty… it's pretty tense right now, I think.

Vinny Catalano: Yeah.

Judith Kunisch: Um, the other one is the Health Industrial Complex, and that's, of course, Big Pharma's in there, but also, it's where they do research.

Judith Kunisch: They create medical models. They're a very, very important part of our system.

Judith Kunisch: And I… the book focuses on the U.S. healthcare system.

Judith Kunisch: But we do a lot of work that influences the delivery of healthcare around the world.

Judith Kunisch: Out of this… out of this bracket, because…

Judith Kunisch: They're doing research, they're creating things, and it's not just for people in the United States, it's for people using.

Judith Kunisch: healthcare. So they're, they're extremely important.

Judith Kunisch: And I… I have a great deal of respect for them. I want to say one other thing about them, because…

Judith Kunisch: I think people don't realize this, but, you know, they get into the price, I'm gonna say it, the price of pharmaceuticals.

Judith Kunisch: It takes 10 years.

Vinny Catalano: Right.

Judith Kunisch: To get a drug from the scientific laboratory out into practice.

Judith Kunisch: 10 years! People think that they're just, you know, doing it quickly. So, a lot of that money goes to support.

Judith Kunisch: all of that work to get the drug ready to go. That's very high level, and I get into more detail about it in the book, but it is… it's important to understand that.

Judith Kunisch: That the research that's done in this country is extremely important.

Judith Kunisch: And it influences not only our country, but the world.

Vinny Catalano: No, for sure, and, you know, I really enjoyed that segment on the health industrial complex, because there's so much in the last, I would say the last 3 years.

Judith Kunisch: Correct.

Vinny Catalano: as AI has begun to, and you touch on this in the book, you know, as AI has become root, you know, there are things like AI scribes now that are becoming more ubiquitous in physicians' offices, you know, the doctor asks you, can I turn my scribe on? And all of a sudden, you know, this AI starts listening to your conversation and makes the doctor's life a little easier. So AI, and there's a lot of venture capital.

Judith Kunisch: Right?

Judith Kunisch: Right?

Vinny Catalano: money floating around in that business looking for a home for medical innovation and whatever, and if you have the initials AI on it, you know, there's a good chance you're going to get some funding.

Judith Kunisch: Yeah, yeah, I agree. I think this is also a personal opinion, but.

Judith Kunisch: I think the policymakers are way behind on that.

Judith Kunisch: And in terms of…

Judith Kunisch: Overseeing it and making sure.

Judith Kunisch: The healthcare providers themselves, I think, are very, very careful with it. Very careful with it.

Vinny Catalano: Yeah.

Judith Kunisch: But I haven't seen much coming out of the… at the federal level about AI and healthcare, and that's disturbing to me.

Vinny Catalano: No, absolutely.

Vinny Catalano: Absolutely. Um, you know, and then I want to sort of segue into sort of one thing that you and I had talked about, and I said, you know, I jokingly said to you, you know.

Vinny Catalano: as a broker, I thought I was in the center of the star, you know?

Vinny Catalano: And I really realized once I read the book, that I was not.

Vinny Catalano: Um, but also the role of the broker and consultant in the healthcare ecosystem. I mean, when I was, you know, doing what I did.

Vinny Catalano: I interacted with, with clients, I interacted with, um.

Vinny Catalano: uh, you know, business, I interacted with providers, I interacted with payers.

Vinny Catalano: You know, and so I felt like I was the traffic cop in a lot of ways, because I understood.

Vinny Catalano: The comings and goings of people, and when…

Vinny Catalano: a client had a problem with an insurance company in many cases, I was the first phone call. Or…

Judith Kunisch: Yeah.

Vinny Catalano: they couldn't get a procedure approved by a hospital system. I was a phone call, and I was an influencer to help them.

Judith Kunisch: Yeah. Yeah.

Vinny Catalano: So, you know, I, you know, we've already jokingly said that.

Vinny Catalano: you know, kind of ready to write the second edition of his book, I definitely want to help contribute.

Vinny Catalano: Sultan and Broker Chapter.

Judith Kunisch: Well, I… I listened to you.

Judith Kunisch: And, um…

Judith Kunisch: I agree with you. And, um, but I have to say, you educated me.

Judith Kunisch: Because I didn't think about insurance brokers and their role around the system. And that's probably why you were interested in the book, too, is because you do.

Judith Kunisch: Go to all the different segments.

Judith Kunisch: Of the system, and relate within them.

Judith Kunisch: And you are, um…

Judith Kunisch: much more informed, I think, than a lot of people working in the system.

Judith Kunisch: About how the system operates, or at least.

Judith Kunisch: the execution of it, because you're, you know… I'm sorry to say they hit you with problems.

Judith Kunisch: I'd like to have you. They hit you with successes.

Judith Kunisch: Because there is so much success that goes on, but of course, why would we tell everybody that?

Vinny Catalano: No, I mean, I was in the problem business, you know, and that's… but, you know, you hit a… you just said something, I think, super important.

Vinny Catalano: I'd say, and this sort of hit me at some point along the way, when I kind of thought that, you know, for…

Vinny Catalano: 99% of the population.

Judith Kunisch: Correct.

Vinny Catalano: Healthcare is accessible, it's usable, it's not affordable necessarily, but.

Vinny Catalano: It's there. There's a problematic segment of the population, chronic illnesses, acute illnesses, trauma.

Vinny Catalano: I mean, things go wrong all the time, but…

Vinny Catalano: For the most part, it is a system that oddly works.

Vinny Catalano: Um, and on a daily basis, it really does.

Judith Kunisch: I didn't… I missed your last thing. It works…

Judith Kunisch: Yes, it does.

Vinny Catalano: No, I was saying, you know, the system works, you know, pretty well on a regular basis, is what I was saying.

Judith Kunisch: Yes, it does. Oh.

Vinny Catalano: Yeah.

Judith Kunisch: I don't criticize the system in the book at all.

Vinny Catalano: Right.

Judith Kunisch: I… but I don't want to criticize the system. I… I think it's… it's incredible.

Judith Kunisch: And, um, because I had learned so much about it, that was another reason I wrote it.

Judith Kunisch: Because I said, wow, I learned stuff that I had no idea.

Judith Kunisch: I had one job, they… I got hired.

Judith Kunisch: And it was a new managed care company for healthcare providers, and they were putting this thing together, and they hired me to be the executive director.

Judith Kunisch: The first two people I hired had worked for insurers.

Judith Kunisch: They were not healthcare providers, they were insurers, and I said.

Judith Kunisch: I need you to educate all of us on insurance.

Judith Kunisch: They weren't going to be able to get directly to the providers, but they could through this kind of organization. So there's been…

Judith Kunisch: You know, interesting opportunities to get people around the table.

Judith Kunisch: And that's why I call it the star, because I say, when you get around the table.

Judith Kunisch: Be there with people who are different than you, and then listen to them.

Vinny Catalano: Right.

Judith Kunisch: And make sure you listen to them.

Judith Kunisch: Um, there's a very famous economist, Drucker, out of Harvard, who said.

Judith Kunisch: Listen first, speak last.

Judith Kunisch: And I started every conversation I would have with these students, I'd put up a slide that said.

Judith Kunisch: Listen first, speak last. You can learn a lot by listening.

Judith Kunisch: We all are.

Vinny Catalano: I'm still work… I'm still working on that. So, uh…

Vinny Catalano: So, so let, let's fast forward…

Vinny Catalano: 10 years. Um…

Vinny Catalano: Do you want to take a gander at… take a guess at what the U.S. healthcare system might look like in 10 years?

Judith Kunisch: That is a very interesting question!

Judith Kunisch: I would say, um…

Judith Kunisch: Now, I have to keep my personal opinion out of this.

Judith Kunisch: So, I would say…

Judith Kunisch: Well, we'll go through the paramount issues, how does that sound?

Judith Kunisch: In terms of health of the population.

Judith Kunisch: I think it will improve.

Judith Kunisch: Um, I think that we are doing a…

Judith Kunisch: Good job, a decent job, of getting out there and getting to people.

Judith Kunisch: And making sure that they have access to care. If you go to an emergency room, they have to take care of you. Now, that's not where we want you to get your healthcare in emergency rooms.

Judith Kunisch: We want you to go to a clinic, we want you to go to a private practice office.

Judith Kunisch: We want you to go get your healthcare that way. But, um, you will never be refused healthcare, and there is access.

Judith Kunisch: The costs, I think, will always be an issue. I, um…

Judith Kunisch: We bring in more research, we bring in more techniques, we bring in more treatment models.

Judith Kunisch: They're expensive. They're expensive to launch.

Judith Kunisch: And, um, one of the things I write about is, is that as healthcare providers, if you've been trained.

Judith Kunisch: to use these things. You're going to want to use them.

Judith Kunisch: you're going to want to use them a lot. And so, I write in the book, I say, if you don't understand what somebody's saying to you, say, is there another way that we could do this?

Judith Kunisch: It's just the only way that we can do it?

Judith Kunisch: Healthcare providers are not used to hearing that, but it is important to ask that, because it…

Vinny Catalano: Right.

Judith Kunisch: Probably… potentially can save costs.

Judith Kunisch: So, I think, do you really have to do surgery? Is there… could I have physical therapy?

Judith Kunisch: Um, you know, questions like that are very important.

Judith Kunisch: In terms of the concept of this consumers versus patients, I did go into that. We're…

Judith Kunisch: We're obligated to take care of ourselves to some point.

Judith Kunisch: And that's what I mean by a consumer. I say people who are customers.

Judith Kunisch: You can go buy a product and you don't use it, that's your choice.

Vinny Catalano: Alright.

Judith Kunisch: But if you're a consumer, you do use it, and we either are consumers or patients, and I prefer to be a consumer. I don't want to be a patient, because that means I've got a real problem. I like being healthy.

Judith Kunisch: And then the final one is the AI, and what AI is going to mean. It's going to be…

Judith Kunisch: One of the things that I've become quite familiar with, because I know people that are doing it, is that they're using it a lot for operations management.

Judith Kunisch: And managing staff, and managing things moving through, and it's being helpful, and they're testing it, and it's being helpful. It's not diagnosing.

Judith Kunisch: It's… and it should never be used. You don't want a machine making a diagnosis for you.

Judith Kunisch: But you would love to have the machine say, here's our staff, here's our level of, uh.

Judith Kunisch: problems that we're having, here's the intensive care, you know, going on, how… help us with that, and AI will be very, very good. That's what I know people are doing right now, and it's very, very interesting.

Vinny Catalano: Yeah.

Judith Kunisch: doing operations management. So… so I think in 10 years, there'll be a lot more of that.

Judith Kunisch: And, um, now…

Judith Kunisch: Technically, that could help reduce costs.

Judith Kunisch: Because…

Judith Kunisch: Yeah, because it…

Vinny Catalano: Well, we can only… we can only hope so. I mean, I… all I'm doing is looking at headlines now that this particular year, and I know this for a fact, that this particular year is probably one of the highest.

Judith Kunisch: I saw the same article in the Wall Street Journal.

Vinny Catalano: insurance increases that people are seeing on an individual level or on a corporate level that they've seen in a very long time, so it's…

Vinny Catalano: It's very worrying, so… but that's a… that's a conversation.

Vinny Catalano: Yeah, yeah, yeah, yeah.

Vinny Catalano: So, that's a conversation for another time. So, um…

Vinny Catalano: I want to wrap up our conversation. It's been brilliant. I really appreciate all the insights, and people go by the book. I mean, it really is… it's wonderful. It's called The Center of the Star by Judith Kunisch.

Vinny Catalano: And, um, it's available on Amazon and other places where you buy books. And before we wrap, Judy, I'd love to ask.

Vinny Catalano: You know, um…

Vinny Catalano: I love wine, and I have my own little Instagram called VinesWith Vinny, and one thing I ask all my guests is, uh.

Vinny Catalano: Do you have a favorite grape, wine, wine region?

Vinny Catalano: You know, what do you like?

Judith Kunisch: Well, that's a very good question. Yes, I like a good glass of wine.

Judith Kunisch: And I tend to be on the white wine side, um, although lately I've been dabbling in rose, but here's my thing that I really feel strongly about.

Judith Kunisch: I love California wines.

Judith Kunisch: And when I go to buy wine, if it's a California wine, I always get it.

Judith Kunisch: And I feel very… I've been to California many times and, um, driven through the beautiful countryside and the vineyards.

Judith Kunisch: So, I am a…

Judith Kunisch: real advocate of California wine, and, um, that's my…

Vinny Catalano: Well, I happen to know a guy, or 20.

Vinny Catalano: You know, so, uh, I'll make sure, text me, make sure you text me your home address.

Judith Kunisch: Well, I'm very… I'm very… I think that the California wines are delicious, absolutely.

Vinny Catalano: There will be a lovely care package on its way, and we'll…

Vinny Catalano: So, Chardonnay, Sauvignon Blanc, did you care?

Judith Kunisch: I like Chardonnays, I like Chardonnay.

Judith Kunisch: Alright, thank you.

Vinny Catalano: All right, well, that settles it. Perfect, perfect. Well, I want to thank you again for your time and attention, and, and being willing to be, uh.

Judith Kunisch: Thank you.

Vinny Catalano: part of my podcast, and I think everybody's learned a lot, and if they get the book, they'll learn more.

Vinny Catalano: And, um, I appreciate you, and I hope to have you on again, because I think, uh, this, uh, to me, was a kind of scratch-the-service conversation. If we want to go deeper on a few things, we can, we can come back to it another time.

Vinny Catalano: How about that?

Judith Kunisch: Thank you, Vinny. Thanks a lot. Thank you very much.

Vinny Catalano: Okay, thanks, Judy, appreciate your time.

Judith Kunisch: Take care. Bye-bye.

Vinny Catalano: Okay. Bye-bye.