In the Business of Healthcare - HSM Faculty & Alumni Perspectives
(upbeat music) - All righty. Hello, so sorry to break up all of the wonderful conversations. I like the social bunch that we have here this evening. Thank you guys so much for being here. Thank you to all of our Zoom attendees who are joining us online.
My name is Ashleigh Carroll. I'm the Assistant Director of Communications in the Office of Admissions at Fuqua. I am a stand-in, actually, for my colleague, David Steber, who unfortunately wasn't able to be here today but I believe you all were probably bombarded with some emails from me throughout earlier this week. So very excited to meet you all in person. Thank you again for being here.
I hope you guys saw the wonderful spread of refreshments that we have set out for you guys. Lots of sweet treats, we've got some soft pretzels, which I will definitely be sampling later on. We have some tea lemonade, so please help yourself.
There is a lot available for you all. Restrooms are down the hall. We have wifi passwords if you guys need that as well. Please feel free to ask me. I am joined here by Professor David Ridley. He is going to be our main speaker this evening, as well as some wonderful alumni, who are going to share their experience that they had while at Fuqua.
So, without further ado, I'm going to hand it on over to David Ridley. Thank you, guys. - Thanks, Ashley. Welcome, everyone. I'm David Ridley, you should please call me David.
I teach health care courses in several of our programs. I'm looking at my colleagues to see how I'm doing on my voice. Good, okay. So, I teach in several of our health care programs.
I teach in the Daytime program, the Weekend program, the Global program and the MSQM Health Analytics program. My claim to fame is that one of our papers became law, and I'd be delighted to bore you with that information at some point, if you're interested. So I'm joined today by Dr. Jill McCabe,
who's a graduate of our Weekend program. I'll ask Jill to come up in just a moment. And Patrick Cox, who's a graduate of our Daytime MBA program. Patrick will also come up here in just a moment. You've already met Ashleigh, and also thanks to Eric and Ryan, back here, from multimedia who came up from Durham to help manage this and make sure that people out in the world can see this.
Wanna talk to you about some health care trends. I wanna try to be provocative, slash, obnoxious, and so you should feel free to disagree. I want to at least say a few things you haven't heard before, maybe, or at least something a little bit contrarian. So, do feel free to disagree, Patrick and Jill know that's just part of the classroom. We have some great discussions and the expectation is that you'll disagree with one another occasionally in a very nice way.
It's "Team Fuqua," we're nice people. But do feel free to disagree. So, three health care trends I wanna throw out there. Number one, we're becoming more French. Number two, we're making more and more fixed payments.
And number three, we're getting excited about flashy outsiders and we shouldn't. Okay. So, first of all, we're becoming more French. And I say this because I get to show a beautiful picture. I could just as easily say we're becoming more like other rich countries.
I could just say we're becoming more Japanese, for example. What I mean by "becoming more French" is that more and more people are being insured. Copayments are falling, that's kind of a contrarian thing. Have you read, you've read on the news, right? "copayments are falling," no, you've read the opposite. The news always telling us just the opposite.
I'm gonna make the claim that maybe copayments are falling, at least in some context, and restrictions are rising. So the good news is that insurance is expanding, copays are falling. The bad news is, restrictions are rising. Okay, more specifically, insurance is expanding. It's just little by little.
Many of us would like it to expand faster. Many of us like would like it to expand faster in North Carolina, for example, but little by little health insurance is expanding in the United States and this is Medicaid expansion. There's only 12 states left, including my own, that have not yet expanded Medicaid, but there's a lot of Southern states, there's a lot of Republican states that have expanded Medicaid and we expect this to continue.
Although, you in the, here, might have different views and I welcome those. Copayments are falling. Again, I tried to submit this to a medical journal and they weren't interested because who wants to hear that news? I mean, you can get your "copayments are rising" article published but you can't get your "copayments or falling" article published. So I'll just share it with you because no one else will publish it. So this is just using National Health Expenditure data.
And this is really mostly retail drugs. If you think about provider administered drugs, then we might have a different story. But what the federal government calls, and its National Health Expenditure data, the prescription drugs, which is mostly retail drugs, we see that the spending out of pocket in the United States has been pretty flat at about $50 billion for 20 years. So for 20 years we've been spending the same amount of money for retail drugs out of pocket.
And this is not accounting for inflation. This is not accounting for population growth. If you account for population growth and inflation, we're spending less on average. You can see third party payment, the blue, what insurers are paying, what Medicare is paying, what Medicaid is paying is rising but what we're paying out of pocket has been flat at $50 billion for 20 years. Okay, that's all pretty good news.
And this is all pretty French. Like more people being insured, people paying less out of pocket, that's all pretty French. Unfortunately, this is also pretty French and that is restrictions are rising. So it used to be in the United States that, you know, we had tiered copayments where you paid $30 for the preferred brand and $60 for the non-preferred brand. Now you just can't get the non-preferred brand. Now it's not covered.
And so now your pharmacy benefit manager says, you can have this drug, but not that drug. Now, the good news is they're in the same therapeutic class. Maybe it doesn't matter that much, but you do have to change. Last year, you were using this drug. It's not available for you anymore on formulary.
Next year, you have to use a different drug. So here we see the count of drugs that are left off of formularies for the three major pharmacy benefit managers. Maybe for those you with good insurance, like those of us at Duke, we have Express Scripts as our PBM, but you might have Caremark or Optum.
You see a massive increase in formulary exclusions. So in the past, PBMs kind of said yes to everything but put a high copay on things. Now they say no to a lot of things.
Okay, so that's kind of French too, that we've got more and more insurance, lower and lower copays. And yet, some things we don't get access to. I think it's okay because there's a drug in class that's covered, but not necessarily the drug you want or the drug you took last year. So that could be problematic. Questions, comments about any of this? - [Man] What does PBM stand for? - Yeah, good question.
PBM, "Pharmacy Benefit Managers." So these are, this is, for me, this is my drug insurer. So they manage my drug benefit. Duke gives me a choice among various health insurance plans, but all of us Duke employees get the same Pharmacy Benefit Manager.
In my case, it's Express Scripts, and they manage my formulary. They say these drugs are covered at these copays. PBMs have been around a long time. Historically, they were just processing claims. They're just a useful intermediary between the insurer and the pharmacy.
And then we realized they've got market power. If Express Scripts, for example, has 25% of the market, when they say to Pfizer, give me a rebate, Pfizer gives them a rebate or else, or else they get left off formulary. If you've got 25% of the commercial insurance market, you got power. And so they are incredibly powerful, even more so than the big insurers. You know, Aetna, Cigna, these insurers have maybe nine, 10% of the market.
These three have 25% of the market each. They have incredible market power. And they're able to threaten pharma companies, "give me a rebate," which we hope is passed on to patients and payers, "or you get left off formulary." Yeah, please do keep, yeah, yeah.
Great question, Jeff, thank you. Please do keep asking questions. Yeah, so many acronyms in health care.
Please do ask questions. And, of course, more detail in our classes if you all come. So, Jeff, okay. Okay. More and more fixed payments, independent of volume.
I'll go through this pretty quickly. There's a lot could be said about this, we say these things in our classes. So more capitated models, more payment per head. And that's the Accountable Care Organization model where you're not paid more for doing more, you're paid to fixed amount per person, per year. I won't go into too much detail.
Afterward we can go into more detail about these. So, all three of these are payments... are payments that are independent of volume. So, you might do more surgery on that patient, you might prescribe more drugs for them, you might have more meetings with them, you get the same fixed amount, regardless of volume. Subscription models for antibiotics I'm gonna throw in.
The UK just said, "We're gonna pay a fixed amount "for a subscription to antibiotics. "So, we're gonna give a drug company "a certain amount of money, "regardless of how much antibiotic is used." That's potentially a good thing because we want antibiotic makers to make money, but we also don't want people to use antibiotics because we don't want drug resistance. So, this is a model where the UK is paying for a subscription to a drug. Other examples of drug subscriptions, the state of Louisiana bought a subscription to a hepatitis C drug and then all their patients on Medicaid and the prisons could use the hepatitis C drug. So they're paying a fixed amount regardless of volume.
And the final, again, another plug for my own stuff, the priority review voucher is a prize for developing a drug worth about a hundred million dollars, regardless of how many units of the drug are used. Okay. Any questions, comments about those? Yes, please. - [Woman] What are you seeing in terms of shift to value-based care? And that might have been captured in the capitated, but-- - Yeah. Yeah, that's a great question, we should mention that.
Especially since we're here at the Margolis Center because the folks down the hall are obsessed with value-based care. So value-based care is very important at this place. So this is a Duke-Margolis Health Policy Center, really mostly over there.
So, a lot I like and a little bit I don't like. So, I really am a big fan of the Accountable Care Organizations. And, although they're not really saving us much money yet, I really like the model. One thing I almost put in my overrated Health care trends was value-based payments for drugs. So, I really like paying based on the value of a drug.
I really like that. X anti, but this is a little technical. This is why I left it out but I'll say it briefly anyway.
I like paying, so I like it when we say this drug adds two months of life and we're gonna pay based on that. I like that value-based model, which is what the British do. I like that model.
What I don't like is, we're gonna wait and see what your outcome is and then your payment's gonna be based on that outcome. My colleagues down the hall like that. I think that's kind of silly. And the reason I think it's kind of silly is if you've got a population of a hundred, you know, on average, how many are gonna benefit from it and just pay based on average what you expect rather than the realized outcome.
Because the problem with paying based on the realized outcome is you need the data for it, you gotta follow up, maybe the patient went somewhere else. It's just a big hassle. So if you've gotta, if you're an insurer with a big population, you should pay based on the value you expect, because that's easy, not based on the value you realize, because that's messy. Okay, okay. Great question.
Yeah, and boy, there's a lot to be said about value-based payment and we spend some time on Accountable Care Organizations. Rob Saunders, who's down the hall here, is an expert on Accountable Care Organizations and teaches one of our classes. That's a great question, thank you, Caitlin.
Okay, so... I think we get too excited about, my third trend is, I think we get too excited about flashy outsiders. So, the first group are outsiders who think the people in health care are idiots. And the second group is people with magical technologies that get us all excited. It turns out they're just, they're not magic.
So, the first group, have you heard of these at all? Yeah. Haven got a lot of attention early on because some big names, Jeff Bezos, Warren buffet, said "We're gonna fix health care." Because the idiots, you know, "Those idiots in health care." But the problem is, they didn't know what they were gonna do. They just knew that health care people are idiots.
Then they hired McKinsey and a celebrity spokes model, Atul Gawande, and then there's no there, there. Now, I should be careful, because I like the fact that rich people are coming in trying to fix problems because some of them may be right and have some great ideas and get some things done and we might learn from their mistakes, nut I think we give way too much attention to, you know, what did Warren Buffet say? "Health care is a parasite on the economy." I don't remember what he said, but he knew that health care was broken and a genius like him needed to come in and fix it. Come on.
So, not a big fan of that. You may have heard of Turing, Martin Shkreli, the pharma bro, Wall Street guy, gonna fix health care. Valeant. Consultant, gonna fix health care.
Mark Cuban, NBA owner gonna fix health care. Mark Cuban is getting a ton of publicity for basically what's an online pharmacy that sells cheap drugs, but, I mean, there's already Walmart and Costco and I'm not sure why Mark Cuban's better than Walmart and Costco. But getting a lot of attention. And then a couple of magical technologies. On this last one, I think with IBM Watson, we got excited by the magic of big data.
I may offend some of you that are in the big data space, I'm gonna talk trash on that for just a moment real fast. So, we are getting better and better at analyzing and storing data. 20 years ago, I bought some data from a PBM and it cost hundreds of thousands of dollars and they could only sell me 25 months of data because they were only keeping 25 months of data. So they would delete data that were 26 months old, and they were selling it for hundreds of thousands of dollars.
So it's really valuable data, but we couldn't store it. At least, couldn't store it cheaply. Now we can store enormous amounts of data cheaply and analyze enormous amounts of data, which is awesome.
So there's a promising future here, but I think there's a lot of people that think that it's magic, they hear "artificial intelligence," and they think "magic." And it's observational data, it's not from randomized clinical trials. So Congress keeps telling the FDA, "Hey, use real world evidence, "use big data collected from insurance records." But the FDA says, "Come on, it's observational. "There's bias involved here."
So we know this person who took the drug had a good outcome, but do people who are going to have good outcomes take the drug? This is like healthy, responsible people who take this drug and have all these advantages and they have good outcomes. Not because they took the drug because they're healthy, responsible people. We haven't randomized here. So, we've still got this problem with bias. Now, I'm an economist, and a lot of what we do is try to find natural experiments, try to find some sort of pseudo randomization we can do, take real world evidence and do something like randomization.
So there are ways to do this, they're just really imperfect and we got a ways to go. And then the other thing is, there are all these technologies that are finding out, you know, these cool technologies, this app that can tell me that I should eat better and exercise more. I mean, that's great, but now you gotta get me to eat better and exercise more and that's not trivial.
I think, and maybe these things can be good coaches for us and motivate us to behave better, maybe, but just identifying people who need to eat better and exercise is actually the easy part. Okay, but so I think, you know, I think, I think we are here, and our expectations on big data are here, and our actuals are here, but we are gonna get there. I mean you're, if you like big data and machine learning and artificial intelligence, it's gonna be awesome, it's just not awesome yet. So when somebody's selling you a magical technology today, you know, just a few years ago, all these hospitals got so excited about IBM Watson, how it's going to fix health care.
Total bust. And it may someday, we're just not there yet, it's just very early days. Just, people need to realize it's not magic.
Okay, that was very negative. My caution is, don't be impressed by arrogant outsiders, celebrity spokes models are magic. Do learn the regulation, the reimbursement, and even the culture of health care. I think there's a lot, there's a lot of those arrogant outsiders that don't understand the culture.
Martin Shkreli from Turing, the pharma bro, said, "Those idiots in pharma are underpricing their drugs." And he was kind of right, but that's part of the culture of health care and pharma. It's crazy to say that you all under priced your drugs, but you kind of do. So, you can't get away with crazy, stupid thousand percent price increases.
So, the culture of health care is sort of a nuance here. And I think you can learn all these things. How can you learn all these things? By coming to our program. (audience laughing) So, the Health Sector Management program at Fuqua. So people getting an HSM certificate, like Patrick and Jill, I assume you both got the certificates, I sure hope you did.
Okay, good. So, like Patrick and Jill, about 20% of our students get the HSM certificate. A lot of them, were you? Jill's a doc, so she was definitely health care before.
Were you health care before, Patrick? I think you were. - Yeah. - A little bit. You were, okay, okay. - [Patrick] Electronic health records.
- Okay. Oh, electronic health records, okay. Okay, that's actually a great point. You're from a part of health care and you got broader exposure to health care, yeah, yeah. A lot of international students and it's across, you know, okay, so electronic health records and hospitals and pharma and lots of areas of health care. Why should you do it? Deeper knowledge, broader knowledge.
We've got this network that's very, it's been around forever. I plot it back to 1964 with these data, but we've been at Duke since 1930 in some form. So when Duke Hospital was born in 1930, it set up a management hospital leadership program. And that evolved into what we are today in Health Sector Management.
So, these, in here were MHA degrees and it moved over to the business school in the '90s and became MBA degrees. But it's an evolution of the same program. And then, more recently, in the light blue, you can see that we also, we expanded from the Daytime MBA to the Executive MBA. And these are our graduates from a couple years ago.
I think this is 2019 because, yeah. Because 2020... (David laughing) Because 2020 was rough. And actually, and we've since then, we're going outside, we're not doing the stairs anymore, which is a shame because I love this picture.
We're doing it outside of the JB Duke these days. Okay, so, if Patrick and Jill would come up, I want ask them a few questions. And, first of all, would y'all introduce yourselves. And should we sit up, you guys want to...
Let's sit back here, yeah. So Jill, who are you? - I'm on this side. - Who am I? - Who are you, Jill? - I'm Jill McCabe, and I am a pediatric emergency physician, and I also am a health care administrator within the Inova Health System. And I... was a Duke undergrad, graduated from Duke in 1990.
And then, I also went to Duke for med school, graduated in 1994 and then, we'll get to the other questions. So now I have my third Duke degree, my MBA. (David and Jill laughing) Went back to school 26 years later, a few things changed in between.
But then I came and joined Fuqua, and I guess I started in '19 and finished in '20 because the WEMBA program was a 19 month program when I started it. - Yes. Thank you, Jill. Patrick, who are you? - Hi everyone, my name is Patrick Cox.
I grew up in the Northern Virginia area, and prior to Fuqua, worked at Deloitte, where I was doing electronic health record development and implementations. Really loved health care, and so that's one of the reasons I chose to go to Fuqua. And then after Fuqua, I'm back at Deloitte and now doing pharma M&A work. So, you know, maybe the HSM program helped me make that pivot. It wasn't really my choice but I now feel more knowledgeable that I can speak to my clients who are in the pharma industry.
- Good. Why did you do an MBA? - Sure, yeah. So my story's probably a little less interesting than yours, Jill, but I took the very typical undergrad, worked at a consulting firm, then got to the point in my career where I needed to, or I felt that I needed to get an MBA to, you know, build out a lot more of those skills that would allow me to be more of a leader on my project teams and succeed on projects.
And so, yeah, that was the main thing for why I wanted to get an MBA. I actually delayed a year from where most of my career cohort went. And, when I was, when a lot of my, the people in my start class started going off to business school, I was talking to them, and just hearing about some of the classes they were getting to take, and you know, like what David just gave you here was a 15 minute example of a lecture that you would get if you took whatever the intro to HSM class is now called, and that just really got me excited. And so, that's when I decided like, it was time to actually apply and go back and get my MBA. And I found that, like, a lot of the skills that I did learn in business school have been useful after returning, not just the health care knowledge that I got from HSM, but also a lot of the soft skills that you learn in business school as well. - Thank you, Patrick.
Jill? - Mine was a bit of a midlife crisis, I'd say, but I... I had long history of practice in medicine, which I love taking care of patients to this day. I find a lot of value in that and is the heart of who I am. But I also had more and more leadership positions over the course of my career, and then right before I decided to do an MBA, I was on a search committee for the new CEO of the Inova health system, and I was just one of three docs that was on that committee, and so I had to meet all of the candidates coming through and see what their experiences were and what they were inspired by and the ability to, to really transform an organization.
And they all pretty much all had an MBA, so it made me think, you know, I really, I admired what they were doing and I could see myself doing that. And so I, that sort of planted the seed. And then, my family went through some turmoil in 2018 and everything kind of changed for our personal life, and we really, like the way we had everything laid out for our plan was totally turned upside down. And it occurred to me that, you know, maybe this would be an opportunity for me to further my education, it would open more doors for us, give me an opportunity to provide in a different way for my family for the last 15 years of my working life. So instead of getting a sports car, which might have been my husband's preference, (audience laughing) I got into the WEMBA program and got an MBA and it was a wonderful experience for me in so many different ways, I gained a ton from it.
- Good, good. And, my next question up here is, "Why Duke?" And it's funny to ask since you are a double Dukey at this point, and why did you choose to be a triple Dukey? - I think it was just easy. A little bit of a path of least resistance. I was at Duke for, actually visiting there with my son, who is now a Duke student, and I was starting to think about it, and I'm gonna stop by over at Fuqua and see if I could talk to them in the admissions office and find out what their, and I had looked into it a little, what their Weekend MBA was all about. The bigger, you know, so other than my allegiance to Duke and I have found throughout my life that the family at Duke has continued to be an important part of my life. I met my husband there, but also, people that I met through med school, undergrad, faculty members have continued to be really influential in our lives, and so, I really saw value there.
And then, as a doctor, I work in the ER, and so I do a fair amount of weekend work, and so to get a weekend after hours MBA, many of the programs are two weekends a month, and to have to give up two weekends a month to school, and then one or two weekends a month to work, you end up with really no, not a lot of leisure time. And the Duke program, being one three day weekend a month, and then another six hour weekend in between, really worked much better for my schedule. So not only was it convenient, nearby, a great program, I had already looked into the HSM as well, and that was really, I'm probably going on too long. As a doctor, you can go do a doctor MBA program, so there are some health care programs just for health care providers that are health care MBAs, and I know many people who've done them. I think they're easier for doctors because they're kind of, they're really geared towards doctors, but I really wanted to have a traditional MBA program and really get the full breadth of the education, even if it was more challenging, and Duke offered that, the schedule worked and I love Duke, so it was easy sell for me. - Good. Good.
I'm glad you did this version of the MBA. I think it's really special to have providers and product makers and payers and patients together in a room having a conversation about health care. I think that's really special. - And we had a fair number of health care, people from health care background. - You did. Yeah. - Within our class, but we still were a minority.
- Yeah. - So there were many different people to learn from, and learning from people in other industries was one thing I really enjoyed about the program. - Good, good. And you mentioned that, for the Executive MBA, for the Weekend MBA, you only need to come to campus once a month and that's proven very popular, I think. - And fun. - Okay, good, good. - Lot's of fun.
- Patrick, why Duke? - Yeah, so I'll start by saying, I don't like this question because it says, "Why Duke?" I went to UVA undergrad. (David laughing) I tell people I went to Fuqua. - [David] Oh, good, good, good. - I am not a Duke basketball fan. (David laughing) If anything, going to Duke made me more of a Duke baseball hater.
(David laughing) And I searched, and I don't think they sell it anymore, but there used to be a Fuqua-specific item of clothing, and I made sure to buy that my first year, but every time I've gone back, it's no longer there. (David laughing) But I'll start by saying like, Fuqua was always like probably my top choice, even when I was still in undergrad, just thinking about what programs I wanted to go. And I can't tell you why, in undergrad, I wanted to go to Fuqua, but after starting to search for schools, Fuqua always came up because, because of the HSM program and I knew I wanted to do something in health care. And so, there are only so many schools that have in the classroom experiences related to health care. And while, you know, of the HSN class, I probably was sort of more in the middle 50% for people with health care experience because I did do health care work before. I felt like I knew a very small niche and I really wanted to get that out, like, I wanted to round out my knowledge and the HSM program was something exactly I was looking for.
I also don't like cold weather, so I wanted to look for a school that was warm. Durham obviously offers warm, great, great weather, and then, just when I visited, both while I was applying and then even after applying at admitted students weekends, I really just loved the people that I was getting to meet, both who were in the class above me and who were gonna be my future classmates, and it just always felt like the right decision was to go to Fuqua, and I'm very happy I made that decision. - That's good, that's good. And what would you do differently, if anything, Patrick? - So...
it's probably very hard to hear this as prospective students, as well, but I would've spent a little less time on my classroom activities and more time-- - Okay, we can cut. Can we cut that? (audience laughing) - More time on some of the like extracurricular activities. You know, you can, this is better advice for like maybe once you're admitted and you're no longer freaking out about getting into business school, but you're on teams for so many year classes, so you can count on your classmates. You know, it's better to go to a company presentation or to go to one of the various social events so you can make lifelong friends.
Not that I didn't do that, but I wish I had maybe moved a little bit more of my time to the extracurricular activities if I had to. - We're gonna cut that. That's fine. (audience laughing)
Jill? - I think... I think I would say the same, and ours got cut short because of COVID, so I think that to spend more time with my classmates out of the classroom, and you, you're, you're not, I mean, you're not always geeking out, but you're often talking about things that are related to the industry that you're in, or your career, and so having those conversations I found really rewarding. I was, I approached business school as something, you know, when you're 50 and you already have a career, you're not so worried about grades. You kind of know that things are gonna turn out okay for you in the end, you have a good backup plan in place. And so, I definitely approached business school just to be there for the learning and not for the grades. I didn't really care that much about the grades, honestly.
And what I found too, very quickly, was the grades part was gonna be okay. If you were there and you were engaged, you were gonna do just fine. So I really, I would say what I saw, other people kind of wish they had focused a little more on was just to be there for the learning and the enjoyment of it all, and then the grades, the grades turn out just fine.
So I think that's, that might be one thing to consider doing differently. - It is nice that grades don't matter. - Yes. - I mean that--
- They really don't. You would say that start your class. - I'd be like, "Yeah, they don't." I know that too. You and I, we're in our 50s, and now these other-- - Yeah, yeah.
Yeah. - You've lived through life, and they don't. - Yeah. - Yeah, so it's nice. - Yeah.
Can you talk about some things you gained from your experience? - So from the overall experience of doing an MBA at Fuqua, I really gained a lot of knowledge in all kinds of aspects of business that I had never had any formal training in. And some of them were, you know, they were, I'm not gonna, you know, deceive you, they were challenging, but all kinds of areas that I feel like I'd have much more of an understanding of. Finance, accounting, and even, actually, I'd had a fair amount of leadership education, but I've found that the leadership education that I received at Fuqua has been very helpful to me, especially as a health care leader in the past few years, we've had all kinds of challenges we hadn't really anticipated and I have really fallen back on those skills.
So I really gained a lot there in terms of leadership. Some of my favorite teachers were like managerial accounting, which is something I never would've enjoyed, but had a wonderful teacher who taught it-- - Who was the professor? - Elia. - Elia, good. - Elia, yeah. - Good, good. - And he was our-- - He's a sweet guy. - Yeah, and he was our class, you know, award winning teacher-- - Yeah, yeah, yeah.
- He taught it in a way that was just unbelievable. And, you really, for someone who was, had no accounting background, it just made so much sense, and I really enjoyed that. And then, from the HSM perspective, you know, having grown up in one health care organization or another as a health care provider, you have a very limited view of things. And what I really, when I started the program, I wasn't even sure I would do the HSM certificate because I thought, I already kind of know the health care piece, I wanna learn the business piece. But then, once I went to Fuqua and I realized, I took, I think maybe one or two of the intro classes to HSM, you were able to see the academic perspective on health care and a broad range of health care, right? It's not just hospitals and caring for patients, but it's, you know, pharma and regulatory things and all different types of, the economics of health care, all different aspects of health care in an academic environment, where there was a lot less bias than you would expect in an organization where the culture really has driven that bias, and you learn that way, whether it be in an academic organization or in a place like Inova, which is a wonderful place, but people get stuck in that view. And so, to have the broadened view from the HSM and to learn from professors that taught, you know, generally without bias and opened my eyes to a lot of different ways of doing things.
So that's what I found was really valuable from the HSM program. - Okay. Just a real minor comment on the accounting courses. The accounting, this is really annoying, the accounting faculty regularly win the teaching awards, which bugs the hell out of me. (audience laughing) I think for two reasons, number one, they really care about teaching and they really work together.
Like, the sort of people we have in our accounting group genuinely care about teaching and work together and share materials to have awesome classes. So I think part of it is we just have a special group of people. The other thing is, that I think is unfair, I think they benefit from low expectations. - Definitely.
(audience laughing) - But do know, if you're thinking about an MBA and kind of maybe worried about the accounting course, we have really good, they really care about teaching and they do a great job. Patrick, what did you gain? - Yeah, I'll second, like, the network was probably the most valuable thing that I've gained and, because of COVID and the situation we were in, my start date was pushed from, I was supposed to start summer of 2020, Deloitte freaked out, thought the world was coming to an end, clients were gonna lose all their money and not buy professional services anymore. So my start date got pushed to early 2021, and, you know, I hadn't been working for two and a half years, sort of freaking out about money, and I think after I enjoyed a month of being unemployed, I started to put feelers out through some people that I met in, like through actual Fuqua, but also recruiters that I met through the recruiting process for internships. And within like a week, I had two different offers that I was really excited about doing, and so I ended up in a problem where I was trying to figure out, A, is Deloitte gonna allow me to do this? Am I gonna lose my offer? And then two, I have two great options, and so, just my mentality on the future of my life totally changed, I think, because of Fuqua. So that was great, but then, also, just like the friends that I made. I know that these are all going to be very successful people, they're very driven, they're very smart.
It always amazed me in the classroom, but also just when you're having a beer, talk, just the conversations that you're able to have with these people was really useful. I would also plug managerial accounting was probably one of my favorite courses and I had Scott Dyreng, so that's now two professors that teach managerial accounting-- - Yeah. - That give a, get a thumbs up. So, yeah. - I agree. - And just another...
So, I was an Econ major in undergrad, but I hadn't really touched a lot of business, my business knowledge, like in my career, and so, that first core semester, where you really get back and it starts at a 101 level, and just getting to learn all of that again was, I think, really useful. - Did you take the econ class fall one or did you test out? - I did take it. I'm pretty sure I could have. but I was like-- - Yeah.
- I want to go through it with-- - Yeah. - My core team and-- - Yeah. - So. - Yeah, so that's an option.
If you're a major, you know, if you're a finance major, you can test out of finance or you can be with your peers and have a slightly easier time and be the genius in the class. - That was also part of my thought process. - That's okay too, yeah. - Yeah.
- Good, good. What questions do you have for Jill and Patrick? And online questions too, Ashleigh, if you have any. - [Ashleigh] Those are coming in.
- Okay. - [Ashleigh] And then, do we have any-- - Okay. Okay. - From the audience first? Great. - Okay.
- [Ashleigh] We can start with one from online. So somebody asked, to what extent do you see co-insurance offsetting lower copays trends? - Oh. Okay, so, okay, question for me back to my trends. - That's for you. - Yeah, yeah. And, although, you guys are welcome too.
Yeah, because I made the bold claim that copays are going down, or at least our, I said copays, but it's really all out of pocket spending for drugs, whether that's copays or coinsurance. So what's the difference? Copay is a flat $20, coinsurance is 20%. I don't, so... My knowledge of this is probably, in terms of what's dominating copays or coinsurance, is probably limited to the Kaiser Family Foundation's annual survey of employers. And from what I've read, so they have a great survey. So, like, every fall there's an excellent survey of employers about what sort of health insurance benefits they're offering.
And from what I can tell from there, coinsurance is not really taking over in that setting. And so, it's not that coinsurance is replacing copays, it's just in general out of pocket spending is coming down. - [Patrick] But premiums are going up, so...
Or no? - Yeah, I mean, they are, they are, but... Yeah, yeah, yeah. Fair, yeah. Yeah.
- Yes, Jeff? - What was the makeup of your cohort? In other words, if you had, if you're coming from an economic background, was there a doc in your cohort? What, I'm just coming, and the same thing with you, with your physician background, was there an economic person in your cohort, or what was the makeup of your cohorts? And how many were there? - Yeah so, that's probably a better question for the admissions on like the actual numbers, but I don't, I think we actually did have a couple of actual like had already graduated med school doctors at some point in my class, and then I think we had three or four MD MBAs. So it was in their third year of med school was when they did their MBA, or like, I guess second and third year. In my section though, I think it was incredibly diverse in backgrounds. I don't want to quote you numbers, but it felt like most people probably came, like the majority was some sort of traditional pre-MBA career, but then there were people who did, who were teachers beforehand, people who were in tech. - [David] Military.
- Yeah, Military was a big one. - [Jeff] But specifically with your group. - Yeah, so my team, we had another Deloitte consultant, so not, not, not super diverse there, but I don't know of any other teams that were like that. Someone who, he was from Peru, and he was in banking beforehand, someone who did product management at a small tech company, a former McKinsey consultant who did private equity beforehand, so also another very traditional.
And then, my sixth member, she's in banking now and she did like very small private wealth manage management beforehand. - And I, my team was a little different than that. We had, most people, I mean, there was a lot more diversity, I think, in terms of backgrounds in the WEMBA program, I would guess. Like one member of my team worked for the "Today Show." One member of my team was in mortgage, in the mortgage industry.
One member of my team was a in energy as an engineer. I'm trying to think of other examples of members of my, one person was in IT and building data centers, and it was his background. So we had really a variety of people. We had people from the, the clothing industry. So really a lot of diversity of background. Not very many people that came out of consulting.
I would, I can only think of a few that had a consulting background and a few that had a finance background in the Weekend MBA program. It was many more people who had different types of jobs but wanted to get an MBA on top of that. So the diversity was great. And to this day, you know, there's things that come up that I'm able to connect with people who are from a completely different industry, I never would've known anybody in that, that I met through the MBA program, which is nice. - [Jeff] Thank you.
- [Caitlin] What was something particularly memorable from HSM, whether it was a guest speaker, a particular class, or just like a lesson that has stuck with you? That might be a hard one. - So, I can give one specific example and then one more general comment. So I took the Duke in DC Health Policy class. Actually, we both took that. - And in the same class. - I thought. Yeah. - That one was combined--
- Yeah. - Some Daytime and-- - Yeah, yeah. - Yeah. - WEMBAs on campus.
- Yeah, and I thought that was, you know, probably the least businessy business school class that I took because it is about health policy and we got to go to the Hill and meet with staffers and just sort of learn more about like policy reform and what's going on on that, which I think is, that's more of maybe your like dinner table conversations about health care, then... Like... economic data about copayments.
And then my, the second example is, and this is probably just something that David and the other professors did a really good job about, was they would tee up a topic and then the class would discuss it. And so, I'd get to learn from people who were coming from Eli Lilly, or coming from nonprofit health care, or who had no health care background but were really interested in health care and had done a lot of research. And that's where we did a lot of our learning rather than, you know, just listening to a lecture. - And that class was taught by David, and we had a little bit of a reverse classroom where we would actually have the lecture on video, not during the class time.
This was kind of where we would, he would present the material, we would do the reading and then much of the class was discussion. And so that, and we had to answer some questions in advance, so everybody showed up prepared. And I liked that format a lot. There was a woman who was a recent Fuqua grad who... was working for the... Bill and Melinda French Gates Foundation, and she had a very interesting role there, and she had been a recent grad from Fuqua, so I really enjoyed hearing her speak.
So, you did bring in people from industry, in each of those classes, that would speak to us. That was another part of it. There was discussion, and then an example of someone from the industry. Many of the Fuqua classes included that, whether it be in leadership, you would have leadership examples, you know, even a little bit in accounting or finance, to try to have the real world example of what you were learning and be able to speak to someone who'd had that experience. And alumni come in often too, to speak in special sessions, and you get to learn from them and talk to them, ask them questions. - Yes.
- I'm Gerard and I'm applying to the full time Fuqua. - Okay. - Next fall. So, to go next fall, admission next fall, I'm thinking about that 50% stat that you shared, 50% of people started with a non-health care background. - Yeah. - And I'm really curious, from all of your perspectives, if you have a sense of why people pivoted from what they were working on before to health care.
- Yeah. - So, I'm working in environment and sustainability now, always been interested in health care and medicine. - Okay. - And this is kind of why I'm thinking about pivoting now. - That's a great question.
Patrick, will you answer that based on your classmates? - Yeah. So, I guess, just to clarify, that is just for the HSM program, not the Daytime class as a whole. - Right, right, right. - So, like if you extrapolate, there's 20% in HSM, 50% have health care. So 10% of the class has a health care background. As for like why people pivot, I think it's the interest that they had at like the stage that you're in, where they're interested in health care, so...
and they choose Fuqua because of the HSM program. They take a couple of the classes there. It just builds on their current interest, and I think Fuqua is in a great position where a lot of the big health care companies come to Fuqua to like recruit on campus.
Health care is not an industry like banking or consulting where every company is coming to every business school, and so you just have more of those opportunities, and so like, there were classmates of mine who definitely were like, they wanted to go work at McKinsey, for example, but they were in HSM, so they also applied to some of the pharma companies and they might have ended up going to work at a pharma company or at Optum, or United Health Care, or something like that rather than consulting. And so that's how they make the pivot, the opportunities are there. - Can you think of a classmate of yours who came in without health care background and then went to a health care company? Does anybody come in to mind? - Ooh. Come back to me.
- Okay, that's okay. - I enjoyed having non-health care people in the health care classes. Because they asked the best questions, you know, and things that we take for granted or make assumptions on, people who aren't in health care point out to us. And I think that was much appreciated.
- One of our student leaders, student government leaders, who just graduated, Jordan Daniel, he did not plan to go into health care, even coming to Fuqua, but he wanted to be in Manhattan. And so he interviewed with Pfizer. So Pfizer's headquarters is in Manhattan, and he got an internship offer with Pfizer, and so, then he frantically needed to learn pharma. So, he took my pharma course in the spring and then came back the following year as a TA.
So here's, he's a person who did not have health care background, but we were able to get him up to speed, so that... And it turns out, Pfizer's a great choice. Pfizer saved the world, right? With, with their vaccine. (audience laughing) So, a good company, but he chose them largely for their location, but we were able to get him up to speed on health care. - [Gerard] Helpful, thank you. - Good, yes.
- Yes, I'm really curious about the opportunities you all took to customize your experience at Fuqua, whether it's extracurriculars, or adding on a course, or getting that mentor. - Yeah, I guess-- - And which program are you thinking about, Day or Executive? - I am going back and forth-- - Okay. - With the weekend or full time. - Okay. - Okay. - So, outside of the core curriculum, you get to pick all of your classes.
And there are like, I think they're called concentrations that are essentially a major, where you take X number of classes and you get that on your diploma, I suppose, but no one, or no one I knew, was like, "I need the strategy concentration, "so therefore I'm going to take these classes." It's, "These classes sound interesting to me, "or I spoke to an alum or someone, a second year, "and they said, this is a must-take class." And so, you know, it's about following your passions, and so, those opportunities are there. As for a couple of the things that I specifically did, was, I did, it's called the Duke University Hospital Experiential Leadership Program. And that's one of, I think, two or three experiential learning programs that are related between Fuqua and either the med school or just Duke Hospital.
And it was me, another Fuqua student and then two med students, and we were helping a doctor at Duke Health who had developed an app to like train future doctors who are in school, and so, that was just an experience to work with people outside of Fuqua that I really liked. So, that's just the first thing that came to mind. - And then in the WEMBA program, and if it's changed, please correct me, but we, a lot of it's core curriculum, but you can do additional study alongside that.
So like, the Duke in DC's course was something that would, I did the part of the, as a, I had the core curriculum, but then I did that as an elective and they were run simultaneously. I also participated in a program that was like a consulting program, it has a different name, but it's the... It was a separate course.
- My am I blanking? - FCCP? - FCCP. - Thank you. - Thank you, yeah. - "Fuqua Client Consulting Practicum." - Yes. - Yeah. - Where, actually that was really fun. We had a group that worked on a project to support an organization in Uganda, a health care organization in Uganda, and they were, they had asked us a particular problem and we worked as their consulting team.
And we had a Fuqua grad that was our, who was our mentor, who helped guide our group, and we created a project throughout the course, and that was the coursework. So we were able to kind of learn how to be a consultant through this course and, with a real life project that you had to deliverable at the end. And I really enjoyed that. And that also is another program that you can do kind of simultaneous with your core curriculum.
And then, when you have your, it's not at the fall anymore, because the timing in the seasons change, but there is a super term where you take your electives and you take four, you have an option to take four electives at the end. - That has changed. - Oh, it's not four electives anymore? - So we're now doing two in the fall and two in the spring. - Oh that's nice, so it's more mixed in.
- That's right, so the advantage is it's a little bit less intense than what you experienced. The disadvantage is, the coursework lasts a little longer. So you finished up your coursework in December.
- Yes. - And now people are finishing it a few months later in the spring. - In the spring. - Because we spread it out. So we made the elective term a little bit less intense. - But there's a, I thought, a broad range of electives.
Everybody was pretty happy with all the different offerings. It was easy to get the elective that you wanted. If there was a lot of interest in one, they duplicated it so that there could be another group. So, in terms of the electives, it was hard to narrow it down to four because there were so many that were interesting. I did choose two of my electives were within my HSM certificate program.
And then when I, after I finished, then I just had to do my one special project to finish up the HSM program. - Yes, that's a big difference between the full time and the Weekend Executive, the number of electives you get to take. They have essentially the same core, and Patrick took a lot more electives than Jill.
Now, Jill still squeezed in some electives, like the Duke in DC was an add on. - Yes, I have a hard time saying no. - Right, right, right. - People like, check it out. All right, I'll try it, why not? - And the Fuqua Client Consulting Practicum - When you don't care about grades, it's easier. - That was an add on. - Yes. - So you did a lot
in addition to your real job. - I did. - I try, I got, I wanted to get every, every morsel out of the 19 months, or however long I was there, and it was wonderful. It was interesting, plenty of interesting, there's more things to do than you have time for, for sure. - Yes. - We have a question-- - Ashleigh, please. - [Ashleigh] From online similar to to curriculum.
So somebody asks, "Why do we need accounting "for something like that? (David laughing) "What will that do?" - Why do we need accounting? Patrick, why do we need accounting? - Well, you need accounting for your MBA because you're getting a general business degree, not just the HSM certificate. I'm... HSM, it prepares you to do business in the health care-- - Yeah. - Industry,
And part of that is understanding how to look at a PNL statement or be able to read a balance sheet. I'm in pharma M&A right now, and while my day-to-day work does not require accounting, there are accounting terms that are very relevant to the work that I'm doing. Which are not taught directly in the HSM curriculum.
- Right. - It's taught outside of that. - Jill, why do you need accounting? - For so many reasons.
- Okay. - I mean, the same, being able to look at financial documents and really understand what they mean. But, for me, right after I did my MBA, I was working pediatric ER, 80% of our patients went away. So all that revenue went away overnight, and to be able to keep people employed and figure out how to do so, managerial accounting was really helpful. I mean, I really, it was really helpful because we had to really understand every, I'm also, even though I work within the Inova health system, I'm a owner of a independent contracting group practice, and so we do manage our own finances.
So it has been very helpful for me in that regard too. And I needed to figure out how could I keep all these critical resources employed when we had no volume of patients to support them. And now we made it through and the masks are off and all the kids are sick and we're doing just fine. (David and Jill laughing) So, but it was a rough road.
When you take all the kids out of school and they don't do sports, all of a sudden there's not many pediatric emergencies. And... That was very helpful. - I saw a hand here. Yes.
- Good evening, my name's Elijah. Debating between part-time and full-time. Patrick, you mentioned the importance of networking and socializing. And then, Julie, you also said if you could do something, different outlet, just having more fun. Well, just recognizing how important that is, what does it look like in the part-time, or the executive program, in terms of actually networking and building those relationships? And second part to it, is for both of you, just, I'm assuming everyone at Duke is fairly smart, fairly bright, but with the emphasis on learning, and instead of grades, how did Duke stretch you to become better individuals? Whether it's the diversity in the teams of people you're with, the coursework, the projects with deliverables at the end. Just curious to hear your take on those.
- Start with the part-time networking. - Yeah, I'll do the part-time networking piece. So, I was describing to a few people before, like you, it's almost like a reunion every time you go back for your three day weekend. And I, you know, you would, I remember the very first weekend, everybody was networking and talking from the very beginning. And I was a little overwhelmed by that. I was like, you know, I think I'm just gonna go to bed early and do my own thing and keep my head down.
But, very quickly, you get engaged with your classmates. They're just interesting people, you wanna talk to them and then it became, you know, you would return on Thursday and you'd have plans to get together with your classmates Thursday night and just walking into the JB Duke, which is where we stay. - Yes. - And everybody's there in the lounge area, and just being able to see everybody. I like, I got a warm feeling inside. I really, really looked forward to seeing my Fuqua friends, even though it was no small task to leave my family and be away and have to do all that schoolwork, just being with them, it was, I got so much out of it, personally, made some great friends.
It is a little bit like networking on steroids when you're just there for one weekend a month for the WEMBA people. It's pretty intense. The program actually creates a lot of social activities for you. I think that might be a difference between the Daytime and the WEMBA program.
There would always be one major dinner out every three day weekend that you were there for the entire class, where we would go together, and faculty would come, there are plenty of opportunities to meet up with people. So it was, and your team would, and usually also each weekend, you'd have one, a team dinner where you'd go out with the six people on your team. Learning from those people and learning how to be a me