DaVita Medical Insights
Nine Questions with Dr. Jeffrey Giullian, Chief Medical Officer for DaVita
Jeffrey Giullian, MD, is passionate about his new—as of Jan. 1, 2020—role as chief medical officer (CMO) for DaVita Kidney Care. Listen to this podcast, in which Halie Peddle interviews Dr. Giullian on his priorities and vision as CMO for DaVita. He gives us some personal background on why he pursued a career as a physician, specifically in the field of nephrology, and what originally brought him to DaVita. Dr. Giullian also discusses his views on kidney care-related innovation and how kidney care is leading all of health care in the shift from volume- to value-based care. Listen and read more DaVita Medical Insights here.
Halie Peddle: 00:33 Hello, everyone. This is Halie Peddle with the DaVita Medical Insights Podcast. Today we're joined by Dr. Jeff Giullian, newly announced chief medical officer for DaVita Kidney Care. Dr. G., Thank you so much for joining us. This is our first opportunity to sit down with you since you started your new role. I'm excited for our listeners to get to know you even better and hear your thoughts on innovation in the field of nephrology.
Dr. Giullian: 00:57 Well, thanks Halie. I'm really excited to be here and share some of my passion for taking care of patients with kidney disease.
Halie Peddle: 01:03 Great. Well, let's dive right in. Lots to talk about today. I want to start off just a little bit more personal. Would love to hear what made you decide to pursue a career as a physician?
Dr. Giullian: 01:16 That's a good question. Believe it or not. Growing up I was going to be a lawyer. Don't tell any of our lawyer colleagues. They won't believe it. Freshman year in high school, I got a chance to shadow some lawyers. And I have to tell you, I realized that day, the law was not for me. I didn't really understand what they were doing, and it really didn't appeal to me.
Dr. Giullian: 01:36 And right after that I had some biology classes where we were actually doing anatomy and physiology, and somehow it just clicked. The timing was right. And finally I found something that I could really sort of sink my teeth into from a passion standpoint. And that was the human body, the physiology of the human body. And from that point on I was dedicated to becoming a physician.
Halie Peddle: 01:56 And of all the fields you could have chosen, what made you choose nephrology?
Dr. Giullian: 02:00 Yeah, that's another, I think, funny story, or one at least I like to tell. When I was a medical student, nephrology was the last possible thing that I enjoyed doing. It wasn't something that I particularly understood very well. It wasn't something that really captured my heart or my interest. And turns out that the very first month of internship, I was given a chance to spend about five weeks with a couple of nephrologists. And by given a chance, I went kicking and screaming. It was the elective that was given to me, not the elective that I asked for. It turns out I absolutely fell in love with the physicians I was working with, the patients that they were taking care of, the pathology and the physiology that goes along with kidney disease. And I was hooked from that point forward.
Halie Peddle: 02:46 And then tell me what brought you to DaVita?
Dr. Giullian: 02:48 So I was in clinical practice here in Denver. My wife and I, we're both from Colorado. We're both natives. I met her while I was in school in Nashville. She and I were, I was in training at Vanderbilt, and she was on faculty at Vanderbilt. And we had every intention of staying at Vanderbilt and staying on faculty. In fact, I was going to practice transplant nephrology and general nephrology there.
Dr. Giullian: 03:12 And then fortunately we had a little gift that arrived, my daughter, and we realized very quickly that if we didn't want to spend every vacation flying home from Nashville back to Denver to see all the grandparents, if we actually wanted to take trips on vacation, we'd be better served coming home and being in Denver. And so I came home, and I went into practice here in Denver. Practiced nephrology, general nephrology and transplant nephrology, just about 15 minutes south of downtown. Loved it. Loved every minute of it. Loved my patients. And during that time became more involved with DaVita, doing some work as the group medical director where I helped other medical directors in the center part of the country with clinical outcomes.
Dr. Giullian: 03:59 And as I got more and more involved with DaVita and started spending more time at DaVita and a little bit less time with my practice, it became evident that I needed to choose one or the other. And so when I had the opportunity to come to DaVita full time, just about four years ago, I jumped at it.
Halie Peddle: 04:14 And now as chief medical officer, what aspect of the role are you most excited about?
Dr. Giullian: 04:19 Gosh, there are so many aspects. I'm really pinching myself every day that I get to wake up and really serve our physician partners, serve our village, and most importantly serve our patients as chief medical officer.
Dr. Giullian: 04:33 And really, I have three big priorities. The first one is holistic care for our patients. And what that means is providing kidney care wherever patients are on the entire spectrum, whether they have early CKD, more advanced CKD, whether they're considering dialysis because they've advanced to the point that their kidneys are not working any longer, or they're on dialysis, or they're waiting for a transplant, or have gotten a transplant. That's really my number one goal is to provide holistic care to that entire group of people.
Dr. Giullian: 05:01 The second is to really double down on the foundation that my predecessor Allen Nissenson put into place, which is a focus on patient safety, clinical quality and patient experience.
Dr. Giullian: 05:12 And then the third is forging a future of innovation so that we can in time truly reduce the global burden of kidney disease.
Halie Peddle: 05:19 There's tremendous innovation in our field right now and as we look to the future. So I'd love to ask the next couple of questions on that topic. So how would you say DaVita defines innovation?
Dr. Giullian: 05:31 Well, for DaVita, continuous improvement is in our DNA, and innovation, I think, takes continuous improvement, really to the next dimension. DaVita pushes for what health care can be, not necessarily what it is right now. And that's especially true around transforming the care that we provide to improve quality of life for our current patients and certainly for our future patients as well. So in that context, I think innovation takes forms. And we are driving innovation by improving care delivery, by developing cutting edge technology, and by advancing new models of care.
Dr. Giullian: 06:06 We've also really focused heavily on the science of implementation. So this is a discipline of science that focuses on applying research findings and evidence based interventions to routine clinical practice. And this is really part of how we innovate. And the bottom line is we are committed to helping patients manage their kidney disease, really at all stages from, from early on as I mentioned, so that we can delay the progression of their disease, and to those that are later on so that we can ultimately, if they do need dialysis, we can help them in that transition. We can provide them the greatest possible health during all of that. And importantly, we can help them seek a kidney transplant.
Dr. Giullian: 06:46 So really regardless of where somebody is on that continuum, I think that at DaVita, and certainly within the office of the chief medical officer, we really embrace our patient's unique lifestyle needs. And we've developed a patient centric care model. And this is all, I believe, due to the innovation that has been put in place. And we believe in offering the right treatment for the right patient at the right time.
Halie Peddle: 07:08 And for a patient with kidney disease today, how do you see innovation showing up for them?
Dr. Giullian: 07:13 Yeah, so that's a good question. As I think about sort of my own patients, patients that I've cared for in my career, I think it really comes down to giving each individual the best possible experience and the best chance for improving their health. And so I think patients want to know that they are cared about as well as being cared for. And that's really something that I've tried to incorporate into my clinical practice back when I was in practice.
Dr. Giullian: 07:38 So for anybody helping care for patients that have a chronic disease, whether that's kidney disease or anything, it means providing holistic care, care for really the whole being. And that's greater than just kidney care for us. It also means helping them with the healthy lifestyle, helping them stay out of the hospital, fewer days in the hospital. At least the way I think about it means more moments at home with their family and with their loved ones.
Dr. Giullian: 08:04 And so, we live in an era now where we can personalize care. We no longer are confined to sort of a one size fits all treatment options. We can really help optimize care for any individual. And so I think that's what innovation looks like to our patients.
Halie Peddle: 08:20 Yeah. And now if we want to look just a little bit broader at the nephrology community as a whole, what do you think the focus is right now in terms of innovation?
Dr. Giullian: 08:30 The kidney community as a whole has focused on improving safety, decreasing hospital admissions, reducing mortality rates through implementation science, which I mentioned earlier, and specifically by leveraging data from the entire population. Research has demonstrated ways that we can implement quality improvement activities really at scale. And I think this is what the community has been focused on as a whole, and we are all to transform the patient experience, provide broader access to care, improve outcomes, and ultimately reduce costs. That's how we provide value.
Dr. Giullian: 09:04 The constraining factor has really been reimbursement, which has been stagnant for more than a half a decade. And the dialysis industry, as an example, provides onsite social work. It provides insurance counseling, care coordination, gosh, you name it, nutritional counseling and a lot more to help provide holistic care of patients. But the ability to innovate, at least in the past, has been constrained by regulations, and to some extent, reimbursement has not kept up with the increasing needs of our patients.
Dr. Giullian: 09:34 Fortunately, I would say that the kidney community has achieved very high levels of health equity. And this is really due to a tremendous amount of work by members of industry and the community as a whole. And that's health equity and access to safe, effective treatments and continuing, I think the entire community is looking towards new models of care to do even more for kidney patients.
Dr. Giullian: 09:58 DaVita believes strongly, and I certainly believe strongly, in equitable access to care from early CKD identification all the way to nephrology care and ultimately to access to kidney transplants.
Halie Peddle: 10:10 So it seems like innovation at an industry level, and even as we look at it from a DaVita standpoint today, it's focused not only on that full continuum of care but also how that shows up day to day. But when we look to the future, 20 years from now, what big innovations do you think could change the way that care looks like?
Dr. Giullian: 10:30 Boy, it's so exciting to think about 20 years from now because I think the landscape for kidney patients will look very different than it looks today. And I was recently remembering that I saw my very first kidney patient as a medical student just a little over 20 years ago. I will probably retire, God willing, sometime in approximately 20 years. So I'm in the middle of my career, and what I can say is that I think things will look very different in the year 2040 than they look in the year 2020. That will include things between now and then like wearable dialysis devices, implantable devices that can go inside the body and work like a kidney, but that are not necessarily biologic. They're technology based. And there will certainly be new options for kidney transplants as well. So I think over the next 15 to 20 years or 25 years, we will see a complete revolution in the way that patients with kidney disease are cared for. And I'm hoping that we will even begin to see the beginnings of regenerative medicine, the ability to actually go in and do things to repair kidney damage for those patients that have chronic kidney disease so that they don't progress on to needing dialysis.
Halie Peddle: 11:41 Very exciting. And I want to switch gears just a little bit, and I'd love your thoughts on this, Dr. G. Many people within the health care community are talking about kidney care because it's thought to be the tip of the spear when it comes to value-based care. Why do you think kidney care is leading this conversation?
Dr. Giullian: 11:59 Well, first off I think it's worth mentioning first and foremost that it's really an exciting time to be part of the kidney care community. There's a lot of attention on us now that we didn't necessarily have in the past. In fact, I would say never in my career have I seen so much emphasis on finding new ways to care for really what I think of as one of the most vulnerable patient populations in our country. So I'm excited. Kidney care in general is leading all of health care in the shift from volume to value-based care and reducing care fragmentation by compensating providers for really improved clinical access, clinical outcomes, quality of life, patient related outcomes rather than just the number of services that are rendered or the number of treatments that are given.
Dr. Giullian: 12:44 Kidney care providers continue to prove that the drive towards integrated care inspires innovation and the delivery of better outcomes compared to what's called the traditional fee-for-service models. So for health systems, for payers, for providers, this means moving to the value-based reimbursement models and managing risk. And it's really about managing what we call outlier populations. Patients that don't necessarily fit in the "norm" from a clinical standpoint. And those can be small in number, but they tend to be very high in acuity, and they tend to be high in cost. And patients with kidney disease often fall into these categories.
Dr. Giullian: 13:27 And so what we're focused on, and what the entire community is focused on right now, is managing the total cost of care for these patients. And I would say this is where DaVita and our partner nephrologists are really in the best position to manage the total cost of care for patients and improve their clinical outcomes. And this is true for patients with advanced stage chronic kidney disease. It's also true for those patients with end stage kidney disease. I think value-based care enables the delivery of holistic care across the entire continuum. And this results in patients staying healthy longer and avoiding hospitalizations. And for me as a clinician first, first and foremost, this is really what we want to achieve on behalf of our patients.
Halie Peddle: 14:08 Dr. G., thanks for joining us again today and sharing more on your clinical vision for DaVita.
Dr. Giullian: 14:13 Thank you for having me. I appreciate it.
Halie Peddle: 14:15 Listeners, thank you for tuning in and be sure to check out other DaVita Medical Insights episodes for more kidney care educational podcasts. You can also find additional kidney care thought leadership and industry news by following @DaVitaDoc on Twitter.