E2A 033: A Value-Based Approach for Health Care and for Business with Dr. Verena Voelter 

 July 12, 2022

By  Scott A. MacMillan

Health care is moving toward a value-based model where metrics and incentives focus on patient outcomes rather than simply delivery of services. There’s much that service-based business owners can learn from this approach.

In this episode of The Entrepreneur to Author Podcast, Scott speaks with Dr Verena Voelter, a passionate doctor and the Founder and CEO of 5P Health Care Solutions, a boutique health care consulting firm, and the author of It Takes 5 to Tango: From Competition to Cooperation in Health Care HER journey from clinician…to executive…to entrepreneur…to author and about why a value-based approach is better.


Dr. med. Verena Voelter is a double-board certified in Internist & Oncologist with 30 years at the forefront of health care. She has held key positions as an attending clinician researcher in the hospital setting and as an executive business leader in small & large biotech pharmaceutical companies (Celgene, Novartis). Her focus lies in cross-sector collaborations and catalyzing novel partnerships across the public and private health care sector.

Today, she is the CEO & Founder of 5P Health Care Solutions AG, a consulting firm that supports leaders in the transformation towards a modern value-based health care system across its main actors: pharma-payers-policy-providers-patients. In addition, her experience is highly thought after by various business, management & medical schools in the US & Switzerland, where she serves as lecturer on topics of pharmaceutical strategy, health care negotiation, market commercialization and value-based health care at large.

She has published her ample experience from the public & private sector in her book entitled: It Takes 5 to Tango – From Competition to Cooperation in Health Care.


5 P Website - https://5phealthcaresolutions.com

It Takes 5 to Tango Book Website - https://tangoforfive.com

YouTube Channel - https://youtube.com/channel/UCCpWov81ER06DfoMmOXNuRA

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Episode Transcript

Please note: The transcript is produced by a third-party company from an audio recording and may include transcription errors.

Scott A. MacMillan:

You're listening to The Entrepreneur to Author Podcast.

Mike Manz:

Welcome to The Entrepreneur to Author Podcast, the podcast that brings you practical strategies for building authority and growing your business. And now here's your host, Scott MacMillan.

Scott A. MacMillan:

Over the past couple of years, we've all become well versed in the intricacies of immunology, virology, and public health. We've seen the interactions between pharmaceutical companies who develop vaccines, the governments that buy them and the doctors and nurses that administer them to us as patients. Some of us, too many perhaps, believe that we ourselves are now experts in these areas.

Well, in this episode of the podcast, I'm talking to someone who actually is an expert in this area. Someone who understands the complexities of healthcare and has literally written the book on how the diverse stakeholders in healthcare can partner more effectively and deliver better outcomes for patients and for society at large. And we're gonna learn about her journey from clinician to executive, to entrepreneur, to author, in this addition of Entrepreneur to Author.

My guest today is Dr. Verena Voelter. Verena is a passionate doctor and former pharmaceutical executive, and she's now founder and CEO of 5P Healthcare Solutions, a boutique healthcare consulting firm that aims to build bridges across the complex 5P healthcare ecosystem of patients, providers, pharma, payers, and policy.

Verena is the author of It Takes Five to Tango, From Competition to Cooperation in Healthcare, first published in English in 2021 and coming soon in German,

Verena, welcome to the Entrepreneur to Author Podcast. Thanks so much for joining us.

Dr. Verena Voelter:

Thank you so much for this. Overly kind introduction.

Scott A. MacMillan:

Well, it's really great to have you, why don't we start perhaps by giving our listeners a little bit more about your background and what you do. Could you speak a little bit about your credentials and experience in the healthcare space?

Dr. Verena Voelter:

Yeah, so I, what I usually say I have the two second version and then the one hour version. No, we're not gonna do the one hour version, but so the two second version is I'm a passionate doctor. That's about it. I think that's what people can remember if they want to.

Uh, the little longer one is yes, I'm a trained internist and oncologist. So I've been 15 years working with and four patients at the bedside, as I tend to say, uh, like on a side note, I've been doing also clinical research and, uh, some lab work as well, but really the red threat always has been the patient and that continued when I switched to, as you kindly said, the pharmaceutical industry for where I stayed for 12 years, uh, in various roles, maybe for those listeners who know that space a little bit. So I've done again, clinical research, clinical trials, innovation, but I also did actually commercial rules. Uh, and this is where I started doing some of the value work. Uh, negotiating and some of the negotiation work that we'll talk about, uh, along the 5P ecosystem.

And, uh, yes, two years ago I started my own firm called 5P Healthcare Solutions, as you said, and I'm sure we'll dive a little bit into what is the 5P and what's the tango.

Scott A. MacMillan:

Very good. Yeah. So, so you published, It Takes Five to Tango in 2021. Um, you know, such a unique perspective that you have, having spent time, like you said, both as a clinician, uh, working at bedside, um, and also as, as an executive. And you've been on both sides, the public and the private sides of healthcare.

Um, can you talk a little bit about the book? Who, who is it that you wrote it for? And, and can you talk about the 5P framework that you've developed and what, what those readers should get from reading your book?

Dr. Verena Voelter:

Yeah. And I think it's really, I actually started, I didn't start off like neither writing, wanting to write a book nor to create my own company. The only thing I decided that I took a sabbatical year, so I can, like, recommend to everybody, if you can, take a break and then great ideas happen to you. Oh. Like the book and, um, the, the company.

So I think, as you said, looking both on the public side that I worked, when I say in the provider hospital sector as a, as a, as a provider, myself and a doctor, but also then the private sector, um, with the pharmaceutical industry, I thought I did see more commonalities than differences. Although in the public narrative, the differences are actually emphasized usually. Things like bad pharma and greedy doctors and stupid policy makers and anyway, greedy insurance companies, payers. So, and I was thinking, well, that was not my experience.

And that's when I felt thinking about that value chain. So I'll say it real quick. Patients receiving care, provider providing care, pharma med tech, life sciences, developing that care and innovation payers paying for care and policy putting the regulatory frameworks.

That's the 5Ps.

And then I thought, well, there are all these silos now and will not dive, I'll invite the reader to look at the book to understand, you know, what other problems, but there are problems, everybody knows them. Cost is one of them. Decreasing quality of care is another one.

But I did think, well, this interconnectivity of these 5Ps. No one can do that job alone. I mean, no patient, no healthcare, no doctor, no healthcare, etcetera.

But the problems also cannot be fixed by one alone. And I think that's the, that's the flawed perception out there to say, well, you know, and I'm always saying, well, if bad pharma and high drug prices would be the issue, well, we would've fixed it long ago.

Look at, you know, some countries, the UK or Australia, who were really strict on drug pricing. Well, they have exactly the same problems, so it's not the solution.

And then I felt, well, the problem is there is no one boss, like of all these five, there's nobody saying you all, as a team should be doing this.

So we are stuck. We have to figure this out, these five entities, at least.

And while I was, I think swimming, um, in my morning swim, I was like, some people have ideas under the shower, I was like doing sports. I'm like, well, it takes five to tango in healthcare to fix the problems together and keep great innovation and progress.

Scott A. MacMillan:

Very good. It’s amazing where those moments of inspiration hit, don't they? And, you know, I often, I'm sure I come up with genius ideas all the time and just don’t have a piece of paper next to me to write them down. So I'm so glad that you did.

Dr. Verena Voelter:

That's the problem with the water. It's like, where's my notebook while you're swimming. Like, oh…

Scott A. MacMillan:

That's right.

Dr. Verena Voelter:

If you're, if you're a runner or a biker, you can still kind of talk and speak into your phone or something, you know, to take notes.

Scott A. MacMillan:


Dr. Verena Voelter:

But I was like stuck, so…

Scott A. MacMillan:

So professionally then what was your motivation in writing It Takes Five to Tango? Obviously, you know you have a desire to, um, to, to change the system to kind of help these parties come together and, and solve these complex problems. But what did you hope that it would deliver in terms of business outcomes?

Dr. Verena Voelter:

Yeah. And I still owe you an answer on the, on the target reader. I mean, people probably figure it well it's for all 5Ps, but I, I really wanted to give, and that is my motivation is yes, it's the change drive and help fix the problem and share my experience. But it's also to give the patient a voice, and also the doctors. And I think you spoke a little bit about the pandemic and maybe we'll get back to that. But I think at the latest, during the pandemic, everybody has heard the headlines about healthcare worker burnout, doctor burnout, nurses burnout. So that has existed before, it continues now, it's up to, you know, 20%, 30% of doctors in anonymous surveys that actually declare that they're totally burned out and that they're actually making wrong decisions. And that is part of the problem.

So I wanted to give these people a voice. I want to give everybody a voice, but what the readers tell me is like “Rena your focus on the patient and that that's the north star for all of us. And that we need to get back to this is really coming across loud and clear.” So that was the driver.

The motivation to write the book, I think was actually my mentor during my sabbatical on a Sunday brunch who said, “Rena, you have to write a book.” And I was like, “what the heck?”

I'm not a talented writer and I have to give credit here to Scott and Grammar Factory for an amazing team who made my book such a nice book with great teams of editors, because yes, every word is from me, but the editing was magic, so now it reads really nicely.

And so I felt I'm a good student, so I said, well, my mentor said, I should write a book, so joking aside, I thought it was a really cool idea. And the other element was that people were encouraging me. It's like, “Rena, you have all these stories, from the bedside negotiating with payers in Korea and in Belgium and being an executive, being a commercial, like a medic, but turned commercial in pharma...you have to write down these stories and you have to share them.”

So I was really driven by: I'm sitting on this wealth of experience. I cannot possibly hold it for myself. There it's useless. So I have to it's that, you know, that inner drive that tells me I wanna share those stories to help others.

Scott A. MacMillan:

Very good. Very good. And in, in terms of what you were, um, hoping to the, the book to, as it connects to your business, um, did you, did you view it as a, as a introduction to, uh, to 5P Healthcare Solutions and to you, um, did you view it as a potential lead generator for the work that you do? Or what, what were some of those objectives?

Dr. Verena Voelter:

Definitely today that's exactly what it is. So I use it all the time. Like when people ask me, what do you do in 5P Healthcare Solutions? And again, a little bit jokingly, I say, well, read my book and come back. And then we see how I can help you. That's not quite how the conversation goes, but it really is totally helpful.

Um, so because I do the consulting on like what is in chapter three. value based healthcare or chapter five, the whole, um, negotiation technique based on the Harvard Negotiation Project, I do use it then for my workshops and in my consulting because people can do both - they can go back and read and then we apply it in the consulting and then the training workshops.

But what I also wanna share with the listeners, and I think my book coach and my editor, Kelly Irving, said that very early on; the objective to write a book shouldn't be to use it as a lead generator. It really needs…there needs to be a big WHY that needs to be strong in the purpose of why do you wanna share these stories? And that needs to…and that really was the initial, as I described. To make it helpful for the business is a nice side product and is an amazing side product now, and that is a huge objective, but that was not the reason why I, I wrote the book, but today it is so, so, so helpful in my day job, as a consultant, working with hospitals, with startups, with pharma companies, with policymakers health authorities. Um, you know, that that's really where it goes hand in hand.

Scott A. MacMillan:

Very good. Uh, so from a writing and publishing perspective, um, I'm interested, uh, in your point of view around what did you find perhaps surprising or frustrating or confusing about going from having your completed manuscript to having books in hand? Cuz um, I think a lot of our listeners haven't been through that journey yet and, and are, are curious what to expect.

Dr. Verena Voelter:

So I have to say again, as a disclosure, I'm neither a writer nor an experienced, you know, in the book scene. No idea. So it was a total novice and for anybody who is similarly a novice, my first recommendation is hang in there. Don't give up. It's gonna be super bumpy. And that's okay. And you learn. And I think if you go in, I think with an open mindset, and I think the key is to find good partners.

Like I figure really the partnership me as an author writer with you guys with the editors was key to success. And it…I think the biggest intersection for me was exactly what you said was this final manuscript, which is kind of in the word document as an example. And then to the fin- um - finished book product.

That was the biggest awe when I did hold it in my hands at the end, I'm like, oh my God. It's like a, you know, a butterfly transformation is like, this is so beautiful and it doesn't even look like close when you are in this word document stage where I found it looked ugly. I didn't like the reading. I didn't like how it read, you know?

So I think that transformation with the editor, with a publishing house, is not a straight line. I think there's back and forth, there's loops, there's turns, there's maybe disappointments… And it's a co-creation process where I think if you go in with a really open mind, and really think this is hard work, it's like building bricks and building a house out of bricks, then it's fine.

I think if you go in with the intention. Oh yeah. But you know, I write, as I see the book, this is when it's tough, I think. So there's this transformation process, which is amazing. I should say that.

Scott A. MacMillan:

Yeah, that's a really good, that's a really good point, cuz it, it, um, it, it is very difficult.

Isn't it? To project forward, you have an idea perhaps in your mind of, of where it's gonna go. Um, uh, of what that end goal is. But the journey to get there is pretty winding, right? And, and there can be surprises and, and, um, you know, unexpected circumstances that come up to get there.

So on the flip side, what have been some of the highlights of your journey to authorship, whether that's in terms of, uh, just the accomplishment itself or certain results that you've achieved with the book or, or maybe a particular part of the process?

Dr. Verena Voelter:

I think it's really to structure your thinking or my thinking and get in that sense, by the way, it was very helpful as in parallel, I was building my own company and enterprise in formulating what will be my services? What type of work will I actually do? What other skills I wanna help people get trained on?

So that whole, when I today refer to chapter three value based healthcare and chapter five, the negotiation technique, and by the way, chapter four is digital, just for those who wonder. um, while the first two chapters is just kind of, you know, diagnostics, what's wrong in the system and bunch of numbers and stuff like that.

But it is that…I didn't start off as I start at the manuscript and say, oh, that's gonna be chapter three and that's gonna be chapter four and five. Not at all. And it happened while I was writing with the editor, you know, the structural edit and really say, well, that idea better fits at the end and that we should put any intro. And, and then somebody, I think really working with somebody else who gives reflection on what you write. I think me, on my own and in my own house, I would not have been able to come up with this product.

So it's really in the dialogue with other people. And that at the same time was highlights because it was really these aha moments when somebody else says, well, you know what?

I think these two ideas over there, they belong together into one chapter. And that's like, of course it totally makes sense, but I would not have come up myself with it. So I think it's that in that, yes, you're the only author, but you need that dialogue and feedback and mirroring all the time. So in that sense, the…it structured my thinking also on what is it I wanna talk about?

And now this is this package around value based healthcare and the package around negotiation that wasn't even clear for me in the beginning, because I had this series of stories from 25 years in the workplace, I wanted to tell, but my, my career wasn’t structured around Chapter 3: Value based healthcare to five negotiations. So I think it really helps with clarity of thinking. And then maybe if you're a business person also help structure your business.

Scott A. MacMillan:

Now this, uh, I'd love to dive in a little bit on, um, and this is a little bit off script, um, but I, I think it would be helpful for listeners to get a bit of an understanding about value based healthcare. Can you talk a little bit about what that is and why it's so important?

Dr. Verena Voelter:

Yeah. And thanks.

And you did in the intro refer to COVID the COVID pandemic and the development of the new vaccines. So in short, it is currently one of the problems is that we have the wrong incentives in the system because the incentives is money.

So let's say elderly person falls, fractures their hip and needs a hip replacement. In the today’s system, the surgery is paid for, the doctor is paid for, the hospital is paid for...Nobody ever looks, if the patient actually can walk again. Worst case, maybe the patient falls again and breaks again. And then again, the surgery will be paid for. So that is kind of leading to duplication of cost. Because maybe nobody really looked into good physiotherapy and support for the patient after they were released. So that's what we call outcomes. So, or in another industry, it's about the result to the customer that's important and the experience of the customer.

So if we think about going to a fancy restaurant or booking a nice vacation somewhere, this is what we call with the experience. And it's obvious in other industries, Why the heck is it not obvious for healthcare?

So value based healthcare will say we stop paying for services. So we call it fee for service, but we start paying for outcomes. So the hospital will only be paid, if let's say the patient can walk again, six months later. And the trick and the beauty is that these outcomes will be defined among the 5Ps.

And I'll give just one brief example on diabetes. So it will be actually with the patient and the doctor and all the other specialists you need - eye doctor and kidney doctor and physiotherapy and whatever psychologist, mental health provider, payer, and maybe even a company that does the insulin, for example, or the pump, the insulin pump - they sit together…they literally go on retreats to say, what outcomes do we wanna aim for? Glucose level, for example, blood sugar, in let's say a year.

And then everybody agrees and that's what the population will be paid for. And then if you're doing better, you get a bonus. And if you don't hit it, you get a malice just like in a business context. And the beauty is in places where this has been practiced for the last 10- 15 years, this works. But it's a massive transformation, going back to the tango for five, not one can say, well, we closed the shop on Friday, on Monday, we start value based healthcare. It doesn't work. You know, you need the IT infrastructure. You need to collect the data. You need to analyze them. You need to agree, whatever you need to reorganize workflows. And stuff like that.

So it's a very cumbersome thing. And that's why, you know, in, in my consulting with 5P Healthcare Solutions, we support that transformation. And then also the negotiation piece is because often people don't agree on those incentives and you know, who's accountable and all of this needs to be figured out within the 5P group, there is no boss and, uh, but I think the pressure is so high in the system right now with rising cost, with errors in care, the care not being good enough for patients that the pressure is high enough to force people to the table and sync that transformation.

And on the vaccine side for COVID just for the, for the listeners, usually it takes over a decade more than 10 years to develop a new therapy. If you everybody, maybe now listening, think what, what are maybe the pills or the therapies and medicines you need to take well to, to get to that point, you can take them, it takes 10 to 15 years and over a billion dollar investment. What happened with COVID? We developed at least four vaccines in less than 12 months. This is unheard of. And this is what happens when people dance a tango for five and have a common objective.

Scott A. MacMillan:

Wow. Well, well said it really was, uh, a bit of a miracle that, that happened so quickly and so effectively. And, you know, I, I love that, uh, notion of value-based and, you know, I, I think even though a lot of our listeners maybe don't work in healthcare, I think there are lessons that can be applied to, um, you know, service based businesses in general, because often we're in a situation where as a, a service provider we're, we're charging for services or we're charging for, you know, by the hour or what have you. And there's so much more value both for us as, as business owners and for our clients when we can, um, you know, reframe that around outcomes. So I, I, I really appreciate how you frame that and how you describe that, cause I think, uh, listeners will really get a lot out of that.

Um, I, I also wanted to talk a little bit about your German version that will be coming shortly. Um, could you talk a little bit about your decision, uh, to follow up the English edition with the German edition? Um, was that something that you had always planned or was there, um, was it demand driven? Where, where did that come from?

Dr. Verena Voelter:

So it was a little bit hidden in my mind in the sense of, was it planned? So I, I did have a nugget of an idea to do it because German is my mother tongue. And so I, you know, of course I have my family. It's like, you know, they're not English natives and, and although it's written for lay public, the book, there are some technical terms, so it's maybe hard to read for somebody who's not so interested in healthcare in English, if you're not an English native. So that was there.

And then yes, it's demand driven through my business because the German speaking market is an important market for me, for the enterprise. And so there was a clear demand and then combined with my personal and private and family reason, I'm like, well, I have really no excuse anymore, not to do it. And so that's where, um, I started then going back to the keyboard.

Scott A. MacMillan:

Very good.

Dr. Verena Voelter:

And re rewrite it.

Scott A. MacMillan:

Yes. Good. Um, Verena, where can listeners learn more about you and the work that you do?

Dr. Verena Voelter:

Thank you. Yeah, so, I mean, on my website, 5P Healthcare Solutions, I also keep a book website, tangoforfive.com and we just launched a YouTube channel, the 5P Healthcare channel. If you're interested on the latest news in a, in a more modern fashion and not in the written word. And I did also record an audio book, which I know some people have listened to and that they really enjoyed and that I narrated myself.

Scott A. MacMillan:

Excellent. Okay. Well, we're gonna be sure to put those links in the show notes.

Verena thank you so much for this for being so generous with your time and for sharing about your entrepreneur to author journey. I know it's been super valuable for our listeners, so thank you again for joining us.

Dr. Verena Voelter:

Thank you so much for having me.

Scott A. MacMillan:

Verena's expertise and path to authorship are unique to her, but there are some wonderful insights she shared that we can all learn from.

As we wrap up this episode of entrepreneur to author. Remember this..

While you may and really should have business objectives for your book, you need a deeper WHY that will resonate with your reader if your book is going to be meaningful for them.

What's the WHY for your book?

The path from manuscript to published book isn't always a straight line. So know your WHY and your book's WHY, but know that publishing is effectively a metamorphosis one from which your book emerges as a transformed, elevated version of where it began…and enjoy the journey.

Value based outcomes have applicability not only in healthcare, but in any service based. Get out of the trap of trading your time for money, and instead, get clear on the value you deliver for your clients and the outcomes that they need to be successful that will win the day every time.

Now is the time to write…time to publish and time to grow. I'm Scott MacMillan, until next time.

Scott A. MacMillan

Scott A. MacMillan is a speaker, international best-selling author, entrepreneur, and the President and Executive Publisher at Grammar Factory Publishing. He and his team help expert entrepreneurs write and publish books that build their authority and grow their business.

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