Sponsored Content by United Healthcare Jan 10, 2020
The
traditional health care system is giving way to a new value-based care model
that focuses on the triple aim of better health, better care and lower costs.
It’s about shifting the health care system to a model that incentivizes and
emphasizes the importance of keeping people healthy with proactive care — both
preventive and to treat chronic conditions rather than reactive care.
To find
out the latest about the move to this health care model, UnitedHealthcare and
the Dallas Business Journal assembled a panel of experts for a discussion
moderated by Ollie Chandhok, the Dallas Business Journal’s market president and
publisher.
The
participants were:
·
Dr. Keith Thurgood, Director, MS Health care Leadership and
Management, UT Dallas
·
Den Bishop, President, Holmes Murphy & Associates
·
Scott Flannery, Chief Executive Officer (North Texas and
Oklahoma), UnitedHealthcare Employer & Individual
·
Dr. Christopher Crow, CEO, StratiFi Health, parent company of
Catalyst Health Network
When many people think about primary care, they
think about going to a family doctor for a yearly checkup, or dealing with a
problem before it arises. However, primary care has evolved. What does the new
health care model look like?
DR.
KEITH THURGOOD: The Primary Care Physician, or PCP, which we’ve
traditionally thought of as the gatekeeper into the health care system, is
evolving. The PCP is really the conductor who orchestrates care along the
entire continuum of care. I see their role continuing to evolve as the center
of a coordinated team effort that is patient-centered not physician centered.
So whether one is talking about acute illness, preventive care or chronic care
management, the role of the PCP will be to coordinate that care across the care
pathway, and do it in a way that improves costs and outcomes. They’re going to
play a very important role in this team-based approach.
SCOTT
FLANNERY: The primary care physician is at the center of the
decision making - in partnership with the patient. But where we may have fallen
down in the past is when many believed the primary care physician should do
everything. It really goes back to the important role of the PCP and how she or
he is quarterbacking a health care team to make sure that the patient gets the
right treatment and the right care, and that includes taking advantage of
telemedicine when appropriate, as well as nurse practitioners and physician
assistants. The relationship between PCP and patient is at the center of this
team effort that can ultimately lead to a better health care experience,
improved health outcomes and lower costs.
BISHOP: Another
important part of this new model is “value-based care.” To many people,
value-based care means different things. A lot of that started with the government
looking at how they were buying health care through Medicare and other
programs. The Affordable Care Act had elements inside of that. But it was
really trying to get specific about paying for an outcome, rather than just a
transaction.
At its
heart, a term I think that worked better for most people to say: we want to pay
for quality, not quantity. And I think if we simplified the average patient’s
understanding when we say “value-based care,” and I think they’re going to look
at us say, “I don’t know what you’re talking about” because that doesn’t mean
anything to the average patient. And if we said, “We want to pay for quality,
not quantity; we want to pay for you to get better, not just to get services,”
then, I think people could understand why insurance companies, the government,
physician groups and others are trying to align to do that. Without simplifying
that definition, I think people gloss over it.
DR.
THURGOOD: Think about how the average American consumes health care.
When one goes to the physician, and the physician says, “Hey, you need these
five procedures,” 99 percent of the population will say, “OK, you’re the
doctor. I trust your judgment,” and the five procedures are done. In the
future, a Patient Centered Medical Home model will emerge that delivers health
care when and where it is needed. The model will be enabled by technology and
data transparency that leads to a more educated, better informed consumer.
FLANNERY: What’s
critical is making sure we are meeting the patient where they are. For example,
the Gen X and the Gen Z generations consume health care differently and have
different expectations.
DR.
CHRISTOPHER CROW: You know, it’s changed a lot even from the
time that I was going through residency and medical school. For example,
patients now have the opportunity to engage in digital experiences, which
wasn’t the case before we had the Internet, smart phones and apps.
Today,
I think we’re going to be challenged with how to meet people where they are,
instead of as a brick-and-mortar office visit. Digitally is one way that we’re
seeing some differences. Secondly, the idea of the physician being the entire
owner of all knowledge and in all things decision making with the patient has
kind of changed in two ways: One is the millennials for sure, and even some of
the Gen Xers, prefer shared decision-making than maybe some of the baby boomers
who used to just would follow what the doctor said. We’re seeing shared
decision-making be something that’s very different and evolving to a team-based
model of care to where the physician is the leader of a team that’s helping
take care of a group of patients, but leading the team, not the sole captain.
Will
you elaborate on shared decision-making? You said the millennials kind of
venture into that role. Who’s sharing in the decision?
DR.
CROW: Patients, employees, members ... people who are seeking
some type of care from their physician … in this case, a PCP. In most cases, in
the shared decision-making model is more along the lines of talking about the
different options that are out there. But so much has changed over the last 25
years: We know so much more … there are more drugs, more treatment options,
whereas the options were fewer for baby boomers, who were more interested in
just getting the answer and just following a strict set of rules from the
doctor. This idea of shared decision-making allows for a higher chance of
enrollment of what the patient actually might do, rather than just following a
mother-child type model that has been the standard over the years.
It
sounds like there are steps required to get the current health care system
ready for value-based care to be effective.
FLANNERY: Yes,
it Isn’t a matter of simply turning on or off a switch: it’s a continuum. There
are different providers in different parts of the continuum. What it’s really
about is collectively moving everybody to the most accountable path where we
can effectively improve patient health outcomes and lower costs.
Our job
is to help providers move along the continuum to further accountability of the
value-based model over time.
DR.
THURGOOD: I think the word transformation is important here, too.
When I think about change, those are short-term transitions. But this is really
transformational step … a change that implies a long-term solution. We’re on a
journey. I think it’s fair to say that the health care system has been evolving
for a long time. We’re on a path that will help us drive down costs, measure
and improve quality and expand access.
How
well has this been received by the consumer?
FLANNERY: Consumers
want to understand drivers of health care costs, and desire a better care
experience with improved health outcomes, so the partnership between providers
and insurers to transition from a fee-for-service to a value-based care model
is a welcomed one. Also, employers are interested as healthcare costs, once
ranked fourth or fifth on their annual expenditures, have grown to number one.
They are looking for solutions.
BISHOP: The
challenge is measurability: Better outcomes at what? Related to what? That’s
one of the challenges I would assume for physician groups, too is: related to
what? With employers, what we often talk about is having a disease-specific
focus. Are you trying to improve your outcomes in cardiovascular disease? Or is
it diabetes or cancer?
The
employer ultimately owns the risk. There are more people in North Texas and the
United States who are in self-insured health plans than insured, meaning that
it’s really the employers’ money and people like UnitedHealthcare are providing
the administration, the networks and the tools and services. But it’s really
the employer’s money.
When
business people look at it that way, they say, “That makes perfect sense. Why
would I pay the same amount or more and get no measurements of outcomes?”
DR.
CROW: When you think about value-based care, we need to ask the
question, “Who’s the value for?” There are really just three stakeholders:
people who receive care, people and organizations that provide care and there
are people and organizations who pay for care. What’s different in healthcare
is there’s a third party in this that pays for the care. Sometimes that does
include the patient, but very often it’s the employers, or the government. To
actually get transformation, you’re going to have to create a system that
creates value for all. And to me value is just a statement of: I’m getting the
outcome I want for a price that I think is fair. Or I’m getting paid for the
service I’m delivering for a price that I think is fair.
Patient
experience: as we attempt to move to a value-based care model or at least try
to define it even, what’s the experience like for the patient?
DR.
CROW: You look to other industries to see what the experience is
like. Because one of the things that I recognized as a medical student and
resident was that being a patient can really stink. You may have a hard time
getting in to see the doctor, but your health is so important, why should you
have to wait? It doesn’t make sense. You don’t know how much it costs. You
don’t understand the choices. They use words that you don’t know. You get bills
six months later. It’s a very convoluted system that really hasn’t gotten much
better.
Access
is one way to improve it … access to care when I need it. Also, the one thing
we know with health care over and over again worldwide is if you have a PCP,
you actually live longer. We’re talking about measurements … that seems to be a
pretty good one: lifespan.
Second,
healthcare is very different than every other service industry for the most
part. If you go to a restaurant that’s more expensive than less expensive, you
expect a better meal. And if you traveled for a night to the more expensive
hotel, you expect a better experience. But in American health care, the more
you spend does not actually equate to better quality or experience.
BISHOP: The
patient is confused. There was a study that came out about two years ago and
they asked people could they define and accurately apply the four big terms in
health care: deductible, copay, coinsurance and out of pocket. Four percent of
Americans could. So every bill is a surprise bill because they don’t know how
it works.
And
then we want to have them be a consumer? They have no chance to be a consumer,
which is why the role and the relationship with effective primary care is so
important.
The PCP
group and the staff and that team can help navigate that world for that individual.
Without that, they’re relying on friends and Google.
DR.
THURGOOD: It’s a great point. Specifically, the US health care system is
fragmented. Health care delivered under a fee-for-service model is complex in
all its bits and pieces. Sometimes I take a can of soup to my classes, and I
say, “I know more about this can of soup than I do about my own health. I know
when it was made. I know the weight. I know the cost per unit. I know when it’s
going to go bad.” But as health care consumers, we really struggle with
information and how the whole system works to deliver care. It’s very
challenging.
What
are some of the other considerations for employers as we shift toward the Value
Based Care model?
FLANNERY: I
think the pitfalls are going to be the status quo. “I’m used to seeing this
physician.” “I’m used to going into this hospital.” “I’m used to going to this
place for care.” And a lot of what we’re talking about is going to challenge
that, and that’s a good thing.
There
are incremental steps that we can take to move the health care system along to
improve the patient experience and achieve better care and lower costs. As we
said earlier, it’s a journey and it’s important to remember that while we play
different roles we are on the same team, working toward the same outcomes.
DR.
CROW: Employers in the future are going to have to fully embrace
primary care, lower all barriers first and then incentivize their employees to
get a primary care relationship. That needs to be done more than anything.
Employers
need to create communication with their employees about the value of a primary
care relationship — that they are making the journey to better health care
delivery on your behalf because we’re paying the bill and you’re splitting part
of it with us in some way, shape or form. But, we’re going to do this together
to get better quality and lower health care costs.
BISHOP: I
think there are things that really defined the employer in this space. First is
fear that this might increase costs. Employers unfortunately have been burned
by investments in health care that haven’t worked.
Executives
need to remember that this is essentially a business conversation, right?
BISHOP: It
should absolutely be a business conversation.
DR.
CROW: Businesses are my favorite group to talk to because I
think a lot of our costs that have gone up over the last 20 years are because
employers have just said, “OK,” over, and over, and over again.
The
government actually clamps down on it: Medicaid, Medicare … you’re not seeing
super inflationary prices on that side of the house. It’s really on the commercial
side, which is the under-65 employed market. Some employers have just turned a
blind eye.
We did
have a period of a recession in the last 20 years. But otherwise, the economy
has had a couple of pretty good spurts. And so they look away, and they don’t
make the tough decisions because they’re scared of retaining talent, worried
that will go somewhere else because you make changes and it could be perceived
as restricting choice.
It’s
the job of the CEO and CFO to actually think about the whole company as a
whole, and they need to just step up.
What
are the steps that local CEOs, CFOs and other executives can take to get
themselves involved?
DR.
CROW: Well, they have at least two people in their ear: one is
usually a benefit consultant and the other is the insurance companies. And all
of them are talking about some of these new things. So it’s not really hard for
a CEO to get this information, if they choose to. They don’t have to go search
the depths of Google to find information on this. It’s readily available.
The
question is, then, will they take the time to understand it? Will they take the
time to consider the path and will they consider a multi-year journey to make
changes necessary for their people and their costs?
DR.
THURGOOD: We need courage, and we need health care leaders. Leaders,
not necessarily managers (although they are needed too), who are going to take
the bull by the horns, drive sustainable, transformational change. To the
extent we can accelerate these changes, and defeat the status quo, the better
patient experience. It is a journey.
BISHOP: When
we enter in a discussion with an employer who’s not a customer and they’re
saying, “Hey, can you help us?,” very often, they’ll say, “We think we need to
change insurance companies.” Then we’ll ask them a few questions. The vast
majority of the time, they are not leveraging what is available from their
existing partnership.
Employers
aren’t asking, “Well, what high performing primary care groups can we work
with? How are they connecting patients with those groups? How are they
measuring that? How are they paying for that and making those investments?” The
mindset of the employer buyer is still on the old stuff that really doesn’t
matter that much. The marketplace has not yet evolved to when we’re having
those discussions. They’ll get there, but it’s going to take a little time.
FLANNERY: Our
role is changing, too. If we pay a provider one dollar, 80 cents of that is not
our money. Eighty cents of that is from the self-funded employer. You have to
keep in mind that in many instances, we’re the fiduciary of that individual or
that organization’s money. When we are paying a facility who represents 15
percent of the utilization with 30 percent of the cost in the marketplace, it’s
not really about our dollar anymore. It’s about us being a responsible and
accountable part of the spend and the overall process. What does it look like
ten years from now for the PCP? How does his or her role evolve?
DR.
CROW: The way we’re doing it now at Catalyst is probably halfway
there, in my opinion. It’s surrounding the physician with a team and creating
access point for the patients all along that team.
DR.
CROW: Primary care will have a system or platform that they’re running
that has team members, that has data and analytics, and has partners that
they’re working with, to actually help manage the patient downstream to a
better, more predictable cost of care. It’ll continue to potentially go up like
a lot of things do every year, but at a more of a CPI or inflationary rate.
FLANNERY: If
we’re bringing down the overall health care costs, we can’t do it on just the
backs of the PCP. We’ve got to give them the ability to continue to earn money
and to do the right things inside of their own programs. Whether it’s helping
to fund care management nurses or outbound calls to potential high utilizers,
these changes are going to be paramount in the model moving forward. Some of it
already exists. We’re going to have to double down on it, continue to do those
things and create the right provider resource level for the right elements.
DR.
CROW: We should be able to see more people manage more people, not
fewer. Unfortunately, that’s flying in the face of a lot of conventional wisdom
right now in America around this idea around direct primary care and in
concierge care. That actually limits the supply of physicians we need in our
country. The supply-demand curve doesn’t work for that to happen anymore.
We have
to create systems that allow us to expand and take care of more patients, and
that needs to be wherever the patient is. It doesn’t have to be in the office.
It can be out in the oil field. It can be offshore. It can be in their home. It
can be still face-to-face with a community health worker, but all led by a PCP
relationship.
BISHOP: It
feels to me that technology can handle an awful lot of the diagnostic. We have
technology that could let the physician group know what your blood pressure is
doing and what your blood sugar is doing.
Whether
it’s a smart watch or some other device that is that’s going to know everything
that’s going on in my body. That information can then go to somebody who could
say, “OK, well, we’ve got a problem here.” It’s going to be fascinating to see,
but it’s really going to be that ability of that group to connect with the
patient who’s still going to be confused around where to go, what it means. To
me, that’s the real fascinating part about why and whether it’s one individual
physician or a group of physicians.
When
you start looking at outcomes data, which we spend a lot of time reviewing for
employers, you say, “For some reason, patients who have this, when they go to
see this doctor or these doctors, they just do better than these other
doctors.”
I don’t
think it’s because one doctor was able to figure out they had high blood
pressure and the other wasn’t. The diagnostic is not the magic, and
technologies will support that. The magic is how to actually engage, motivate
patients, so they’ll do what’s best. I can’t tell you why, but for some reason,
there is a measurable difference. Some groups of physicians just do that better
than others. I believe that employers should be educating and incenting their
employees to get connected with those high performing primary care groups. It’s
not that complicated.
DR.
CROW: When you look at the most high performing networks across
the country, you should ask What’s the difference? Why are they actually
bending the cost curve? What’s unique about them? One reason is that they have
aligned incentives. We talked a little bit about that. And the other reason is
they had this extra non-financial infrastructure, which is this team data and
analytics to actually help inform that system and platform. We’re excited about
that because it is the kind of thing that employers will have to get their
heads around and say, “Hey, you’re going to have to spend a few more bucks next
month for that platform to actually bear fruit in the years to come and then
continuously bear fruit for years to come.” Because a lot of times, they say,
“If I put $1 in here that I can pull $1 somewhere else.” Well, in health care
that’s hard to do at the same time. And they’ve been fooled by this many times
before, but actually, you’re starting to see some academic rigor where there is
performance. Here’s why and here’s how you can predictably actually invest in
that.
DR.
THURGOOD: I think it’s also an important point to underscore again
the important role of the PCP in the future. it’s about aligning the right
resources, so that the right kind of care can be delivered at the right time in
the most effective and efficient way. One way to ensure effective and efficient
use of resources is to leverage emerging , enabling technology like predictive
analytics. In many ways it is “back to the future” when it comes to the
emerging model and the importance of relationships that are patient-cenetered.
DR.
CROW: The 1950s, the primary care, the family physician actually
could know everything. They could know everything that was in the medical
literature at that time. Now it’s just exploded, and there’s no way. But the
relationship piece of that and the shepherding, which is the word I use a lot
more because there’s no way that a non-health care person could ever understand
the exploding amount of information we’re going to have.
BISHOP: We
need to remember that the real enemy of the health care system is disease. The
enemy is not a broken reimbursement system. The enemy is not the government or
hospitals or doctors or insurance companies. The enemy is not any of the
stakeholders. The enemy is disease.
When
all the stakeholders align about how to try to figure out how to best win our
cumulative battle in this country against disease, it works. Whatever works
best, wherever we can go, to find cancer faster, to prevent the onset of
certain conditions and to help people survive cardiovascular events if they
happen, that’s what we need to do.
FLANNERY: The
stakeholders are having conversations today that they probably weren’t having a
decade ago. I think those that are clinging tight to the status quo are finding
themselves on the outside of those conversations looking in.
It’s
not a pharma-only problem. It’s not a payer-only problem. It’s not a
physician-only problem. It’s everyone’s problem, including employers. Everybody
is in it together.
We’ve
got to come together and have discussions to let go of things that were our
core businesses in the past and look for new ways to build on the future
system. As an organization, as individuals, we’re very bullish on the role the
PCP plays, a role that we compare to the role of a quarterback in football. The
quarterback is going to be key to what we do moving forward. Again, I think
those who are not comfortable with changing the status quo will find themselves
on the outside of the health care continuum looking in because it’s moving
forward with or without them.
DR.
THURGOOD: There are probably three things that support the idea of
the important role of the PCP, all of which we’ve talked about. I would
summarize it in three ideas.
First,
we need a care delivery system that’s different than what we have today. At the
center of that are the patient and the PCP. This implies that all the
incentives are aligned to reduce costs, improve outcomes and access. Second,
one cannot underestimate the important role of the PCP and the relationship
with the patient. One important role of the PCP is to help educate patients
about the importance of individual or personal health care decisions. Our
personal choices have a dramatic impact on our health and subsequently health
care costs. Our lifestyle is one of the big determinants of our health care
spending so we have to do something about that.
And
third, at the end of the day, none of this is going to happen without great
leaders — transformational leaders of character, competence and courage making
a difference every day.
DR.
CROW: We think health care is a pillar of any community, not
necessarily the health care industry, per se, but just having good health. It’s
like education. It’s like jobs. It’s like good civic government leadership
there. It’s a pillar of the community to help us thrive.
SPEAKERS
Den
Bishop
President/Shareholder,
Holmes Murphy & Associates
Den
Bishop is President of Holmes Murphy and a member of the company’s Executive
Committee leading the Employee Benefits practice. He’s also the co-founder of
ACAP Health, an innovation and consulting subsidiary focused on clinical
solutions.
Holmes
Murphy’s tradition of commitment to dynamic leadership and independent
ownership continues in the shareholders who lead the company today where Den
has spent more than two decades of his career.
Den is
a recognized industry leader, a member of the Council of Employee Benefits
Experts, serves on the Board of C2 Solutions, and is a member of the Dallas
Regional Chamber. He’s also the author of The Book on Healthcare Reform and is
a recognized speaker on the subject of economic implications of the Affordable
Care Act.
A
graduate of Southern Methodist University, Den earned his degree in Business
Administration while also earning All American and National Senior Player of
the Year honors in tennis.In his free time, Den enjoys spending time with his
family, riding his bike and trying to fix America’s health care system.
Christopher
Crow, M.D.
Co-Founder
and CEO of StratiFi, Health and President of Catalyst
Christopher
Crow, M.D. Co-Founder and CEO of StratiFi Health and President of Catalyst
Health Network, is a nationally recognized healthcare innovator. Dr. Crow
created StratiFi Health and launched Catalyst Health Network after founding
Village Health Partners and Legacy Medical Village in Plano in 2007.
He is
an award-winning primary care physician and has spent the past 20+ years
focused on helping communities thrive through improving the delivery of
healthcare. As President of Catalyst Health Network, Dr. Crow has connected and
aligned a network of more than 525 Primary Care Providers with nearly 1 million
lives across North Texas, to build a better care model for patients that
improves health and lowers cost. His work with Catalyst led them to be the
first North Texas physician network to hold value-based contracts with the top
four major carriers: Aetna, UnitedHealthcare, BCBSTX, and Cigna. To date (after
the first two performance years), Catalyst performed with significant savings
of approximately $50 million for the communities they serve. Additionally,
Catalyst became the 5th URAC Clinically Integrated Network in the nation in
December 2017.
As CEO
of StratiFi Health, Dr. Crow has been instrumental in the company’s incredible
895 percent 5-year growth and success.
Scott
Flannery
CEO,
UnitedHealthcare, Employer & Individual North Texas & Oklahoma
Scott
Flannery serves as chief executive officer of UnitedHealthcare’s Employer &
Individual operations in North Texas and Oklahoma. Notably, he served as health
plan CEO in 2011-13 and returned to the role in April 2017 after spending more
than three years as UnitedHealthcare’s central region growth officer and the
sales national practice lead for UMR where he and his team worked with local
markets to drive business growth.
He’s
held other sales leadership roles since joining the company in 1999 including
vice president of sales and account management and senior account executive,
where he garnered extensive experience in sales and service, account
management, and sales processes including pricing, plan design and
communications.
Before
joining UnitedHealthcare, Scott held various positions with Prudential
Healthcare in Dallas and Philadelphia. He started his health care career at The
New England.
Scott
serves on the board of directors for the Collin County Business Alliance and is
a member of the Junior League of Dallas Advisory Board.
A
native of Pottsville, Penn., Scott earned a Bachelor of Arts in economics and
business administration from Ursinus College in Collegeville, Penn.
Keith
L. Thurgood, Ph.D.
Clinical
Professor of Healthcare Leadership and Management
Keith
Thurgood is a Clinical Professor of Healthcare Leadership and Management and is
an Adjunct Professor of Marketing and Entrepreneurship. In addition to his
responsibilities at UT Dallas, Dr. Thurgood is a faculty member and senior
advisor for the Thayer Leader Development Group (West Point, N.Y.) and is a
managing partner with Pioneer Partnership Development Group.
Dr.
Thurgood brings a unique perspective on healthcare, operations management and
leadership having served at senior level leadership positions in for-profit and
not-for-profit organizations. He was also the President, Spend and Clinical
Management, MedAssets. He served as President and CEO of Overseas Military
Sales Corporation and as the Senior Vice President of Operations for Sam’s
Club. He also served as the CEO of The Exchange and he has also held executive
positions with Frito-Lay and PepsiCo. He has over 28 years of Army service,
both active and reserve. Major General Thurgood served as the Deputy Commanding
General and Chief of Staff, United States Army Reserve.
He
holds a BA in Political Science from Brigham Young University, a MS in
Strategic Studies from the Army War College, a MS in Business Administration
from Boston University and a PhD in Organizational Development and Leadership
from Capella University.
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