Disrupt yourself or be disrupted. That's how Mark Ganz, CEO of Cambia Health Solutions, views today's uber-competitive world. Ganz has led Portland, Ore.-based Cambia for 14 years. The company has moved into multiple markets across the healthcare sector. There's an insurance arm, including Regence, a large Blue Cross and Blue Shield plan; a technology portfolio and a venture capital wing. Ganz said healthcare leaders need to put consumers first and be willing to take risks. He recently spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
Modern Healthcare: Cambia puts a lot of emphasis on being consumer-centric. How do you define the healthcare consumer?
Mark Ganz: The individual and those who care and love them. So, their family; it might be either close friends or a life partner. It's not just the individual, because what often gets a person through an illness, what drives a person to stay healthy, is mediated by the relationships they have in life. If all we think about is serving one person, we're missing something.
That's taken us to some interesting places. In our palliative-care program, we actually offer direct support to the caregiver and even started a physician burnout program. Physicians are dealing with burnout issues, especially those who are caring for people who are very, very sick, and too often, die.
I don't really want people to say, "I love Cambia." I'd be happy if they did, but what would really make me happy is if they say, "I consistently have a great experience when I engage in services related to my health or my healthcare." That would be the true measure that we're doing a good job, that Cambia and its companies are doing the right job.
MH: How does that drive you organizationally? What are some examples of how you're using that to impact performance?
Ganz: I recognize that a bad culture will defeat good strategy. And so, over time, that's led to bringing in a number of people from other industries who understand consumers and understand the consumer experience much better than healthcare has. We have people from Amazon, we have people from Expedia. Believe it or not, our chief marketing executive came to us from ESPN. Michael Koppel, our board chair, is the longtime CFO of Nordstrom.
I made the decision, based on experience, that bringing in people who were within the healthcare community was not going to drive innovation because, time and time again, these were people who had learned how to do things one way and they often would simply replicate what they had learned from other health organizations.
We've moved from transactional measures and saying, "Well, we're really good at these," to "OK, what do our customers really think about us?" We still do what we have to do, because the Blue Cross and Blue Shield Association has service metrics. We've worked hard to change them, and we have been probably the primary influencer of that, going from transactional to consumer.
MH: For example?
Ganz: First-contact resolution is one, because our consumer research indicated that's what consumers wanted most when they called about an issue with their provider. If we could resolve the issue on the first call, without having to say, "We're going to have do some research. We're going to have to get back to you tomorrow," or "It's going to take us a while." If we can do it on the first call, satisfaction scores soared, and so it demanded that we completely rethink how the company was organized.
To resolve something on the first call, somebody in medical services or finance will have to drop whatever they're doing to help our customer service professional, and that's what we do. We changed what was important and what we measured, and what we incentivized, for employees. We have an overall employee incentive that everybody participates in, and it's part of their compensation. We don't talk about it as a bonus, because it's not. We say, "Part of your comp is base salary and part of your comp is based on performance. Here are the performance metrics that, if you want to get the rest of your comp, you have to hit these performance targets." And those performance targets are heavily weighted toward the consumer experience.
We are not in competition with other Blues plans or other health insurers. Our competitors now are Amazon and Google; it's the companies that either have built or are building consumer-based platforms that create a seamless experience and are bringing that thinking into healthcare.
MH: How much do you think those types of companies are going to disrupt healthcare?
Ganz: There's a great potential that they will. The best way for disruption to occur in healthcare would be if more companies like us disrupt themselves; we understand the space. If we're willing to innovate past our time-honored business models, then no one should be able to stop us. But if we don't, then someone else is going to come along.
I think that's what people are longing for in healthcare. They want to see that seamlessness between hospitals, and between hospitals and clinics, and between that and the pharmacies, and between the pharmacy and their health plans.
MH: Those are all great ideals, but we're still mired in a payment structure that doesn't necessarily allow for that.
Ganz: My view is our soul is how well we serve individuals and their families. To the extent we have to serve the interest of regulators or laws that are out of step with the future, that is not an excuse. I'm amazed when people will say, "Well, I can't do it because of all of this regulation." It's like you're defeated before you start.
Right now, I think healthcare leaders have to ask three questions: No. 1, do I have hope? I mean sincere, deep hope that the system can change to be truly person-centered, seamless, frictionless and economically sustainable? The second question is: Do I believe I, or my organization, can be a fundamental catalyst for change? Am I willing to risk my business model?
I remember being scoffed at early on when no one thought transparency around price and quality would ever matter to consumers. Yet we built that ecosystem and the next thing you know, some of those same CEOs who scoffed at me are investing in it.
The third question is: Do I have the courage, as a leader, when I don't know what the outcome might be? I think that's what we need more of in healthcare—people who can answer those three questions and really mean it.
MH: Switching gears a bit, you are unveiling a new insurance platform early next year, right?
Ganz: With Oregon Health & Science University, yes. The tradition has been hospitals and plans being in an adversary role: how much risk? How much can I push off on you by higher reimbursement for X, Y and Z? How much can we push on them?
The approach we took with OHSU for the Affordable Care Act markets in Portland was we both wanted to be able to serve that market, but in this messy, crazy thing that we've got right now, in that marketplace, neither of us felt we could do it alone.
What we said is, "If we're going to do this, we really need to go into business together." We need to see ourselves in business together, which means we work together on deciding what our target price is going to be in the market. And we work together around what it's going to take to actually deliver and break even at that target price.
MH: What will it take then for more of those types of relationships to develop in other markets?
Ganz: Leaders who can answer those three questions. And realize they can't do it all alone. Our market research absolutely supports the notion that most consumers don't want to be locked in to a tight system. God bless the fact that there are organizations that are all-in like Kaiser Permanente. If we can create that sense of seamlessness and integration across the community, which is what we're focused on doing, then there's going to be a lot of people who are going to want that, and want to buy it.
MH: Thinking about this question of the consumer, Blues plans have pulled out of exchanges in Oregon and Washington.
Ganz: Yes, but not completely. It's been surgical.
MH: So, put that into the context of this consumer-focused initiative that you're talking about.
Ganz: I see them as two different things. It goes back to your earlier question: Do you run a company simply responding to the latest thing coming from D.C., or the latest regulation? Or do you run a company that's building for the future?
The ACA markets are a fraction of our total community. And especially as a not-for-profit, we have to pay attention to, and manage, the overall financial risk for that community as a whole.
In the mid '90s, I was at a company called Pierce County Medical Bureau. There was a law passed in Washington that was very similar, on a smaller scope, of what the ACA is today, and we leaned in heavily, and we got our head handed to us, and almost lost the company.
When the ACA passed,I tried to warn people in the Blues to be careful. Learn the lesson from what happened in Washington. You have an absolute perfect case study. It is playing out on a national scale, and the only way that we can manage it, and stay true to our values, is do our best to stay in the market and serve where we can.