DENVER — Executives find themselves at the crossroads on virtually every critical issue facing the industry. From adapting to new payment models to embracing a consumer-centric mindset, there's no shortage of “what do we do now?” moments.
And while none of the decisions are easy, leaders at some of the nation's most forward-thinking organizations say the industry must fix itself rather than waiting for outside influences—be they political or entrepreneurial—to fill the void.
That may be most evident in the industry's sluggish pace to address diversity, which ultimately impacts equity of care and social determinants of health.
“White men in leadership need to name structural racism as a structural cause” of inequities across the delivery system, Dr. David Ansell, senior vice president for community health equity at Chicago's Rush University Medical Center said during a panel discussion at Modern Healthcare's Leadership Symposium Oct. 11-12.
Ansell implored attendees to look at the racial makeup of their leadership teams and boards. “If we can't get it right at home, how are we going to get it right in the community? These are not easy conversations to have, but we have to desensitize the word. If you don't attack the root cause, you can't fix it,” he said.
Ansell, and on a later panel his boss, CEO Dr. Larry Goodman, detailed how Rush has made bold moves to invest in Chicago's West Side, which has a large low-income and minority population. It started with an “epidemiological needs assessment” in 2016 that found stark inequities between the affluent Gold Coast just north of downtown Chicago and the West Side, where Rush is situated.
From that, Rush worked up a plan to not only increase local hiring and create better career growth opportunities for nonclinical staff, but to make local purchasing decisions. The idea being that investing financially in people and communities will have a large impact on health. “We had lots of community programs,” Ansell said, “but they were not designed to move the needle on health outcomes. We went to the board and made community health equity a strategy.”
Rush has since enlisted other Chicago-area hospitals to join the effort.
“We are anchor institutions in our communities; we have a responsibility to understand what brings a person to our doors,” added Tessie Guillermo, chair of Dignity Health's board of directors. She noted that the California-based system has a grants program that helps people and communities in need. Since 1991, the program has awarded more than $70 million to 3,382 community-based health projects, according to Dignity's website.
For Pamela Sutton-Wallace, conversations around race and equity hit home in August 2017 when a march by white supremacists sparked a weekend of riots and violence. Those events prompted some tough conversations.
“We heard our team members say, 'This happens to us every day; it happens to me here every day.' That was a real 'aha' moment,” said Sutton-Wallace, CEO of the University of Virginia Medical Center in Charlottesville.
Leadership held “honest” talks about race, gender, economics and other issues impacting staff and the community. Medical students, she said, were being exposed to racist comments from patients, including, “I don't want anyone with slanted eyes touching me,” but there was little action by attending physicians.
The medical center worked with attendings, giving them more authority and accountability to respond to those tricky situations, to the point of letting them suggest that a patient find another venue for care if they aren't comfortable with UVA's staff. Just as patients have a right to change physicians, she said, there's a “moral imperative” for clinicians to stand up against racism.
While less controversial, leaders at the symposium also delved into the business imperative to address some big operational issues, including payment reform.
Even among the organizations whose executives gathered in Denver, there was wide variation in the appetite and ability to move away from fee-for-service payment.
Dr. Anthony Coletta, president of facilitated health networks at Independence Blue Cross, noted that the Philadelphia-based insurer last year inked significant value-based contracts with two of the city's biggest providers, University of Pennsylvania Health System and Jefferson Health. Both five-year deals are designed around quality metrics, shared accountability and lowering the cost of care, Coletta said.
Conversely, Peter Banko, CEO of Centura Health, said there's “no burning platform” for new payment models in Colorado. Although Centura has a partnership, including an accountable care organization with UnitedHealthcare, Banko estimated the health system will see just 5% growth in value-based payment over the next few years.
“The market isn't driving that way, so why would we push it?” he said. Rather the focus for Centura is on enabling physicians and consumers to become more engaged with one another and have meaningful conversations around improving care. Banko cited the recent hiring of a former Coca-Cola employee to help with consumer engagement.
“Target and Walmart can predict exactly what you are going to buy the moment you walk into a store,” he said. “We need to get to that point in healthcare.”
Oscar Health Chief Clinical Offer Dr. Dennis Weaver said that knowing and understanding the consumer has been instrumental in the technology-based insurer's growth. He noted that of Oscar's 260,000 members, 63% of their interactions are virtual. “We added enough value to their lives that they interacted with us on some basis,” he said. “And I'm not talking about just paying their bill.”
As an example, Oscar last quarter made 40% of primary care and 45% of specialty appointments for its members. And following each appointment, the insurer reaches out to the patient—in whatever modality they've said they prefer—to talk about next steps in their treatment plan. “We want to be the front-end partner to the hospital,” he said.
What issues will drive change in 2019? Learn from some of the industry's most influential executives at Modern Healthcare's Leadership Symposium 2019, March 21-22 in Scottsdale, Ariz. Visit ModernHealthcare.com/Leadership for details.
Correction: A previous version of this article stated that 62% of Oscar Health members interacted with the company on a monthly basis. Among Oscar's members, 63% of interactions are virtual.