Intermountain Health President and CEO Rob Allen wants value-based care to be more than a provider payment system.
The Salt Lake City-based health system merged with SCL Health two-and-a-half years ago, creating a system with 33 hospitals and close to 400 clinics across six states, in addition to a health plan covering 1.1 million people. It continues to navigate operating challenges, including staffing constraints, while investing in technological tools to improve workflow and looking for ways to redefine care delivery.
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One of Intermountain's longtime value-based care partners, Kaiser Permanente, announced two new deals with CommonSpirit Health and HCA HealthOne in the past month to bring several of their Colorado hospitals into the Kaiser network starting in 2025. The move came as a surprise to Intermountain executives and raised questions about the future of Intermountain's relationship with Kaiser.
Allen said in an interview he wants the nonprofit system to stay focused on what it refers to as proactive care and look for ways to reach more patients. The interview has been edited for length and clarity.
What’s the status of your relationship with Kaiser in Colorado?
We didn’t get a notice of termination. What we got was a notice that, "We’ve decided we’re not going to dance exclusively with you." It was a surprise to us. They didn’t talk to us about it before they announced it. They made a phone call just before they made the public announcement to let our team know.
It’s been our desire to continue that relationship, and we’ll continue to focus on how we serve those that choose us. We’re still a part of that network and will continue to move that forward.
What do you think about a growth model such as Kaiser’s Risant Health?
I’m interested to see it play out over time. I think one of Kaiser’s challenges is it has been hard for them to grow with the structure it has. I think the Risant move was an effort by [CEO Greg Adams] to look at how they open that further. I think their challenge is similar to Intermountain’s historical challenge. The model they have in California, they’ve tried to plant in other places, and probably more often than not, it’s not gone as smoothly as they would like it to. But there is value to be deployed.
Is Intermountain open to more acquisitions?
Possibly, yes. We will look at opportunities where we see value created for the communities being served and Intermountain’s ability to do that. In our service areas, we are looking at where our gaps are and if there are things we need to add. We acquired a home care agency in Las Vegas. We acquired a number of physician practices, usually with ancillary connections.
We’re not hot after any large deals. We’ll look if opportunities come. Yes, we’re going to do more. No, our strategy is not to go out and actively scour the country.
How do you view the state of value-based care?
I think we’ve lost the wind in our sails on value-based care. The promise of it was better quality at a cost that is manageable. It became focused on this payment mechanism, and we have to start asking the question in that scenario, "What value for whom?" Seventy-five percent of consumers, when you pose the term to them, their interpretation of it is, "I got the economy ticket." They believe value-based care is lower quality. We’ve shifted, and we’re talking about it as proactive care.
Have plans like those in Medicare Advantage encouraged more value-based care?
Medicare Advantage created this process where we started to go upstream and manage health and wellness more effectively. I think it accomplished some important intended outcomes, but it really became a coding focus. At the end of the day, payment that comes in — does it incentivize you to keep people well? I think Medicare Advantage did that, but I think it also incentivized movements to try and extract value for an entity instead of patients.
How are you tackling staffing challenges?
For our caregivers, we’re working on how we create system flows that work. A year ago, we piloted ambient listening dictation and now every physician employed by Intermountain has access to it if they want it.
We’re also piloting right now in Denver this ambient listening technology for nurses with Copilot. The pilot isn’t done, but we just saw interviews with several of these nurses who have been working with it. They’re reporting spending more quality time with the patient. I think we should let the system be innovative and figure out how to staff with the number of nurses we're going to have and increase the time at the bedside.
What about capacity issues?
In St. George, Utah, we had no primary practices accepting new patients in the community not long ago. It’s a fast-growing community. Our teams got together and worked with our physicians in the clinics, streamlined scheduling, looked at staggering shifts, tried to work on some different things to create new options. By simplifying the process and simplifying the workflow side of things, we have 20 practices today that are taking new patients.
In Salt Lake City, we have a large central lab. We went from an average turnaround time of 85 hours for a test to 45 hours for a test. We redesigned the workflow. We redesigned how the samples get collected. We have a fleet of vehicles that are bringing these in every day from our sites, and so we redesigned and streamlined that, and redesigned the entire flow through the lab with new automation.