Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. David Callender, President and CEO of Memorial Hermann

Transcript

Dr. David Callender, President and CEO of Memorial Hermann · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Thank you for listening to the Becker's Healthcare Podcast. I'm Molly Gamble,
• 0:02
  and today I have the chance to spend time with Dr. David Calender. Dr.
• 0:06
  Calender is president and c e o of Memorial Hermann.
• 0:09
  He joined the system in this capacity in 2019.
• 0:12
  Memorial Hermann includes 17 hospitals, more than 250 sites of care,
• 0:15
  nearly 30,000 employees and 6,500 affiliate physicians.
• 0:20
  Dr. Calender is an e n T surgeon who specializes in head and neck cancers.
• 0:24
  He earned his medical degree from Baylor College of Medicine and completed his
• 0:27
  fellowship with MD Anderson. Dr. Calender,
• 0:30
  thank you so much for joining me today. How are you? Where do we find you?
• 0:34
  Well, thank you very much, Molly.
• 0:36
  It's great to have this opportunity to speak with you today. Um,
• 0:40
  looking forward to talking a little bit more about what the value
• 0:45
  means or should mean within healthcare.
• 0:49
  Yes.
• 0:49
  We are devoting our time to talking about a really important word that I feel
• 0:53
  like used to circulate much more fre frequently when discussing healthcare about
• 0:58
  10 years ago. That is value today, at least from my seat. And I'm, you know,
• 1:02
  in media, I'm not on the ground like you are Dr. Calendar,
• 1:05
  but it seems like that concept, you know, prices,
• 1:08
  you hear a good amount of attention paid around that,
• 1:11
  especially with the transparency regulations that went to effect.
• 1:14
  Same with costs amid inflation especially,
• 1:17
  but value not as much. Do you see the same from your seat,
• 1:21
  or do you see it differently?
• 1:24
  I, I, I do. I see it, uh, essentially the same way I, I, I think the one,
• 1:30
  um,
• 1:31
  con set of conversations that we're having in healthcare that do
• 1:36
  involve the term value, uh, really, um,
• 1:41
  seem to focus on value-based reimbursement,
• 1:45
  but even that oftentimes is unclear or may have multiple
• 1:50
  meanings to the different participants in a conversation.
• 1:54
  So yeah, it's,
• 1:56
  it's something that we need to talk more about and I think considering all of
• 2:00
  the underlying issues in US healthcare today,
• 2:03
  we need to be much more focused on as we go forward with a much more precise
• 2:07
  definition. Mm-hmm. .
• 2:10
  I'm so glad you brought that up,
• 2:11
  cuz sometimes that apples and oranges effect can happen,
• 2:14
  people using the same term in different ways. So how do you define value? Uh,
• 2:19
  can you share how you think about it?
• 2:22
  Yeah, we, we think, uh,
• 2:24
  value is defined by the Quinn Couple aim in
• 2:29
  healthcare. You know,
• 2:31
  I think many of us who have been around for a little bit longer,
• 2:35
  remember the Institute for Healthcare's Improvement.
• 2:38
  All of its great work in the 1990s and early two thousands.
• 2:42
  And it's coining of the phrase, and certainly they did this with many others,
• 2:48
  but the aaa,
• 2:49
  which really was focused on decreasing cost, improving outcomes,
• 2:54
  particularly for populations,
• 2:57
  and enhancing the overall experience of the patient or or healthcare
• 3:02
  consumer. Through the course of time, uh, you know,
• 3:05
  a lot of people engaged in that. We,
• 3:07
  we added the element of the experience of healthcare workers
• 3:12
  that's so important in terms of the delivery of high value care.
• 3:17
  And then more recently is we've more carefully and thoroughly considered
• 3:22
  the status of healthcare in this, this country.
• 3:24
  All of the disparities in delivery of healthcare,
• 3:30
  even in, um, a access to great health, um,
• 3:34
  we said, well, gosh,
• 3:35
  it's really a quintuple aim with health equity being that fifth piece.
• 3:40
  So at Memorial Hermann, we think about, uh,
• 3:43
  the quintuple aim as essentially defining the road to
• 3:48
  value. And so it makes it a little easier for us to, uh,
• 3:51
  as we think about the elements of the, of the quintuple aim to think about,
• 3:55
  okay, where should we be focused and what should we be doing?
• 3:59
  Mm-hmm. . Mm-hmm. .
• 4:01
  And then when you think about sometimes Dr. Calendar, I find it helpful too,
• 4:04
  just as there's a definition of what something does include or encompass or
• 4:07
  touch. What does it not, you know,
• 4:09
  does your definition of value or the way you think about it and your philosophy,
• 4:13
  does it actively exclude anything? Are there any perhaps things that we,
• 4:17
  you wanna make sure that we aren't conflating when it comes to how we talk about
• 4:21
  value?
• 4:23
  Well, I, you know, I think if we think about in terms of the Quint aim,
• 4:26
  it's pretty inclusive.
• 4:29
  I think the things that we want to avoid are, um, uh,
• 4:34
  points of focus on single elements that drive value,
• 4:38
  like price or cost.
• 4:40
  We don't want to race to the bottom with a focus just on price.
• 4:46
  So, uh, uh, you know, we, um,
• 4:48
  as we think about that quintuple aim and how we use value,
• 4:51
  we actually have a high level set of strategic
• 4:56
  initiatives that are defined by the acronym health,
• 5:00
  H A L T H.
• 5:03
  And so let me just tell you what each of those represent to us,
• 5:06
  and then I think you'll better understand the concept and how we use it and how
• 5:11
  it really is inclusive. But also, um, you know,
• 5:15
  all of those elements are linked.
• 5:16
  So h is for humanize every experience,
• 5:20
  and of course that gets to the experience of consumers as well as people who
• 5:25
  participate in the system.
• 5:27
  E is for enable high reliability care,
• 5:31
  we really need to be focused on quality on what we are delivering
• 5:36
  and make sure that we're doing that in the most effective way A is
• 5:41
  aligned with our providers, physicians, all the different providers,
• 5:45
  nurses who practice in our facilities. Very importantly,
• 5:49
  we all have the same mindset and approach.
• 5:52
  We understand what we're trying to do l lower the cost of care,
• 5:57
  think about how we become more efficient, how we reduce variability,
• 6:02
  how we use the resources that are available to us to deliver the
• 6:07
  very best products at the optimal cost. T is transitioned to value.
• 6:12
  Now that could be, if you look at that statement on its own,
• 6:16
  be a little confusing because of, you know, the,
• 6:19
  the issue of what does value really mean. But in our case,
• 6:22
  it's really talking about move towards value based reimbursement,
• 6:27
  taking more risk thinking about how we can do that and do that
• 6:32
  effectively.
• 6:33
  Because we think if we can do that as a moderate sized health
• 6:37
  system in a large urban area, we can reduce the cost of purchasers,
• 6:43
  both, uh, employers, governmental agencies,
• 6:46
  as well as those who purchase healthcare coverage from one of the exchanges.
• 6:51
  Finally, h the last H harness smart growth.
• 6:56
  What that really signifies is that we know we need to grow not so much in terms
• 7:00
  of physical size. Now,
• 7:04
  some physical growth is important for us here in Houston because Houston can
• 7:07
  continues to grow quite dramatically.
• 7:11
  But what we're really talking about is a growth in our capabilities,
• 7:15
  doing that on our own, and in combination affiliation,
• 7:20
  collaboration arrangements with partners who bring the opportunity to
• 7:25
  deliver services on a more cost efficient basis and
• 7:29
  produce better outcomes. So, you know, again,
• 7:33
  that health-based acronym's pretty inclusive,
• 7:38
  but the reason we like the acronym is cuz it says all of this needs to be in
• 7:42
  existence.
• 7:42
  We need to do all of these things if truly we're going to drive value to the
• 7:47
  people that we serve here in Greater Houston.
• 7:49
  Mm-hmm. , it's easy to remember.
• 7:51
  I I love that and I love how inclusive and intentional this philosophy is, Dr.
• 7:56
  Calendar. And it brings me to thinking about if,
• 7:59
  if I were a consumer or a physician or a healthcare worker, I, I am,
• 8:03
  I'm trying to find health systems in the country that are really deliberate and
• 8:08
  intentional about value such as Memorial Hermann. You know,
• 8:11
  there's no shortage of rankings,
• 8:12
  ratings out there available to the general public,
• 8:15
  but do we have a unified or agreed upon way to assess value
• 8:20
  in healthcare? And if not, what could that end up looking like?
• 8:26
  ? Well, you know, some of those, um,
• 8:29
  groups that operate those systems might disagree with me,
• 8:34
  but I don't think we really have a great system today. You know,
• 8:38
  a number of different groups try to define, um,
• 8:42
  high quality and provide rankings or scores.
• 8:47
  Others, um, say they're focused on value. The challenge is,
• 8:53
  you know, there,
• 8:53
  there really aren't a good set of metrics which are easily
• 8:58
  applied across the system to help us come to uniform
• 9:03
  determinations about what represents value.
• 9:07
  I realize that's a long and complicated statement,
• 9:10
  but I think that's where we are today. I, I think a,
• 9:14
  as health organizations go forward, it,
• 9:18
  it really is on us to do a better job of
• 9:23
  defining the metrics that truly describe value. You know,
• 9:27
  how you take all of these different attributes and initiatives that we describe
• 9:31
  with our health-based acronym, uh,
• 9:35
  our health acronym and, and, uh, you know,
• 9:38
  describe the outcomes that we're generating.
• 9:41
  So some things are out there today that are pretty reasonable,
• 9:46
  but I don't think we're quite there yet. Mm-hmm. ,
• 9:48
  and it's really on us as the principal drivers in the healthcare
• 9:53
  system delivery system to do a better job of defining where we're going and
• 9:58
  what success looks like. Mm-hmm.
• 10:00
  , you know, the, the other thing too,
• 10:01
  in addition to value dropping off the radar a bit compared to a few years ago,
• 10:06
  the other thing I I've thought about too is there's a shortage of so much,
• 10:11
  so much is scarce in healthcare, but at the same time,
• 10:14
  overutilization is still a problem. And,
• 10:17
  and I wanted to get your take on this Dr. Calendar, you know,
• 10:20
  one way of looking at value is best outcomes, best price.
• 10:24
  When we talk about value as a really lofting,
• 10:26
  admirable goal for healthcare organizations,
• 10:28
  I also wanna talk about it in the day-to-day. You know,
• 10:31
  I'm gonna provide an example, and it actually is in your specialty. I,
• 10:34
  I was visiting one healthcare system in my home city that I would come
• 10:39
  to find. I, I, I saw it as test happy.
• 10:42
  And then one in which the specialist I saw an E N T surgeon actually advised me
• 10:47
  to cancel tests and imaging that another physician had ordered because he was so
• 10:51
  confident in his diagnosis.
• 10:53
  But I only had the information to discern what test hap can look like
• 10:58
  and what high value can look like after those two separate and distinct
• 11:02
  appointments had occurred.
• 11:04
  Is that distinction something patients can inevitably only
• 11:09
  make downstream after their encounters unfold?
• 11:13
  Or do you feel like there's some information that you can start to look at
• 11:17
  utilization rates or feel confident in your physician to decision making when it
• 11:21
  comes to the most, the best outcome at the, in the most efficient way?
• 11:27
  Yeah, you know, that's,
• 11:29
  I think that's one of the dilemmas today. Again,
• 11:33
  we don't have good systems that really describe
• 11:37
  value.
• 11:38
  I think all of us who are in the business of offering better
• 11:43
  health and trying to, uh, improve access to healthcare use,
• 11:48
  um, healthcare delivery to improve the health of individual patients, you know,
• 11:53
  have to take on this challenge, um, more effectively than we have in the past.
• 11:58
  It, it, it really is, uh,
• 12:00
  sort of an after the fact determination situation for many patients.
• 12:06
  I think, you know, you know,
• 12:08
  patients can actually look to some of the
• 12:12
  health systems in which their, uh,
• 12:16
  physicians participate. Um,
• 12:19
  they can get a sense of how health systems
• 12:24
  approach delivery of services and what seems to be important,
• 12:28
  perhaps get a sense of value. But I, I think you're right. Again,
• 12:32
  we just don't have a, any good system today for a patient,
• 12:35
  individual patient to use to say, you know what?
• 12:39
  I'm gonna choose this provider over the other because I want somebody that's
• 12:42
  really focused on delivering the highest value service to me. Uh,
• 12:46
  the other side of the, the coin, if you will, as a provider,
• 12:51
  every patient's different and what's high value for one is not likely
• 12:56
  to be high value for the next. So, uh, particularly as you know,
• 13:01
  patients have present to us with more complex diseases. So it's, uh,
• 13:05
  it's a complicated problem. And again,
• 13:08
  I think we all have to continue to work on it to come up with, uh,
• 13:11
  better solutions, better offerings for patients as we go forward. Mm-hmm.
• 13:16
  , well, let's bring in the payers here, right?
• 13:19
  Cause you'd be remiss not to make mention of this stakeholder.
• 13:22
  Do you feel as though payers and health systems see value any closer
• 13:27
  to eye to eye today than in years past? And if not,
• 13:31
  how do those perspectives differ today?
• 13:35
  Yeah, I think at a very high level, we do.
• 13:38
  I think there are really none among us, between,
• 13:43
  you take payers and providers who will argue that the US healthcare system is
• 13:47
  highly efficient in producing the level of outcomes that we need to produce,
• 13:51
  particularly based on the amount of investment that we make every year. Uh,
• 13:56
  I think, you know, our points of focus for, uh,
• 13:59
  providers are a little different than they are for the payers,
• 14:03
  but ultimately, if we're going to drive value,
• 14:08
  I think the, the payers and providers need to be more aligned.
• 14:12
  And I think we're seeing that today. I think we're seeing, um,
• 14:16
  providers systems like ours who are working closely with one or more payers
• 14:21
  thinking about, gosh, what can we do together? What information do we have?
• 14:26
  What information do you have? What populations can we focus on?
• 14:30
  Where do we know that there are significant opportunities for improvement?
• 14:35
  What are your ideas about that? What are hours about that?
• 14:37
  Let's see if we can put those together and come up with a better approach.
• 14:40
  Certainly we're excited about some of those opportunities that we have here in
• 14:45
  Houston, and we think there will be more as we go forward. So yes,
• 14:49
  I think we're moving in that direction.
• 14:52
  Is there anything on the topic of value that we haven't touched on yet,
• 14:56
  but we should?
• 14:59
  I, I think, you know, for health systems in particular today,
• 15:04
  no matter which market, um,
• 15:08
  that you're engaged with, that, you know,
• 15:11
  you've got some straight fee for service arrangements
• 15:16
  and situations, probably have some risk based arrangements,
• 15:20
  and you've got everything in between.
• 15:24
  So question that often comes up among leaders of health system is how,
• 15:28
  how do we navigate this? How do we keep a foot in both camps,
• 15:33
  if you will, you know, how do we, um,
• 15:36
  navigate this transition?
• 15:39
  Some people are using the phrase cross the Rubicon , but you know,
• 15:44
  do it in,
• 15:44
  in a logical way considering that we have to deliver,
• 15:49
  uh, high value fee for service. Um, and,
• 15:53
  and we have to deliver high value, um, you know, service in a value based world.
• 15:59
  So to, to address that,
• 16:01
  what we've done here at Memorial Hermann is created what we call our no regret
• 16:06
  strategies.
• 16:07
  And these are the initiatives that endeavors the efforts
• 16:13
  that we think drive high quality and lower costs,
• 16:16
  but work in a traditional fee for service world as well as in the value-based
• 16:21
  reimbursement world. So to us, that means that, okay,
• 16:25
  we need to manage every cost that we can control, optimize those costs,
• 16:31
  continue to innovate with regard to the models that we
• 16:36
  have with payers. We just talked about that we need to focus,
• 16:40
  make sure that we maintain our focus on patients and, and not get,
• 16:45
  um, caught up in thinking about sites of service.
• 16:48
  We really need to keep that principle focused on the patients. Um, clearly,
• 16:53
  um, we need a lot of help. We need great tool sets,
• 16:57
  so think about partners, technology partners, um,
• 17:02
  new investment partners,
• 17:04
  other investment opportunities that can accelerate
• 17:09
  our efforts to move down this road towards higher value.
• 17:13
  And finally, um, you know,
• 17:15
  be very proactive in our communities a and think about what does
• 17:20
  access to health look like?
• 17:23
  What does good health maintenance look like?
• 17:27
  Do our very best to engage on our own and with others in the community
• 17:32
  to try to promote good health.
• 17:35
  Do our best actually to keep people from developing high intensity
• 17:40
  acute illness are, um, waiting, um,
• 17:45
  in terms of coming forward with, uh,
• 17:48
  symptoms of a chronic illness so that they get to the point where they're quite
• 17:52
  ill and require very expensive care. So, uh, again,
• 17:56
  we think these are the sorts of things, the sorts of ideas,
• 18:00
  the sorts of efforts that work,
• 18:02
  whether you're focused on fee for service or whether you're focused on value,
• 18:06
  value based reimbursement. Considering where we are today,
• 18:10
  we think having a set of no regret strategies is very important to success.
• 18:15
  Mm-hmm. , Dr. David, er,
• 18:17
  I wanna thank you for spending some time with me,
• 18:19
  president and c e o of Memorial Harman talking about value.
• 18:23
  I think an important conversation always,
• 18:25
  but I imagine especially as some of the financial pressures that have affected
• 18:29
  healthcare providers over the past year,
• 18:31
  and so start to show up more in contract negotiations,
• 18:35
  perhaps passed down to consumers and premiums.
• 18:38
  Just a really important time to be revisiting this topic.
• 18:40
  So I wanna thank you for the opportunity to explore it in more detail with you.
• 18:46
  Well, thank you Molly,
• 18:47
  and enjoyed the conversation and hopefully be helpful to others as we all
• 18:51
  contemplate how we move forward and drive to this concept of higher value,
• 18:57
  improved outcomes at optimal cost.