Latest / CareTalk: Healthcare. Unfiltered. / Why Value-Based Care Is Finally Hitting Its Tipping Point w/ David Snow, CEO, Cedar Gate Technologies, an IQVIA business

Transcript

Why Value-Based Care Is Finally Hitting Its Tipping Point w/ David Snow, CEO, Cedar Gate Technologies, an IQVIA business · CareTalk: Healthcare. Unfiltered.

• 0:00
  David Williams: Value-based care has been healthcare's promised future for a long while, and yet progress has often been slow.
• 0:06
  David Williams: Many organizations have stayed in upside only or limited risk arrangements, and the data infrastructure needed to manage real risk has lagged behind the ambition.
• 0:15
  David Williams: Now, with CMS launching its first mandatory bundled payment model and signaling more to come, the era of voluntary experimentation may finally be over.
• 0:25
  David Williams: One executive who spent a long time pushing the industry toward this moment says the tools are finally catching up to the vision.
• 0:38
  David Williams: Hi, everyone.
• 0:39
  David Williams: I'm David Williams, president of strategy consulting firm Health Business Group and host of the Health Biz podcast, where I interview top healthcare leaders about their lives and careers.
• 0:47
  David Williams: My guest today is David Snow, founder, chairman, and CEO of Cedar Gate Technologies.
• 0:51
  David Williams: David has helped or helped build some of the most consequential companies in managed care and healthcare services.
• 0:57
  David Williams: Those include US Healthcare, Oxford Health Plans, Empire Blue Cross Blue Shield, and Medico Health Solutions.
• 1:04
  David Williams: He founded Cedar Gate in 2014 to build the technology platform the industry needs to make value-based care actually work.
• 1:11
  David Williams: David, welcome to the Health Biz podcast.
• 1:13
  David Snow: Thank you, David, and thanks for inviting me.
• 1:16
  David Williams: So you've been in healthcare for a while, and which I, it sh- I think is what is required to get much done.
• 1:21
  David Williams: You know, it's not like tech.
• 1:21
  David Williams: You can come in and out, do this, that, and the other.
• 1:23
  David Williams: You gotta stick with it.
• 1:25
  David Williams: Um, so you've been around since the early days of managed care.
• 1:28
  David Williams: You're a pioneer in a lot of other, uh, areas, and I wonder, is there a thread that connects all of those stops?
• 1:35
  David Williams: Um, and then why, you know, why, why one more company?
• 1:40
  David Snow: Yeah, so I'm, I'm pretty passionate about this.
• 1:43
  David Snow: Uh, this is, uh ... I, I wanna make a difference in the healthcare system before I retire, and I don't have many more shots left, but, uh, you know, this all started when I got out of grad school.
• 1:54
  David Snow: I, I, uh, got my MHA, my master's in healthcare administration, and I thought my entire career would be running hospitals.
• 2:02
  David Snow: So, uh, I ran hospitals for the first five years of my career.
• 2:06
  David Snow: Uh, this is when we were implementing the DRG system, which is a form of value-based care, believe it or not.
• 2:12
  David Snow: It's a case rate at the hospital level.
• 2:14
  David Snow: Um, but, uh, I got my passion for f- reforming healthcare from my hospital experience because I saw how the perverse incentives of fee for service drove really poor beha- behaviors, uh, where the system was utilized incorrectly and it wasn't patient centric, uh, and it was fee for volume more than, you know, f- quality of care, and there was, there were no consequences.
• 2:41
  David Snow: So, uh, I got angry enough that I joined the, uh, HMO movement.
• 2:46
  David Snow: I joined US Healthcare in the early '80s.
• 2:49
  David Snow: And ba-- at US Healthcare, we were doing primary care attribution.
• 2:53
  David Snow: We were doing capitation.
• 2:55
  David Snow: Uh, we were experimenting with various forms of retrospective and prospective bundle.
• 3:01
  David Snow: The big observation back then is plenty of providers were willing to move from fee for service to other forms of reimbursement where, you know, attribution was guaranteed, and in fact, volume was there.
• 3:16
  David Snow: The challenge back then was, uh, technology didn't support the play well, because to support value-based care, you need deep insights driven by data around patients and populations.
• 3:31
  David Snow: And, uh, remember, back in the early '80s, we were still using green screen computers and floppy disks for data transfer.
• 3:37
  David Snow: There was no such thing as cloud computing.
• 3:40
  David Snow: So, uh, y- you know, you had a lot of... It was like asking a pilot to fly an airplane.
• 3:44
  David Snow: There were a lot of crashes'cause they were blindfolded.
• 3:47
  David Snow: Literally, they didn't have the insights because the data didn't support the play and the technology didn't support the play.
• 3:54
  David Snow: So after selling Medco to Express Scripts, flash forward, I decided these value-based care incentives, whether it be primary care attribution, bundles or capitation, really do work, and now the technology supports the play.
• 4:12
  David Snow: So at Cedar Gate, we built out an end-to-end set of capabilities from analytics to care management to interface with the EMR to payment technologies, capitation bundles, all over a single source of truth, which solves a lot of problems when it comes to using technology to support value-based care initiatives.
• 4:33
  David Williams: Great.
• 4:33
  David Williams: Well, there was progress in the '80s in terms of the floppy disk, 'cause I think it went from the eight-inch floppy to the five and a quarter, and then the three and a half, and it's still called a floppy, and people who just saw that couldn't understand why it's a rigid thing and you're still calling it a floppy disk.
• 4:45
  David Williams: But, uh, there's been, there's been continued progress from there.
• 4:48
  David Williams: Okay.
• 4:48
  David Williams: So let's talk about, uh, value-based care and really kind of where it's come and, and, a- and where it is now.
• 4:53
  David Williams: So the concept, as you say, has been around for a long time, and yeah, the DRG is not volume based.
• 4:59
  David Williams: It's, you know, it's a, it's a case rate.
• 5:00
  David Williams: But the organizations- Right ... that have participated, they're still mostly, I think, in upside only or, you know, limited downside arrangement.
• 5:07
  David Williams: It's kinda like training wheels, okay?
• 5:08
  David Williams: Start with this- Right ... and I'll give you a bonus if you do well, but don't worry, you're not gonna get penalized.
• 5:12
  David Williams: And, and ha- a lot, you know, most have not moved into a, a full risk through prospective bundle or full capitation.
• 5:19
  David Williams: Yeah.
• 5:20
  David Williams: So why has progress been... Am I right?
• 5:21
  David Williams: And why has progress been slow so?
• 5:24
  David Snow: I, I, I think it's actually accelerating.
• 5:26
  David Snow: You know, we have 75 million lives on our platform today.
• 5:31
  David Snow: Uh, and they are doing all forms of value-based care.
• 5:34
  David Snow: And, and you're right Delivery systems, um, who are traditionally fee for service, there's a huge learning curve to manage risk.
• 5:43
  David Snow: Uh, and so what we see is they do start with upside only models, but the in- once they master it, once they realize they can chart their destiny, they're attracted to downside risk because the upside rewards are better.
• 6:00
  David Snow: And so we, you know, on our platform, we see a, a definite migration from, you know, simple upside only models to upside downside risk, all the way out to global capitation.
• 6:13
  David Snow: And we have customers across that entire spectrum, uh, who just as they get better, um, they take more responsibility and, uh, they've been very successful.
• 6:24
  David Snow: So, uh, I think, you know, the, the stated goal of the federal government is 100% of Medicare in some form of value-based care by 2030.
• 6:34
  David Snow: I think they're on track.
• 6:36
  David Snow: You know, the teams mandate for, for bundles payments, uh, are, are an- another big step in that direction.
• 6:45
  David Snow: Um, I, I, uh, I would also, I would also say that the commercial carriers, their goal for 2030 is 50% of all their membership in some form of value-based care.
• 6:57
  David Snow: Across the country today, believe it or not, we're at 60%.
• 7:00
  David Snow: So that's not bad.
• 7:02
  David Snow: We're at 60%.
• 7:03
  David Snow: We're past the tipping point.
• 7:06
  David Snow: Um, and in that 60%, you're including various forms of fee for service with clawbacks and or other incentives relative to quality measures.
• 7:18
  David Snow: So that is still, to your point, training wheels.
• 7:21
  David Snow: I would say 40% now are in real risk-based, value-based care and, and that's not bad.
• 7:29
  David Williams: So I guess the way to look at it then at a very simplistic level, and then we'll get into some more detail, is maybe this training wheel analogy.
• 7:36
  David Williams: You got a lot of, well, I don't know what age kids ride bikes these days, but you got a lot of people with training wheels riding around and, and pretty soon you're gonna have real bikers because they're, they're up and they're, they're ready for it, and they're gonna wanna shake those off 'cause it's more fun to go fast than- Yeah you're limited to whatever you can do with the training wheels.
• 7:52
  David Williams: Is it- Well,
• 7:52
  David Snow: they wanna, they'll soon want a motor on it, right?
• 7:54
  David Williams: Yeah.
• 7:55
  David Williams: Exactly.
• 7:55
  David Williams: Get the e-bike- Yeah ... out there.
• 7:57
  David Williams: Yeah.
• 7:57
  David Williams: So let's talk about this, um... So it's encouraging to hear people are in some form, and that once the health systems master it, that they wanna go, they wanna go more and deeper.
• 8:07
  David Williams: The teams one, as I understand it, is, is mandatory, and I think- That's right ... that, that makes a difference.
• 8:13
  David Williams: Talk about mandatory versus voluntary.
• 8:16
  David Snow: So, uh, CMS mandate has, has mandated effective January of 20, uh, '27, uh, retrospective bundles for specific procedures, specific episodes of care to over 700 hospitals So those hospitals, if they wanna participate in Medicare when they do these various episodes, they must be in a bundled arrangement.
• 8:43
  David Snow: Um, and so that's a kind of a first, uh, and they haven't backed off on that.
• 8:47
  David Snow: So that will, that will further accelerate things.
• 8:51
  David Snow: Um, and obviously Cedar Gate uses its platform to support that play.
• 8:56
  David Snow: As we've supp- we're do, you know, we, we're supporting all the various federal CMMI demonstrations, uh, but we're also supporting a lot of commercial payers and their work.
• 9:08
  David Snow: Um, but the mandate does drive things faster.
• 9:11
  David Snow: That's no question about it.
• 9:13
  David Snow: And there's another thing that's going on that's, I think, helping accelerate, and that is in negotiations, this is more commercial payers than the federal government, they don't have the ability to mandate the way the federal government does.
• 9:27
  David Snow: But what they can do is to the extent a provider system insists upon remaining in fee for service, they can really hold the line on, uh, rate increases over time, and they can make their value-based care program more attractive over time than fee for service.
• 9:48
  David Snow: And we see a lot of that right now where, yes, healthcare is inflating at level X.
• 9:54
  David Snow: We're not supporting that in those fee for service reimbursement rates, but here's what we'll do if you move over to our value-based care program.
• 10:02
  David Snow: And so that's another nice tailwind that we're seeing for commercial carriers trying to, you know, move more to that value-based care world.
• 10:11
  David Williams: Got it.
• 10:12
  David Williams: So you, you mentioned upfront that, you know, data has always been kind of the Achilles heel, you didn't use that term, but of value-based care.
• 10:19
  David Williams: And I remember back in the early days of, you know, quality, say in the'90s, and people you get rated one way or the other, and the physicians always say, "Well, my patients are, are sicker than, than others." And, and we knew that, uh, they can't all be right, but half of them are right.
• 10:34
  David Williams: And so there was sometimes- Yeah yeah, I get the toughest cases.
• 10:37
  David Williams: And when you provide data to people that says, "Hey, you know, your costs are higher," or whatever, some of them will rightly say, "Yeah, but you haven't done it right." And so the doctors are busy, hospital administrators are busy.
• 10:48
  David Williams: You look at something once, and it's sort of that doesn't make sense, and, you know, I'm not gonna look at it again.
• 10:53
  David Williams: So we've, we've moved on from that.
• 10:55
  David Williams: But where are we now?
• 10:56
  David Williams: W- w- let's talk about maybe what, what this data problem really looks like in a health system that's, that's trying to take on risk.
• 11:02
  David Williams: Where, what's the current state of play?
• 11:05
  David Snow: So, you know, I would tell you that, um, t- uh, when we, when we built this platform, we wanted to solve some problems, um, relative to the data world.
• 11:18
  David Snow: So before Cedar Gate was created, it wasn't unusual for those participating in value-based care to hire four or five different point solutions to do their job.
• 11:30
  David Snow: So that meant you had to get proprietary data to each of those vendors, the same data for different purposes.
• 11:38
  David Snow: One could be analytics, one could be care management, one could be, uh, payment systems, one could be population health analytics, um, and so-- and actuarial analytics.
• 11:50
  David Snow: Uh, and if you give your data to four or five different vendors, you're paying each and every one of them to onboard, homogenize, e-enrich, and then store the data.
• 12:01
  David Snow: So you're paying four or five times for the same thing.
• 12:06
  David Snow: Number two, when you give your data to four or five different vendors, they all onboard and enrich the data differently.
• 12:14
  David Snow: So what does that mean?
• 12:15
  David Snow: Numbers don't tick and tie.
• 12:18
  David Snow: So if you're a payer working with providers, collaborating around a value-based care arrangement, and numbers don't tick and tie at the base analytic level, you're not gonna... They don't trust each other to begin with, and they just throw their hands up and say, "These numbers don't tick and tie.
• 12:33
  David Snow: I can't act on this 'cause I don't trust the numbers." So what-- So-- And the third issue is you give your, your data to four or five different vendors, you're exponentially increasing your HIPAA risk.
• 12:45
  David Snow: So what we did at Cedar Gate is we created a single source of truth, taking over fifty different types of data, depending on your use cases, and all, all the analytic care management and payment technologies use the same single source of truth.
• 13:02
  David Snow: So we've solved a major problem that's existed, uh, as people try to, uh, create the insights needed to manage the risk.
• 13:12
  David Snow: So that, that's a big start.
• 13:14
  David Snow: I-- Uh, and, but I will say it's still a lot of work.
• 13:18
  David Snow: You know, we have to... We do all the work for our customers.
• 13:21
  David Snow: We get the PBM data, we get the EMR data, we get the payer claim data.
• 13:27
  David Snow: We're taking on workers' comp data.
• 13:29
  David Snow: We're taking on, uh, disability.
• 13:32
  David Snow: We're taking dental and lab and all, wearables.
• 13:36
  David Snow: Whatever we get, we stitch it at the belly button level, and we can do f-powerful analytics.
• 13:41
  David Snow: It is a lot of work.
• 13:42
  David Snow: Wouldn't it be great if there was a single source of truth more broadly that we could tap into and then really innovate at the analytic level above that?
• 13:53
  David Snow: We're not there yet, so we have to do heroics, um, but we do it at great scale, uh, and it's working.
• 14:01
  David Snow: Now it's about how do we get more efficient?
• 14:03
  David Snow: How do we do it even better?
• 14:04
  David Snow: And that, I think there's gotta be a, a much more universal play where this data, patient-centric, is stitched together in a way that, uh, it's more easily used.
• 14:16
  David Williams: You know, there's your, you're, uh, obviously, uh, uh, understating perhaps the challenges of getting people to be, uh... to, to make changes in healthcare, especially these large hospital systems.
• 14:28
  David Williams: And this, uh, patchwork of point solutions is, is a real problem.
• 14:31
  David Williams: Yeah.
• 14:31
  David Williams: And I wanna underline what you mentioned actually about HIPAA, uh, because when you have all of these, uh, different places, it's, it's, uh, creates a new attack surface, uh- That's right it multiplies it across a lot of them.
• 14:43
  David Williams: And I'll just say, you know, we have experience in the cyber, uh, business, and we s- recently saw a large analytics company that works for hospitals that has a terrible, um, basically a, a heap dump where all sorts of information is coming out all the time.
• 14:58
  David Williams: We actually tried to get in touch with them, and they haven't paid attention.
• 15:00
  David Williams: But they are, they are doing HIPAA violations as we speak, um, here, and there's just no way that a health system can look at all of those, all those suppliers.
• 15:10
  David Williams: There's huge amount of supply chain- Yeah ... attacks now.
• 15:12
  David Williams: So it's, like, one more reason, and perhaps a, a reason for companies to, to come together, uh, and to, to reduce that, that patchwork.
• 15:20
  David Williams: It's just dangerous for them.
• 15:21
  David Snow: It is.
• 15:22
  David Snow: It's, it's hard to manage.
• 15:23
  David Snow: It really is.
• 15:23
  David Snow: So, you know, I think we've created a, a competitive advantage for ourself, uh, um, in that we are now operating, you know, on a single source of truth o- using all the capabilities you need to really be successful in value-based care.
• 15:41
  David Williams: Let's, let's talk about this, um, tipping point concept, 'cause it's, it's a good one and it's got a...
• 15:45
  David Williams: it, it, it's very appealing sounding.
• 15:48
  David Williams: It's like you get to a certain point and it sort of like goes over.
• 15:50
  David Williams: Now if- Right ... you hear this, uh, with, from companies especially that are trying to scale, and often when they're raising, uh, the next round of investment and saying why it's gonna really take off'cause we're getting to a tipping point.
• 16:00
  David Williams: I can remember things like we're talking about, you know, physicians, once they have 100 patients on, you know, their, uh, web-based doctor-patient communication, then the whole practice goes that way.
• 16:09
  David Williams: Now with, with, with payments, the issue is that you're, you're really... I don't know if it's like a Dr. Jekyll and Mr.
• 16:16
  David Williams: Hyde, but you gotta, okay, now this patient, I get paid if I do more to them, and this one I get paid if I do less to them.
• 16:22
  David Williams: That's right.
• 16:22
  David Williams: It's pretty damn hard to operate in that.
• 16:24
  David Williams: It, it, it- What does the tipping point mean in that, in that environment?
• 16:26
  David Snow: Yes.
• 16:26
  David Snow: Yeah.
• 16:26
  David Snow: That's a really, really good point, and, uh, you know, I ha- I have a different way of talking about this, um, and that is that moving from fee for service to value-based care is like crossing a chasm of death.
• 16:39
  David Snow: Imagine yourself walking on this rickety bridge, this gorge down below, nothing but rocks, and you'll definitely die if you've, if that bridge breaks in the middle.
• 16:49
  David Snow: Uh, and as you're, as you're making the journey, um- It gets harder and harder as you get to the middle of the bridge because when you're 50% value-based care and 50% fee for service, you're schizophrenic.
• 17:04
  David Snow: They're completely different ways of managing a patient, to your point.
• 17:07
  David Snow: And doctors aren't gonna say, "I'm gonna treat this patient this way, I'm gonna treat that patient that way because of the way I'm reimbursed." So it's, it's really hard, uh, to, to create the c- company-wide muscle memory about running your business in a, a value-based care world when you're only 10% value-based care and 90% fee for service.
• 17:32
  David Snow: So to me, the tipping point is when I'm more than 50% value-based care, I'm committed, and I've gotta finish the journey.
• 17:40
  David Snow: I'm not gonna run back to the other side.
• 17:44
  David Snow: So, you know, if I s- go to the public policy level, when people mess around with these value-based models as people are trying to learn and create muscle memory, every time we do it, we risk them running back to fee for service.
• 18:00
  David Snow: Uh, so we need some stability in these programs so that we can c- get through this learning curve that we're going through.
• 18:07
  David Snow: We're literally retraining generations of healthcare, uh, providers to think about patient care, uh, and outcomes differently than they historically have thought about it.
• 18:23
  David Williams: You know, I remember, I'm thinking about now the role of, you know, federal policy versus state and, and you've talked a lot about the commercial payers and what they can do.
• 18:31
  David Williams: I remember way back when, uh, when Charlie Baker was running what was then Harvard Pilgrim- Mm-hmm ... you know, before he became governor of Massachusetts.
• 18:38
  David Williams: They did this program.
• 18:39
  David Williams: They were really trying pretty hard with, uh, whatever the flavor was of, uh, you know, pay for performance or value-based care.
• 18:46
  David Williams: Right.
• 18:46
  David Williams: And, and they said, you know, they ... And they're, they were one of the biggest players or maybe even bigger at Blue Cross at the time.
• 18:51
  David Williams: But, you know, big, well-known, nationally ranked- Yep ... top one or two players.
• 18:56
  David Williams: And what they said is they went to the hospitals, and then when they went to see what the impact was, basically hospitals say, "Well, my biggest customer is Medicare, and so what I do is I just take, uh, what you've given me, whatever it is, and I just sort of convert it into like Medicare equivalent, and I just do whatever I'm doing for Medicare for you." What is the interplay these days between, you know, the federal side in particular and what's happening in the commercial space?
• 19:20
  David Snow: Yeah.
• 19:21
  David Snow: So I, I, I know Charlie Baker, and back then I was, I was at US Healthcare back then.
• 19:27
  David Snow: And, uh, you know, when docs say they, you know, they convert it to the thing they know, it's because they don't have the precision analytics.
• 19:38
  David Snow: Today Our platform has the ability to monitor and manage and project actuarially how you're doing in each and every value ba-based contract you have.
• 19:50
  David Snow: So you can understand what are the levers you pull to perform well or, and optimize your outcomes, both financially and clinically.
• 20:00
  David Snow: And so the world is different today than that world that Charlie talked about or that I experienced.
• 20:08
  David Snow: We're so much more precise now.
• 20:09
  David Snow: It's so much more manageable that you don't have to generalize the way you just described.
• 20:15
  David Williams: Good.
• 20:16
  David Williams: All right, so let's talk about AI.
• 20:18
  David Williams: So now, and, and let's bring it back to the conversation about the fragmented data.
• 20:23
  David Williams: So you've got fragmented data.
• 20:24
  David Williams: So on the one hand, you could say,"Well, we have all these point solutions, all this fragmentation, and the AI is gonna allow us to just deal with that.
• 20:32
  David Williams: So instead of all the time spent, you know, manually cleaning it and, and, and calibrating it, we're just gonna be able to turn AI on it." The other s- the other argument would be s- be to say, "This is just a new version of garbage in, garbage out.
• 20:44
  David Williams: And so- Mm-hmm ... if I've got all this data, it's all over the place, and it's not quite right, I can run fancy stuff that looks great, and by the way, is super confident in the way it presents itself, but it's actually taking me down the wrong road." Uh, is that the way to look at it?
• 20:58
  David Snow: Right.
• 20:59
  David Snow: I think early stages, yes.
• 21:00
  David Snow: I think longer, uh, longer term, no.
• 21:04
  David Snow: I, I think that, uh, AI is incredibly powerful as it relates to finding patterns in, in, in care delivery.
• 21:12
  David Snow: Uh, and I, I, I do think you're gonna get ghosts, you're going to get false positives, you're going to get misled in early stages.
• 21:20
  David Snow: That's why you can't rush to release things.
• 21:23
  David Snow: You've got to thoroughly test them and train the models so that they are accurate.
• 21:29
  David Snow: And over time, they're going to become more and more precise and accurate and become more dependable.
• 21:34
  David Snow: In healthcare, I don't ever advise, uh, giving a diagnosis or prescribing a care path without a human, a provider, a trained, uh, you know, licensed provider involved.
• 21:49
  David Snow: But if, if you, if, if, uh, AI can draw you to things faster than you otherwise would find them, it's better for the patient, and it's helpful to the physician who's delivering the care.
• 22:02
  David Snow: So I think there's huge promise in it, but we're in the early innings.
• 22:06
  David Snow: Um, we're seeing some really exciting things, and there...
• 22:08
  David Snow: In healthcare, there are two areas where AI's going to make a difference.
• 22:11
  David Snow: Number one is administratively Just, you know, for example, onboarding, homogenizing, and enriching data.
• 22:19
  David Snow: Uh, you- and coding, doing coding, you know, developing software.
• 22:23
  David Snow: Very, very large opportunities there to just be more efficient.
• 22:28
  David Snow: Uh, and then I think clinically and clinical insights, and those, those are bigger poles in the tent.
• 22:33
  David Snow: They have superpowers in the future.
• 22:37
  David Snow: Um, and, and we just need to be patient and work them through and make sure, uh, that we're very disciplined about not using AI standalone, uh, that we always have a human in the mix when we're delivering information to a patient.
• 22:54
  David Williams: Let's talk about, a bit about Cedar Gate and what your strategy has been in building the company.
• 22:59
  David Williams: So as I understand it, you go from data management, analytics, population health, bundled payments, capitation on a single foundation, and you've done that organically, but also with, with acquisitions.
• 23:11
  David Williams: That's right.
• 23:11
  David Williams: What, what is the approach to this, uh, platform, and why is it so important to put all those pieces together?
• 23:18
  David Snow: Well, I think we've ... The, the fundamental pieces you need to, to manage a population are, number one, value-based care analytics that can help you model contracts before you ever sign them, help you understand inside a contract and its structure, um, where are your opportunities to be successful.
• 23:41
  David Snow: Uh, it also, our analytics can model episodes of care.
• 23:45
  David Snow: So how do I perform in a, as an episode of care?
• 23:49
  David Snow: How do I perform on a risk adjust- uh, adjusted basis against my peers?
• 23:55
  David Snow: Am I doing high performance referrals?
• 23:57
  David Snow: Or, you know, there's tons and tons of opportunity, even in fee for service, if you just understand the bell curves of performance, cost, and quality among providers.
• 24:08
  David Snow: And if you m- you, if you tend to refer to the left of the mean of the bell curve, if you have that information, you are saving the system a ton of money while you're driving better outcomes.
• 24:19
  David Snow: So, uh, you know, you have to have that level of analytics that's, I'd call it at the mountaintops.
• 24:25
  David Snow: How to, how do we perform inside an MSA?
• 24:29
  David Snow: How do we perform at the provider level?
• 24:34
  David Snow: Um, how should we structure a network?
• 24:37
  David Snow: Or if you're a health system How do we manage the f- the providers who are to the right of the mean of the bell curve all the time?
• 24:45
  David Snow: How do we get-- how do we narrow the width of that bell curve, and how do we move the mean to the left over time?
• 24:51
  David Snow: Those are the, those are the powerful conversations that go on when you're empowered with data.
• 24:57
  David Snow: After that, you've got population health analytics that really look at the patient level, at the belly button level.
• 25:05
  David Snow: You know, what are the red flags around quality scores, com- uh, you know, uh, compliance, you know, uh, you know, gaps in care, uh, risk scores?
• 25:16
  David Snow: You know, are you dropping important diagnoses year to year that are important relative to risk scoring?
• 25:23
  David Snow: So having that information, making certain that when you're doing medical management, you have the insights to know this patient hasn't done these four things, and they've got this chronic disease.
• 25:35
  David Snow: Or when you're in the exam room, having access through the EMR, which we do.
• 25:40
  David Snow: We, we are-- we have an app inside the EMR, single sign-on.
• 25:44
  David Snow: We push what we find in the analytics to the physician in the exam room, who can close those gaps in care, who can, who can help that patient navigate, keep them at a place where they're not going to the emergency room for care, and they're not being admitted to the hospital for care, which is really where the money is buried right now.
• 26:04
  David Snow: Yeah, and then obviously, medical management technology and claim processing technology, uh, it, it becomes more and more important the more sophisticated you get in this value-based care world.
• 26:17
  David Williams: So let's say I were running one of these, uh, health systems that has kind of dipped its toe in the water but now is gonna be, is sort of, uh, you know, looking at what you're looking at and saying, "I've got this mandatory model coming, like this is gonna happen.
• 26:31
  David Williams: I need to embrace it." What does a successful value-based care implementation look like for an organization like that?
• 26:39
  David Williams: What does, what does it need to do to be successful getting started?
• 26:43
  David Snow: They should be, uh, they know which, which episodes of care they're mandated to be part of.
• 26:49
  David Snow: They should be onboarding data and looking at those specific mandated episodes right now to understand how they're performing and understand where the opportunities are to improve that performance so that when they come out of the gate, they're ready to go, and they're going to outperform the expectations of the program.
• 27:11
  David Snow: Um, you can't just close your eyes and, and come Jan one, jump into these and, uh- Hope for the best.
• 27:20
  David Snow: That's just n- not, that's not what you should do.
• 27:23
  David Williams: Yeah, yeah.
• 27:23
  David Williams: I mean, I don't know if he makes it, if, I don't know if the, uh, the benchmarks are relative or absolute, but I guess for, for the good players, it, it's good if some bad guys, uh, jump in to poor performance.
• 27:32
  David Williams: Is, is that right, or it just hurts the poor performers?
• 27:34
  David Williams: Y- yeah, I mean,
• 27:34
  David Snow: sometimes people are just, they are so busy that they're saying, "I'll deal with that later."
• 27:38
  David Williams: Yeah.
• 27:39
  David Snow: They should be ... Th- you know, this is January 1, 2027.
• 27:42
  David Snow: Do you know what's going on in those episodes today?
• 27:45
  David Snow: And I would bet you, if you asked, there are a lot who don't.
• 27:49
  David Snow: Now, I've got over 500 big health systems on the platform doing all forms of value-based care, and they're asking the right questions.
• 27:57
  David Snow: Um, you know, and s- by the way, some of the rules from CMS are still coming out.
• 28:02
  David Snow: So but getting prepared is my best advice, getting prepared with the data you have so that you understand for your medical staff in, in the specialty disciplines that are included in the, in this mandate, how are you doing?
• 28:18
  David Snow: You know, who's, uh, to the left of the mean of the bell curve?
• 28:21
  David Snow: Who's to the right of the mean?
• 28:22
  David Snow: And how can we help those to the right get to the left so we all succeed?
• 28:27
  David Snow: Those are the conversations should be happening right now.
• 28:30
  David Williams: So to close things out, I want to ask you to, to go back and think about the, you know, history of your involvement in value-based care over the, you know, the past few decades.
• 28:39
  David Williams: And I'm wondering, as I hear you speaking confidently about where we are now, what gives you the confidence that, that this time is something different, that we're actually closing in on the tipping point and we're not just in, let's say, another cycle of optimism which we've been in before?
• 28:55
  David Snow: I think people understand that fee for service is a perverse incentive much more foundationally than they ever have before, and there's no going back.
• 29:06
  David Snow: By the way, if we don't get our act together and do this the right way, and this has always been kind of my mission here, I don't want a single payer system.
• 29:16
  David Snow: I don't think that drives the best in the healthcare system.
• 29:19
  David Snow: I don't think it drives the innovation we as Americans expect.
• 29:23
  David Snow: Um, you know, I want to avoid that, but that, that will be the next choice.
• 29:28
  David Snow: If we don't get this under control and do it the right way, we're gonna be left with no choice.
• 29:34
  David Snow: So I don't see it, it in the cards to go back.
• 29:38
  David Snow: For fee for service, uh, approach here in the US is highly, highly inflationary.
• 29:45
  David Williams: Well, that's it for another episode of the Health Biz Podcast.
• 29:48
  David Williams: I'm David Williams, president of Health Business Group.
• 29:51
  David Williams: My guest has been David Snow, founder, chairman, and CEO of Cedar Gate Technologies.
• 29:55
  David Williams: If you like what you heard, please subscribe on your favorite podcast platform.
• 29:59
  David Williams: Thank you, David.
• 30:00
  David Williams: Th-
• 30:00
  David Snow: thank you, David.
• 30:02
  David Snow: Good to see you.