Latest / Becker’s Payer Issues Podcast / Mark Rich, Former President and current Board Member of Steward Health Care System LLC

Transcript

Mark Rich, Former President and current Board Member of Steward Health Care System LLC · Becker’s Payer Issues Podcast

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  Evernorth brings the power of wonder and relentless
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  Barriers to care can lead to gaps in
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  and prevention of health care's most complex conditions
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  and people forward.
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  Hello, and welcome to the Becker Payers Issues
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  podcast
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  recorded live at the third annual spring payer
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  issues roundtable here in Chicago.
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  I'm joined today by Mark Rich, until recently
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  the president and current board member of Stewart
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  Healthcare System.
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  Mark, thank you so much for joining us
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  today. Thank you. I appreciate the opportunity.
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  Well, the pleasure is all ours. Would you
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  please take a moment to introduce yourself and
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  tell us a little bit about, what you
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  do? Sure.
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  Sure. So I'm a a health care executive
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  with forty years of experience,
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  thirty of it in c suites,
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  but I'm from the provider side and the
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  ACO side. So a little bit different view
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  than some of the people you may have
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  been talking to from the plan side. You
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  know, I've served as a a part a
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  partner in a firm and as the CFO,
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  the chief administrative officer, the president of a
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  of a number of providers,
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  and, I'm kind of a turnaround crisis guy
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  these days.
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  Okay. So balancing affordability and quality is a
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  constant challenge for health plans. How is your
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  organization innovating to manage the cost of care
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  while maintaining or improving member outcomes?
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  That's a great question. I really appreciate it.
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  And, you know, I could share from the
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  provider side, the ACO side, what I think
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  the the solution is.
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  And I think we've heard about it at
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  the conference today here and in the other
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  side.
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  So
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  I think you have to define affordability
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  and quality.
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  I'm not sure we always do that. And
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  and if does affordability mean,
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  cheaper
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  premium for the patient
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  or the customer?
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  And quality, as you know, is all performance
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  metrics. It's rearview stuff. It's did you give
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  a glucose test. It's not really outcome based,
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  and that's because that's very difficult to do.
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  I'm not it's what we've got, and we're
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  working with it. But, if you could define
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  those two and just put that aside,
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  I'm a big
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  believer in ACOs
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  and,
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  having come from just one of the biggest
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  in the country.
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  And
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  I think that you have to
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  answer this question in context of the overall
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  strategy.
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  And for me, our strategy has been value
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  based care and embracing value based care. I've
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  given it a big bear hug. I'm bullish
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  on it.
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  It it works. You know, it's gonna do
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  $3,600,000,000,000
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  over ten years in the total commercial space.
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  It's a,
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  3.1
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  to 5,000,000,000 in '23 just for Medicare,
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  and that's the MSSP program, which is the
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  hardest kind of of managed care in that
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  bit in that side of the business, because
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  you you it works on attribution and not
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  as and not directly chosen PCP.
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  So I think you have to embrace that.
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  And then
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  if you do that, then you need to
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  think about the core things you need, and
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  and ACOs are really simple. Once you have
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  the physicians,
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  you it's really IT,
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  then it's data management,
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  because you want to you wanna be able
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  to use the data for predictive outcomes and
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  everything that we're trying to do these days.
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  So big data warehouse.
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  And the thing you need for,
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  an ACO
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  or forming an ACO, value based care company's
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  money. Mhmm. Mhmm. All those things cost a
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  lot of money. We need to have reserves.
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  I think there's plenty of money in the
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  system right now. I just don't think it's
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  evenly distributed. We could talk about that if
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  we want. Mhmm. Yeah. Mhmm. So in an
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  ever evolving regulatory
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  landscape,
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  what best practices or tools does your organization
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  rely on to keep the quality of care
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  at the forefront?
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  Well,
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  again, you know, I think quality metrics are
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  performance metrics,
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  so we measure those.
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  We give feedback. We try to keep it
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  simple.
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  When we measure data,
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  I'm a big believer that the only data
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  that should be supplied to anybody in the
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  organization
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  is is actionable immediately actionable
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  data that they could turn into information and
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  move. And that could be because I'm from
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  a crisis centered chaos centered world. Mhmm. But
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  clouding everybody's inbox with a bunch of random
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  data
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  basically just gives people the
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  opportunity to admire the problem. Mhmm. They're not
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  really working. Right. So we wanna get the
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  right data in the right hands. And so
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  we measure all that. We measure quality. We
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  measure performance up to that. We have, pharmacists
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  that go to go to the home to
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  make sure that the patients are taking their
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  drugs, and they're not, you know, after the
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  shoulder surgery, not up swinging a golf club
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  two days later. Right. Right. So you try
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  to get a lot of that in. And
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  then,
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  I think value based care becomes a big
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  big way to do this. Mhmm. It it
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  it clearly saves money. It clearly works.
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  And the beauty of it is better for
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  the patient. Mhmm. I mean, if you think
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  about it,
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  value based care, we make a big deal
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  about it. But if you think about it,
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  it's what the patient thinks is happening anyway.
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  Right? They think that you're the PCP. Right.
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  You're talking to me, this surgeon, and giving
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  me notes because Right. I'm getting personalized care.
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  And we know that that is difficult to
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  do, and it doesn't really happen
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  until you're able to,
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  get a standard EMR and bring people under
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  the umbrella. Mhmm. And you have to you
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  have to line the economics or they won't
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  come under the umbrella, and that's really the
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  key. Right. Well, looking ahead, what do you
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  see as the biggest opportunity for payers to
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  lead the charge in transforming health care delivery
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  and driving better outcomes, for all stakeholders?
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  And how can leaders take a step in
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  this direction right now? I think I think
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  commercial insurers,
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  can play a big part, in two ways.
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  One, they need they need to take a
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  look at their systems, and they need to
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  embrace value based care a little bit. We've
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  run into problems as Stewart went across the
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  country
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  with with the value based care that that
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  we were ready. We had the infrastructure and
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  the ACO in place, but we didn't have
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  an insurance partner who had the IT infrastructure
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  to handle that. And it's unique, and you
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  gotta you're gonna have to make the the,
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  you know, the investment, and it's a big
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  number. But I think, that's where we're going.
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  There's 608,000
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  clinicians in value based care right now,
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  and it's growing at an 8% CAGR over
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  the next ten years. So Mhmm. It's gonna
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  be big, and it's gonna be here.
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  But,
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  the cash is out there. I think we
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  need to look at relook at risk based
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  capital, which I know is the rail the
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  rail.
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  But when you have 800%
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  of the minimum required
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  minimum required risk based capital
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  and you're a nonprofit plan, like a Blue
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  Cross plan, it's not tax paying, I mean,
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  isn't that just isn't that just excess premium
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  that people have paid to you over the
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  years that you maybe could have lowered the
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  rate if you invested that capital?
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  So there's plenty of cash there. There's a
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  trillion dollars sitting in private equity on the
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  sideline. Now not all that's for health care,
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  but that's a big pretty big pool to
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  choose up to pull pull from. And the
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  government is gonna continue to make investments in
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  value based care. Medicare is is all of
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  this. I think the I think the new
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  secretary,
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  even had meeting special meetings on value based
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  care, like, last week as soon as it
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  works out again.
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  Well, Mark, I really appreciate you, taking the
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  time to join us today on the Becker's
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  Perry issue podcast.
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  Before I let you go, do you have
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  any final thoughts you'd like to leave with
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  our listeners? I think that
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  if I had a final thought, it would
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  be the solution to this problem and really
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  bending the cost curve is having to work
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  together. Mhmm. Payer and provider. That's been a
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  very big success for Stewart with Blue Cross
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  of Mass. Started that in 02/2010.
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  That's where the money's gonna come from. That's
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  where we can think about capital. We can
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  think about new capital structure.
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  And I don't I'm not a big provider
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  insurer kind of base guy. I think providers
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  do what they do, and insurers do what
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  they do. And never the twain shall meet,
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  but Mhmm. There is a good opportunity to,
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  work together. Right. Right. Well, Mark, thank you
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  again for joining us today, and I hope
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  you have a lovely rest of your day.
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  Thank you. I appreciate it. My pleasure.