Latest / Becker’s Payer Issues Podcast / Eric Witte, Chief Operating Officer of Genesis Orthopedics & Sports Medicine

Transcript

Eric Witte, Chief Operating Officer of Genesis Orthopedics & Sports Medicine · Becker’s Payer Issues Podcast

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  Evernorth brings the power of wonder and relentless
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  providing clinical care and support services that provide
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  whole person care, we improve health equity, access,
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  and outcomes for the populations we serve.
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  This is Gracelyn Keller with the Becker's Health
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  Care podcast, and we are live at the
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  2024
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  payer issues roundtable.
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  I'm currently joined right now by Eric Witty,
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  who is the chief operating officer at Genesis
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  Orthopedics and Sports Medicine. So, Eric, thanks for
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  joining me today. I'd love to have our
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  conversation start with a brief introduction about yourself
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  and your role.
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  Yeah. Great. Thanks so much, Grace. Delighted to
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  be here with you.
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  So I come from the payer world originally.
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  So starting out with a clinical doctor in
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  physical therapy before moving into kind of management
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  roles, it's been nice to come to the
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  payer issues,
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  and see all the great collaboration that's happening.
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  Now that I work for Genesis Orthopedics and
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  Sports Medicine as the chief operating officer,
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  it's great to come into a context like
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  this
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  and,
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  collaborate with all the work that's happening on
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  the on the payer side. So, Genesis Orthopedics
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  and Sports Medicine
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  is a private orthopedic
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  multi specialty group that has, you know, orthopedic
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  surgeons,
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  advanced practice providers,
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  physical therapy, and occupational therapy across Chicagoland area,
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  and has been doing a lot of really
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  amazing stuff across the area with a lot
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  of growth that's underway.
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  Wonderful. Well, thank you for being here. And
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  let's start our conversation
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  talking about growth goals. So from improving member
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  experience and expanding value based care to controlling
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  costs, payer executives have ambitious growth goals for
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  the rest of this year and looking ahead
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  into 2025.
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  So in your role, what is your top
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  priority, and how are you planning to get
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  there?
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  Yeah. That's a great question. Thanks so much
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  for asking. So Genesis has one of the
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  more interesting organizations I've ever come across in
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  my career. So
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  organization decided about 6 years or so ago,
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  based on their values that they were going
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  to see all patients and payers regardless of
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  their ability to pay
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  and regardless of the payer type that they
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  had. So it's made us a really great,
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  I think, opportunity to collaborate with health plans
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  who have a great vision for their community,
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  to build these kinds of partnerships.
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  So one of the ways in which I
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  think we're most excited about is advancing,
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  value based care strategies.
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  Having seen a lot of waste across the
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  industry, I think Genesys is well poised to
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  to partner with
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  the great intellectual capital that's been put into
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  value based care in recent years.
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  So most of this has started out with
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  primary care based opportunities.
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  And the whole industry seems right to figure
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  out how specialists can move from fee for
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  service and to help collaborate with identifying ways
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  and opportunities within their communities
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  and advancing that out. So that's one area
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  in which we're particularly excited for the opportunities
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  ahead.
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  Absolutely. And going along with that at an
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  industry level, how would you describe the biggest
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  barriers to effectively serving and engaging members?
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  What opportunities do you see for larger scale
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  improvements, and how are you applying all of
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  this to your current strategies?
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  Yeah. That's great.
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  And this is a
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  a huge problem that exists across the industry.
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  So, you know, as most of us have
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  realized, when you get sick, your first phone
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  call is usually not to your payer to
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  figure out what they're gonna do with you.
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  And so, having struggled with these kinds of
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  programs on the health plan side, our providers
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  are really adept at engaging with their members,
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  you know.
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  No one's more interested to,
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  you know, solve problems as when they're sitting
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  down and talking to their doctor dealing with
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  an active illness.
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  So I continue to think that
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  provider risk delegation is the best way for
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  us to solve these kinds of issues. And
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  so rather than have the payer struggle to,
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  pull certain levers that are very hard, rusty
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  levers for them to pull on, if they
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  can delegate the risk over to the provider
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  side and leverage the tools that they have
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  through,
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  existing in the communities that they live and
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  work in. That, I think, is gonna be
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  the,
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  the best opportunity for for health plans and
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  partnerships to deal with the, kind of engagement
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  quandary that we all have.
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  Absolutely. And let's shift gears here to health
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  equity. So as this becomes increasingly cemented in
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  payer strategies,
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  how is your organization
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  addressing health disparities? And can you share specific
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  examples of measurable successes to date?
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  Yeah. Thanks for the question. So
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  I loved years ago, I was on the
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  board of directors with the National Association For
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  Healthcare Quality,
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  and Stephanie Mercado had done this very interesting
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  thing on all of our, board placards as
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  we would sit down in our meetings.
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  And they put the values at the back
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  of them. So when we sat down, it
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  was front and center for all of the
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  decisions and conversations that we were making.
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  And so I've loved being here at Genesis
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  and having the values not just be some
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  ethereal,
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  theoretical construct that we have, but something that's
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  front and center for the decisions that we
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  make. And so, in line with that,
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  values first mindset of saying, what would it
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  look like if we actually believe that all
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  patients mattered and had equal dignity and worth
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  and to see them regardless of, kind of
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  payer type?
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  Genesis has gone in and said,
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  Not only do we want to just open
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  the door and allow any patient to be
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  able to come to us, they realized after
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  doing that experiment for a little while, despite
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  going, you know,
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  significantly
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  higher Medicaid payer type for our orthopedic practice,
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  they said, if we really cared about this
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  work, we wouldn't just sit out here and
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  wait for these patients to come to us.
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  We would go and move into the neighborhood
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  for people who are struggling with access. And
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  so, one of the best measures that we
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  found to help inform this work is something
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  called the area deprivation index,
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  which, if you've not heard of this before,
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  is, it was considered by Health Affairs as
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  the most powerful tool in advancing health equity.
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  And so, this practice that started out years
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  ago with, with an area deprivation index of
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  1.5,
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  that essentially means
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  wealthy,
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  healthy
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  individuals.
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  We started planting clinics in the areas that
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  were underserved,
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  and our health equity, index has now gone
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  to to 5 out of 10, which is,
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  you know, a significant advancement that we're really
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  proud of in trying to mitigate this issue.
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  Absolutely.
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  And how is your organization ensuring equitable access
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  to care across diverse member populations?
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  And what strategies have worked well for you
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  or on the other hand have been challenging
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  for you in this?
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  Yeah. As far as what's going well, you
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  know, when you move clinics into neighborhoods that
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  are have vulnerable populations,
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  it becomes
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  easier to recruit people to staff these clinics
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  too. So,
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  when you care about a community
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  and you start by asking questions, you can
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  find out what are the issues and you
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  can recruit,
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  providers
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  and staff,
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  to go in and start to listen. And
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  the more connected you are into the community,
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  I think the more able you are to
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  solve the challenges that are unique to those
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  populations.
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  There certainly have been a number of challenges
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  that we've had too, and including,
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  you know, this issue that exists across the
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  payer world. There's member churn. Most of our
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  quality issues that we're looking for are risk
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  adjustment. These are annual based kinds of things.
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  And so as much as,
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  we found some tremendous payer partners out there
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  who are willing to collaborate with us on
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  data, help us figure out where
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  access is poor, where quality is poor,
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  you know, because most of our economic models
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  are built around annual constructs
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  with the Medicaid redeterminations
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  and annual enrollments,
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  churn issues,
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  it's hard for us as an industry to
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  figure out how to create these healthy communities
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  over a longitudinal basis.
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  And so I look forward to finding innovations
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  that are gonna let us get out of
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  this 12 month cycle of figuring out what
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  success looks like and figuring out how we
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  can collaborate in these communities
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  and agree on what success looks like. And
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  I think it's gonna mean something that's a
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  longer term view than just,
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  teaching to the tests and dealing with annual
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  process based measures that,
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  won't give us the kinds of outcomes that
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  I know that we want for flourishing communities.
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  Wonderful. Well, thank you so much for taking
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  the time to join me today on the
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  Becker's Healthcare Podcast and share these insights. Again,
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  we are recording live at the 2024
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  payer issues roundtable.
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  My pleasure. Thank you so much, Grace.