Latest / Becker’s Healthcare Podcast / Redefining Primary Care Through Value and Culture with Dr. Rob Bessler and Amy Perry

Transcript

Redefining Primary Care Through Value and Culture with Dr. Rob Bessler and Amy Perry · Becker’s Healthcare Podcast

0:00
This is Scott Becker with the Beckers HealthCare
0:02
podcast.
0:03
I am thrilled today to be joined by
0:05
two remarkable leaders.
0:07
We're joined today by Amy Pirie. Amy is
0:10
the president and the CEO of Banner Health.
0:12
We're also joined by doctor Rob Bessler. And
0:15
doctor Bessler is the CEO of Honest Health,
0:18
and he'll tell us about that journey as
0:20
well. We're we're gonna talk about redefining primary
0:23
care and what the next chapter of primary
0:26
care and value based care perform value based
0:28
performance looks like. In such an important subject
0:31
given the shortage nationally of primary care physicians
0:33
and and the changes and transformation that's happening
0:36
in the delivery of primary care. Be before
0:39
we get started, I'll ask Amy and doctor
0:41
Besworth to take a moment to introduce yourselves.
0:43
Amy, let me ask you to kick us
0:44
off as president and CEO of Banner Health.
0:46
Take a moment and tell us about yourself
0:48
and about Banner Health and then then doctor
0:50
Bessler. So glad to see you again. We'll
0:52
give you a chance to do the same
0:53
thing. Amy.
0:55
Thanks, Scott. So
0:57
Banner Health is
0:59
sort of
1:00
a ecosystem
1:01
that contains all of the potential elements you
1:04
could possibly put into healthcare from
1:07
acute care hospitals
1:09
to outpatient,
1:11
everything and everything in between
1:13
academic medicine, community,
1:15
rural,
1:16
physician enterprise.
1:18
And on top of all that, we have
1:20
an insurance company.
1:21
So we are sort of
1:24
a a potpourri
1:25
of everything anyone
1:27
could possibly need,
1:29
for their care and coverage here at Banner
1:32
Health.
1:34
Thank you. Banner Health developed just this tremendous
1:37
reputation over the last couple decades. So thank
1:39
you for the introduction, and thank you for
1:41
that. Doctor Bessler, you've done an amazing job
1:44
with Honest Health. Tell us about the the
1:46
generation of Honest Health, how it started, and
1:49
and about yourself.
1:50
Thanks, Scott, and great to be with you
1:52
and Amy.
1:53
You know, my my journey to Honest Health,
1:56
starts with,
1:58
being an emergency physician
2:00
many moons ago, generation ago, I guess. And
2:03
from being an emergency physician
2:05
to being challenged that nobody wanted to admit
2:07
my patients and those doctors that did, I
2:09
thought were practicing for med evidence. From twenty
2:11
years prior, I founded and led
2:14
Sound Physicians for twenty three years across
2:17
and grew that from, you know, one hospital
2:19
and three doctors to about 450
2:21
hospitals in 42 states and
2:25
over 5,000
2:26
providers, at the time.
2:28
And the thing I learned over running, hospital
2:31
based services,
2:33
and a very big value based care business
2:35
across both bundled payment and ACOs
2:38
was,
2:39
that our hospitals kept partners kept coming to
2:42
me in particular and saying, well, what about
2:45
primary care?
2:46
And, the what about primary care was a
2:49
combination of
2:50
docs feeling like they're on the treadmill of
2:52
volume,
2:54
hospitals,
2:55
employing 70% of the nation's primary care providers,
2:59
hospitals
3:00
recognizing they lose money on every medical Medicare
3:03
or Medicaid admission,
3:06
and
3:07
subsidizing primary care to the tune of a
3:09
quarter million dollars of provider.
3:12
And so when,
3:14
I went around the country looking at various
3:17
enablement models, and most of them are focused
3:20
on independent primary care.
3:22
And I joined Honest,
3:23
invested in the business and
3:26
pushed for a pivot to focus on using
3:28
that infrastructure to serve health systems.
3:31
And the idea is quite simple.
3:34
How you know, every health system's on a
3:36
different place on that journey
3:38
from volume to value,
3:40
and how can and everybody kind of believes
3:44
and understands that there's a recipe
3:47
to deliver on that promise and that journey
3:50
to value.
3:51
The ingredients and whose ingredients they are is
3:54
less
3:55
important. And since everyone's at a different place
3:57
on that journey,
3:58
our job is to make sure that you
4:00
don't leave out the, you know, the baking
4:02
soda or the flour or the physician leadership
4:05
component
4:06
or the analytics, etcetera,
4:08
for that recipe.
4:10
And,
4:10
it turns out there's a big opportunity, and,
4:14
very few health systems in the country have
4:16
invested,
4:17
fully in what it takes
4:19
to make that transformation. And so that's what
4:21
we're doing at Honest.
4:23
Thank you so much. I'm gonna I'm gonna
4:24
start off with asking you each two questions,
4:26
and and I'll start with Amy here and
4:28
then pivot back to you, doctor Besler.
4:30
Amy, talk a little bit about
4:32
how primary care fits into your current business
4:34
model. And and I know it's a it's
4:36
a general question, but a big question given
4:38
the size of Banner and and what you're
4:40
doing. And then also we've talked about
4:43
the transformation of primary care as a way
4:46
to transform the nation's health care delivery system.
4:49
What does that mean in practical terms from
4:49
your perspective? And and I'll ask both of
4:49
you to comment on this. But, Amy, let
4:49
me
4:56
Sure. Thanks so much. So
4:58
for us, the whole primary care provider piece
5:01
of what we do
5:03
is largely about access. Right? How do people
5:06
connect with their health care?
5:09
How do we provide care navigation
5:12
for what they need?
5:13
It usually starts somewhere in that, you know,
5:16
primary
5:17
relationship. And and I say that very specifically
5:20
because there's some models
5:22
of primary care that are much more transactional.
5:25
If you're you're going to be a just
5:27
a pure telehealth client or, you know, with
5:30
a with a different,
5:32
provider every time you visit, you know, you
5:34
need something urgently.
5:36
I think that our primary care access and
5:39
relationship
5:40
is so critically important for having a shot
5:43
at keeping people well,
5:45
having them navigate the system more efficiently,
5:48
which is critically important now
5:50
going into an era where we're gonna have
5:52
so much less resources.
5:55
We need to learn how to maximize
5:57
these
5:58
our providers.
5:59
And and by that, I don't mean having
6:01
them work fourteen hours a day. That is
6:03
definitely not where we're at. We're at how
6:06
do we have people work more efficiently? How
6:08
do we give them the technology tools, whether
6:11
it's ambient listening or team care,
6:13
you know, pairing with APPs
6:16
and pairing with technology
6:18
so that we can provide access in a
6:20
more effective way. So our primary care physician
6:24
team is critically important for having,
6:28
that connection to the communities we serve. It's
6:31
also critically important from an efficiency perspective when
6:35
we are getting a,
6:37
a per member per month as part of
6:39
a premium, as part of our insurance plans.
6:42
And so we really rely on
6:45
our primary care physicians to be that quarterback,
6:49
and we're trying to make it easier for
6:51
them because it is it's a very, very
6:53
heavy burden,
6:55
and we want to try to make
6:58
make their lives more
7:00
enriched
7:01
because they can actually spend more time with
7:03
their individual
7:05
relationships keeping people well.
7:07
And this is sort of the stark, I
7:10
think,
7:10
difference or uniqueness of Banner in being an
7:13
insurance company
7:15
because we can actually make the economics of
7:18
those kinds of investments work. So,
7:21
you know, primary care is a it's actually
7:24
such a big broad word, and and we're
7:27
actually making it broader.
7:29
Because of the lack of specialists in certain
7:31
areas, we're relying on our primary care physicians
7:34
to be part of the behavioral health
7:36
team, to be part of the cardiology team
7:38
with heart failure management.
7:41
We expect so much of our primary care
7:44
physicians now to pro to be that connector
7:47
to our communities.
7:49
We can't do enough for our physicians and
7:52
and we keep training them. I mean, one
7:54
last thing I'll say is Banner has made
7:57
a huge investment. We train 1,300
8:01
residents and fellows. We just added 250
8:05
more primary care physicians to our training program.
8:08
We train APPs.
8:10
We train about 7,000
8:12
nursing rotations here. We're trying to populate Arizona
8:16
and beyond. In our other states we serve,
8:18
we have relation academic relationships, Colorado, Wyoming,
8:22
some of the other states that we're in.
8:24
So this is a community effort. We all
8:27
have to come together to try to break
8:29
through some of the barriers that have been,
8:32
put up in of of late, that are
8:35
changing our reimbursement structures.
8:38
Thank you. You mentioned
8:40
several things, one of which I find fascinating.
8:43
You you do see this movement towards this
8:45
transactional
8:45
model of care
8:47
where episodic. Somebody goes to the urgent care,
8:49
sees a primary care physician. They have no
8:51
ongoing relationship with that person. It might be
8:54
similar by some of the national telehealth agencies.
8:57
You talk to somebody, you never talk to
8:58
that person again.
8:59
And and, obviously, that's suboptimal. It's
9:02
it it fills a gap, but it's not
9:03
what we prefer. We prefer that longer term
9:06
primary care relationship,
9:07
whether it's with physician, advanced practitioner, or so
9:10
forth.
9:11
How do you sort of view that transition
9:13
or that ability to continue to provide that
9:15
longer term relationship
9:17
versus the transaction relationship
9:19
in a in a very changing world, in
9:21
a in a labor scarce world?
9:23
Right. So I think there is a couple
9:25
things. Number one,
9:27
You have to be value you have to
9:29
provide value to a human at some level
9:32
so much value
9:34
that
9:35
they want to be part of a
9:38
Relationship with you either you're helping them achieve
9:40
their fitness goals their nutrition goals. You're helping
9:40
them stay on their
9:42
goals, you're helping them stay on
9:45
their blood pressure medicine, you're helping them reduce
9:48
their,
9:49
a one c three. You're you're you're making
9:51
a palpable
9:52
change in their life so much that they
9:55
they value the
9:57
relationship.
9:58
To the extent that they're just looking for
10:01
a transactional,
10:03
we still provide that. You know, Banner is
10:05
here with 50 some urgent care
10:08
facilities.
10:09
And and if you all if you wanna
10:11
experience us in that way, we're there for
10:13
the for that approach as well.
10:16
We're really dealing with an enormous variation
10:20
in generations
10:21
right now and what they expect from us.
10:24
So we need to be different. We need
10:27
to be so much different depending on whether
10:29
we're dealing with our Gen z's, I'm looking
10:31
at my kids, or the, millennium millennials or
10:36
or the boomers who have different expectations as
10:39
well. So being an effective health
10:41
care delivery provider right now is really delivering
10:45
the care that people want, and that is
10:49
not one definition.
10:51
No. I I I love that explanation because
10:52
it resonates so true with all of us,
10:55
this concept of it. At my age, I'm
10:57
so used to my long commotion with my
10:59
primary care physician.
11:00
At my children's age, they're very happy to
11:02
go into the urgent care, get what they
11:03
need, and and and get out. And it
11:06
it really is. There is a piece of
11:07
that that's you're you're serving multiple different communities.
11:10
Doctor Bessler, how do you sort of see
11:12
primary care fitting into what you do at
11:14
Honest Health? And also how do you see
11:16
the transformation
11:17
of of primary care system in in in
11:20
health care in in practical terms? What are
11:22
some of your observations? Yeah. So I think
11:24
I've I've seen the access problem for the
11:27
last thirty years, and some would say, well,
11:29
how's a ER doc running a pop health
11:31
organization? And and the reality is is in
11:34
the emergency I always thought if you brought
11:36
politicians to the emergency department, you could see
11:38
what the challenges are in our country,
11:41
in one shift. And
11:42
without a doubt, access is a huge issue,
11:45
but,
11:46
we're not gonna create I think most experts
11:49
would agree that there's no way to create
11:51
enough
11:52
primary care providers to handle our population.
11:55
But what most don't realize is we should
11:58
be doing a lot more around risk stratification
12:01
of who needs to see
12:03
the,
12:03
you know, experienced primary care provider with twenty
12:06
five years of of of care under their
12:09
belt
12:10
versus, you know, someone else that doesn't have
12:12
that. Another example is, you know, we're using
12:15
technology
12:17
to text all of our seniors.
12:20
And instead of our care coordinators getting hung
12:23
up on,
12:24
because they think it's a spam call, they're
12:26
interacting with this AI texting tool and then
12:29
opting in for a phone call from a
12:31
nurse.
12:32
And so we're able to instead of contacting
12:35
2,000 patients,
12:37
we can contact 8,000 patients because they didn't
12:40
spend all day calling people that don't pick
12:42
up. And so I think it's about risk
12:45
stratification
12:47
and using our time more effectively
12:49
to give the right people access that, you
12:52
know, the heart failure patient needs to be
12:54
contacted
12:55
weekly and monthly.
12:57
Whereas the 72 year old out on their
12:59
bike on a bike path near Amy's
13:01
hospital,
13:03
you know, might want urgent care and an
13:06
annual wellness visit and making sure their blood
13:08
pressure medicines are kept up to date because
13:10
they're not a high utilizer. And so it's
13:13
it's really a risk stratification opportunity.
13:17
You you make a point there about so
13:18
many things, but I'll talk for a second
13:20
about
13:21
texting versus phone calls.
13:23
When somebody gets a text, we get it.
13:25
We almost always read it or respond to
13:27
it. You get a phone call today.
13:30
If you don't recognize the number, there's a
13:32
very good chance you're just not picking it
13:34
up. Is is so somebody knows who it's
13:36
coming from. You're just not picking it up
13:37
today. Once in a while, I get a
13:38
call from somebody. I'm like, oh my god.
13:39
Am I glad I picked that up? Because
13:41
it was actually somebody I needed to talk
13:42
to, but you just don't expect a day
13:44
where it looks to text you, you know,
13:45
but trying to find these different modes
13:47
of working with people based on the situation
13:50
seems so critical to this stratification you're talking
13:52
about. Exactly. You know? I mean, Apple's this
13:55
latest,
13:57
iOS system has a feature that under phone
14:00
where you can if it your the number
14:01
is not in your contacts, it doesn't even
14:03
ring anymore.
14:04
Right. It little literally remarkable. And and and,
14:06
doctor Russ, let me start with you on
14:08
this next question.
14:09
We've talked about value based care for literally
14:11
a decade, two decades.
14:13
In a lot of ways, it's progressed, not
14:15
progressed. I mean, even with Medicare Advantage, so
14:18
many different challenges right now that are coming
14:20
to fruition, everybody thought everything's gonna move towards
14:22
Medicare Advantage, but but so many different challenges.
14:26
How does tighter alignment between financial accountability
14:29
and cure delivery,
14:31
how can that drive better performance while keeping
14:33
the medical system,
14:36
while keeping it practical, the the system for
14:38
people to use? How how can we
14:41
align finances and critical and and and and
14:43
actually make a difference or make it work?
14:45
Yeah. I think it's about the Venn diagram
14:48
of where is this good for the patient,
14:50
which is kind of the easiest one. Where
14:52
is this good for the payer,
14:54
and where is this good for the provider?
14:57
And we all my whole career has been
14:59
focused on putting the doc the provider at
15:02
the center
15:03
and, like, how you drive results. And, you
15:06
know, it's a pretty easy sell
15:08
to the provider to work at the top
15:10
of their license,
15:12
have a team around them doing the the
15:15
the tasks that are not as much,
15:17
why they went to medical school,
15:20
and getting paid to keep people healthy,
15:23
right, or to help them, those that wanna
15:25
stay healthy, I guess. But it's, they're they're
15:28
that's the real opportunity.
15:30
And so we always start our model with,
15:33
are the processes that we put in place
15:35
going to make the providers more proud
15:38
of the care they provide?
15:40
And and, really, that's where it starts. The
15:43
second
15:44
piece to that puzzle is
15:46
it is comparative data.
15:49
Right? So how, like, how do I drive
15:51
performance for providers? Like, well, nobody wants to
15:54
be the last. We're all competitive. A lot
15:56
of type a's.
15:57
And then the third one is financial incentives.
16:01
And what turns out is if you keep
16:02
things simple on those incentives and and really
16:05
focus on the behaviors that really make a
16:08
difference
16:09
for the patients,
16:10
you can put meaningful dollars up front to
16:13
the providers to get because they the other
16:15
part is you can't wait eighteen months
16:18
to show people the money from all the
16:20
savings. Like, you you know, it's just that
16:22
that they're they're human. They're that that's too
16:25
long.
16:26
And so we have to,
16:28
put near term incentives in. But you can't
16:30
put them in the opposite order. You can't
16:32
start with incentives. You really have to start
16:34
with, are they more proud of the care?
16:36
But but I love that that that concept
16:38
of three different concepts. Are they proud of
16:40
what they're doing? Do Do they have comparative
16:42
data? And are there financial incentives? And then
16:44
then I love your point on financial incentives.
16:46
We've all seen people draw up incredibly complicated
16:50
financial incentives that at some level makes sense,
16:53
but they're almost useless. Because if they're not
16:55
simple to understand, you get people focused on
16:58
too many indicators. It it doesn't really work.
17:00
So simple to understand, simple to use, comparative
17:03
data, proud of what they do. Amy, let
17:05
me ask you a similar question.
17:07
Driving clinical alignment together with financial accountability,
17:11
you're one of the systems remaining with a
17:13
large insurance operation to go with a large
17:15
health system.
17:17
And in some ways, trying to make that
17:18
Venn diagram work between what the insurance company
17:20
is trying to do, the providers wanna do,
17:22
what the patients need, and making that all
17:24
work. How do you sort of see this
17:26
alignment,
17:27
among sort of finances and clinic clinical and
17:30
so forth?
17:31
Well, I'm just gonna build a little bit
17:32
on what Rob said. You know, first of
17:34
all, a a great deal of what we
17:37
get done at Banner is because of the
17:38
purpose.
17:40
You know,
17:41
people
17:42
generally get into health care because they care.
17:44
They care about what they're doing. They care
17:46
about making a difference in people's lives. And
17:49
so that connectivity
17:51
with our providers
17:52
and
17:54
showing them a way or providing the environment
17:58
where they can make investments
18:00
in in things that
18:02
make people's lives better,
18:05
that feeds on itself. So there is a
18:08
natural
18:09
movement or want physicians wanting
18:12
to have that. So being able to
18:15
give that,
18:16
opportunity in a little bit more streamlined way
18:19
is is still something we're working on, but
18:21
I think it's critically important.
18:24
The models, they
18:26
they do conflict on a in a lot
18:28
of ways, And I think that's why you've
18:30
seen a lot of health systems not stay
18:32
in for the long run. You know, I
18:34
love the raw Venn diagram idea where it
18:37
when we look at it, we have things
18:40
that work in the fee for service side,
18:42
things that work in the value based care
18:44
side, and then we have this center where
18:46
it works in both worlds.
18:48
And that's to me how people get started.
18:52
Right? What works? Well, let's focus on, like,
18:54
the stay. Let's work on discharge planning. Let's
18:57
make sure people have a safe transition to
18:59
home.
19:00
You win in every model in that kind
19:03
of approach. So
19:04
look at those things where you win and
19:06
get good at those, and then you can
19:09
extend.
19:10
We are we're trying to flip our model
19:12
as you know, Scott. We are so dedicated.
19:14
We're about a third
19:16
value based care or premium based revenue, and
19:18
we're about two thirds fee for service. We're
19:21
moving like a freight train that might to
19:23
try to make that two thirds, one third
19:26
because
19:27
it's so much more rewarding, going back to
19:29
the purpose question,
19:31
to make sure that someone is cared for
19:33
with their chronic diseases,
19:35
to give people access prevention, all of those
19:38
things. And by the way, that's the only
19:40
way we, in my opinion, we are going
19:42
to meaningfully
19:44
change the cost curve in this country.
19:47
The financial
19:48
incentives
19:49
are not
19:50
they are not based at all
19:53
in wellness. They are only based on transactional
19:56
sick
19:58
exchanges,
19:59
in a commercially insured environment. And so we
20:03
have an opportunity right now.
20:05
We have an opportunity to show that there's
20:07
a better, more cost effective way, more rewarding
20:10
way
20:11
for people
20:12
to take care of our communities.
20:14
It's gonna require
20:15
some policy changes, some reimbursement
20:18
changes,
20:19
some
20:20
acknowledgment of regional health care providers like Banner
20:23
that do provide this
20:25
movement, this this hopeful shift in how health
20:29
systems are reimbursed.
20:31
It's not gonna happen,
20:33
without a lot of direct intervention.
20:37
Thank you. There there's so many things you
20:39
said there that resonates. One of them that
20:41
I loved is is that, ultimately, great care,
20:44
taking care of people really well,
20:47
it shouldn't be system should be system agnostic.
20:50
That that you're taking great people great care
20:52
of people whether in their fee for service,
20:54
whether they're premium revenue, whichever it is, that
20:57
at the at the heart of everything is
20:59
is great care. And then figuring out how
21:01
to get paid for that care is a
21:03
is a next issue. But but I think
21:04
that Venn diagram, so much of it starts
21:06
with is great care being delivered. Amy, let
21:08
me start with you on this next question.
21:11
For for moving we're trying to move the
21:13
needle
21:14
to to more value based care or at
21:16
least premium based care versus free for service.
21:19
And and system leaders evaluating their next step
21:22
in value based care. And I'll ask doctor
21:23
Bessel the same question.
21:25
Where should systems focus first? Let me ask
21:27
you first, Amy, and then doctor Bessel, let
21:29
me ask you. How does system start to
21:31
approach this? Obviously, you're doing it at scale.
21:33
Some systems are doing it at a much
21:34
smaller scale. But but how do you approach
21:36
that? Where where do you focus first?
21:38
Well, I think there's a couple things. First
21:40
of all,
21:41
I would focus on that center of the
21:43
Venn diagram. Right? The win wins. I win
21:45
if we accomplish
21:47
a
21:48
a strong
21:49
quality care experience
21:51
in patient, you will have a shorter length
21:53
of stay. You will win on fee for
21:55
service. You will win in value based care.
21:57
There is there are a lot of examples
21:59
where smart
22:02
quality
22:03
care
22:04
wins on both sides of the equation. So
22:07
that's not even controversial.
22:09
Whether
22:10
health systems want to or not, they are
22:13
now clearly in the risk based
22:16
space
22:17
because
22:18
if you just look at the state of
22:20
Arizona,
22:21
400,000
22:22
people lost health insurance in the last sixty
22:24
days.
22:26
Those 400,000
22:28
people are now a risk based population
22:31
for all providers in the state, whether they're
22:34
health insurance companies or not.
22:36
So how do we care
22:39
for those people
22:41
that don't have access to a reimbursement
22:45
system
22:46
to get their care?
22:47
And do we wait for them to show
22:49
up in our emergency rooms?
22:52
Not probably the most practical or smart.
22:55
So we may have to do things differently.
22:57
We may have to connect with our
23:00
populations in different ways.
23:02
That puts all health system at a bit
23:05
of a risk. And so now how are
23:07
we gonna care for that population? How are
23:09
we gonna care for
23:11
the people that might not have access? It's
23:12
the same concepts.
23:14
We need to keep them well. We need
23:16
to make sure they have food security.
23:18
We need to make sure that they have
23:20
access to,
23:21
chronic disease medications that might help them stay
23:24
well. So that's a different
23:27
approach. That is and how we manage that
23:31
can be applied
23:32
throughout our whole health system. So I think
23:34
everybody
23:35
that may not have thought they were in
23:37
the risk based business are sort of going
23:40
to be,
23:41
in the risk based care business just because
23:44
of the
23:45
increasing number of people that don't have any
23:48
other way to get health care except through
23:51
our traditional
23:52
hospital infrastructure.
23:55
Well, I think that's a fascinating perspective that
23:57
that if four hundred thousand people lose coverage
24:00
in Arizona,
24:01
that whether we want to or not I
24:03
mean, we do want to, but we're in
24:05
the business taking care of those people and
24:07
doing so as efficiently as possible because they
24:10
gotta get taken care of. And if and
24:12
if we waste resources doing so, we can
24:14
bankrupt the system,
24:16
and and so we have to secure them
24:17
as efficiently as possible. So so whether you
24:19
wanna be in value based care or not,
24:21
you're in value based care. Then it's trying
24:24
to transition or or transform and use those
24:26
lessons for everybody, not just those that can't
24:28
pay, but using them for everybody because so
24:30
many things that work work for everybody,
24:33
not just the concierge population. They work for
24:35
the industry population. The the same concepts are
24:37
are are at play.
24:39
Doctor Bressler,
24:40
where would you look at in advising health
24:42
system leaders? You've been a leader. You know,
24:45
you're a leader now. Where should where should
24:47
where should people focus first when they look
24:49
at value based care and and and sort
24:51
of next steps?
24:52
Well, the first thing I ask them, they
24:53
say they're not in value based care. I
24:56
kind of have a similar comment to Amy's,
24:59
but I say, you know, if if your
25:00
self pay population, your PM PM payment,
25:03
your premium is zero.
25:05
So you're in the business with no revenue,
25:07
just all the cost.
25:09
And, all joking aside, I think,
25:12
you know,
25:13
we think that
25:15
every health system's at a different place on
25:17
that bell shaped curve or the journey.
25:20
Meeting people where they are, keeping things simple
25:23
is a very important theme,
25:25
and getting some quick little victories. So it
25:26
could be as simple as getting simple
25:28
as getting primary care into an ACO, which
25:31
isn't simple to deliver on, but
25:34
it's
25:35
simple in the
25:36
sense of, hey. We're not gonna try to
25:38
boil the ocean day one, but we're gonna
25:40
put meaningful dollars into both the hands of
25:42
the providers and to the back to the
25:44
health system
25:45
on a subset of the population
25:47
and show what's possible.
25:49
And then how do we expand from there?
25:51
Because what ultimately
25:53
the primary care doc wants, they want one
25:55
process of care in their office,
25:58
not by patient selection. Right? And so it
26:02
turns out care coordination is good for a
26:04
subset of all patients.
26:06
It turns out that good documentation
26:08
is good for every patient for it's better
26:11
care.
26:12
When you identify diagnosis in patients, it's not
26:15
a coding game. It's, oh, by the way,
26:18
you didn't document that they actually had heart
26:20
failure, so how can you treat heart failure
26:23
or their kidney disease,
26:25
that's been chronic in nature and progressing?
26:28
And so, you know, it's how do we
26:29
tie
26:31
some of the financial
26:32
drivers to better care,
26:35
and and really get people to understand the
26:38
why and and just meet people meet the
26:40
health system, meet the people where they are
26:42
on that journey.
26:44
And it there is a wonderful flywheel effect
26:46
that we've seen,
26:48
because once they start seeing the results and
26:50
they start seeing the benefit,
26:53
you know, we know we're winning when the
26:55
doc walks out of the room and says,
26:57
hey. This patient should have a care coordinator.
27:00
Call Susan or John,
27:02
you know, that's that's attached to their clinic.
27:05
You know? And that's when we know we're
27:07
winning is when they start to think about
27:09
it as better care.
27:11
And and and, Rob, doctor Bessel, let me
27:13
ask you a question. You've worked at large,
27:15
large companies, and you work with very large
27:17
systems.
27:18
We talk about this concept of starting with
27:20
small victories.
27:22
How do you translate some of those small
27:24
victories to enterprise wide efforts?
27:27
Because
27:28
that seems to be at the end of
27:29
the day. We've gotta get momentum. We've gotta
27:31
get the flywheel going. And at some point,
27:33
we've gotta make these things not just one
27:35
off. It's not just being done with that
27:37
primary care group in that office, but we're
27:40
doing this as a system. How do you
27:42
think about making things work as an enterprise
27:45
versus individually? And I know you had a
27:47
lot of experience with that in complex large
27:50
organizations. Yeah. I think that I think you
27:51
do have to start small,
27:53
and you have to find the providers that
27:55
are ready and want to go take risk,
27:58
or that feel they're ready to do that
28:00
and be successful with a subset
28:03
of the providers
28:04
and show what's possible. Every doc, you know,
28:07
I'm sure me included, said my patients were
28:09
sick of the nurse.
28:10
And but the reality is is we all
28:13
are facing
28:14
very similar challenges. The priorities might be different
28:16
that day.
28:18
But, you know, showing that it's possible,
28:20
getting some
28:21
wins, building belief,
28:24
and not making it more complicated. Right? I
28:26
think
28:27
constantly studying clicks that the doc doc
28:30
uses,
28:31
how do we streamline,
28:33
the tool the AI tools are moving
28:35
so fast.
28:36
We, you know, we the the ability, for
28:40
example, for our care manager to get data
28:42
in real time
28:44
from all the local EMRs, the pharmacy,
28:47
the claims information, the ophthalmologist that's not part
28:49
of the network,
28:51
all at you know, with one click and
28:53
see it all in a very organized fashion
28:55
is is the reality we're living in today.
28:57
It's fantastic.
28:59
And, you know, a year and a half
29:00
ago, that nurse was spending a half hour
29:03
trying to figure out what's going on with
29:05
the patient before calling them. And now it
29:07
happens at that point of, you know, in
29:08
in a millisecond. And so,
29:11
I'm super optimistic
29:13
about what's possible, but you do have to
29:15
start small.
29:17
No. It's a it's a fascinating discussion because
29:19
in some ways, the overload of information at
29:21
one's fingertips
29:23
feels, like, helpful and daunting at the same
29:26
time.
29:27
Because all of a sudden, you're getting stuff
29:29
that's useful quickly
29:30
that and and you have to do that
29:32
at scale in an enterprise way. But but
29:34
but think about that. Yeah. Right? Think about
29:36
the physician with 3,000 patients on their panel.
29:38
400 of well, maybe in Maricopa County, five
29:41
hundred of them are seniors,
29:44
you know, on their panel, but only 50
29:46
of them are the top 10% risk stratified
29:49
patients. Right? So it's like we we gotta
29:52
focus first on those 50. And once we
29:54
have good processes
29:56
on those 50 out of the 500 in
29:58
that PCPs practice, then we'll go to the
30:00
next tier. But we don't have to
30:02
over engineer day one.
30:04
Right? And and,
30:05
and I learned this, you know, a long
30:07
time ago that every dollar you save is
30:09
savings.
30:10
Doesn't matter where it comes from. But it's
30:12
a really great perspective
30:14
on how to look at this, both small
30:16
and large.
30:17
That we don't have to be fixing everything
30:19
today for
30:21
the the five million patients in the state
30:23
or whatever the number is. But if we
30:25
could focus on the five hundred thousand of
30:27
a chronic condition or start there with the
30:29
right data, we can really start to move
30:31
things in the right direction. I I love
30:33
that perspective. I mean, it's it's sometimes You
30:35
gotta give people hope. You gotta you gotta
30:37
show them that they can make it happen
30:39
and and not try to overwhelm.
30:41
I I know. I I love that perspective.
30:43
Be before we close, let me ask each
30:46
of you, you know, a a a quick
30:47
round here. Anything we've not touched on that's
30:50
important for the audience to understand
30:52
as things move forward? Amy, let me start
30:55
with you. And anything that you'd like to
30:56
add, and then doctor Besserofsky the same thing.
30:59
Well, I'm gonna, pick up on something that
31:01
I think Rob
31:02
talked about
31:04
and why Rob's been very successful, and that's
31:06
in culture development.
31:08
You know, what we're talking about here, we
31:11
we tend to talk about everything in economic
31:13
terms, and and we do as well because,
31:16
you know, we have a very tight margin.
31:18
We have to make this work.
31:19
But I think that
31:21
what's different about banner
31:23
is the culture
31:25
and a a culture that together is trying
31:29
to change things for the better.
31:32
That approach
31:33
where we don't sit back and say, gosh,
31:35
you know, what was what what were us,
31:37
you know, and
31:39
and this is,
31:40
you know, this is complicated. What are we
31:43
gonna do? We say this is complicated. We
31:46
need to figure it out. We need to
31:48
move forward. We need to be the we
31:50
need to change together. We need to pull
31:52
forward together.
31:54
And having that approach,
31:57
that
31:58
culture of innovation,
32:00
of drive to make things better, I think
32:03
is going to help Banner
32:05
forge through
32:06
into this next generation
32:08
of reimbursement
32:10
and care
32:11
in a different way, and and I can't
32:13
understate how much how important it is to
32:15
be able to balance the compassion part of
32:18
what we do and the business model. Because
32:21
at the end of the day, when we
32:22
can tie those two tightly together, we will
32:25
accelerate our progress.
32:27
And it's one of the reasons why Banner
32:29
is an extraordinary system is is that desire
32:32
to do both, to be compassionate and to
32:34
run-in a practical way, to be both, to
32:36
be very great with taking care of patients,
32:38
and to be at least cautious of where
32:40
the budgets lie and how things work and
32:42
and to tie those together.
32:44
Doctor Bessler?
32:45
Yeah. I'd say two themes throughout my career
32:47
that have been good guideposts for me. Number
32:51
one is very common one, but how culture
32:54
trumps strategy.
32:55
Right? And, like, if you and if you
32:58
can really get people to understand the why,
33:00
you know, that's a tremendous benefit. And the
33:03
second one,
33:04
I mean this very seriously, is, like, do
33:07
not make perfect the enemy of good. And
33:09
what I mean by that, especially with health
33:11
systems, is, you know, oftentimes when I have
33:13
the first conversation, people are worried
33:16
on the other side about, oh my gosh,
33:18
their hip surgery volume or spine surgery volume
33:21
is gonna drop. And I have to reassure
33:23
them,
33:24
what we're talking about is low value care.
33:27
We're talking about
33:29
people getting readmitted
33:31
for chronic conditions that are preventable.
33:34
Nobody wants those people admitted.
33:37
They clog up the system. The hospitals lose
33:40
money on them. It's not satisfying for anybody.
33:43
Like, we have so far to go before
33:45
we ever have an intervention
33:47
model
33:48
for complex spine surgery, right, in our in
33:51
our value based care journey. There's just tremendous
33:55
opportunity
33:56
where, you know, you can
33:58
really
33:59
deliver,
34:01
for our country, for our patients, for providers,
34:03
etcetera. And so I'm I'm quite optimistic about
34:06
our future.
34:07
No. And and I and I love that.
34:09
And anybody that's done anything for a long
34:11
time knows that perfection is the enemy of
34:13
the good. You wanna keep on getting better,
34:15
but but you have to get started. You
34:17
have to get moving. And and that kind
34:19
of
34:20
paralysis thinking, you know, by too much analysis,
34:22
too much aim for perfection doesn't work.
34:25
Doctor Bessler, Amy, I know I kept you
34:26
guys longer than expected.
34:29
Thank you so much for joining us. Amy
34:31
Pirie, CEO, president of Banner Health,
34:34
doctor Rob Bessler,
34:35
CEO of Honest Health. Thank you so much
34:37
for joining us today on the Beckers Health
34:39
Care podcast. We appreciate your time, and what
34:41
you're doing so much. Thank you very, very
34:43
much.
34:44
Thank you all. Have a great day. Thanks,
34:46
Scott. Thanks, Amy.