Creating a value-based healthcare ecosystem with the highest quality outcomes at a reasonable cost for employers and their healthcare consumers requires collaboration. In the state of Connecticut, a grassroots community has formed with the mission to create a value-based healthcare ecosystem. The Moving to Value Alliance is a multi-stakeholder community composed of individuals, practices, and organizations deeply rooted in Connecticut’s healthcare environment. They believe that collaboration is the key to solving complex problems and are leading the way to transform healthcare delivery in their state.
Joining us this week are two leaders involved in this important movement to employer-based healthcare transformation in Connecticut. With more than 35 years in the health care sector, Jeff Hogan is a consultant to payers and large provider groups for product development and launch and a resource to employers desirous of implementing strategies to manage their health spend. Lisa Trumble is the President and CEO of the Southern New England Healthcare Organization (SoNE HEALTH), a clinically integrated network comprised of six hospitals and 1,700 physicians, which is a for-profit entity owned jointly by Trinity Health Of New England and its employed and independent physicians. In this episode, we talk about healthcare transformation in the state of Connecticut, vertical and horizontal consolidation in the industry, the dysfunctional health benefits market, the need for employer alliances, leading innovators in the marketplace, value-based insurance design, prescription drug costs, healthcare consumerism, and bundled payment innovation.
The time to move to value is now! We can create a transformed healthcare ecosystem through industry collaboration. Thank you, Lisa and Jeff, for showing us the way.
01:30 “Collaboration is the key to solving complex problems.”
01:45 The Moving to Value Alliance – a multi-stakeholder grassroots community creating a value-based healthcare ecosystem for employers in Connecticut
03:45 Eric reflects on his recent experience attending the MTVA 2022 Symposium
05:00 The leadership of Dr. Stephen Shutzer and other leaders
06:00 Referencing Michael Leavitt’s book, “Finding Allies, Building Alliances” where he talks about the power of collaboration networks
06:20 “Connecticut is known for being ground zero for most of the BUCA health plans and has also been the land of frozen molasses in value-based care.”
07:00 “Healthcare is opaque and balkanized, and COVID has inspired the opportunity to think about things differently.”
07:30 Transparency, Collaboration, Innovation, Consumer Expectations, and the “Great Resignation”
08:30 Lisa shares her background in value-based care transformation in Massachusetts and how that differs from Connecticut
09:30 “We must break away from the traditional structures of fee-for-service, and pursue clinical integration, innovation, alliances, and partnerships.”
10:00 A new wave of horizontal and vertical consolidation between hospitals and physician practices
12:00 The inevitability of consolidation after the pandemic and how consolidations have not resulted in cost and quality improvements.
12:30 The lack of value-based transformation strategy in health systems and why that is short-sighted
13:00 “The pandemic opened up the doors to innovation in a way that none of us anticipated in every sector of healthcare.”
13:40 Concerns about vertical integration of providers in consolidated payer-led structures
14:20 Lisa shares background on SoNE HEALTH (Southern New England Healthcare Organization) and how they partner with physicians.
15:20 Jeff describes how he has never seen so much change in healthcare in such a short period of time.
16:00 The movement to health equity as a result of consumer pressures, innovation, and market trends.
17:00 The hybridization of health systems, balancing in-person care with digital therapeutics, virtual care, home-based care, and other tech-enabled innovations.
17:30 Recent announcement from Mass General Hospital that they are doubling down on hospital at home care investments.
18:30 State of Connecticut employees have moved to value-based care models.
19:00 Variation in cost and quality data across hospitals across the US (referencing RAND study) and how consolidation leads to higher costs/lower quality
20:00 Commercial insurance costs have gone up 4X the rate of other benchmark goods and services!
21:00 Lisa describes the fallacy of the “free market” in employer-purchased healthcare and how it contributes to high costs and health disparities.
22:00 “If we truly believe in health equity, we need to look at our insurance market with employers.”
23:00 Direct-to-employer solutions in healthcare where providers and employers can drive value-based transformation.
24:00 Pay increases to employees occur when healthcare costs are lowered.
24:30 Jeff discusses the challenges with employer brokers and advisors due to their compensation model that favors more expensive healthcare.
26:30 Public disclosure of compensation with benefits brokers and risk-sharing arrangements between them and employers.
27:15 “The employer needs a truth source and agent that is on their side when purchasing benefits. That role has yet to be revealed in the marketplace.”
28:00 Coupling direct-to-employer contracting with benefits transparency
29:00 $1 billion in employer spend on healthcare in Connecticut
29:30 “Connecticut is dead last in primary care investment in the country.” (referencing PCC study)
31:00 “Legislators don’t understand the relationship between cost and quality in the provider supply chain.”
31:45 Bright Spots for Value in the State of Connecticut (e.g. SoNE, Optum)
32:30 Collaboration with Advanced Primary Care companies (e.g. Vera Whole Health)
33:00 Lisa provides her observations on the private equity landscape in Advanced Primary Care.
34:30 Virtual care can improve health equity as an extension of primary care.
35:00 How Lisa’s health system is partnering with advanced primary care groups in the marketplace.
35:45 The challenges of implementing virtual care capabilities in a health system.
36:30 Local partnerships in the marketplace are needed for long-term sustainability.
38:00 How are self-insured and fully insured employers coming together to build a Value Based Insurance Design (V-BID) consortium to address benefit design?
39:00 The leadership of Dr. Mark Fendrick in V-BID
40:00 Difficulties of employers and payers understanding value-based insurance design
41:00 Some Connecticut employer-sponsored health plans have annual premiums >$40,000 per family!
42:00 V-BID failed because there was not any “skin in the game.”
43:00 Variations in quality measurements for diabetes create variations in patient outcomes.
44:00 V-BID can only work with normalized quality measurement.
45:00 Lisa expresses her frustration with providers getting blamed for not moving to VBP when other system reforms are ignored.
46:00 For many employers, prescription drug spending can be as high as 30% or more!
47:00 Jeff discusses how Pharmacy has the highest trend factor of any other medical cost category
48:00 >50% of specialty pharmacy is on the medical side and doesn’t go through PBMs
48:30 Referencing the transparent PBM model of Capital Rx that uses deflationary fixed-pricing based on NADAC
49:30 CAA reporting requirements of PBMs will accelerate the business case for transparent PBMs
50:00 Site of service challenges in managing specialty pharmacy costs
51:00 How complexities of pharmacy reimbursement and variations in drug efficacy prevent real understanding of how to reform it
53:00 The rearchitecting of healthcare will need to be based on consumerism and digital transformation
54:30 How do you measure digital transformation?
55:30 Hospitals are seeing declines in patient volumes and why care needs to patient homes and communities.
57:00 The value of innovation and how it will drive care delivery transformation
58:00 Cancer is either #1 or #2 cost category for employers and ~73% of those diagnosed never get a second opinion!
59:00 Democratizing patient access to clinical care trials for treatment of cancer
60:00 The general distrust in government will necessitate that health transformation be driven at the local level.
61:00 Self-insured bundled payment programs being modeled after the CMS Bundled Payment for Care Improvement (BPCI) program
62:30 Lisa provides a comprehensive overview of Bundled Payment innovation for employers
64:30 Chronic care bundles do not have the same effect as surgical procedure bundles
65:45 Jeff on how employers choosing the right bundle can prevent them from hitting their stoploss corridor
68:20 Wildflower Health is managing maternity bundles
69:00 Lisa explains difficulties in administering bundled payments between providers and payers.
71:00 Parting thoughts (Lisa) – collaboration and community is the only way towards value and equity
72:00 Parting thoughts (Jeff) – the percent of GDP spent on healthcare will rob the future of our grandchildren if we do not align incentives and democratize access to primary care.