clinicallyintegratednetwork

Here’s a quote from Rolling Stone magazine: “A supergroup is a very fragile thing. Rock bands are always about balancing huge egos, but when those egos are oversized from the get-go it can lead to huge problems. That’s why supergroups like Blind Faith often fail to go beyond a single album, and why long-lasting ones like CSNY had drama that never seemed to end.”

Hmmm … that’s apropos because, turns out, super ACOs (accountable care organizations) may have some similar issues. A super ACO means multiple ACOs or CINs (clinically integrated networks) which are each comprised of multiple practices or provider organizations, and it’s all under different ownership. Said another way, there are multiple levels of competitors—frenemies, if you will—trying to work together or not work together as the case may be. There’s a lot of infrastructure complexity and process complexity and, frankly, inefficiency. There’s trust issues. There’s the problem that rule #1 of change management is to create “quick wins” so that everyone can smell potential success and realize it’s possible, so momentum happens. But if doing anything is hyper-complicated, then it’s really tough to have a quick win.

Today in this summer short, this is what I am chatting about with Eric Gallagher. We talk about how Ochsner evolved from a super ACO or super CIN into its current form. This summer short is a 13-minute clip that went a little far afield from the main topic of episode 405, which was the full episode with Eric Gallagher, and therefore, I cut it. But as I always do when I cut an actually pretty great section from a show for reasons of time, I have been on the edge of my seat to share it with you.

This show is actually a very nice follow-on to the one with Dan Serrano (EP410) from last week. As Eric describes Ochsner’s history and its path forward, it is a case study of some of the recommendations that Dan mentioned. This summer short also really echoes some of the themes in episode 409, which was the one with Larry Bauer, and also one upcoming with Jodilyn Owen. What will work in one local market, don’t count on it working elsewhere—or not work as well at a minimum. Healthcare is local. This is a lesson many investors and entrepreneurs looking for rapid scaling prototypes have learned the hard way, and listening to Eric, it’s really easy to catch the why for that.

If this topic intrigues you, also listen to the show with Dr. Amy Scanlan (EP402). Also episode 349 with Lisa Trumble. And lastly, I would recommend the show with David Carmouche, MD (EP343). Dr. Carmouche was talking about Ochsner’s work improving patient outcomes with a Medicare Advantage plan.

One final note/point to ponder: scale. To really get value-based contracts, you need it. You need it to afford the infrastructure, and you need it to demand a seat at the table. But yeah with that … everything in moderation, I guess, because any scale that starts to approach monopoly proportions seems to invite bad behavior. You have to get big enough to matter in the market but not so big that your big footprint squashes market dynamics, because it seems like many succumb to the siren song at that point of putting profits over patients.

 

You can learn more at Ochsner Health Network.

Eric Gallagher, chief executive officer for Ochsner Health Network (OHN), is responsible for directing network and population health strategy and operations, including oversight of performance management operations, population health and care management programs, value-based analytics, OHN network development and administration, strategic program management, and marketing and communications.

Prior to joining Ochsner in 2016, Eric held leadership positions in healthcare strategy and execution—including roles at Accenture, Tulane University Health System, and Vanderbilt University and Medical Center.

A New Orleans native, Eric earned a bachelor’s degree in human and organizational development from Vanderbilt University and an MBA from Tulane University.

 

04:23 How Ochsner Health went from a super ACO to their current value-based care model.

06:09 What signs did Ochsner Health see that helped them recognize that the clinically integrated networks they were building wouldn’t help them achieve the outcomes goals they were aiming for?

07:42 Why Ochsner Health’s story is a classic example of change management.

08:41 What tough decision did Ochsner Health have to make that’s ultimately led to much higher success rates?

10:46 “Really … it’s about changing the economic model.”

11:03 Why was CMS a driver of change?

13:00 What’s the more sustainable business model in Ochsner Health’s market?

15:09 How has Ochsner Health been ahead of the game in the healthcare market?

 

You can learn more at Ochsner Health Network.

 

Eric Gallagher of @OchsnerHealth discusses #valuebasedcare and #superACOs on our #healthcarepodcast. #healthcare #podcast

 

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Dan Serrano, Larry Bauer, Dr Vivek Garg (Summer Shorts 3), Dr Scott Conard (Summer Shorts 2), Brennan Bilberry (Summer Shorts 1), Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela

 

This interview with Lisa Trumble is mostly about clinically integrated networks (CINs)—what they are, how they work, how data get shared. Furthermore, we talk about hybrid CINs, meaning, for example, a virtual front door that might lead to in-person care. After that, we talk about the potential impact of direct contracting, which Lisa says could significantly change the healthcare marketplace. The hybrid talk, by the way, is toward the middle of the show; and we talk about direct contracting—that’s near the end if you’re short on time and you want to skip around.

But before we go there, let’s just level set a little bit, shall we, on the topics of accountability and integration as general constructs. Specifically, what’s the impact, or lack thereof at times, when the provider is not accountable for patient results? I’m talking here about fee for service, in general, where the provider is not accountable for patient results.

Like, if we’re talking about a fee-for-service world and what it incents, it goes like this: Transaction happens. Somebody sends a bill. The end.

I mean, in a fee-for-service world, the patient encounter may be the highest- or the lowest-value patient-doctor transaction in the history of humankind; but either way, the payment is the same. So, the incentive is to figure out how to encounter lots of patients and/or upcode wildly, I guess. The incentive is not to coordinate care or teach a patient how to take advantage of a telehealth offering to mitigate some social determinant of health or spend 10 minutes doing some education or shared decision making or establishing rapport and being culturally sensitive. Any docs who are doing that stuff are doing it on their own time in an FFS world.

Here’s the good news and the bad news—and I don’t often hear it spelled out this bluntly, so I’ll do the honors: If anyone wants to get paid to create patient health, they have to be accountable for the outcomes created—upside and downside. Frankly, when an organization is super worried about the downside, that could be—not in all cases, but it certainly could be—a clue that maybe their approach is a little bit more transactional and/or inefficient than perhaps they would like to admit.

There’s been much talk over the years about the importance of giving patients so-called “skin in the game,” but what might work out better is to mandate that providers have so-called skin in the game. Providers have to be accountable so good providers can reap rewards and bad ones don’t. The episode with Sunita Desai (EP334) is all about how providers have proven to actually be better “consumers” than “consumers,” so there could be a constellation of rationales here.  

Now, if you’re accountable for care, you must actually create outcomes, as just discussed. And to actually create outcomes, there must be integration. Integration is necessary. Care coordination is necessary both with internal and external other providers and entities. There are very, very few cases where a chronic condition can be appreciably improved by a random assortment of 7- to 15-minute patient encounters. Managing chronic conditions requires a longitudinal journey that weaves together most often more than one doctor, also nurses and a PA and a speech pathologist and a nutritionist and a Certified Diabetes Educator and maybe a physical therapist or two. Considering that 85% of healthcare spend in this country has to do with chronic conditions also ... yeah, integration is really required. And, yeah, how many decades later, we’re still talking about interoperability.

Here’s a tidbit I found kinda apropos: Female doctors make $2 million less, apparently, over a 40-year career than their male counterparts. That’s per research in Health Affairs, recently reported in the New York Times. More men become surgeons, and women have been shown to spend more time with their patients, leading to fewer services that can be billed for.  

What’s the actionable takeaway there, I wonder?

In this healthcare podcast, I have the honor and pleasure of speaking with Lisa Trumble. Lisa is president and CEO of a CIN, a clinically integrated network, called the Southern New England Healthcare Organization, or SoNE. SoNE was formed in January 2020 to integrate three ACOs [accountable care organizations] in two states. The CIN manages a population of over 200,000 patients—about $1.5 billion in total costs of care. Previously, she worked at Cambridge Health Alliance building their pop health and value-based structure to the point where about 60% of their business was in some form of risk or alternative payment models.

There is one disclaimer that I would just ask you to keep in mind when listening to any conversation about value-based care—and there are lots of them going on right now—but I just want to tuck this in here because I’d be remiss not to mention it at some point. Dr. Mai Pham (EP325) has put this better than I ever would. She said recently, “After a decade of value-based payment contract negotiations in both public and private sectors, I would like to point out that [health systems] can talk a good value game, but if their ... organizations push for ever-higher unit prices, the word value is meaningless. I’ve seen trends in unit prices for a given health system outstrip the legitimate savings it produces by reducing volume, which was the plan all along.” Dr. Pham is currently writing a piece about this exact topic that’s going to appear in AJMC soon, so definitely look out for that.  

You can learn more at sonehealthcare.com.  

Lisa M. Trumble, MBA, president and CEO of SoNE HEALTH, has had a career showcased by successes in generating strong clinical and financial operating results for healthcare organizations. She has 30+ years’ experience at integrated delivery systems and physician organizations. Prior to joining SoNE HEALTH, Lisa served as senior vice president of accountable care at Cambridge Health Alliance (CHA); the scope of her responsibility included systemwide duties for accountable care and population health management, incorporating payer contracting, financial medical economics, regulatory compliance, and administrative and clinical programming. Under her leadership, the organization realized significant improvements in clinical and financial outcomes.

Lisa joined CHA from Berkshire Health Systems, where she served as vice president of physician services and executive director of the Berkshire Health Systems Physicians Organization. She was instrumental in transforming physician operation, restructuring provider employment agreements and provider compensation plans, and enhancing patient satisfaction. Prior to Berkshire Health Systems, she served as the vice president of finance and operations at the Cambridge Health Alliance Physician Organization, where she achieved similar outcomes.

Previously, Lisa was administrative director for anesthesia and surgery services lines at North Shore Medical Center and chief financial officer of North Shore’s Physicians Organization, a subsidiary of North Shore Medical Center. Additionally, she held positions in operations and finance at Commonwealth Health Management Service and Independent Physicians Association. Lisa holds a bachelor’s degree in business administration from North Adams State College and a master’s degree in business administration and healthcare finance from Western New England University.

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06:20 Why do accountability and integration go hand in hand?
08:56 “Aggregation just for the point of aggregation doesn’t necessarily produce better outcomes.”
09:18 What questions should we be asking when considering aggregation?
09:45 Does aggregation equal integration?
11:42 What exactly is a clinically integrated network?
12:26 What is the intention of a clinically integrated network?
13:22 Are all CINs ACOs? Are all ACOs CINs?
17:22 What entities make up a clinically integrated network?
19:26 “We want providers that are able to generate the outcomes that we’re expecting.”
20:44 “There is a lot of work that goes into data integration.”
23:14 What is a hybrid CIN model?
25:22 Encore! EP206 with Ashok Subramanian.
26:53 “Everyone is sitting around the table proactively.”—Stacey
29:37 What kind of structure could move the Medicare market quickly?

You can learn more at sonehealthcare.com.  

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Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Why do accountability and integration go hand in hand? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

“Aggregation just for the point of aggregation doesn’t necessarily produce better outcomes.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What questions should we be asking when considering aggregation? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Does aggregation equal integration? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What exactly is a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What is the intention of a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Are all CINs ACOs? Are all ACOs CINs? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What entities make up a clinically integrated network? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

“We want providers that are able to generate the outcomes that we’re expecting.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

“There is a lot of work that goes into data integration.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What is a hybrid CIN model? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

“Everyone is sitting around the table proactively.” Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

What kind of structure could move the Medicare market quickly? Lisa Trumble discusses #ClinicallyIntegratedNetworks on our #healthcare #podcast. #healthcarepodcast #digitalhealth #CIN

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera