This episode seemed particularly relevant right now because it gives insight into how large self-insured employers are prioritizing their efforts to disrupt health care revenue streams that do not provide adequate health outcomes for dollars spent.
This episode’s conversation is with Lee Lewis. This is an encore episode. The original was recorded when Lee was the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as HTA. The HTA is a group of 50 major corporations that have come together in an alliance to do one thing: fix our broken health care system.
Anybody who knows Lee knows he knows a lot about how to improve health and health care benefits for large employers. The most amazing thing I always find about improving health and health care benefits is that it’s like having your cake and eating it, too. On one hand, both employer and employee save money. On the other hand, employees get better care and spend less time away from work struggling to navigate the health care jungle all by themselves.
Lee’s playbook consists of three chapters which we get into here. The first chapter covers the “how” of health benefits, including what Lee calls the “administrative superstructure.” The second chapter in Lee’s playbook is the “what,” which usually comprises drug spend and then, on the medical side, how care is delivered for specific clinical conditions like musculoskeletal, cardiometabolic, etc. There are a few conditions that tend to rack up the most costs categorically. The last chapter in Lee’s playbook is the “who,” meaning where employees are steered for care, especially in those high-cost areas.
If you’re looking for actual examples of forward-thinking employers doing some—or more than some—of the general categories of things that you’ll hear about in this health care podcast, let me drop a few names. Because they may not get as much credit as they often deserve, I wanted to highlight the amazing progress made by some state employee health plans. So let me spotlight the work being done in New Jersey, Connecticut, and Montana, led by Christin Deacon, Thomas Woodruff, and Marilyn Bartlett and their teams. So, to all of you and everyone else working on these endeavors, thank you very much for your service as both a taxpayer and also someone keenly interested in the other things that that money could be used for instead of low-value care like, for example, teachers and firefighters and students and everything else in the budget.
Finally, I just want to toss in a mention here of the upcoming Aspirational Healthcare Conference, which will be held on July 14 and 15, 2021 (virtually). Go to the Relentless Health Value Web site because I got you a promo code for free entry that you’ll find there. Lee Lewis, my guest today, is the keynote moderator for Day 1; and yours truly will step up to the microphone on Day 2. This conference will kind of be a who’s who of employer benefit design for the forward thinking looking to do the best they can for their employees at least, and it’s gonna highlight really the Aspirational Healthcare Systems like Southcentral Foundation’s Nuka System of Care in Alaska, for example.
You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn.
Lee Lewis serves as chief strategy officer and GM medical solutions for the Health Transformation Alliance. He leads efforts across over 50 large and jumbo employers and six million employees to save lives and save millions of dollars through improved health delivery, outcomes, and experience. Key initiatives in this role include new models of health benefits administration, curated provider steerage, and improved clinical delivery and outcomes.
He has advised health care strategy at Fortune 10 employers, insurance companies and administrators, medical associations, and the Departments of Justice and Labor. He incubated and helped form two dozen health benefit start-up companies and has been quoted and featured in Bloomberg and the Wall Street Journal.
Lewis is a founding, charter member of the Health Rosetta organization and is credited as a co-founder of the Health Value Exchange.
Before joining the HTA, Lewis was a consultant at Gallagher, where he founded Gallagher’s innovation lab and national jumbo employer practice. In 2019 he was recognized with the industry’s top honor as the Outstanding National Consultant for Large & Jumbo Employers Award by the independent Validation Institute. His consulting clients won Diamond Innovation Awards at the World Healthcare Congress, Innovation Awards from the Texas Business Groups on Health, Top 20 Innovator Awards from Healthcare Revolution Conference, and Financial Innovation and Large Group Management Innovation accolades from the Validation Institute.
Lee is a Rhodes Scholar nominee. He graduated second in his class, magna cum laude with university honors in accounting from Brigham Young University.
04:00 A playbook to reduce health care spend and achieve better outcomes.
04:08 The “how,” or “administrative superstructure.”
05:19 What Lee typically does when working with companies.
08:57 The “what” of delivery—connecting the “what” to the “clinical.”
10:52 Overseeing the pharmacy benefit manager (PBM).
12:37 EP241 with Vinay Patel.
12:50 Looking at the medical side of health.
15:46 Improving spend and improving quality simultaneously.
18:10 EP240 with Olivia Ross.
18:53 Why centers of excellence make sense.
21:54 The “who”—who is providing the care.
24:06 Enabling and empowering PCPs and improving PCP pay to compensate for that.
26:57 Lee’s advice for brokers.
28:02 Lee’s advice for provider organizations, hospitals, and centers of excellence.
29:07 “Hospital systems are not [a] monolith.”