If you listened to the show with Dan O’Neill (EP359), you would know this already. But let me tell you: If you’re a provider, even a provider very confident in your office’s ability to confer better patient health, you will still have a super hard time getting off the fee-for-service (FFS) hamster wheel.
Why? Because it’s hard to find payer contracts out there which will reward you (the provider) for actually taking care of your patients and to be accountable for the value of healthcare that you deliver. This is a tangled web we weave because, despite some payers offering risk-based contracts, a lot of times there’s some IPA (independent physician association) or other “holder of the actual payer contract” who does not pass along these contract terms. These IPAs or health systems even sometimes just keep paying docs or provider offices FFS even if they themselves have a risk-based or capitated or value-based-of-any-kind agreement.
If I actually kept track of the issues raised in the emails I receive from docs, there’s one thing that I would likely find amongst the most frequently cited points of consternation: Physicians or practices or CINs (clinically integrated networks) or ACOs (accountable care organizations) want contracts where they can do right by patients. These are the good docs. These are the ones burned out and suffering from moral injury because physicians, PAs (physician assistants), nurses, clinicians who actually follow up and coordinate care and spend time making accurate diagnoses instead of cramming in more procedures … these are the clinicians who want to do the right thing and are also the ones who are getting dinged on performance reports and paid less.
Bottom line here, for a physician practice to transform itself from an FFS machine cranking out volume but not necessarily health or care, the office has to have a high enough percentage of their patients in value-based arrangements to make it actually feasible to transform. It is only when they hit a tipping point of enough volume, enough patients in risk-based contracts that they can afford to be accountable for their results. At that point, yeah, everybody wins—doctors, patients, actually the entire community wins because when a local practice transforms, all of their patients tend to benefit at some level from the new processes and procedures and standardizations and pop health systems that get put in place.
So, let’s move forward with this with all haste, shall we? Why aren’t we? What’s the problem here? Well, there are lots of problems, don’t get me wrong. But a big one is self-insured employers on the whole are not offering any sort of accountable care arrangements to the providers in their community. This is 150 million patient lives we’re talking about here—a huge chunk of many providers’ patient panels. Self-insured employers have a really big opportunity to level up the care in their whole community due to the spillover effect when a provider practice transforms itself because it has enough patients to do so.
But these employers are stuck. They are paralyzed. They are doing the same thing this year that they’ve done last year, and therefore their whole community is equally stuck in a smorgasbord of suboptimal FFS goings-on.
So, offering accountable care contracts is one thing (a very big consequential thing) that is also one of the five things self-insured employers can do to improve employee health that I talk about in this healthcare podcast with Dan Mendelson. Dan Mendelson, my guest today, also wrote a Forbes article listing out these five things. Here are all five things that Dan mentions in one handy list:
Expand availability of accountable care models to improve the care experience, quality, and affordability at a local level. For a deep dive on this, listen to the show with Dave Chase (EP374).
Invest in the data access needed to assess health outcomes. For a deep dive on this, listen to the show with Cora Opsahl (EP372).
Align employees’ health benefits with pop health outcomes. For a deep dive on this, listen to the show with Mark Fendrick, MD (Encore! EP308).
Prioritize care models that can meet employees wherever they are. For a deep dive on the DEI (diversity, equity, and inclusion) aspect of this, listen to the show with Monica Lypson, MD, MHPE (EP322).
Make care navigation a central part of the benefits package and experience. I am looking for an expert to take a deep dive on care navigation who does not work for a care navigation company. Hit me up if you know someone (again, who does not work for a care navigation company).
My guest today, Dan Mendelson, is CEO of Morgan Health at JPMorgan Chase. He previously founded Avalere Health. Before that, Dan served as associate director for health at the Office of Management and Budget.
Besides exploring the why and the what for each of the five things employers should do right now, I also wanted to find out from Dan what’s going on at Morgan Health and how they are looking to help self-insured employers who want to do these five things actually do them.
You can learn more at the Morgan Health Web site.
Dan Mendelson is the chief executive officer of Morgan Health at JPMorgan Chase & Co. He oversees a business unit at JPMorgan Chase focused on accelerating the delivery of new care models that improve the quality, equity, and affordability of employer-sponsored healthcare.
Mendelson was previously founder and CEO of Avalere Health, a healthcare advisory company based in Washington, DC. He also served as operating partner at Welsh Carson, a private equity firm.
Before founding Avalere, Mendelson served as associate director for health at the Office of Management and Budget in the Clinton White House.
Mendelson currently serves on the boards of Vera Whole Health and Champions Oncology (CSBR). He is also an adjunct professor at the Georgetown University McDonough School of Business. He previously served on the boards of Coventry Healthcare, HMS Holdings, Pharmerica, Partners in Primary Care, Centrexion, and Audacious Inquiry.
Mendelson holds a Bachelor of Arts degree from Oberlin College and a Master of Public Policy (MPP) from the Kennedy School of Government at Harvard University.
05:53 Why did Dan direct his article about health benefits at CEOs?
06:56 What does an accountable care model mean to a self-insured employer?
08:50 “This alignment of value will never work … if the 150 million Americans … getting their health insurance through their employer are not also aligned in the same way.”
12:21 “We’re offering them a higher level of service.”
12:32 “Everything that we do is intended to be scalable and not just for us.”
13:01 “We have an obligation to do better for our employees.”
15:44 “Employers need to understand, the only way to get outstanding care is locally.”
18:21 Encore! EP206 with Ashok Subramanian and EP358 with Wayne Jenkins, MD.
19:10 Why is getting quantitative metric data important?
19:42 Encore! EP308 with Mark Fendrick, MD.
21:50 “This is a much broader vision of accountable care than … primary care.”
23:41 “Until everything is aligned, the employer is just not going to be providing an optimal product.”
24:32 “There are substantial issues with … health equity, and employers are paying for the care of 150 million Americans in this country.”
26:15 Is digital health access important for creating meaningful relationships between patients and providers?
30:43 What is the myth that employers need to tackle?
31:10 Why is care navigation important for employees?
32:37 EP334 with Sunita Desai, PhD.
You can learn more at the Morgan Health Web site.
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Wendell Potter, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein