So, let me just cut to the chase here with very little preamble, and all of this is a setup to the interview that follows, although it is not really what the interview that follows is all about. A mentor of mine used to say, you can’t legislate the heart. Let me also suggest you can’t give someone in finance financial incentives and then expect them to not prioritize financial incentives.
It stands to reason that if the healthcare industry is found to be quite attractive to those who are money focused, then do I need to say this? The money focused amongst us will, of course, do the whatever to the extent that they can make money. They aren’t gonna be throwing their backs into quality or cost effectiveness or taking care of patients. They are throwing their backs into making money. Is anyone shocked?
You can read the full transcript over on the transcript page.
Now, don’t get me wrong; I’m not a Pollyanna. And in this country, in order to run a healthcare business, you have to make money; otherwise, you’ll go out of business. So, do well by doing good and all of that. But how much money is too much money? This is an important line to figure out because that’s where you are doing well but you’ve stopped doing good—you’ve tipped into financial toxicity. You are taking more than the good you are doing, and the net positive becomes a net negative.
But complicating fact of current life, it’s becoming increasingly obvious that in order to stand up a practice that can take advantage of value-based care payments—payments where primary care docs mainly at this time can get paid more and likely more fairly to care for patients well—you need a lot of infrastructure. You need data, you need tech, you need a team. Translation: You need money, maybe a lot of money, to invest in all of this. And let me ask you this: Who has a lot of money in this country?
Here’s the point of everything I just said: These are the external realities that hit anyone trying to do right by patients from every direction. But on the other hand (or maybe different fingers on the same hand), as Amy Scanlan, MD, says in this healthcare podcast, physicians are the backbone of this system. Dr. Scanlan talks in the interview today about the opportunity, and maybe the responsibility, that physicians have here for patients; but also the Eric Reinhart article comes up again about rampant physician moral injury (unpaywalled link with my compliments).
Right now might be a great time to read something from Denver Sallee, MD. He wrote to me the other day. He wrote, “Like many physicians, I did not have much understanding of the business side of medicine, as I mistakenly thought as long as I helped take great care of patients that I was doing my job. More recently, it became apparent to me that by ceding the management of medicine to nonclinical administrators and to companies interested primarily in value extraction for the benefit of shareholders that I needed more education in order to truly help patients.”
Today as aforementioned, I’m talking with Amy Scanlan, MD, who is chief medical officer of the clinically integrated network (CIN) that is the new joint venture between Intermountain Health and UCHealth in Colorado.
We talk about what it’s like to be in the kind of messy middle of transformation to integrated care in a clinically integrated network, trying to figure out how to help physician practices and the CIN itself navigate the external environment in a way that empowers different kinds of practices at different points in their transformation journey that empowers physicians to be in charge, and considering clinical and financial outcomes (ie, the business of healthcare).
Dr. Scanlan brings up four main factors to consider when plotting strategy from here to there:
1. Give practices the tools that they need to succeed—not what you think they need but what you’ve discerned they actually need because you’ve listened to them.
2. Many times, these tools will consist of some combination of data, tech, and also offering the team behind the scenes to help doctors and other clinicians help patients through what Dr. Scanlan calls the “in-between spaces”—the times between appointments.
3. Medical culture really has to change, and in two ways: doctors learning how to be part of and/or leading functional teams and building functional teams. Because there are teams, and then there are teams. Well-functioning teams can produce great results. Nonfunctioning teams, however, are, as Dr. Scanlan puts it, just a series of handoffs. And don’t forget, handoffs are the most dangerous times for patients. The DNA of team-based care—real team-based care—for better or worse, are the relationships between team members, between physicians who work together, between doctors and patients, between clinicians and clinicians. So, fostering relationships, creating opportunities to collaborate and talk, is not to be underestimated. How do you re-create the doctors’ lounge in 2023?
4. Getting out from underneath the long shadow of fee-for-service incentives, specifically the paradigm that only patients who get mindshare are the ones in the exam room. Value-based care, integrated care is as much contemplating the patients who don’t show up as the ones who do. This is a really big mind shift, much bigger than many realize.
You can learn more by reaching out to Dr. Scanlan on LinkedIn.
Amy Scanlan, MD, serves as chief medical officer for the new joint venture CIN between UCHealth and Intermountain Health—a physician-led, clinically integrated network of more than 700 primary care providers from UCHealth, Intermountain Health Peaks Region, the University of Colorado School of Medicine, and multiple independent practices along the Front Range.
Dr. Scanlan trained as a family practice physician and has continued to practice for the past 25 years. She has worked as a physician-owner in a small independent practice and has held multiple leadership positions as part of large health systems. She has served on numerous health system committees spanning quality, innovation, recruitment, and credentialing. She is very familiar with value-based care models, having been part of an accountable care organization (ACO) practice for the past 15 years, as well as participating on an ACO Practice Performance and Standards Committee and serving on a local ACO board.
She received a bachelor’s degree with honors from Wesleyan University in Connecticut. She obtained her medical degree from Case Western Reserve University in Cleveland, where she received the Kiwala Award for Research in Family Medicine. Her residency was completed at St. Anthony’s Family Medicine Residency program in Denver. She is currently board certified by the American Board of Family Medicine and NCQA (National Committee for Quality Assurance) certified in diabetes.
06:33 How is Dr. Scanlan thinking about the transformation process and the shift to value?
09:14 “It is really trying to think about, how do we help practices get there?”
11:46 “The hard part is the in-between spaces.”
14:10 “Team-based care done badly is really just a series of handoffs.”
15:50 “We have to get to that point where the culture of collaboration is more pervasive.”
19:57 “How do we as healthcare providers step in and solve this problem?”
20:04 Why do providers have a responsibility to step in and try to fix the healthcare system?
20:20 Article (unpaywalled) by Eric Reinhart, MD, PhD.
21:50 Why do physicians need to be accountable for the cost of care as well as outcomes?
23:37 Why does physician burnout give Dr. Scanlan hope?
24:25 What is the solution to changing fee-for-service incentives?
25:42 What are some of the challenges facing changing incentives?
27:14 Why is data so important?
28:53 EP393 with David Muhlestein, PhD, JD.
30:11 “It’s important to understand that we are in the middle of this change.”
31:16 Dr. Scanlan’s advice for those trying to stand up a CIN.
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber