EP405: What Else Physicians Trying to Clinically Integrate in the Real World Really Need to Know, With Eric Gallagher

Let’s cut to the chase. You’ve gotten to the point where you have a gang of physicians/clinicians/physician practices who have expressed a desire to work together. What do you need to know right now?

Eric Gallagher, CEO of the Ochsner Health Network, is my guest in this healthcare podcast; and I largely asked him the same question that I had asked Amy Scanlan, MD, from the UCHealth/Intermountain clinically integrated network in Colorado in episode 402 a couple of weeks ago. The question I asked both Eric and Dr. Scanlan is: What are you doing to help align physician practices into an integrated model? How are you going about that?

Now, let me remind you, Ochsner Health Network is practically long in the tooth when it comes to clinically integrated networks; and it also exists in an environment that is unique, as are most local markets. But Ochsner’s local market is mostly Louisiana, which has an older population and a huge Medicare Advantage penetration. That is quite a different local market from what’s going on in Colorado, which is the location of Dr. Scanlan’s joint. As we all know, different stages of any journey require different solution sets; and different local markets certainly require different solution sets.

But what was so interesting to me was to notice that despite the market differences and the where-are-we-in-the-transformation-journey differences, how many of the things that you’ll hear about in this episode are in the same spirit as the stuff that we talked about in that earlier show with Dr. Scanlan.

Eric Gallagher lists three things that he says are essential in the transformation journey:

1. Making sure that physicians, care teams, and those working directly with patients are part of the transformation process, both from a practice standpoint but then also from a financial standpoint.

This makes so much sense when I state it explicitly here, but so frequently, it doesn’t happen. So frequently there’s a value-based care team that tinkers around in a silo and then an announcement comes over the loudspeaker one day that henceforth we shall add some more clicks … but trust us, it’s important for some reason we aren’t going to bother to tell you about … you’d be bored by it or you wouldn’t understand it. Even if this was not the intention (and it probably wasn’t), the result is going to be the bad taste in your mouth that I just left you with.

Eric Gallagher’s #1 here, that everybody be part of the transformation, might be the umbrella really over the first thing that Dr. Scanlan talked about in that earlier episode, which was to make sure to 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. It’s a bidirectional exchange here with everybody working together.

Eric adds some new ground to that. He says that to make sure that everybody can productively contribute to this transformation process (and probably know what tools they may need), it’s vital that everybody understands the “why” behind what the organization needs to do, meaning educating physicians and other clinicians in the business of medicine and the financial reasons for the “why” with the whatever. Insulating docs from the real world here helps no one, and it’s not really viable actually in the world that we live in today …

… which is a callback to the point that Denver Sallee, MD, made also in episode 402, which, in a nutshell, was that he thinks that unless docs, as a gang, start learning a lot more about the business of medicine, that we’ll continue to see this value extraction and financial toxicity and moral injury–inducing environments that we see right now. Dr. Sallee wrote, “I needed more education in order to truly help patients.”

So, let me posit that this “everybody works together and gets educated together” step can help the practice and help patients in a myriad of ways, both at the practice level and at the patient level and also probably at a national level.

2. A recognition that practice transformation requires process transformation and thinking about things very differently. Now, all of a sudden, we are getting paid to coordinate care. We must work as a team because there are people on staff who can influence social determinants of health, for example. We have a vested interest to create a community board advocating for food banks and sidewalks and air pollution controls so all the kids who play soccer don’t wind up with asthma. Ochsner actually set up a school because they realized educated communities are healthier communities.

Dr. Scanlan’s clinically integrated network? They’re much earlier in the journey. They’re at the point where they’re working hard to get participating practices the tools that they need to succeed and help doctors and other clinicians help patients through what Dr. Scanlan calls the “in-between spaces”—the times between appointments.

But all of this really rolls up to the point that Eric Gallagher is making about everybody working together and recognizing that practice transformation requires process transformation.

3. The culture change that’s necessary among physicians and other clinicians (pretty much everybody), and Dr. Amy Scanlan leaned into this one, too—hard. Both brought up the same nemesis: inertia. And the requirement to change culture can’t be underestimated, and the change management that’s required here cannot be phoned in. Culture eats strategy for breakfast, lunch, and dinner, as they say.

My two macro-level takeaways after talking with Eric Gallagher today and Dr. Amy Scanlan earlier are that, even though the local market and the nuances of any given particular practice have such a huge impact on what’s going to work at an operational and tactical level, if we stay up in the strategic zone, there’s some best practices and points to ponder which are likely possible to universalize.

Now, emphasis on the “stay up in the strategic zone.” I was just talking to another person today with yet one more story amounting to “it didn’t work because it never was going to work,” wherein, in this case, apparently a very large payer is running around attempting to do a pilot in an attempt to learn exactly and specifically how to operationalize something, and then their plan is to roll out this one model nationwide. So, something works in one local market at one practice, and we’re just gonna assume if it worked there, it’s gonna work everywhere. And, yeah … good luck with that.

After you listen to this show, listen to episode 402 with Amy Scanlan, MD, as I have mentioned multiple times. Episode 343 and episode 316 with David Carmouche, MD, would be good to check out. Also episode 393 with David Muhlestein, PhD, JD, and episode 394 with Vikas Saini, MD, and Judith Garber, MPP.

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.

08:14 What does everyone need to be on the same page about when it comes to clinical integration?

13:42 “For physicians, we really have to overcome this threat to physician autonomy.”

16:52 “Health inequity is really just societal inequity.”

19:24 What is the principal agent problem?

20:00 “There are things health systems can do that are probably outside of their traditional field of responsibility.”

20:09 Why did Ochsner Health Network start a couple of schools?

20:42 What can empower a care team in a value-based care model?

21:53 Why is it important to transform into a team-based model?

23:24 “In the DNA of our organization, resiliency runs strong.”

26:01 Why is building an effective care model easier than building trust with patients?

26:14 What is Eric’s advice to physicians trying to integrate right now?

28:50 How do you get everyone on the same side of aligning for integration?

You can learn more at Ochsner Health Network.

Recent past interviews:

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Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde