These are the topics discussed on May 15th. We hope these can help you and your teams as you make decisions moving ahead.
This past week’s session provided a refreshing look at the future of healthcare in our country and why it matters in the midst of this pandemic. This shareout captures the themes from our Q+A session with Intermountain Healthcare CEO Marc Harrison.
Takeaways from Q+A with Marc Harrison of Intermountain Healthcare
Marc spent over 40 minutes with us last week discussing a number of topics related to the COVID-19 pandemic and what it is revealing for business leaders. We saw five compelling themes in his message worth your consideration as you navigate your planning needs. Each of the five is our perspective on what Marc shared, and each is followed by specific quotes from Marc during the session.
1. COVID-19 Has Demonstrated “Heads in Beds” Volumetric Model for Healthcare is Wrong
The healthcare industry in the US is too much of the GDP. It has too long been too much about making money instead of keeping people healthy. As health systems have shifted resources to prepare for and deal with COVID-19, they have lost money and let go over 1.4 million healthcare workers. The model is reliant upon fee-for-service and is failing miserably when the services with the highest fees and margins are not able to be performed.
Most healthcare leaders today simply do not know what to do for a different model. There is a lack of business experience and creativity in finding partnership solutions within communities and across sectors that keeps the focus on health instead of on making money on acute care.
Business leaders are impacted by the current model in the costs of care and the opportunity cost from unhealthy and unhappy employees.
Healthcare is 18% to 19% of the GDP and should be more like 7-8%.
I got in a lot of trouble back at JP Morgan in January when I gave a little talk and I pointed everyone in the room and I said, “You guys are the problem.” You’re the reason why the number one cause of bankruptcy in the United States is healthcare.
We are fat and historically it’s been too easy to make money doing the wrong thing.
The number one risk factor for having spine surgery in the United States, and this is old data, but it’s still true, is the number of spine surgeons in your community. So you can perfectly map the likelihood that you’re going to end up on an operating room table for spine surgery based on the number of spine surgeons in your community. That tells you that there’s something fundamentally wrong with how important resources are getting distributed. And Intermountain, we’ve never liked that kind of stuff. And as a payer provider, it’s to our advantage to make sure that people get exactly the right care, as intense as they need to at exactly the right time, but no more than they need.
In general, my peers and I are not the very best business leaders in the United States. And I don’t see enormous creativity in how healthcare systems are getting run. And I think maybe our biggest stumbling block is the skill of the executive teams who are running these systems and the boards of trustees, particularly, for the not-for-profit systems that have actually never challenged those leadership teams to take cost out and make care more affordable. People just don’t know what to do. That means, all they know how to do is put heads in beds.
2. Human and Community Centric Health is Future
A value-based model putting human and community health as the priority and aligning the financial incentive to that outcome is the future.
As this pandemic unfolded in Utah, Intermountain Healthcare had already shifted more than half its revenue to value-based contracts – they receive a fixed amount of money per year to keep someone healthy, they do not receive a fee based upon the procedure performed, etc. Intermountain had also already initiated community partnerships that were immediately activated for COVID-19 needs to help with the community. Utah has responded well to the pandemic. Incredibly, Intermountain has not laid off a single employee, nor have they furloughed anyone, nor have they reduced anyone’s salary. These provide evidence this model works.
For about half of our business, so about $4 billion to $5 billion a year, we’re paid to keep you well. So we get a chunk of money every month and our job is to keep you happy and healthy and out of the hospital, hopefully, and if heaven forbid you need something big done, we’re going to do it really, really well and very efficiently. And if there’s a little bit of money left over, then we go ahead and plough it back into the organization as a whole. If there isn’t, then we’ve got to find it somewhere else. And it’s a fundamentally different way of looking at healthcare.
Half of our business is based on heads and beds, still on volume, but that gets smaller every month, I hope. And we do well when people stay well, which is actually a very healthy way of doing things.
It’s all based on keeping people well. So we’re pretty much the only system in the United States that day after day, we try and live these values. Now there are a lot of risks associated with that, and that’s okay, but right now these investments are looking like they’re pretty much the right thing to do. And our neighbors can see us doing that and they trust you for it.
3. Human-Centric Means Truly Focusing on People
No matter the sector, focusing on people can’t be faked, and when it is authentically done in a consistent manner it yields trust. It requires transparency, leveraging digital solutions, listening and empathy. The priority must be the human need to inform and execute on a model that resonates with the people it is intended to serve. And this requires leadership that acknowledges the everyday realities we all face and treat each other differently with that awareness.
In healthcare this means changed practices. It also means a shift away from an attitude that the patient is “lucky to see me” to the reverse; the provider is privileged to serve the patient and their family. This approach requires a different set of solutions to go beyond physical health to emotional and mental well-being by reaching out to the root cause issues and not addressing the symptoms alone.
For Intermountain during this crisis it has meant answering the difficult question of how we keep every patient as safe as possible and then having the commitment to follow through and execute on that plan. Across every sector, this same question would serve us well as applied to our staff and our customer given the needs they face.
Healthcare is… look you guys know this better than I do, we’re a very arrogant industry. So I’m a pediatric intensivist and sort of deep down in my soul for a long time, I believe people were just really lucky to see me. They were really lucky to have me show up at their kid’s bedside in ICU and take good care of them. And I think that what has changed is I think we should feel lucky to take care of those people, and we should know that.
So whether it’s Telehealth or whether it’s transparency, whether it’s affordability, whether digital front doors and platform-style companies, we need to know that the move away from very traditional healthcare is done. The move has been made, that the genetic code has been changed, now who wins? And hopefully the people who win are the members and the patients and our community members.
This [crisis] has only made [mental health] worse. I think a lot of folks, the adrenaline surge will get them through. And I think that we’re starting to see all the things that you describe. What we know is that the historic approach to behavioral health is just not going to work. We cannot hire enough psychiatrists, psychologists, social workers, et cetera. And actually we really believe that mountains beyond mountains approach to community health workers around behavioral health is actually what it’s going to take to keep our population well.
What I’m hearing or reading is about one out of every four folks who is experiencing what we’re experiencing right now is having a significant behavioral health issue of some sort or another. And as a guy whose kids are in their twenties, I can only imagine what it’s like being… What if you have no resources? What if you don’t have enough money for your next meal? You’re stuck in a house with six little kids running around. I have no idea how people survive this. I mean, this has got be incredibly dangerous, both for the kids, but also for the grownups as well. So I think it’s going to take a different approach. It’s going to be avatars. It’s going to be online. It’s going to be digital. It’s going to be community health workers. It’s not going to be the same old stuff because we can’t afford it. We can’t hire those people.
[ASKED ABOUT DEALING WITH CANCER WHILE ALSO DEALING WITH THIS CRISIS] Everybody is dealing with something. We’re not special at our house, really. Whether it’s marital problems or financial problems or health problems or a kid who’s unwell, I think, all of us who are grown-ups recognize that every other grown-up has something big going on in their life, and it feels big to them. So there’s nothing special about me in this regard. I will say that, probably the thing that is the biggest for me is to recognize that I never worried about losing my job because I was sick. I never worried about losing our house because I was sick.
We’re really pretty fortunate, and that’s not true for most Americans. And it really has put a fine point on things for me to recognize that there’s some stuff that’s really pretty fundamentally wrong about how we’re delivering health to people, and I’ve gotten to see it up close and personal. The only other thing I’ll say that’s really been…
I had a bit of a hospitalization recently getting some stuff squared away. And with the COVID-19 things going on, there were some visitor restrictions which my wife and I complied with, we’re trying and be good citizens, but boy, some of this stuff is lonely and alienating. And I think that making right biomedical decisions is very important, but I think making good human decisions is really important too. So even for a guy who runs a health system or as an ICU doctor like me, trying to make sure that we never ever forget about the people’s stuff, what is somebody going to tell their family at Thanksgiving dinner? That’s really important.
4. Pandemic Can Drive Meaningful Change in Workplace and Employer Responsibility
The current crisis drives home the necessity of looking differently at how employers provide healthcare for its staff. The value-based contracts that have seemed too risky are now more obviously needed at a time when keeping your staff healthy and happy are paramount. Business leaders should explore this approach to pay a healthy system to keep their people healthy.
This crisis has also stirred the very good intentions of most people to be concerned about others and do all they can to help. At a time of division and lack of civility in our public discourse, this presents business leaders a moment in time to inspire and enable and even facilitate efforts to help others do good. Intermountain was able to send 100 doctors to NYC; they had 700 sign up to fill those 100 positions. They were also able to channel an effort of 10,000 volunteers in Utah to make 5 million masks in just one week. Now is the time to lead these efforts with your people.
The remote workplace is even possible within healthcare – they were able to move from 1,000 working remotely to 10,000 in two weeks. And it is opening new opportunities to keep people employed with needs that emerge.
Crisis also yields innovation in how an employer takes on a responsibility to help keep people employed during and beyond this pandemic. The private sector should not wait for government solutions; rather, business should find new ways to cross-train and employee people. Intermountain is rolling out a new approach to commit to 5 years of employment as long as each staff commits to cross-training in three other jobs. Solutions are there when the responsibility and commitment is real.
In a fully employed economy where everyone’s really worried about losing every worker, your HR functions didn’t want to take any kinds of risks at all, that would unsettle your workers, that would have you lose people from your organization to somewhere else. That fear has gone now, folks. Now it’s time to actually figure out how to keep these people well and fully engaged and productive. And I think it’s going to be a very exciting time in healthcare.
Employers should be asking, “How do I go ahead and get a package for my employees so that I pay X amount of money and it keeps them well?” And if it doesn’t work out, then that’s on the payer and the provider to figure out how to make it, make that change happen.
I think the trust piece, a lot of it’s going to revolve around employment, to be honest. So I think this is going to be the interplay between keeping people well, but also keeping them gainfully employed.
We are the largest employer in the state, private employer by almost 2X. We feel that every day. And then you say to yourself, “Okay, so we’re facing potentially great depression levels of unemployment. How do I keep these folks fully engaged in Intermountain’s mission to keep people well, so that they can worry about lots and lots of other things, but they don’t have to worry about whether they can feed their family or not.”
And so I think that we’re going to have to change our value proposition to those workers. So maybe we say to them… I was talking with our chief people officer last night, So maybe we say to them, “Hey, we’re going to guarantee that you keep your job for the next five years, but you’ve got to cross-train in three other jobs besides what you’re doing right now. If you promise you will do that… So maybe you’re going to be an environmental services worker, but you’re also going to understand how to mow the lawn and serve people food. So maybe those are your two other jobs. If you promise to do that, we promise that we’re going to keep you employed and that your family is going to be okay.”
I think it’s going to require just really different kinds of relationships than we’ve actually ever historically done in healthcare, but I also think it’s completely doable.
5. Trust Matters – Keep it Simple and Go Fast
People know when you’re playing games with them. They know when you’re doing your best to look out for them. Trust matters. Trust is earned through consistent actions over time.
At a time of crisis such as this, Marc’s advice is to keep it simple and go fast. Make decisions knowing some won’t be right. But keep moving with an eye on the vision being true to your culture and reason for being. Don’t worry about, or don’t even care what others may think. Set the course and stay on it. Adapt as needed. Find partners who do things better than you and make those “frenemies” in the spirit of building solutions. And, go fast.
People are real smart and they can see folks getting politically whipsawed. The WHO or the CDC, who by the way have amazingly bright people who are highly motivated and fantastic professionals working within them, you can see their leadership get thrown around. And they’re not necessarily as stalwart as they might be.
I think that one of the things that really good hospitals and doctor groups do is, we haven’t played any political games at all. Every decision we make is for our community. Every decision we make is for a patient. No one’s lost their job in our system. There’ve been no furloughs, no one’s had a pay decrease. We’ve made unbelievable sacrifices so that the lights stay on, the professionals are there and that we’re ready when things get really ugly.
So it’s when things get ugly, we’re a forever organization, we’re able to provide you with the community health that you need. So I think people can see it and feel it. It’s not fake. This is real stuff.
I actually don’t really care what the rest of the sector thinks of us to tell you the truth. We know we’re doing the right thing. We know that healthcare is too expensive. We know it’s inaccessible to people.
And so we’re going to keep forging ahead and work on social determinants and we’re going to work on having healthcare be prepaid, and we’re going to work on making sure that access is good for everybody, and the economics will sort themselves out. So I actually really don’t care what those other folks think. And they got to deal with their boards and they got to deal with their consciences. And, that’s up to them. Good for them.
[This crisis gives] the opportunity to realize that we shouldn’t do everything ourselves. Partner with private organizations who could do them a lot better than we could. I think we’re going to end up with a lot of frenemy-type relationships. So, in some places we compete in other places we collaborate. And I think it’s going to be really good. But it’s going to require a whole different set of leadership skills and deal skills and to be honest, the ability to execute.
Keep it really simple. Maybe that, and I had nothing to do with this idea, the fact that we sent two teams of 50, one to Northwell in Long Island and one to New York Presbyterian. My chief people officer worked with their leaders and we went from idea to deployment in 10 days. And so we had 700 Intermountain caregivers who volunteered to take 100 slots to go help these folks.
And I can’t even express the profound nature of the way it changed our organization. And we weren’t actually looking for a proof point, we were looking to change polls. We were just looking to do the right thing and also to learn a lot so that when our turn for the surge came, we were as ready as we could be clinically. And the collateral benefit of keeping it simple and doing the right thing and being a little bit selfless and a lot humble, has paid off in spades.
Cut through the bureaucracy and just make a lot of decisions as fast as you can, and recognize that about 20% of them are going to be wrong and just shrug them off and keep moving. Because we’ve never been a super fast organization, although I’ve tried, we’re really fast right now. And it’s feeling good to people. And I think we finally have… I want to maintain this momentum.
Please reference the additional documents provided for our weekly tracking data findings and slides that we have shared.
Also, please go to http://heartandmindstrategies.com/covid-19/ to access any of this information at any time. Please feel free to share and use however is most helpful for you.