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Healthcare Roundtable

D CEO talked with some of the region's notable healthcare leaders to get their assessment on the state of healthcare in North Texas.

For a special section in its June/July edition, D CEO turned to some of Dallas-Fort Worth’s most respected thought leaders to get their assessment regarding the current state of healthcare in North Texas. We asked them where the industry is headed, about the biggest challenges organizations face, and how businesses are being impacted. The experts also shared their perspectives on everything from healthcare trends to how innovation and technology will affect patients, businesses, and providers.

How will COVID-19 influence healthcare services or benefits moving forward?

Karen Pinkstaff: One word, virtualization. In the past few weeks, we have seen years of evolution occur when it comes to adoption of virtual service delivery. The providers, payors, and patients have all adopted virtual services. Several providers are reporting anywhere from a 50 to 1,000 percent increase in virtual visits since the middle of March. Virtual services aren’t just for social distancing. Not only are they convenient, they scale much better than traditional services. This scale shows real promise in bending down healthcare’s cost curve for everyone, employers included. Patients will not desire to return to a completely in-person healthcare experience once social distancing requirements end.

David Goldfarb: My prediction is that COVID-19 will bring a level of comfort to more virtual healthcare tools simply out of necessity that will well outlive the virus. It has also created a call to action for employers who were once satisfied with ‘status quo benefits offerings’ but are now faced with making tough decisions around their financial forecasts while considering employee retention and overall well-being.  Even if it is out of necessity, this should be a time to reflect and review current offerings and explore new options and take advantage of new solutions within the benefits landscape.

What tactics are employers using to reduce their healthcare expenses?

Christopher Crow: As a business owner, I’ve made sure my employees can create an ongoing relationship with a primary care provider. I also advocate that our employees seek out annual wellness exams to keep them on top of their personal health situation. By encouraging them to take control of their health through primary care, I have personally seen a workforce that is healthier, while everyone is saving costs.

Karen Pinkstaff: Some employers, particularly very large ones, have built center of excellence models, which is essentially an extremely narrow network for specific procedures. In this model an employee with a certain condition, for example a kidney transplant, will essentially be required to go to a single hospital for treatment. The out of pocket for the employee is often very low or even zero. The employer then works with that hospital or system to manage the cost of providing care and the quality outcomes.

David Goldfarb: Most health plans are inefficient.  For employers that have a partially self-funded health plan, we highly recommend a thorough evaluation of all moving parts that make up the health plan.  This includes the actual stop loss insurance, third-party administration, pharmacy benefit management, disease management, network access, and case management.  For any of the parts that are not performing well, replace them to optimize the overall performance of the plan.  Also, it is very important that all contracts be reviewed–many times healthcare expenses can significantly be reduced by revising existing contracts.

How is technology impacting the way healthcare businesses innovate to meet their patients’ needs?

Awstin Gregg: The introduction of technology is significantly enhancing the ability to deliver timely care in the service-based business model for many providers, including myself. The recent pandemic accelerated the community’s adoption of the idea of telehealth, and it is my strong opinion this chapter in care-delivery survives this pandemic and presents as the new preference for many patients. Additionally, telehealth introduces a delivery platform which largely mitigates typical barriers to treatment. I believe treatment compliance will increase secondary to this chapter in innovation.

David Goldfarb: Just as technology is changing our everyday lives, it is impacting the way healthcare businesses innovate. Providers and patients now have opportunities to engage directly, even outside of in-person visits. As long as we stay conscious to continue to serve the sectors of the population who are not regularly using technology, the increase in technology can continue to grow and change the way we “do” healthcare. From a businessowner’s perspective, constantly improving technology provides tools for not only accessing data about plan performance but also interpreting it and performing predictive modeling to build a sustainable healthcare strategy.

Karen Pinkstaff: Technology through virtual healthcare has the potential to drive down costs. As in other industries, as services become digitized, they are easily scaled and distributed to a larger population, thus driving down costs, especially in industries with large fixed costs. Our viewpoint is that the rapid adoption of virtual healthcare will drive down healthcare costs, perhaps more than any other effect.   

Are telemedicine or digital apps changing the way healthcare organizations operate? Are they here to stay?

Christopher Crow: Telemedicine is absolutely here to stay. Being able to see your doctor from the comfort of your home is the future of medicine. We’ve seen the adoption of telehealth and telemedicine in our network reach 99 percent to help keep patients and physicians safer during COVID-19. Even beyond the pandemic, Catalyst Health Network’s care team model works even better in this new virtual setting, allowing physicians more flexibility and a great way to coordinate care delivery to patients wherever they are.  However, I don’t think the telemedicine companies that aren’t connected to patients and their local physicians will be around in the coming years. 

Karen Pinkstaff: Telemedicine is a piece of what we define as virtual healthcare delivery. If we look at the ability to provide healthcare via video conferencing, the ability to scale that across a larger population has not previously existed in our industry. For providers that focus on digitizing services, it is important that the patient experience is consistent on their virtual platforms and in their physical space.  Patients, particularly younger ones, are becoming less aware of the distinction between physical and virtual. In other words, patients are increasingly less likely to forgive a confusing and poorly designed app with limited functionality if your physical space is beautiful and well run. The two must work in concert.

Awstin Gregg: I do believe telemedicine is changing the way healthcare organizations operate, and at the very least, it certainly requires organization leaders to challenge the way they think from an operational perspective. Telehealth removes the typical barriers to treatment by making it profoundly convenient to the user. I think some practices may prefer the in-person model to the telehealth model–and there’s nothing wrong with this stance, but I do believe the consumer market is changing. This is a hurdle that will need to be jumped by healthcare practices as the delivery of services innovates itself.

Preventive care is another buzz term today. What role does a business owner play in improving the health and wellness of their employees?

Awstin Gregg: The role is significant! The “cost” associated with this can sometimes be hidden because we are investing in something we are trying to avoid. An example of this could be changing the oil in your car. We change the oil because we want to preserve the engine. We know what happens when an engine is in disrepair. I don’t complain about an oil change, because I know what I’m investing in. In the same way, I don’t look at my monthly P&L and complain about the financial allocation to employee wellness, because I know what I am investing in.

David Goldfarb: Early disease detection and preventive care help bend the curve of healthcare costs for employers. Studies have shown that higher engagement between individuals and their primary care physicians lead to less occurrence of high-cost emergency room visits and episodic care. Reactive healthcare causes unintended consequences and unsustainable costs.  Business owners that do not take a proactive approach to employee health and wellness are far more likely to face unpredictable situations with that can costly and difficult to manage.

Karen Pinkstaff: It certainly can be a cost saver. According to the Society for HR Management and the American Diabetes Association, the average full-time employee with type 2 diabetes misses an extra 5.5 days of work. The total cost of type 2 for U.S. employers is $16 billion. Obesity is a leading comorbidity of type 2 diabetes and a whole host of other chronic conditions. Providing programs and resources to help employees manage their weight could meaningfully reduce the prevalence of type 2 diabetes and incidence of stroke and cardiac events.

Christopher Crow: Preventive care is more than a buzz term. Off-the-shelf wellness programs have never truly shown to have an ROI, but patients with existing relationships to primary care providers pay less and live healthier, longer lives than patients without a primary care provider. Primary care should be the cornerstone of a strong healthcare system, and everyone should have a primary care physician. It’s a no-brainer.

How are healthcare-related businesses managing growth?

Karen Pinkstaff: Companies in other industries are now coming around to the idea of ESG, or environmental, social, and governance, as they work to become more sustainable and improve the impact they have on their communities while still managing growth. Healthcare has been doing this since the dawn of medicine. That said, I think there are techniques healthcare organizations can learn from other industries. Pre-pandemic, many healthcare providers were focusing on ways to reduce supply chain waste. I expect that post-pandemic that focus will return and we can learn from other industries how to eliminate waste and source more sustainable inventory while growing, managing the mission and maintaining adequate reserves of critical supplies.

Awstin Gregg: The scalability of a healthcare organization leans on the same key performance metrics of other typical organizations. Instead of asset usage and activity ratios, you may find more benefit in reviewing efficiency and growth ratios. Regardless, the analytically informed business owner can lean on these metrics to understand when to hire, when to grow, and when to adjust course in the market. Understanding your numbers is understanding your business.

What do you think the healthcare landscape will look like five years from now?

Christopher Crow: Our healthcare system in five years will be drastically different than it is today. The coronavirus epidemic has shined a light on several of the limitations of our system. One thing is clear: primary care must be a cornerstone of a strong and functioning system. Right now, primary care accounts for less than 7 percent of healthcare expenditures, yet primary care physicians fielded 54 percent of all patient visits to doctors’ offices. We have an unprecedented opportunity to redesign our healthcare system so that it truly serves Americans. We must save our frontline primary care and public health professionals and set the foundation for a better way of delivering and paying for care. If we ignore it, the long-term consequences of our healthcare system will be dire.

Karen Pinkstaff: Maybe not five years from now, but in the future, we see an industry where over a third of visits are performed on a virtual platform. Where patients know the price of services before they receive them, and they are involved with making care decisions using data, like quality outcomes and costs, to make decisions along with their care providers. We also believe there will be a smaller workforce in healthcare five years from now as compared to “pre-COVID” times through building efficiencies into their business model.

Any tips for entrepreneurs or small businesses? What is the best place to start in terms of ramping up health insurance?

David Goldfarb: The first place to start is outlining their primary objectives of why they are offering a health insurance or benefits program. HR may want to design a plan that is competitive in the marketplace while finance may want more of an economical plan.  Once goals and objectives are aligned, business owners should partner with an experienced employee benefits consultant who can assist with not only the designing, implementing and managing of the plan, but also help the employer remain in compliance with State and Federal laws as well as the many ACA regulations.

Christopher Crow: One of the trends we are seeing is that small businesses that can’t afford the rising cost of healthcare, and they are seeking out plans that allow employees to have ongoing services from primary care physicians. These small companies are realizing that paying for primary care goes a long way in terms of caring for their employees at a fraction of the cost. 

Awstin Gregg: It would be my recommendation for entrepreneurs to invest in healthcare for employees as an upfront priority utilization of capital. Small businesses have options available through Professional Employer Organizations (PEO) and other jointly sponsored programs. As an employer, you may find it quite challenging to recruit and retain talented employees without this offering. Beginning your journey as an entrepreneur by taking a shortcut here could create the incorrect long-term trajectory. In my opinion, if you do not have the capital to offer talented employees competitive health insurance, then keep saving for just a bit longer.

How will transparency and the disclosure of costs and quality ratings affect the healthcare industry?

Christopher Crow: If there were true transparency and quality, we would see improved outcomes, including lower and more predictable costs. This why I am an advocate for systems like transparent prospective payment, which creates incentives for both the payer and the patient. Both parties know the predetermined pricing structure so there are no surprises on either end.

Awstin Gregg: If done correctly with balance and standardization, I think the transparency could create a scenario where quality metrics have an opportunity to become competitive through comparison. I think it will be a particular challenge to create this standardization because without such a variable, the data offered to consumers could be misrepresentative. For example, I have never thrown an interception in a Super Bowl, but Tom Brady has, and if this is the only metric offered, the variability of assumptions could misinform a consumer about my quality as a quarterback. If not careful, the same dynamic could become in play within healthcare.

How does PCR and antibody testing play a role in being able to safely return to work in the coming weeks and months? 

Christopher Crow: As businesses open and people continue returning to work, testing will play a pivotal role in combatting the spread of COVID-19. The United States is currently testing about 150,000 people per day; Texas has maximized testing capacity to perform 15,000 to 20,000 tests daily, with the goal to reach 30,000 per day in the near term. PCR tests will be crucial in figuring out where the virus is and where it is going; meanwhile, antibody testing helps identify who has had it and whether the larger herd of Americans might be gaining some immunity.  atalyst Health Network is leading this way in North Texas, working with employers, city, county, and state officials to bring dozens of testing sites across the region, including those that are healthcare deserts.

Has COVID-19 affected how you deliver your services or the guidance you’re providing employers?

David Goldfarb: It is necessary for us to be constantly monitoring and informed of new regulatory issues and carrier provisions to support our clients and their employees. Zoom is the new norm for client meetings…at least for now.  Various forms of communications are being used to connect to and engage employees, from text messages and push notifications to customized apps and websites and telephonic open enrollments–all to make it easier for employees to access information to help them make the best possible healthcare decisions.

Awstin Gregg: The recent impacts of the pandemic have required our business model to pivot entirely to telehealth. Telehealth has always been a minor segment of the discussion, but COVID-19 accelerated its relevancy to the front center stage almost literally overnight. What we are discovering are the benefits of telehealth as it relates to the ability to access care. The convenience of telehealth for patients are improving outcomes and compliance so far, and it is my opinion the utilization of this platform to deliver services could become a worthy competitor to the previously standard way to provide care.

Mental health is becoming a routine part of the conversation these days. In what way does an employee’s mental health contribute to a healthcare organization’s success?

Awstin Gregg: The relevancy of the mental health of employees relates to an organization reaching its internal and external goals hand-in-hand. Ensuring our organization has resources to address mental health is equally as crucial as ensuring physical health. In my opinion, one of the most significant ways an organization can promote an employee’s mental health is by choosing leaders who have the skill of leadership. The ability to communicate criticism constructively, the ability to resolve conflict civilly, and the ability to understand EQ without condescension, belittling, or hostility are just a few of the ways that employers can promote mental health.   

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