0:1:22.40 –> 0:1:50.950
Bill Russell
Uh, you. You know what’s interesting? It’s made no progress, but so on that. I’m gonna disagree a little bit because it was the same app side of Inter mountains made some significant gains, but UPMC was doing this a long time ago. Kaiser was doing this a long time ago. Kaiser was our largest competitor in Southern California, and their model has been pretty consistent. They haven’t been able to scale it, but they’ve been pretty consistent for a long time. Sharp HealthCare is another one that does a good job with risk based contracts, we.

0:1:51.830 –> 0:2:22.140
Bill Russell
At the Saint Joe’s and to get this to data pretty quickly, we entered into risk based contracts for I think half million lives. While I was CIO at Saint Joes and it was, it was really that experience for me that sort of set the foundation for how I feel about data in healthcare. And it was, I’m sitting there, it was Blue Shield at the time and our clinically integrated network. And if you know anything about California, we don’t employ the physician groups.

0:2:22.240 –> 0:2:54.250
Bill Russell
And so they’re all splitters, splitters, meaning they practice at our hospital, they practice at other hospitals. They’re EHR’s, are independent, and we have to figure out how to share. And so we had a clinically integrated network and integrated would be a misnomer, but they were independent practices on independent Ehrs. And we were doing this deal to keep people healthy. And they came to me as the CIO and said, alright, here’s what we need. We need a a common messaging framework that we can message across this entire.

0:2:54.350 –> 0:2:57.450
Bill Russell
Clinically integrated network and no less than 58 hours by the way.

0:2:58.630 –> 0:3:7.670
Bill Russell
A messaging platform. We need to be able to share the data and the records across all 50 of these UHRS and oh, by the way, we need to create a set of metrics.

0:3:8.370 –> 0:3:21.300
Bill Russell
Across across all these disparate physicians and practices and specialties that they’re measured on health because that’s in fee for service, we don’t really measure health, we measure.

0:3:21.960 –> 0:3:28.340
Bill Russell
Uh, I mean not to be too pessimistic, but we we we measure money for.

0:3:26.920 –> 0:3:29.450
Jordan Cooper
For the vision of healthcare, maybe.

0:3:29.550 –> 0:3:58.890
Bill Russell
Yeah, I mean, it’s for, for lack of a better term, we we measure outcomes for sure. But but we don’t measure health per se. Are we keeping people healthy? Are we keeping them out? And when you enter into those risk based contracts, that’s what you’re measured on. But in order to do that, you have to go beyond the 20% of data that impacts health, right? So the healthcare data, the medical record only impacts 20% of health. We know this social determinants of health impact. The other 80% of health.

0:3:59.140 –> 0:4:23.730
Bill Russell
And unless you’re bringing all that data together, and so my experience, let’s see. What was that eight years ago was setting up that clinically integrated network and it was virtually impossible. Now we did it on the health share platform as an aside, but it was virtually impossible. It was so difficult to do, and I’m not sure it’s any less difficult today.

0:4:25.10 –> 0:4:55.0
Jordan Cooper
So I mean a few points on that one, there are European countries that do have EHR that account for social determinants of health. That’s been covered on a previous episode of Healthy Data Podcast. But on the other hand, I do wanna go back to we listed at least four different sharp KP, Inter Mountain and UPMC integrated networks that are in the United States that have been functioning. So the question is I guess how have they been successful and why hasn’t it spread?

0:4:55.220 –> 0:5:1.530
Jordan Cooper
Even if they’re only able to control 20% of of what we referred to as total well-being and health.

0:5:3.10 –> 0:5:25.820
Bill Russell
It’s important to note that they they struggle to spread, right. So Kaiser, one of the things that said about Kaiser is it doesn’t scale. They’ve been unable to take it into new markets. And there’s a good examples of that. I mean, they tried to go into the Texas market and we’re completely shut out. There’s still trying to go into the Arizona market and they’ve been able to do it. They’re wildly successful in California.

0:5:26.160 –> 0:5:54.160
Bill Russell
But part of that could be the contracts that they have and then some other marks. I think DC, they do pretty well and others so they’ve been unable to scale that model across the country for whatever reason, UPMC is regional and they’ve been able to do it regionally. And Intermountain it’s been able to do it regionally as well. Same with sharp. Nobody’s been able to to really break out and do it on a national level. And part of the reason for that is the incentives, right. So the incentives don’t line up.

0:5:55.240 –> 0:6:6.790
Bill Russell
You have you have a multi billion dollar industry, no trillion but you have multibillion dollar health systems that essentially.

0:6:8.230 –> 0:6:28.300
Bill Russell
Rely on fee for service and so they’ve it’s been described to me this way and everyone’s heard this analogy. They have 1 foot in this boat and then the other boat is OK we know that we need to transition. We need to go to more of a value based care model. But if we do that, we’re going to get paid to keep people healthy, which essentially takes money away from this boat.

0:6:29.90 –> 0:6:44.760
Bill Russell
And so we have to transition from this boat to this boat. We have a foot in each boat and those boats are slowly drifting apart and this could explain somewhat of what’s going on in industry from a financial standpoint right now is.

0:6:45.680 –> 0:7:5.570
Bill Russell
You know, people, are they? It’s it’s not that there’s been a mass exit of Exodus from healthcare. It’s been that slowly but surely these other movements outside of healthcare have been chipping away at this fee for service model because we all know it’s broken, including the people who work in it. They don’t like it.

0:7:6.370 –> 0:7:18.910
Bill Russell
We we wonder why there’s burnout and that kind of stuff. One of the reasons there’s burnout is people operate in this fee for service model and they sit there. Go. I don’t like this. I don’t like this for my family. I don’t like this for my community. It drives up, costs it.

0:7:19.510 –> 0:7:48.300
Bill Russell
It’s highly redundant the the coding and and all that stuff is way too complex for what we’re trying to do and at the end of the day we caused more bankruptcies from healthcare costs than anything else. So we know that that model’s broken, but we’re not able to make the transition because in order to do it, you have to do create what has been termed creative destruction of a business model and that creative destruction of a business model.

0:7:49.0 –> 0:8:2.420
Bill Russell
This doesn’t really support the underlying investments we have made in the larger healthcare ecosystem. We’ve built huge campuses, we’ve bought really expensive equipment and in order to keep paying the sours we’re paying.

0:8:3.180 –> 0:8:12.880
Bill Russell
Yeah, you know, you you have to keep this model going, so I’m not sure the change of health care is gonna come from within healthcare. It’s probably gonna be more and more pressure from the outside.

0:8:13.500 –> 0:8:33.140
Jordan Cooper
And when you see pressure from the outside, just I wanna contextualize United American healthcare and I think around after World War Two, I think around 1948 you had Britain go to the national, the single payer National Health Service around 1994 you had Canada go to single payer.

0:8:34.300 –> 0:8:49.970
Jordan Cooper
You’ve had in the latter part of the 20th century multiple major Western nations transition from a more hodgepodge approach to kind of universal coverage and shifting away.

0:8:50.280 –> 0:8:56.520
Jordan Cooper
I I don’t know as much towards value based payments, but but the idea is at least on small scales.

0:8:58.20 –> 0:8:58.910
Jordan Cooper
What can I say?

0:9:0.530 –> 0:9:2.900
Jordan Cooper
Why do you suppose Kaiser?

0:9:3.440 –> 0:9:9.530
Jordan Cooper
UM and and has difficulty scaling. Let’s start there more concretely.

0:9:10.510 –> 0:9:14.260
Bill Russell
Why does Kaiser have? There’s probably several reasons, but.

0:9:15.630 –> 0:9:44.740
Bill Russell
The first is they come in with an insurance product that doesn’t partner with other health systems, right? So they have to immediately go to scale and it’s very expensive for them to go to scale. They don’t stand up acute hospitals right away. So again, they have to partner with the local health systems and the local health systems. I’ve seen what they’ve done in California and other locations, and they’re not prone to help them. Right. It’s like, I don’t want to do a deal with Kaiser knowing full well what they’re going to do is.

0:9:44.950 –> 0:10:15.410
Bill Russell
They’re gonna continue to chip away at my business and then eventually they’re going to plop down a very efficient and well run hospital and really start to impact our our market. It’s interesting when Kaiser, when we were competing with Kaiser at Saint Joe’s, our quality scores and everything was way above Kaiser early on. And we sort of used to look down our nose at them and derision like they can’t deliver quality care and then slowly but surely, their quality of care kept going up and up and up and up and up.

0:10:34.660 –> 0:10:35.190
Jordan Cooper
So.

0:10:15.460 –> 0:10:46.410
Bill Russell
And then it was better than ours and and part of that was they they managed the quality of care in a way from one end to the other. And the the variability of care from one end to the other, much better than we did as a health system because they were completely integrated and we were not integrated. Why haven’t they been able to scale? It’s it’s it’s a tough, it’s a tough model to go into a new market with the way they’ve they’ve designed it. They’re probably other ways they could scale, but they haven’t tried.

0:10:47.20 –> 0:11:16.490
Jordan Cooper
So I heard you mention one of the reasons why it’s difficulty why Kaiser experiences difficulty scaling is because there are huge capital expenses associated with doing so, acquiring standing up acute hospitals, going to market immediately without partnerships. And you would think, well, the way to do that is very capital intensive process is there capital and then you’re looking throughout healthcare, there are a ton of M&A’s. First of all you had maven or sorry Haven.

0:11:17.10 –> 0:11:27.860
Jordan Cooper
Which was the endeavor between Amazon, Berkshire Hathaway and believe Walmart. Oh, no, no. JP Morgan.

0:11:26.520 –> 0:11:29.830
Bill Russell
JP Morgan. Yeah. JP Morgan, Berkshire and Amazon.

0:11:28.730 –> 0:11:50.20
Jordan Cooper
Yeah. Yeah, so that failed. So the the question is, why did that fail? And then you also have M&A’s all over healthcare, you have Walgreens taking over summit, you have Amazon taking over one medical. So there is there are other players getting in there is traditional finance getting into healthcare? Why did we find?

0:11:47.380 –> 0:11:51.970
Bill Russell
There there’s there’s. There’s a battle for primary care right now and.

0:11:51.560 –> 0:12:3.520
Jordan Cooper
So why doesn’t? Why doesn’t big money? Why doesn’t private equity venture capital, traditional finance, start investing in the integrated care delivery model that would support scaling up at Kaiser like model?

0:12:5.310 –> 0:12:36.580
Bill Russell
Well, by the way, I mean there’s a ton of VC and and private equity backed roll up strategies for primary care right now. I mean that’s where the battle is being run. One because essentially if you can get in between the consumer and the health system and you can direct care, that’s a winning strategy. Optum’s proved that United Healthcare optimists proved that you’re seeing CVS run after that. You’re seeing Amazon run after that. Everyone’s sees that as sort of the, you know get in between start to direct care.

0:12:36.860 –> 0:13:7.990
Bill Russell
Because one of the things that’s going to happen is it used to be all Healthcare is local. You know that was the big phrase. All Healthcare is local. I remember hearing that when I first came into healthcare and it made sense cuz we had 30% market share. They couldn’t go anywhere else. They came to us. Well, now you have deals like for employers doing deals where they contract with Mayo and they contract with City of Hope and they contract with you know and so on certain diagnosis they actually put their, their employees eat these can be minimum wage employees. They’re putting them on a plane.

0:13:8.90 –> 0:13:33.170
Bill Russell
And sending them to California or they’re sending them to Rochester and other places. So they’re they’re fundamentally changing that game before we go too far off of this. I’m not a fan of socialized medicine either. I just want to be real clear. I think the answer is in the free market system, I think it’s transparent. I think it’s data, right. I think it’s transparency. I think it’s data and I think it’s choice.

0:13:34.300 –> 0:13:43.610
Bill Russell
I I live, I live in an area that’s loaded with Canadians and they come down here and they have procedures done and I’m like, why are you having procedures done? I mean you’re.

0:13:43.160 –> 0:13:45.790
Jordan Cooper
But in Florida, for our listeners who don’t know where you would.

0:13:45.130 –> 0:14:14.460
Bill Russell
Yeah, yeah. In Florida and like 10% of the people who live in, like, actually 15% of the people who live in my community are from Florida. And I’m like, why don’t you get your healthcare in Canada? And they’re like, well, cuz I have to wait for nine months. I’m like, wait for nine months. That’s like, we wouldn’t even understand that in the United States. And so if you go to that kind of model, you end up with rationing of healthcare because you can’t possibly pay for and have the kind of investments that you have in the United States.

0:14:15.50 –> 0:14:21.960
Bill Russell
And so I don’t think it’s a complete swing to socialized medicine and that’s what it is. It’s socialized medicine.

0:14:21.570 –> 0:14:30.780
Jordan Cooper
It will hold on. Just turn to to define terms. Here the four examples of integrated delivery models is that are those examples of socialized medicine.

0:14:31.230 –> 0:14:37.970
Bill Russell
No, I’m talking about single payer. I’m talking about government run single payer Medicare for all, all that kind of stuff.

0:14:38.70 –> 0:14:48.140
Jordan Cooper
All right, but OK, so back to the original question, why isn’t traditional big finance and large retailers investing in the proven integrated care delivery models?

0:14:48.540 –> 0:14:50.410
Bill Russell
Oh, why aren’t they investing in that?

0:14:51.770 –> 0:15:9.980
Bill Russell
It it’s a bad business model. Healthcare makes money. Hospitals make money from essentially only three lines of business, 3 or 4 lines of business and you know it’s it’s it’s tests and imaging, it’s oncology and it’s surgery right primarily.

0:15:10.80 –> 0:15:12.90
Bill Russell
Uh, you know.

0:15:13.270 –> 0:15:35.730
Bill Russell
Cardiac surgery and and other specialties. But it’s primarily surgery, so they make money there and they lose money everywhere else. Nobody looks at that business model and says boy can’t wait. Capital intensive, nobody looks at that business model says I gotta run into it. Now the question the real question here is how do we transition because there is a transition and we’re seeing it. Intermountain is doing it.

0:15:36.230 –> 0:15:40.220
Bill Russell
But extremely well and they’re doing it on multiple fronts.

0:15:40.860 –> 0:15:54.380
Bill Russell
First of all, they have the health plan, which is now up to, you know, over over a million covered lives. And so that health plan which they launched, I don’t know how many years ago, but it’s at least five years ago they launched it and it’s been wildly successful and they’re going to scale that.

0:15:54.990 –> 0:16:15.880
Bill Russell
And they’re going to grow through acquisition and other things, but they’re going scale that model. But there are also doing a lot of great work in the social determinants area and all that. And they’re partnering with the United Way. They’re partnering with local communities because they understand it. If you cover these lives, you have to engage the local community, the United Way, the the.

0:16:16.40 –> 0:16:34.130
Bill Russell
You know the the the, quite frankly, the religious institutions, the people who are there at the social institutions, people who are there on a day-to-day basis, if 80% of health is outside of healthcare, you have to partner and they’re doing that extremely well and they’re going to scale it. The question is?

0:16:35.290 –> 0:17:5.460
Bill Russell
How many others are going to be able to scale it and what is that going to look like? And I think you’re going to see specialties specialists like the academic medical centers primarily who are gonna live on brand and they are going to be the highest end acute care delivery that you can find and they’re going to, they’re going to thrive because they do research, they’re advanced and that’s where you want to go. If you have cancer and other things that’s going to happen, the Idns.

0:17:5.720 –> 0:17:34.270
Bill Russell
Are gonna get squeezed from both ends. They’re gonna get squeezed on the primary care side and and people starting to move around and do things, and they’re gonna have to really reduce their cost structure or they’re gonna have to figure out how to get into the player game and to start taking on risk and manage care lives like Intermountain has done, or they’re going to be acquired or they’re just gonna run out of money and really have to scale back. And we’re seeing all of this happen right now.

0:17:34.790 –> 0:17:51.220
Jordan Cooper
How do you see payers responding to the Inter Mountains to the core wells of the of the country uh, creating their own payer models? How is how are the Blues plans responding to hospitals setting up their own insurance groups?

0:18:18.10 –> 0:18:18.720
Jordan Cooper
Umm.

0:17:51.680 –> 0:18:22.470
Bill Russell
It’s it’s coopertition, right? So they, they united has to partner with Intermountain because they have, what, 40 percent, 30% market share in most of the markets that they serve. So they they can’t just say they’re a competitor unless they figure out a way to deliver care outside of them. So they have to partner with them just like Intermountain has to partner with the United because there’s a. So you’re gonna have this sort of coming together of.

0:18:22.570 –> 0:18:24.170
Bill Russell
Of models.

0:18:24.750 –> 0:18:41.230
Bill Russell
Uh, which is gonna continue to happen. And the other thing on the data side is we used to sit sit across from the payers and they had so much more better data than we did on our on our patients like they knew things that we didn’t know.

0:18:55.80 –> 0:18:55.610
Jordan Cooper
So.

0:18:42.390 –> 0:18:56.280
Bill Russell
And I think in these more sophisticated health systems that data and that that playing field is starting to get leveled. So the conversations are starting to get very they’re just on even terms. And so that’s changing the game.

0:18:56.790 –> 0:19:27.200
Jordan Cooper
Dude in pop culture in the United States, there’s a story that’s gone around where we’ve heard about how a father somewhere in the United States found out that his teenage daughter was pregnant because Target started sending diaper ads or something to the house based on their big predictive data models. As you see, provider organizations starting their own payers or at least or potentially sharing more data and get ingesting more data from payers.

0:19:27.520 –> 0:19:39.600
Jordan Cooper
Do you see how how do you see the care of patients evolving with greater access to predictive analytics and based on large datasets?

0:19:40.810 –> 0:19:44.500
Bill Russell
Uh, I’m trying to figure out the analogy you gave me with the question.

0:19:45.40 –> 0:19:49.870
Jordan Cooper
Yeah. Well, it’s like, OK, so if you have more data from payers.

0:19:50.190 –> 0:19:50.560
Bill Russell
Yep.

0:19:50.670 –> 0:20:6.220
Jordan Cooper
Uh, will healthcare be able to find more insights about patients that will lead to better outcomes as target was able to come up with an insight about that teenage daughter that she didn’t even know herself?

0:20:6.730 –> 0:20:38.20
Bill Russell
Yeah, uh, I think what’s going to it it the look the claims data, the claims data is the claims data and it tells you more about that 20%, the health care line of business. I think what health systems are getting more attuned to is they need to be better at the things that consumer companies are good at, which is figuring out what your preferences are, figuring out what your decisions are as an individual. And so they look at the community and say.

0:20:38.80 –> 0:20:58.590
Bill Russell
We have 1.5 million patients in our community, but there’s 3,000,000 patients, potential patients in our Community. We need to know all three million and and those people we need to start growing out of that 20% of just healthcare data into what are their preferences, do they exercise, how do they make decisions, psychographic data.

0:20:59.660 –> 0:21:22.250
Bill Russell
You know, how do they make decisions? Because we want them to be well. And how do we keep them out of line at, you know, Burger King and McDonald’s? No offense to either of those. I love them, but but they, you know, going there repeatedly does not make you healthy. And the health system needs to establish itself as the partner for health in the Community. Otherwise someone else will.

0:21:23.240 –> 0:21:35.940
Jordan Cooper
We’re approaching the end of this podcast episode bill, so I’d like to give you the opportunity to speak to our community of CIO’s Health IT leaders in large health systems across the United States.

0:21:36.480 –> 0:21:47.710
Jordan Cooper
Umm, about risk and where we how we see risk sharing and and basically what’s the next step in this conversation, what are we going to see in the next year or two?

0:21:56.310 –> 0:21:56.770
Jordan Cooper
OK.

0:21:49.600 –> 0:21:59.130
Bill Russell
What are we gonna see in the next year or two? Well, actually, you you gave me two different prompts. I’m gonna take the prompt. I want, which is. What would I say to CIOs right now? And I would say.

0:21:58.760 –> 0:21:59.140
Jordan Cooper
Yeah.

0:22:0.650 –> 0:22:30.520
Bill Russell
First of all, know your consumer, as many of them as you possibly can. As many data points as you possibly can. Bring it together in insights and then the other thing I would say is embrace 21st century cures and all it represents and what it represents is patient empowerment with data, patient centric interoperability, patient empowerment with data, giving the patient data and then becoming that guide we all know and I know if you give me my patient data.

0:22:30.630 –> 0:22:31.700
Bill Russell
I don’t know what to do with it.

0:22:32.410 –> 0:23:2.870
Bill Russell
But once you give it to me, I’m gonna be looking for a guide and I want the health system where I have my trusted providers and they’re the trusted brand in the marketplace to come alongside me and provide a service that says, hey, we gave you all this information. We want to help you to collect even more information from your Apple Watch and all this other stuff. And outside of delivering your medical care, we’re gonna become your guide, your almost a concierge type service that is totally digitally driven.

0:23:2.970 –> 0:23:4.750
Bill Russell
Data-driven and.

0:23:5.370 –> 0:23:22.510
Bill Russell
You know and gives me access 7 by 24 to somebody to talk to. I think that’s. I think that’s the future. I think that’s a strong path for health systems to take to establish that consumer centric patient centric, community centric approach to care.

0:23:23.590 –> 0:23:38.760
Jordan Cooper
Well, thank you. This has been Bill Russell, founder of this week health have you haven’t lessened, you can go take a lesson. I think it’s this week. Health.com bill is also President of health lyrics and former CIO at Saint Joseph Health. Bill, thank you for joining us today.

0:23:39.200 –> 0:23:40.870
Bill Russell
Thank you. Really appreciate the time.

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