Scott Webb (Host): Welcome to the Healthcare Executive Podcast, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. I'm your host, Scott Webb.

And on today's podcast, we're discussing strategic collaborations in population health and advancing value-based care with Dr. Selwyn Rogers, Jr., Chief Section of Trauma and Acute Care Surgery; Founding Director, Trauma Center, and Executive Vice President for Community Health Engagement with the University of Chicago.

And I'm joined by Ryan McFadden. He's the Head of Account-Based Solutions, Organized Provider Strategy with GSK, one of ACHE's Premier Corporate Partners. Our premier corporate partners support ACHE's vision and mission to advance healthcare leadership excellence.

So, I want to welcome you both here today. We're talking strategic collaborations in population health and advancing value-based care, and what does that mean. That was a lot of words, but it's good to have you both here and have your expertise and explain all this to us. But before we get there, I just want to have both of you introduce yourself. So, Dr. Rogers, I'll start with you. Maybe you can describe your roles, passions, priorities related to population health and value-based care.

Dr. Selwyn Rogers, Jr.: Thank you very much, Scott. My name is Dr. Selwyn Rogers, Jr. I serve as a Professor of Surgery and Chief of the Trauma and Acute Care Surgery Service at the University of Chicago Medicine. And I have an additional role directly related to the topic today, which is I serve as the Executive Vice President of Community Health Engagement. And in that work, we largely try to tackle the longstanding health disparities and inequities of outcomes of populations that we serve on the south side of Chicago.

Host: Yeah. And it's great to have you here to speak directly to those disparities, and we're going to roll up our sleeves and dig in more. But before we get there, Ryan, I'll just have you, you know, introduce yourself, roles, passions, priorities, and your role in this conversation maybe.

Ryan McFadden: Yeah. Thanks, Scott. I appreciate it, and it's great to join Dr. Rogers today. So, I have the privilege of representing the organized provider function at GSK. It's a group that we stood up a little over a year ago, largely to advance value-based care and population health initiatives through collaborations with health systems across the country. I've been in healthcare for over 20 years, different leadership roles in the Life Sciences space, but it's also spent a good portion of my career on the provider side of healthcare, led the BD function for a large academic medical center in Philadelphia for a while. So, sort of a hybrid of experiences that I hope contribute to the conversation today.

Host: Yeah, I'm sure you will. No pressure, of course. But we're going to try to get as much done as we can here in a length that's appropriate for listeners, of course. So, good to have you both here. Good to learn about your roles and how you're going to fit into this conversation. And Ryan, I'll stay with you. I just want to get a sense of, you know, how has the acceleration of value-based care impacted your organizations and your strategic priorities?

Ryan McFadden: Yeah, that's a great question, and I think it's really at the core of everything that we do on a consistent basis. You know, when I think about when the Affordable Care Act was passed into law 15 years ago and what it intended to do, to improve health outcomes, to reduce total cost of care and to provide patients with an exceptional experience, I was on the provider side of the world about a year after the ACA passed into law. And I think those objectives were absolutely what we were driving toward, but at the time, relatively difficult to operationalize when you think about the infrastructure required to move from an exclusive model of acute care medicine into a hybrid of acute care, appropriate level of acute care, and also strong ambulatory footprint, which is really what value-based care is all about, right? It's matching the site of care to the acuity of patients.

And so, it took time, right? It took time from a workflow perspective, introducing the right type of capabilities into health systems, the right ambulatory infrastructure and, again, the capital required to deliver against those objectives. But we're largely there at this point, right? When you think about the last three to five years, there's been an acceleration, a little over 60% of all volume currently in the U.S. is flowing through some type of alternative payment model, whether that's through a direct risk contract and accountable care organization, a clinically integrated network, et cetera. So, provider's worlds aren't changing. They've fundamentally changed. And so, the question then becomes can industry sort of watch that change happen or participate in it and help enable that change? And that's really the lens with which we approach a lot of our work at GSK, is how can we help enable that change? How can we help advance population health goals, prevention initiatives, and really focus on long-term durable collaborations, right? Where we're looking at multi-year collaborations aligned to shared KPIs, et cetera.

So, our view is that, again, the healthcare delivery and how it's paid for isn't changing. It's fundamentally changed. And so, how are we going to approach it? And we're excited to, I think, step forward into that work, and happy to highlight some of that work that we're doing today.

Host: Yeah. And I think you're right that you can feel that acceleration over the last three to five years or so. And I want to bring Dr. Rogers back here and get a sense, Doctor, how are you, Chicago strategic partnerships, advancing your population's health goals?

Dr. Selwyn Rogers, Jr.: Scott, that's a great question. But following up on something Ryan said, I'll probably go back 25 years and bring up a National Academy of Medicine Report called Crossing the Quality Chasm that basically outlined so many of the challenges in healthcare delivery where the focus has largely been on what we do to patients and the large challenge or chasm between what we do and the outcomes that we desire for the patients that we serve, and defining value as quality over cost, which can sometimes be uncomfortable when you talk about healthcare costs, which has been steadily rising. If we try to focus on maximizing the quality per unit cost, we know that we have some challenges. And if we look at the population health level, we will ask ourselves have we appreciably moved the needle to improve the health of populations, and partly because of how we pay for healthcare, that is we pay for things that are done, not necessarily the prevention of things not happening. It makes it somewhat challenging to align the right incentives to get the right outcomes.

Concretely, what does a patient want? They want to live a long, healthy life, ideally without disease. And if they have disease, how best to manage that disease in the most efficient, effective, patient-centered, timely, safe way. And specifically here at University of Chicago, where on the south side of Chicago, we have a relatively large population of patients who have many social determinants or social drivers of poor health outcomes, how can we as a health system realize that in reality can affect better health outcomes for the patients? And some of the things that we've been increasingly focused on is establishing robust partnerships with community-based organizations through our community health workers program that basically tries to tackle a couple things from the patient perspective. That is, if you have congestive heart failure, how can we keep you out of the emergency department, out of the hospital, which ultimately most patients would want ideally.

And so, we've been increasingly extending our reach to think of innovative ways that we can actually meet the needs from the patient perspective. That's just one example. Another one, and certainly interrupt me if you want me to expand, but another one is violence prevention or violence reduction. The best trauma center is one that you never need. It's one that's there. It like a firehouse, but you actually never need it. And the best trauma center is one that would ideally prevent people from being injured in the first place. And we know we're a long way from being there. And one of the challenges that the University of Chicago Medicine has is how can we actually be a larger part of the solution of violence prevention, violence reduction in order to secondarily prevent trauma and mortality of violence, or ideally prevent people from being injured in the first place.

Host: So then, Dr. Rogers, let's talk metrics or success indicators. In other words, how do you evaluate the impact of strategic collaborations on population health?

Dr. Selwyn Rogers, Jr.: Well, it's a great question related to how do you actually measure the impact and/or develop adequate metrics of progress. We've elected at University of Chicago to focus on what are the problems that we're trying to solve and be disciplined about programs that we initiate and have them be aligned with the problem that we're trying to solve. For example, if we're trying to address readmission for congestive heart failure or readmission for asthma, and we know that a population of our patients have recurrent asthmatic attacks that take them out of school. We've actually developed a program in partnership with the school systems to embed community health workers and nurses within the school systems to try to help patients prevent recurrent asthmatic attacks, because we know that that will interfere with their education.

Similarly, we try to be fairly clear about where we have capacity constraints and where the opportunities are to have impact. And the end result is focused on improving some outcome and fairly, by being disciplined at the outset about what problem we're trying to solve, what resources we're going to deploy for that particular problem, who we're going to partner with, and potentially what technological solutions will bring to bear in terms of people and resources. Then, we can measure the impact on the patients and patient populations that we serve over some time. And this work is work in progress. I think as many of the listeners to this podcast will attest, this is not something that has a beginning, a middle, and an end, but it's an ongoing process.

Host: Yeah. A process, for sure.

Ryan McFadden: Yeah. And I think Dr. Rogers often talks about the importance of aligning mission, vision, and values. So before we even talk about, you know, KPIs and how we measure success, I think really taking time to ground ourselves on the goal, and the timeline associated with it. You know, when you think about improving outcomes and reducing cost, advancing population health goals, those things take time, right? They're not going to happen in six months or even twelve months. It's often going to take years of development, an implementation of programs that have a meaningful difference, that make a meaningful difference. And so, I think that's really, really important to make sure that you're truly fundamentally aligned, especially with outside organizations on what it's going to take from a timeline perspective.

And then, to Dr. Roger's point, really matching the resources required to deliver against those objectives. And then, making sure that you're really totally transparent around how you're sort of grading the success, through formal governance oftentimes. And when we talk about shared KPIs, if we're focused on reducing readmission rates or inpatient days, increasing immunization rates, whatever it may be, making sure that we're working from the same data to make sure that we're having a meaningful impact over time. So, we're truly aligned in not just what our objective is, but aligned from an infrastructure perspective, data perspective, et cetera. I think that's so important to make sure that we're seeing off the same sheet of music. And that's what's, I think, so exciting about this space. And that if you really commit to durability and you commit to open dialogue and a shared sense of purpose and measurement, you're going to be off to a great start and we'll see it through to the end for sure.

Host: Yeah. And it makes me wonder, Dr. Rogers, you've mentioned social determinants that's come up a few times today, and just wondering how the strategic collaborations can be leveraged best, you know, to address social determinants of health and just drive better outcomes.

Dr. Selwyn Rogers, Jr.: Scott, that's the quintessential question of the time, largely driven by the fact that as we've learned over time, how impactful the social drivers of health are, it becomes clear that it's not simply the ability of a nurse practitioner or a physician or a health system to make a prescription or to do an operation if the social context and the social drivers, be that poverty, access to food, healthy foods, access to transportation to get to and from the hospital. All those things are on the pathway to recovery from an acute illness. And we haven't done an overarching job of solving that problem, partly driven by the fact that the question always comes up, who pays for that?

We've been blessed to have some community partners who take up some of the charge of some of these social services. For example, food banks for people who are food insecure, partnership with organizations that do that work, and the medical center or health system serving as a connector or a broker for information about such services in the community, has been one approach that we've taken with some benefit to our patients.

But in many ways, the problem is structural. We don't have, and we haven't really, even with the Affordable Care Act, fundamentally disrupted how we pay for healthcare. An employee-based system misses a whole segment of people who, for example, may not have a job. There is a donut hole with respect to Medicaid not being able to cover those who make, if you will, too much money to qualify for Medicaid, but too little to be in the commercial health insurance market and without some fundamental restructuring of how we, if you will, pay for healthcare. And when I say healthcare, I mean the big healthcare, the Big H, that is how do we keep people healthy so they don't develop chronic diseases, I think is the question for our time. And up until now, we've been willing to pay more and more dollars to deliver more and more healthcare, but not necessarily do the fundamental reorganization of how do we prevent potential chronic diseases early so that patients stay healthy, and we're not dealing with illness.

Host: Right. Maybe it's beyond the scope today, Doctor, you know, the prevention piece of this, there's a lot of layers here. And just trying to keep up with you, Ryan, I'm wondering, could we talk about the lessons that have been learned from these collaborations that include all the, let's say, non-traditional players?

Ryan McFadden: Scott, I think, we've learned a lot over the past year in the current work that we're doing in the last, you know, 20 plus years in healthcare. I think so much of it comes down to the fundamentals. We talked about the importance of aligning on the front end, which is really so important.

But I think there has to be also too an acknowledgement that, you know, healthcare delivery is a team sport. And when you think about healthcare being localized, the healthcare landscape is different from city to city, market to market across the country, I think first you have to be open to an idea of the enablement or the acceleration of value-based care and pop health goals, not just sitting on providers' shoulders alone and health systems' shoulders alone. I think that's so important.

And I think it comes down to trust in the groups who you decide to collaborate with, the organizations you decide to collaborate with. And so, I think what we've learned over-- really over the years-- is that when you align on the fundamentals, some of what we touched on earlier in the conversation, that's super, super important.

But I think the importance of open dialogue to course correct as you progress through a collaboration around if something's not working, how do we solve for it together, but not walk away from it, right? And I think that speaks to trust. We often tell our teams like, when you focus on your first or you're faced with your first challenge in a collaboration, that's often the biggest test, right? How are you going to see through it together? And again, this is, you know, healthcare delivery, incredibly sophisticated, nuanced with a lot of different stakeholders involved. And so, I think being able to have that open collaboration is so important, trust, et cetera. And we talked about, again, shared KPIs and long-term thinking, that typically will see you through some of the potential challenges, especially when you bring together again, large integrated health systems and maybe industry or other groups, for example.

Host: Yeah. As you say, just bringing all them together. You mentioned all the fundamentals aligning and you know, all the complexities of that. A lot of food for thought today. A lot to consider. I'll just give you a chance here, Ryan, and then we'll give Dr. Rogers last word. But as you look ahead, what trends do you think you're going to reshape how organizations collaborate to improve population health, maybe in the next five to ten years, something like that?

Ryan McFadden: Yeah. So, I think it's a great question, Scott. And I think there's a number of proof points that we can sort of point to, to get a sense of where we're headed over the next five to ten years in the U.S. One is the stated goal by CMS to have 100% of their lives in some type of accountable care relationship by 2030. There's bipartisan support for that objective, or at least there appears to be. And I think that's something that will continue.

When you think about the most recent objectives stated via the Center for Medicaid and Medicare innovation, their focus and areas of priority, one of them is to continue to push sort of risk into the provider community, right? Which fundamentally is aligned to value-based care and risk-based medicine. So, I think what we're going to see more of is employers working with their employees to seek care at high quality, low cost health systems, and also high quality lower cost sites of care, so think of urgent care facilities, for example, ambulatory surgery centers, et cetera, through copay offset programs and copay redesigns. And so, I think the focus on value-based care will continue. We see this trend as being a core sort of fundamental in U.S. healthcare delivery in the years ahead. And we're looking forward to helping to support that change.

Host: I mean, just, me, Ryan as a lay person, as a patient myself, you know, high quality, low cost. You mentioned the sheet of music earlier. That is definitely music to my ears. And Dr. Rogers, I'll give you a chance here at the end, final thoughts, takeaways, but, you know, get that crystal ball out and give us a sense of where you think things are going over the next five to ten years.

Dr. Selwyn Rogers, Jr.: I echo a lot of what Ryan said, so I will try to be parsimonious and incremental. Over the next five to ten years, I suspect that there will be much more innovation, collaboration across what historically may have been non-traditional partners, and a significant push to put patients at the center of healthcare's focus and to truly focus on keeping people healthy as much as dealing with their illnesses as they come. And as a very concrete example, in my world as a trauma surgeon, clinically, I take care of a lot of young black men, who are in their 20s and 30s, some of whom have undiagnosed hypertension or undiagnosed diabetes until they come to the hospital having been injured.

And what's always amazing to me about that is that we know that there are things that we can do to both prevent onset of diabetes or delay its effects civilly. We can improve outcomes related to hypertension with relatively standard interventions that have been proven to be able to control people's blood pressures and prevent subsequent over decades end-stage renal disease, which costs a lot of money to be on dialysis, or end-stage heart disease, which also costs a lot of money to treat. And the magic question that I think we all should have is, why don't we do more to prevent the progression of chronic diseases when someone presents with a creatinine in 1.5 in the early 20s? Because the natural history of that, sadly, will be likely to be on dialysis and potentially need something like a kidney transplantation. And if we reframe our mind to pay more attention to how to prevent the progression of early disease to late disease through interventions, we probably would be better served. And ultimately, if I can quote the age-old adage, an ounce of prevention is worth a pound of cure, we may be able to bend the cost curve that's been escalating and how much money goes towards healthcare of our gross domestic product.

I also think that innovation is going to demand disruption to some level because the way we're currently doing things is not getting the results that we want. I mentioned at the top of the podcast the enduring impact of healthcare disparities and inequities. We really haven't moved the needle very much on those reality of disparities by race, ethnicity, socioeconomic status and, in some cases, gender and just talking about it's not doing it. So, we're going to have to be creative and a bit disruptive not to do the same things and expect a different result. And so, I think over the next five to ten years, we're all going to have a bit of a reckoning to accept that we have to do some fundamentally different things, even if it's simply doing pilot tests of change that can be scaled.

And then, following up or augmenting something Ryan said, "This is a team game." This is not a they-problem or those-people-problem. This is a we-problem and our-problem. So, how can we get everyone on the field, if you will, to work together to solve the most important problem, which is if we are not healthy, we can't maximize our potential.

Host: Yeah, just one of my many great takeaways today, Dr. Rogers, from this and from you and Ryan, is, you know, it is a we-problem, right? And it is a work in progress, and it's just good to have these conversations, right? It's good that we're having this conversation, that folks are listening to this conversation that, as you say, Dr. Rogers, that conversations are ongoing, but it may require more than talk. And maybe that's a different podcast. But for today, thank you both. Really appreciate your time.

Dr. Selwyn Rogers, Jr.: Thank you, Scott. Thank you, Ryan.

Ryan McFadden: Thank you, Dr. Rogers. Thanks, Scott.

Host: That's Dr. Selwyn Rogers, Jr., from the University of Chicago, and GSK's Ryan McFadden. GSK is one of ACHE's premier corporate partners. Our premier corporate partners support ACHE's vision and mission to advance healthcare leadership excellence. And if you enjoyed this podcast, please share it on your social channels and please consider rating and reviewing our show. Thanks for listening.