Lisa Farren (Host): Hello. Welcome to Crushing Healthcare, where we explore diverse perspectives regarding the state of healthcare today and gutsy visions for a more affordable, accessible, equitable, and sustainable healthcare model. My name is Lisa Farren. I'm your host today. And today, we're going to explore healthcare.

Our theme is locality, specifically healthcare is local and what that means, why it's preferable. Recognized as leaders and advocates for value-based care, we have two physicians here today to help us understand the topic and why healthcare is local, why it's important to both patients and physicians.

Anthony Posteraro, MD, is a radiology specialty care physician who has served in various healthcare leadership positions in the Greater Hartford area. He is currently Chair of the Board of Directors at Southern New England Healthcare, also known as SoNE Health. SoNE Health is a clinically integrated network providing population health management support to its network providers.

Dr. Posteraro has worked with clinical, hospital policy, and business stakeholders over the last 15 years as part of SoNE Health, as well as its predecessor organization, St. Francis Healthcare Partners, to help stakeholders come together to navigate the changing healthcare landscape as it transitions to patient-centered and value-based models of care delivery.

We also have a returning guest today, Jim Uberti, MD. Dr. Uberti works closely with Dr. Posteraro on the SoNE Health Board of Directors, serving as the Vice Chair. Dr. Uberti is Medical Director at SoNE Health, where he works closely with SoNE providers to maximize performance improvement and clinical outcomes. Additionally, Dr. Uberti leads the organization's network development initiatives. Dr. Uberti is a recognized leader and advocate for value-based care. His career as a primary care internist spans more than 30 years in the greater Waterbury, Connecticut market, with experience practicing medicine as both the physician employed by a hospital system as well as an independent physician. So, I'm super excited for our very knowledgeable guests today as we explore the concept of healthcare is local.

From my perspective, as we interact with the healthcare system, I think it's safe to say that most of us would like to have a trusting relationship with our physician, someone who's local, who understands us and the environment in the community where we work and live, someone who can really partner with us along our health journey to help us live the healthiest life possible. So, that's the image I have from a patient perspective, but I'd like to understand your perspective. As physicians with strong ties rooted in the community, can you share what healthcare is local means to you?

James "Jim" Uberti, MD: So, to give the background of my perspective, it's important to, you know, kind of recall where I've been. So, I founded and was a partner in an independent internal medicine primary care practice for many years. It became a very large, busy practice that was ultimately acquired and employed by our local hospital in 2009, and then it became part of Trinity Health Medical Group. When St. Mary's Hospital in Monteverde, Connecticut was acquired by Trinity in the mid-teens.

Over the course of my career, I also had many roles in governance, whether it be for a hospital health system, medical group and, more recently, a clinically integrated network. From my perspective, I'm aware of independence versus employed and also keenly appreciative of what physician independence and governance means.

So, SoNE Health is Connecticut-based. It's owned by local physician shareholders. It's locally governed by physicians, and committed to supporting community practices in Connecticut and Western Massachusetts. The physicians and advanced practice providers, that is APRNs and PAs, comprise the entire board of directors at SoNE and populate all its key SoNE committees. When healthcare is local, it has to be locally overseen and governed, and SoNE Health accomplishes that.

Host: Interesting. All right. So, can you dive into a little more specific, what makes SoNE Health different and unique?

Anthony Posteraro, III, MD: One way to look at this lease is to ask yourself what SoNE is not, especially at this time, you know, in history that we're going through with all these changes. And, you know, SoNE basically is not a legacy health system as we've been used to it. You know, over my career, you know, I've worked in Diagnostic Imaging, Radiology, really starting off in a hospital-centered area. You know, in imaging, you end up servicing so many different stakeholders and parts of the health system, and the primary care level, specialist level, at the hospital level, you know, dealing with other players, other systems, the state, you begin to get an appreciation for what a large ecosystem we're navigating and the stresses and strains and the changes that we're really going through and some of what are driving it.

And I'd say that, at this point, we're really in a paradigm shift in how healthcare is delivered that we haven't seen since, you know, the passage of the Social Security Acts and the advent of employer-based healthcare in World War II. It's really driven by a confluence of the need to take care of a broader population of aging Americans. And technical advances, which 30 years ago coming out of training, you know, I could not have imagined, things that allow us to really, if applied correctly, you know, take care of a population with much lower cost and morbidity, between newer generations of drugs that can obviate surgery, you know, biologic pills, even so far as being able to non-invasively or minimally invasively, like, replace aortic valves and obviate the need for complex cardiac surgery. And the list goes on.

But I mean, it's important beyond that to understand that we ultimately end up serving our patients and our community. I mean, people, this country, our population, our state, there's only so much money resources to go around. And it's really our duty to find out how best to use technology and what we have at our tools to be good stewards of these resources and take care of our patients. And that really requires everybody. I mean, we are all being pushed to really reimagine and re-engineer how we're going to deliver care on a system-wide level. Being physician-led, it really puts us at an advantage because we as the providers really understand how to take care of patients, both on the technological end and also because we do this because we are here to take care of patients on a societal level and be engaged in that way.

And I think SoNE is different because it's structured to allow the providers the ability to lead and essentially find better ways of caring for our patients at a time where we really have to re-imagine, re-engineer how we're going to be operating in the future. It's good for patient care, and it really is fundamentally the right business model, I firmly believe.

Host: Thank you, Dr. Posteraro. Well said. I'm curious, Dr. Uberti, what are your thoughts around that? Why is it important for healthcare to be local?

James "Jim" Uberti, MD: The old adage is that all politics is local, I believe that all Healthcare is local. And you can't support providers locally unless you're really on the ground with them, and working with them on their front lines where they do their work. A wise colleague of mine once said that all physicians desire is to have help taking care of their patients and to be fairly compensated for their work. SoNE ensures that practices and providers are supported clinically with a really robust population health management structure. It also supports providers financially by negotiating optimal reimbursement rates for its participants. And that's a national organization, for example, can't negotiate rates well in the Northeast or in Connecticut, which is unique. It's much different than Wyoming, for example.

SoNE saves time and cost for its participants by credentialing providers with all major payers. It saves providers cost in FTEs in trying to get credentialed on their own. And SoNE in turn distributes 80% or more of shared savings that are earned in alternative payment contracts, distributes that to our providers.

So, SoNE essentially appreciates independence of its participants. It's cognizant of the challenges that independent providers face every day. And then, by supporting providers with a wide array of services that sustain independence, SoNE allows its providers to better focus on cultivating strong provider-patient relationships, which is really the essence of all healthcare. So by working with them locally, we ensure that healthcare is local.

Host: Great. So, you mentioned SoNE and the services that they provide wrapping around the physicians to allow them to remain sustainable, adequately compensated for their work. And you mentioned that that allows them to focus more on developing that strong patient-provider relationship. So, what does that look like from the patient's lens? Is there like an actual example you can give?

James "Jim" Uberti, MD: Well, just broader examples about how we guide patients through the continuum of care. The patient really is the focus throughout SoNE. Anything we do, the patient has to be the center of that focus. And along with that, the relationship between the provider and the patient has to be the focus. It's really the essence of what we do. So, we do provide value to patients. Patients attributed to SoNE, especially those patients who have, you know, more complex medical problems or those at risk for deteriorating health are guided across a continuum of care.

And what does a continuum of care mean? Well, it means that we ensure that patients see their providers, whether it be their primary care doc or a specialty doc, regularly for scheduled followups. And then, promptly, if they have an ED visit or hospitalization, and then SoNE further has a variety of chronic disease programs, we have patients with COPD, CHF, diabetes, other chronic diseases, and there's programs developed to help the providers optimize the care of those patients, and in turn, help patients avoid hospitalizations. Just like, you know, nothing good occurs after midnight, nothing good occurs with a hospitalization.

Host: I would think everyone would agree with that. We want to avoid hospitalization and the idea of preventative care to really capture things upstream so that chronic conditions can be managed or possibly avoided. I think that's the goal for all of us. We want to live a healthy, happy life.

So, you mentioned benefits to the physicians, the providers, as well as to patients. I'm curious, when healthcare is locally managed, are there advantages to others? Say, employers or anyone else in the healthcare system? There are a lot of stakeholders in the healthcare system.

Anthony Posteraro, III, MD: I think, you know, in terms of all the stakeholders, ultimately, if you have a well-functioning health system, everybody benefits from a standpoint of the employers, you know, your employees are healthy, they're engaged, and they are not spinning around with uncertainty, concerns. Realistically, you know, it's philosophically looking at, as the Healthcare systems evolve, I often ask myself, do we need to think about Healthcare like we think about, you know, dare I say, a public utility, something that needs to serve the public good? I think we really are kind of evolving in that direction from a standpoint of what the expectations are of us.

And I think as physicians, to a greater or lesser extent, we're used to that because ultimately being local means that we are accountable to our neighbors, our fellow colleagues, you know, our patients. The best way to do with that is to be plugged in on the ground and really part of the community, not detached. That's what locally owned and locally led really means to the providers in SoNE.

A lot of these concepts we look at, and I totally echo what Jim's saying is we're really here to serve the patients. And ultimately, the question from a standpoint of our patients, you know, we all have to ask ourselves, who do we serve? Well, ultimately we serve the patients. It takes a village to serve patients. And the idea is that all these things Jim talks about, population health programs, support for various disease processes and things, they're enabling and empowering the people who are at the ground, who are, like, dealing with the community, Jim seeing the patients in his office. This is the village that helps serve the patients. And I think, our structure, our business structure, is one that from the ground up, being provider-led and owned, allows us to do that in a meaningful way here in the state.

James "Jim" Uberti, MD: Tony, that's well said, and I could not agree more. And so while the patient is always the center of our focus at SoNE, and the physician or provider patient relationship reigns supreme, we also provide value to payers, whether they be government, employer, or commercial. Payers seek a clinically graded network that focuses on quality and efficiency. And SoNE is such a network. And it's arguably really the only fully clinically graded network in Connecticut and western Massachusetts. SoNE's emphasis on value, whether it be cost, quality, outcomes. It ensures that patients receive the right care in the right setting at the right time, and it positions SoNE as a network of choice and future, partially capitated and capitated payment paradigms, which is very important to payers and providers alike.

So, many are familiar, or, I hope are familiar, with the Institute of Healthcare Improvement's Triple Aim. The Triple Aim describes improving the individual experience of care, improving the health of populations or groups within those populations, and also reducing the per capita cost of Healthcare. You could extend that to the Quadruple Aim, which also improves the work-life of providers. So, the Triple Aim or the Quadruple Aim, it sounds nice, but it's only aspirational and only rhetorical unless it's acted upon. SoNE converts aspiration to action every day.

Host: Well said. Very nicely said. And yes, I like the idea of the Triple Aim or the Quadruple Aim, if you will, where it really benefits everyone. Everyone sort of is working together to improve the healthcare system. So, great. I think we can all understand firsthand the importance of, as you added, the quadruple-- the fourth arm of that Quadruple Aim-- the importance of a good work-life balance and appreciate the inclusivity of the Quadruple Aim that it benefits everyone-- the patients, the providers, the healthcare system in general, payers, everyone. So, I think that's awesome.

Really good discussion today. a lot of really great insights, particularly around how and why we benefit when Healthcare is rooted in the local community, and how everyone can benefit from that. So, I thank you both. Thank you, Dr. Posteraro and Dr. Uberti, for sharing your time, your thoughts, and your expertise today. and of course, I also want to thank everyone listening.

Let's remember that we all have a role to play in Healthcare transformation. So, please join us in Crushing Healthcare.