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Michael Carrese (Host):  Welcome to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. I’m Michael Carrese. And today, we’re going to be talking about value-based care, which is kind of a buzz word, I think you’d agree Roxanna. And what does that mean to you, value-based care?

Roxanna Gapstur, PhD, RN (Guest):  Yeah, I do think it is a buzz word. I think the industry itself has been struggling with what that means over the last ten years or so. But in general, here at WellSpan, what we think it means is really decreasing the per capita cost of healthcare. Really providing what we have heard called the last ten years or so, the triple aim; great experience, great outcomes and quality at a more affordable cost. And in order to that, of course, it takes team work from many members of the team. But that’s how we look at value.

Host:  And why has it become such a popular concept in healthcare?

Roxanna:  I think all of us know that the reimbursement and business model in healthcare is not sustainable over the long term. You’ve heard how the country has very high healthcare costs considering the outcomes that we have. And in order to improve what we just called value; we will need to think through the way we deliver care. And the way we deliver care, needs to move more toward a value-based equation meaning the quality and experience of the care divided by the cost of that care needs to be of value to the consumer.

Host:  So, really this is put in terms sometimes of moving away from this fee for service mentality that patient comes in and needs x, we do x and that’s it. But really shifting the thinking some to as you are talking about the whole experience and what are we doing for that patient and are we guaranteeing a good experience and better quality when you look at it down the road?

Roxanna:  Yeah, it’s really about the right patient, the right treatment at the right time and with the right level of quality. And that sounds so simple when we say it like that, but it’s actually really difficult. It’s everything we do from selecting the right patient for the right procedure or the right test to providing the best outcome for that patient to what we are charging for that service. So, it really involves the entire value stream of care. And so it’s really quite complex.

Host:  So, how do you think the industry, healthcare industry thinks about value and how does that compare maybe to how other service providers think about it?

Roxanna:  I think right now, with the rise of what we’ve termed consumerism over the last ten years or so; the healthcare industry is looking at value as well it’s whatever our consumers want to buy and it’s how they want to buy it. Sort of like an Amazon experience. And I would say that that’s only a small part of what we would term value here at WellSpan. We certainly want to be easy to use. We want to have a digital platform and we want patients to have healthcare at their fingertips where, when and how they want it. But there’s more to value than that.

What we need to do is work on additional clinical resources and projects around what we call clinical variations. So, are we standardizing our care to the very best science that we can? Are we decreasing the variation among all of our teams so that we’re providing that care reliably and we have reliable high quality outcomes for our patients. That’s also a really big part of the care and then to your point, on the fee for service mentality, the you come for a visit or you come for a test and the healthcare system gets paid; we need to move away from that towards more preventive care.

So, the part of our vision, our new vision that says inspiring health is really about providing that preventive care so that people don’t get sick and they don’t need to come to us.

Host:  So, can you pick an area where you think there’s room for improvement with standardization or where becoming more highly reliable would make a really big impact?

Roxanna:  Yeah. I think there’s a number of different areas. So, I’ll just choose one area. If we could think about ordering high tech imaging for patients with low back pain. So, it’s been pretty reliably shown over the last ten years that doing an MRI in the first six weeks after someone has low back pain; really brings no value unless the person has additional neurologic symptoms that are concerning. And yet, I bet you would find in most healthcare systems in south central Pennsylvania; that some people without concerning symptoms are still getting that MRI scan. So, that would just be one example but there are literally hundreds of examples of things that we could do that in a fee for service world, maybe make sense, but in a value-based world, they don’t make sense.

Host:  Yeah, that’s a real shift. And a lot of this thinking is going on in healthcare around the country because there is some vary major for profit businesses that are figuring out that maybe they could do a bit of a better job maybe than the healthcare industry is known for doing in terms of the consumer experience. You have Walmart, Amazon, CVS, all those folks coming in and it’s being called disruptive influence. Talk about disruption a little bit and how you see that impacting WellSpan.

Roxanna:  Yeah, I think what you are bringing up is really important. We’re seeing some of those really large employers like Walmart say we think we can do this better and we want our employees and actually some of our customers to be able to get the kind of care that we think people deserve and they don’t think the healthcare system is doing it well. And so, they’re trying to offer that right care, right person, right time at an affordable cost. So, they’re looking at value as well and in addition to that, they’re thinking about for their own employees if I send my employees to a center of excellence, and they have criteria for that; could that employee get a better evaluation, and could they even avoid maybe a surgery that’s been recommended if it’s not needed.

So, one of the things we really need to be thinking about as a healthcare system is what are those right types of care that are actually needed versus when would we not move ahead with that and I think the savings that some of the employers are seeing around that has been significant and that’s why it’s getting so much press.

Host:  And affordability is driving so much of this. I mean it’s just – healthcare is incredibly expensive and really has a big impact on people and so what is – for affordability, what does that mean? What’s your affordability equation?

Roxanna:  Yeah, well I think affordability is really if we’re providing value which is that outcome plus experience divided by cost and we’re doing the right tests and the right procedures to the right people at the right time and we’re providing great preventive care as well; that should translate into affordability. And when you look at organizations like Kaiser or others, that’s the kind of work that they are doing day in and day out to try to provide that value and to really provide care 10 to 20% less expensively than any of the competitors in their markets.

Host:  So, what part of that affordability piece belongs to WellSpan employees? What role do they have in that?

Roxanna:  I think our physicians and care teams have a huge role in helping us identify and standardize to some of those best practices and best science to really decreasing clinical variation and honestly, to using our lean tools and to taking waste out of the system as well. So, our employees and our teams have a great role in helping us become more affordable.

Host:  Can you think of an example of removing waste, what employees might have an eye out for?

Roxanna:  Well I think there are many – probably many examples of removing waste. One of the examples that we think about quite a bit actually as a healthcare system is that a number of patients who come to our emergency center every year, really could have been cared for in another setting. And so, helping us think through how can we provide better options for our patients and families that don’t include a trip to the emergency room. And I think WellSpan has done a really good job of this but there’s always more to do. So, we do have other options for patients. We have walk-in hours in primary care, we have online urgent care actually. The patients can be in the comfort of their own home and go on their iPad and have an urgent care visit. And we do have urgent care centers as well.

Host:  So, as consumers, because all of us are also people who receive healthcare, how should people be thinking about value?

Roxanna:  I think it’s great when consumers and patients think through what is the care that I need and how can I get that care before they make that trip to the emergency room. So, just – there’s a number of resources that consumers can use, some of them include things like care lines at their health systems or at their health plan that can help direct people. There are certainly different apps. One of them is called Buoy. I don’t know if you’ve ever heard of that. Another one is called Ada that people can go online and actually put in their symptoms or what they want and try and determine what’s the best setting for them to receive care. So, just being a thoughtful consumer I think is really helpful.

Host:  Yeah, there’s some work on the part of the patient too in all of this. So, what do you want people to expect from a WellSpan experience? What is the WellSpan experience?

Roxanna:  What I’d love people to expect from the WellSpan experience is the living of our values with every single interaction that we have with our communities, our patients and our families. So, the working as one, the respect for all, the assuming positive intent, doing the right thing and finding a better way; to me, those values really lead us toward a great consumer experience.

Host:  And that is an every time situation, right as each patient walks in the door; you have to have those things in mind.

Roxanna:  Yes, you do, and I think that’s one of the reasons why we provide such great support for our employees here at WellSpan. We have a number of different supports for each of them that are available 24 hours a day so that people can really bring their best self to work.

Host:  So, give me some examples of how you think WellSpan is leading at value?

Roxanna:  Well, we’ve just started a brand new partnership this year with one of our payor partners Capital Blue Cross and our plan is really to help lead the region in value. And the way we are partnering together is identifying innovations and care that in a fee for service world would not have been reimbursed, wouldn’t have been paid for and it wouldn’t have allowed WellSpan to make the investments we need to make to really provide value. Capital is will to provide that for us. They are willing to provide a payment system because they share our vision of being a trusted partner and reimagining healthcare. And they also share our values. And so, it’s been just a tremendous experience for us in partnering with them as we think about different ways that we can provide value to central Pennsylvania.

Host:  So, as we wrap up, what are some of the things you want people to have in mind walking away from this conversation?

Roxanna:  I think for any employee, team member or physician thinking about being highly reliable; having all of our processes be reliable. So our patients and communities know what to expect when they come from us. Thinking about that great patient experience and living our values each time we see someone but also thinking about for the clinical team; what’s the clinical variation that we see and is it warranted or unwarranted and how can we work on decreasing the clinical variation and really providing the very best care to the right patient at the right time.

Host:  Some good thoughts to leave with. You’ve been listening to Inspiring Health, a series of conversations with Roxanna Gapstur and other WellSpan leaders about WellSpan 2025. I’m Michael Carrese. Thanks for listening.