Salt Lake City-based Intermountain Health has been a leader in value-based care for years. The health system now includes 33 hospitals, 385 clinics and a health plan as well as key partnerships across the continuum of care.
Greg Poulsen, senior vice president of policy at Intermountain, joined the "Becker's Healthcare Podcast" to share insights on how value-based care evolved within the system and what's next.
Early on in his tenure, Mr. Poulsen found himself in a strategy retreat with the other C-suite executives of the system, including the CFO. He had joined the health system out of business school, where he had been taught to always maximize shareholder value. He asked: who are our shareholders and how do we maximize that value?
Leaders in the room spent nearly half a day discussing those two questions.
"Ultimately, they came to the conclusion that they weren't quite sure who the shareholders were, whether it was the people who came to us for care or whether it was the community as a whole, but they did come to a very definitive conclusion on how to maximize value and that was delivering highest quality at the lowest possible cost," said Mr. Poulsen. "That started us down a path that I think has been important ever since."
The idea of value in healthcare delivery continues to dominate the strategy discussions at Intermountain, as capabilities and technology have evolved significantly. Here is an excerpt from the podcast discussion.
Q: What are your top priorities right now? How are you thinking about policy and value?
Greg Poulsen: I think there are certainly many levers that can be pulled to enhance value, but I believe the most influential lever that we have at our disposal is aligning incentives correctly. I've absolutely come to believe at Intermountain, we've had experience with that and seen changes in peoples' behavior when incentives are correctly aligned and we need to think about what people actually want from the health system. I know very few people, I know a few but not many, who actually want procedures done to them. The vast majority of folks simply want to be as healthy as they can be.
It turns out the tools to help people be as healthy as possible include procedures, but they're not exclusively procedures. There are many things health systems can do as partners with people to advance their well being and healthiness. Many of those are less expensive than trying to clean up after a train wreck, but that happens if peoples' health isn't maintained and enhanced early on. Early intervention is very frequently both good medicine and good finance. We've worked with that for decades at Intermountain. We're not perfect by any stretch of the imagination, but we are better than we work and we continue to improve.
I think that is something that should be a banner that everyone carries that works in health because we have such an important responsibility that people we care for, none of whom want to spend more for healthcare if they can avoid it, and all of whom want to have their health and wellbeing.
Q: What aspects of what you've done at intermountain are really scalable at systems nationwide. How can executives take lessons in operational efficiencies and spread them across healthcare organizations so they can emulate your success?
GP: That's a really important question. Some of the things Intermountain has done and a number of other organizations who are tremendously worthy of admiration and emulation have been fortunate enough to move all the way upstream. We started back in 1983 when we started our health plan and ramped it up to become a really significant part of the care we provide and now more than half of the care we provide is done on a prepaid basis. That ends up really helping us to align incentives. One of the things that makes that difficult when I talk to my friends and colleagues is they say, 'Well, that's great, but we're not in a position to create our own health plan.'
I do understand that it is tremendously difficult. It took us many, many years to become good at it. It took us a long time to figure out all the mechanics and all the incentives. We still haven't figured it out after almost 40 years. I'm totally sympathetic to that.
That said, we're in a situation in the United States where an increasing percentage of care that we provide can be correctly incentivized even if we don't have our own health plan or insurance mechanism. More and more the federal government and state government, Medicare and Medicaid in those two categories are pursuing providing prepaid incentives if you will, capitation like incentives to providers who work in those areas, and that can be incredibly satisfying and energizing. Many of us are scared of that and not without reason. It's new and it's challenging. I love a quote from Leeba Lessin, who was one of the early leaders of CareMore, which is an organization, especially in the early days, that was really interesting and did wonderful things. She said, 'Capitation is freedom.'
Her point was, when you have prepayment, you can do whatever the right thing is for patients. Sometimes that is an expensive procedure, but often it's doing something to intervene and prevent the need for an expensive procedure, and keep people healthier and happier. That is certainly the way we view it. I believe that's both the federal and state governments are moving and would like to move more assertively in that direction of providing those very attractive incentives to our organizations and we should embrace that and forward, and to the extent that we can try to provide influence to commercial payers to provide similar incentives to help practitioners to be rewarded for providing the highest value of healthcare.