May 18, 2023
Let’s cut to the chase. You’ve gotten to thepoint where you have a gang of physicians/clinicians/physicianpractices who have expressed a desire to work together. What do youneed to know right now?
Eric Gallagher, CEO of the Ochsner HealthNetwork, is my guest in this healthcare podcast; and I largelyasked him the same question that I had asked Amy Scanlan, MD, fromthe UCHealth/Intermountain clinically integrated network inColorado in episode 402 a couple of weeksago. The question I asked both Eric and Dr. Scanlan is: What areyou doing to help align physician practices into an integratedmodel? How are you going about that?
Now, let me remind you, Ochsner Health Networkis practically long in the tooth when it comes to clinicallyintegrated networks; and it also exists in an environment that isunique, as are most local markets. But Ochsner’s local market ismostly Louisiana, which has an older population and a huge MedicareAdvantage penetration. That is quite a different local market fromwhat’s going on in Colorado, which is the location of Dr. Scanlan’sjoint. As we all know, different stages of any journey requiredifferent solution sets; and different local markets certainlyrequire different solution sets.
But what was so interesting to me was to noticethat despite the market differences and thewhere-are-we-in-the-transformation-journey differences, how many ofthe things that you’ll hear about in this episode are in the samespirit as the stuff that we talked about in that earlier show withDr. Scanlan.
Eric Gallagher lists three things that he saysare essential in the transformation journey:
1. Making sure that physicians,care teams, and those working directly with patients are part ofthe transformation process, both from a practice standpoint butthen also from a financial standpoint.
This makes so much sense when I state itexplicitly here, but so frequently, it doesn’t happen. Sofrequently there’s a value-based care team that tinkers around in asilo and then an announcement comes over the loudspeaker one daythat henceforth we shall add some more clicks … but trust us, it’simportant for some reason we aren’t going to bother to tell youabout … you’d be bored by it or you wouldn’t understand it. Even ifthis was not the intention (and it probably wasn’t), the result isgoing to be the bad taste in your mouth that I just left youwith.
Eric Gallagher’s #1 here, that everybody be partof the transformation, might be the umbrella really over the firstthing that Dr. Scanlan talked about in that earlier episode, whichwas to make sure to give practices the tools that they need tosucceed—not what you think they need but what you’ve discerned theyactually need because you’ve listened to them. It’s abidirectional exchange here with everybody working together.
Eric adds some new ground to that. He says thatto make sure that everybody can productively contribute to thistransformation process (and probably know what tools they mayneed), it’s vital that everybody understands the “why” behind whatthe organization needs to do, meaning educating physicians andother clinicians in the business of medicine and the financialreasons for the “why” with the whatever. Insulating docs from thereal world here helps no one, and it’s not really viable actuallyin the world that we live in today …
… which is a callback to the point that DenverSallee, MD, made also in episode 402, which, in anutshell, was that he thinks that unless docs, as a gang, startlearning a lot more about the business of medicine, that we’llcontinue to see this value extraction and financial toxicity andmoral injury–inducing environments that we see right now. Dr.Sallee wrote, “I needed more education in order to truly helppatients.”
So, let me posit that this “everybody workstogether and gets educated together” step can help the practice andhelp patients in a myriad of ways, both at the practice level andat the patient level and also probably at a national level.
2. A recognition that practicetransformation requires process transformation and thinking aboutthings very differently. Now, all of a sudden, we are getting paidto coordinate care. We must work as a team because there are peopleon staff who can influence social determinants of health, forexample. We have a vested interest to create a community boardadvocating for food banks and sidewalks and air pollution controlsso all the kids who play soccer don’t wind up with asthma. Ochsneractually set up a school because they realized educated communitiesare healthier communities.
Dr. Scanlan’s clinically integrated network?They’re much earlier in the journey. They’re at the point wherethey’re working hard to get participating practices the tools thatthey need to succeed and help doctors and other clinicians helppatients through what Dr. Scanlan calls the “in-between spaces”—thetimes between appointments.
But all of this really rolls up to the pointthat Eric Gallagher is making about everybody working together andrecognizing that practice transformation requires processtransformation.
3. The culture change that’snecessary among physicians and other clinicians (pretty mucheverybody), and Dr. Amy Scanlan leaned into this one, too—hard.Both brought up the same nemesis: inertia. And the requirement tochange culture can’t be underestimated, and the change managementthat’s required here cannot be phoned in. Culture eats strategy forbreakfast, lunch, and dinner, as they say.
My two macro-level takeaways after talking withEric Gallagher today and Dr. Amy Scanlan earlier are that, eventhough the local market and the nuances of any given particularpractice have such a huge impact on what’s going to work at anoperational and tactical level, if we stay up in the strategiczone, there’s some best practices and points to ponder which arelikely possible to universalize.
Now, emphasis on the “stay up in the strategiczone.” I was just talking to another person today with yet one morestory amounting to “it didn’t work because it never was going towork,” wherein, in this case, apparently a very large payer isrunning around attempting to do a pilot in an attempt to learnexactly and specifically how to operationalize something, and thentheir plan is to roll out this one model nationwide. So, somethingworks in one local market at one practice, and we’re just gonnaassume if it worked there, it’s gonna work everywhere. And, yeah …good luck with that.
After you listen to this show, listen toepisode 402 with Amy Scanlan,MD, as I have mentioned multiple times. Episode 343 and episode 316 with David Carmouche, MD, would begood to check out. Also episode 393 with DavidMuhlestein, PhD, JD, and episode 394 with Vikas Saini,MD, and Judith Garber, MPP.
You canlearn more at Ochsner HealthNetwork.
EricGallagher, chiefexecutive officer for Ochsner Health Network (OHN), is responsiblefor directing network and population health strategy andoperations, including oversight of performance managementoperations, population health and care management programs,value-based analytics, OHN network development and administration,strategic program management, and marketing andcommunications.
Prior tojoining Ochsner in 2016, Eric held leadership positions inhealthcare strategy and execution—including roles at Accenture,Tulane University Health System, and Vanderbilt University andMedical Center.
A New Orleansnative, Eric earned a bachelor’s degree in human and organizationaldevelopment from Vanderbilt University and an MBA from TulaneUniversity.
08:14 What doeseveryone need to be on the same page about when it comes toclinical integration?
13:42 “Forphysicians, we really have to overcome this threat to physicianautonomy.”
16:52 “Healthinequity is really just societal inequity.”
19:24 What isthe principal agent problem?
20:00 “Thereare things health systems can do that are probably outside of theirtraditional field of responsibility.”
20:09 Why didOchsner Health Network start a couple of schools?
20:42 What canempower a care team in a value-based care model?
21:53 Why is itimportant to transform into a team-based model?
23:24 “In theDNA of our organization, resiliency runs strong.”
26:01 Why isbuilding an effective care model easier than building trust withpatients?
26:14 What isEric’s advice to physicians trying to integrate rightnow?
28:50 How doyou get everyone on the same side of aligning forintegration?
You canlearn more at Ochsner HealthNetwork.
Eric Gallagher of @OchsnerHealth discusses#clinicalintegration for #physicians on our #healthcarepodcast.#healthcare #podcast
Recent past interviews:
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