Interview with Tufts and Navvis on Value-Based Care

The future of healthcare isn't just about treating illness, but fundamentally reshaping how care is delivered and experienced. Join us as Emily Young from Tufts Medicine Integrated Network and Courtney Fortner from Navvis share their compelling insights on the transformative potential of value-based care. Emily delves into the importance of integrating value-based and volume-based approaches, while Courtney brings to light the inspirational story of a physician who found renewed purpose and postponed retirement thanks to the positive impact of value-based care.

Strategic partnerships and collaboration between payers and providers are crucial in accelerating the shift to value-based care. Emily and Courtney explore the intricacies of this journey, emphasizing the necessity for clinical and payment transformations to work in tandem. The discussion highlights how organizations like Tufts leverage market dynamics and strategic relationships to advance in value-based care, painting a vivid picture of a healthcare system poised for long-term, meaningful improvements. 

Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.

Transcript

0:00:01 - David Williams
Value-based care has been discussed for a long time, and yet there are very few examples of true commitment and success. Can value-based care live up to its promise and how can partnerships make the dream come true? Hi everyone, I'm David Williams, president of Strategy Consulting Firm health business group and host of the Health Biz Podcast, a weekly show where I interview top healthcare leaders about their lives and careers. My guests today are Emily Young, president of Tufts Medicine Integrated Network, and Courtney Fortner, ceo and president of Navvis. They are partnering on Value-Based Care. If you like the show, please subscribe and leave a review. Emily and Courtney welcome to the Health Biz Podcast. 

0:00:51 - Courtney Fortner
Thanks for having me. 

0:00:53 - David Williams
So here's a broad question for you what are the big challenges today in healthcare? 

0:00:59 - Emily Young
Yeah, I'll kick that off. We have a very broken healthcare system. I don't have to recite the statistics to you about our cost and our quality and how we look across the other nations or even just Massachusetts and how we look here compared to other states. I think that affordability is a huge issue. It's one that we've been talking about for years, but it still remains in the forefront and it's becoming a bigger and bigger issue in a global environment. I think that access huge issue and while we talk about it here in Massachusetts that everyone has coverage, I'd argue that that doesn't mean you actually can get seen unless you go to the emergency room. I think demographics and the workforce huge challenge for healthcare when I think about what's happening with the baby boomers and when they all age into Medicare and just a declining workforce. That's impacting primary care, it's impacting nursing, it's impacting every single person that touches part of the patient journey. The health inequities are definitely an issue and just continuing chronic disease management and what's going on driving our costs. 

0:02:10 - David Williams
It sounds like a pretty good list. You know you talk about international comparisons. Sometimes we talk about, you know, cost. We cost too much and we get too little. I always think a good comparison. When someone's telling me about, for example, the Canadian health system it has this, that and the other problem I said how do you think they would do if you gave them twice as much money? Do you think they could do better? And so we spend twice as much? 

0:02:31 - Courtney Fortner
I don't think we get twice as much for it, I would agree. Yeah, I was just going to say, you know, what it culminates in is a bad experience for both the physician and the patient, and so that becomes a key issue that we're dealing with, because our primary care physicians are burning out, and that's just unsustainable for people like us, who are young as we age, who knows what the PCP landscape is going to look like when we're going to need it most? And so that's a very scary thought and it's a real issue. 

0:03:00 - David Williams
It could be a big head scratcher because it seems like there's a lot of resources in the system and yet still, as you're talking about, people might have insurance, but it doesn't mean they have access and it doesn't mean, when they get access, that they can actually afford what they're getting, even though it's presumably mostly being paid for by third parties. And then you hear that the hospitals say they don't have resources, lawyers are paying too much, et cetera. Hospitals say they don't have resources, lawyers are paying too much, et cetera. So we do hear about value-based care being a very central approach to the solution. And why is that? Why is that put forward as such a strong solution? 

0:03:37 - Emily Young
Yeah, I think it's put forward for a few reasons. I think that we need much more than incremental change and I think we've been talking about this forever. I sometimes think I've been a colossal failure when I think about how long I've been working on this and we're still here talking about this. But I think we need something much more than incremental change. We need transformational change. 

Value-based care can be a driver of that transformation. It can be an economic engine that can drive that transformation. But I think one of the things we have to start doing is thinking about value-based care. But it's not either value-based care or volume. I think the language pits us against each other in a way that actually will slow transformation down, because then it becomes well, which side are you on? Because you're clearly here for value, you don't want to do what we're working on on this side of the house. I think the power of the value-based care journey is bringing people together and really thinking about the right care and designing care in the right way, and stop pitting us against each other. I think historically, that's what many of the attempts at value-based care have done Someone's making money at someone else's expense. It's not getting at the true affordability, the true transformation, the improved experience that we need. 

0:04:54 - David Williams
Courtney, what's your impression about how transformational value-based care could be? You've obviously got a stake in being important, but is it too much to call it transformational? 

0:05:06 - Courtney Fortner
Yeah, I think that's exactly the right word is transformational. And when we look across the country and we get down to the actual individual experience of physicians and patients who and I'll give you an example I was actually in Hawaii last week with our partner there and a physician said you know, I was going to retire this year, but because of this care model, because of what I'm getting now through this approach, I'm good for another five or six years. So talk about transformation. If all of our physicians can feel that way, that's transformational to our country. Same thing for our patients really receiving the kind of care that they're not getting today. 

It's disparate health care. It getting today. It's disparate healthcare. It's disconnected, it's hard to navigate. We all work in the healthcare industry and I'm sure we all have our own stories around how challenging it is to navigate. So when you think about the fact that you can extend the life of a patient if you provide better care and that can be done through a value-based care approach, that's transformational. So all the way down to the micro level and the macro level of the financial stability of health systems, this is part of that. As Emily said, this is part of what's driving that. So absolutely transformational is the right word to use. 

0:06:23 - Emily Young
I would comment that part of what makes it transformational is the role that physician engagement plays in this space. I think that a lot of people dip their toes in value-based care. A lot of people step in and step out. A lot of people look at value-based care and look at business management doing something to physicians, imposing a framework on them, and it doesn't work. I think that what we believe at Tufts Medicine is that you have to engage your physicians. We believe in not doing things to our physicians, but doing them with our physicians, and that is where I think the true transformation happens. Ask any physician if they have better ideas on how to care for their patients today. Find me one that doesn't they all do. They're never allowed to have that opportunity to redesign care, to reimagine care. I don't think you can transform health care without the clinician and the physician at the center of the journey. 

0:07:21 - David Williams
You know, I hear about physician engagement. There's another term that's maybe a related term that I hear about, that I have maybe less positive connotations for, which is enablement. I hear about a lot of companies that are, you know, enabling physicians to take value-based care and I, honestly, I guess maybe I've met physicians that want to be engaged. I've rarely met one that said they wanted to be enabled. So how, what is the? I know those are different, they're different words, of course, but what are you really getting at? Like, what's the empathy for the, for the physician? 

0:08:05 - Emily Young
Yeah, you know, I think that part of what needs to happen and part of what I try to do every single day is listen to physicians, and I think that we often think we know the problems and we go to them. I say we, we as the industry, do this with. Here's what you need to do, here's what you need to fix. Here are the metrics that CMS has imposed on you. Here are the metrics that the health insurers have. That's all important, don't get me wrong. We need to perform. But when you change the script and ask physicians, what problem are you trying to solve? What would be the one thing that you could do in your office that would change your workflow, change your work, make you go home at night in a better space and make you take better care of your patients? And if you listen to what that is, it's usually really aligned with. If you do that, the performance metrics will come. But as an industry, I think we've not allowed physicians to have that voice. 

I'm not a physician. I've spent a career bringing physicians to the table and helping facilitate physicians leaning into driving the change rather than being disrupted. I also think it's pushing forward that with health plans and with others. Instead of engaging every disruptor, every for-profit entity into doing things, ask your physicians to do them Some of the same things that often a payer will engage with someone to do. Well, why don't you pay a physician to do that, pay a provider entity to do that? They've been dying to do that, to have a chance at innovating, to have a chance of doing something different. I think it's that. Maybe I would phrase it as the authenticity around engaging physicians and then being ready to listen and act, because you don't always like the answer. But if it's authentic and it's real, how do you partner with physicians to make that change? 

0:09:39 - Courtney Fortner
And I would just add to that you know we're asking, or the industry is asking today, for physicians to see 30 patients a day and have these intimate discussions with them and document it using codes that, frankly, the physician probably shouldn't even know, and we're asking that of them but we're not taking the time to stop and say you know what matters to you. 

As a company, we've always said we do a good job of saying what's the matter with you, but we don't do a good job of saying what matters to you. 

So really getting at the heart of that with a physician, and what we find across the country is that what matters to them is their satisfaction and their professional, their lifestyle and their income satisfaction. Those are kind of the three areas that we look at, kind of the three areas that we look at. And when we talk about physician engagement, it's not only the boots on the ground, putting the resources and their practices to partner with them, to partner with their staff, but it's also the physician peer-to-peer engagement. So we today deployed in our partnership we have a group called ESSA, located in St Louis, one of the highest performing physician groups across the country, and we have deployed practicing physicians to our Tufts partner to do peer-to-peer education and training. And it's not about HCC coding, it's not about doing tactical check the box kinds of things. It's about engaging the physician. To get back to why frankly, why they chose this career. 

0:11:10 - David Williams
Emily, you mentioned that you've been talking about value-based care for some time in your career and we're still talking about it, as opposed to looking back and having it be done. I see one thing that's different now is the partnership, and I'm wondering you know why partnering and why Navvis in particular? 

0:11:29 - Emily Young
Yeah, yeah, Tufts Medicine is not new to value-based care. We've been doing it for a long time. But I think the movement to really lean into value-based care not as a side hustle, but as a true transformation when we stepped back and had an honest conversation about our capabilities, about how fast we wanted to move into this space, we felt that we would benefit from a partner to accelerate that journey and also, to hope, with scale. There are investments that you need to make that, quite frankly, if I can spread those costs over three or four million lives instead of 300,000 lives, it makes more sense. So leaning into that expertise to accelerate that journey is really important. I think the timing is right to really lean into value-based care because of the workforce crisis and the demographics. I don't think it's optional. I think it's a way of doing business in the future. So it is in our best interest to develop those skill sets, develop those capabilities. 

When we were looking for a partner, we were looking for someone who was really interested in that true transformation. So many people out there, many that we spoke to, were interested in a Medicare Advantage play and we just said fundamentally our physicians, our system it's not going to work that we treat Medicare Advantage patients with this entire exclusive suite of services but then everyone else doesn't benefit from that. That just didn't work for us. So NavVis' commitment to transformation and all-payer transformation is something that was of great interest to us. And then the cultural alignment with physician-led change. We joked early on in the partnership that we could finish each other's sentences Even the language that both of us have used about you can't do things to physicians. You have to work with physicians. Cultural alignment and what we wanted to do. 

0:13:22 - David Williams
You know for a long time, in talking about value-based care, you hear from providers how difficult it is to have one foot in each bucket. You know, on the one hand, fee-for-service, where the incentives are about volume, on the other hand, value-based care care, where it's more of a holistic approach, and I felt like maybe around 2019 or so, people were saying, okay, now we can kind of go all in. And then the pandemic came and that kind of reversed things for a while. I still wonder about to what extent is it in the hands of a provider organization to decide they're going to go all in on value-based care and how much of it is dependent on what's going on with first the federal government, cms in particular, and also private payers or anything else that may be going on. How much can you actually make that decision and execute it? 

0:14:05 - Emily Young
Yeah, I think that we do have a lot of power, especially given that many of our relationships are in negotiation. With health plans, you need payer partners and I think one of the real opportunities is for providers and payers to look at each other differently and to end the negotiation. I mean we all can go to the table. We can negotiate, we can discuss how you know healthcare is not affordable, agree on a number and then come back in three years and have the same conversation. No one's winning in that conversation. So I think that we have a lot of power to the extent that it's a negotiation. We need to prioritize the journey and the movement to different payment models. You can't have clinical transformation without the payment transformation. They're connected. So I think we have a lot of power in going to the payers with a different framework. 

I think that with CMS, we have less power, but I think that where CMS is is they've clearly made it. They've made it clear that what I would say is there are two choices you can accept discounted fee for service or you can lean into value-based care in a variety of models. My hope is they continue to listen and build reasonable models that actually allow that create a sustainable healthcare system. You know some of the models are you sign up the latest one it's a 10 year window so that it goes through an entire administration. If there's eight years of the same party in office, it's hard for me to get my head around a model the last 10 years. So I hope CMS continues to be reasonable and adjusts as needed. 

0:15:43 - David Williams
Courtney, I wonder and this will be an unfair question so you feel free to dodge it if you want but if you look at your clients around the country and you see sort of how Tufts fits in. So Tufts is a well-known organization. It's been around for, I guess, a quarter of a millennium, if I read the numbers correctly, and yet it's not nearly the largest player in the market. There's a couple of dominant players. How does it fit in? What is Tufts' opportunity compared with, let's say, a big player somewhere else? Are they in a better place, a worse place? How do they fit in? What can they do in value-based care? That? 

0:16:19 - Courtney Fortner
others can't do and vice versa. Yeah, I think that the market dynamics of Boston in and of itself really put Tufts at an advantage. There's a lot of disruption that's happening in this market and someone is bound to leverage that disruption, and we want it to be us and our partnership together. So, market share aside, this is the opportunity and this is the time to leverage that. Certainly, there are other players in the market also to work with in our partnership that may have market share, and this goes back to the relationships that we need to have with payers. We have to have good relationships. They're strategic relationships. So I think it's a great opportunity. We look for partners that sure we want them to have some type of market share, but what's more important to us is collaborative IQ and, as Emily expressed, all the things that make us just culturally aligned and such a good fit to partner with one another. That's why we're partnered with them. 

0:17:21 - David Williams
Emily, what's your take on the market and what's your position enables you to do or not? 

0:17:26 - Emily Young
Yeah, you know, I think that our position does allow us to experiment as a system. We have fewer beds, we have fewer brick and mortar assets, which that, in a way, makes the move to value a lot easier than other systems with more brick and mortar assets, so I think that's something that plays into our favor. Certainly, the financial pressures are very, very real, so I think that that's a challenge, but I think it's that challenge that presents the opportunity. I always say if things were great and we were making lots of money as a system, no one would be letting us flip the system and think about doing value-based care. It's the challenging situation that's presenting the opportunity and I truly believe it will result in better healthcare and a more affordable system. 

0:18:12 - David Williams
Well, it's good to hear and I think you know to your point earlier about having worked on this for a long time, it doesn't mean we should give up. It means maybe we've got the opportunity coming. You know, one of the things that we see here in Massachusetts is certainly the story of Stewart Healthcare and their bankruptcy filing. I have been one of the ones advocating to say let's actually use this as an opportunity to shift away from brick and mortar and more to community resources, primary care and so on. And yet you see, even some of our senior political leaders at the state level, federal level and then at the local level, the focus is very much on preserving a hospital. Like that's the objective, and I think this is actually one of those few opportunities to have a kind of a break from that. How does? Obviously you're not steward, but how does what's going on with steward impact what you're doing? Does it help with your story? Does it make things harder? Because everyone's saying now, you know, take these hospitals, take more hospital care. 

0:19:07 - Emily Young
Yeah, you know, it's probably a little bit of both. I think that the opportunity it presents is the disruption in the marketplace. I also think it presents an opportunity in highlighting that there are people that come into this marketplace that really are not interested in healthcare here in Massachusetts and some of the concerns that we need to look for in terms of who comes into the state and who comes into the market, and are those margins reinvested back into our system or are we left with what we've been left with with Steward. So I think that's good. It's challenging, you know. I think that the challenging part of it is we're not at a point where we have excess access in the state. You know. That's what makes this really challenging and I do worry, you know, from a community standpoint, it's concerning that we have our communities, with more Medicaid and Medicare, really closer to financial ruin in terms of their hospitals Not a good thing for the state. 

And when we talk about health equity, these are some of the issues that we have to wrestle with. What I like is that it's elevating the conversation and I think that something good will come. Confident. Something good will come of it. 

0:20:36 - David Williams
And I think that something good will come. I'm confident something good will come of it. Massachusetts and her point is that employers did have a seat at the table. They really stepped up during the whole RomneyCare discussion and have been absent since or have been backed away, and the sort of focus on service for their employees and keeping costs down is something that they want to bring to the party. And there's this emphasis on primary care and, I think, on value-based care as well. Do you see that having a potential for accelerating your initiatives? 

0:21:04 - Emily Young
Yeah, I think there's a tremendous opportunity. One of the things that we talk about a lot often with our payer partners is how we do bring the employer to the table. You know healthcare is so interesting in the United States, right, you don't actually pick where you get your healthcare from. Most of us work for an employer that offers a solution If we become disabled or we lose our job. We go on Medicaid. At certain times in our life we'll age into a different product. So one of the important things is thinking about that model having consistent care that I don't have a. If I'm a person, it's not my choice as to when I go in and out of insurance. I don't want to suddenly be offered then less. You know more or less products as I go through that journey. But I think there's a tremendous opportunity to partner. 

I think that one of the things that also has to happen as we partner is sometimes, when we talk to employers and when we talk to the payers, we talk about only that commercial population, but the reality is we finance everything Medicare and Medicaid on the backs of commercial insurance. So I do think the opportunity to fix affordability is about yes, how do we make healthcare more affordable for your population, and what do we do with you as the employee? But the reality is, if we improve Medicaid and Medicare, your healthcare will become less expensive, and there's tension in the system about that. We hear that all the time, but I just think it's something that, as a state, we have to work through and guarantee you it will make health care more affordable for everyone in the state. 

0:22:41 - David Williams
Courtney, I want to ask you a question about this partnership with Tufts and, in particular, you know what are the different components of it and how do you progress and how do you know whether you're being successful or not. 

0:22:58 - Courtney Fortner
Yeah, this is what I would refer to as an operating partnership and really we're touching everything that is what you would consider value-based care anything that has implications to both the physician and the patient experience, ambulatory care management to practice what we call practice optimization, with our resources and the practices to analytics insights, to payer strategy, to comp redesign All of those things really creating this ecosystem of care for the patient and the provider. And I just want to go back to emphasize the point that we talk about value-based care. We use the word value but it's not at the exclusion of volume. We passionately believe that you can have volume-based growth through value-based care. So our partnership also encompasses the acute side, from a throughput and capacity standpoint, and post-acute very much plays a major role in this. 

We know that post-acute costs are, you know, 30% of costs across the country. So, really emphasizing our post-acute management and how we measure that, I would say it's both qualitative and quantitative. All the things that we've talked about here today already from a quality, access, affordability, experience standpoint, the physician income, lifestyle, professional satisfaction. But then those quantifiable metrics how are we performing in our value-based contracts and what are the leading and lagging indicators, whether that be annual wellness visits, hcc recapture visits, htc Recapture, pmpms, admin rates. So that's how we're. It runs the gamut of services and capabilities, but we believe that we've created a really best-in-class ecosystem. 

0:24:45 - David Williams
Well, I have one last question for you, for both, and that's whether you've read any good books lately, anything that you would recommend to our audience or anything you recommend to avoid. 

0:24:57 - Emily Young
It's funny. I have two that I picked up at my local library, who happens to have a fairly decent selection of books on the health care environment, so two that I am in the middle of reading. One is Legacy by Usha Blackstock. That is a black physician reckoning with racism and medicine. So I've started that um and it's pretty interesting so far and I think it's so important to the journey that we're on and just the uncomfortable reality that we have to grapple with Um. So I'm enjoying that and I'm not through it yet. 

But the other one I picked up which is very interesting is Future Care by Jag Singh, and it is a local physician who it starts off with his experience having COVID and then he is writing all about sensors, artificial intelligence and the reinvention of medicine. And you know, I think about this moment in time we're in, where everyone is so afraid of change, and I think back to what healthcare looked like 50 years ago, 25 years ago, and I'm trying to wrap my head around what healthcare is going to look like in 5, 10, or 15 years. So I'm reading it to just really try to think about what system do we have to be designing? 

Well, I can't quite imagine it, yet that's what's coming. So that's what I'm reading. 

0:26:20 - Courtney Fortner
How about you, Courtney? Yeah, I'll give one outside of the industry, but it's applicable to any industry. It's a little intense, but it's Leadership Strategy and Tactics by Jocko. It's been a great read. 

0:26:33 - David Williams
Excellent, well, great, well. I want to say thank you to Emily Young from Tufts Medicine Integrated Network and Courtney Fortner from Navvis for joining me today on the Health Biz Podcast to talk about value-based care. If you like the show, please subscribe and leave a review. You've been listening to the Health Biz Podcast with me, david Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroup.com.