‘Payers are not enemies'
Aside from getting a master’s degree at Arizona State University in the early 1980s, Jim Hinton had never been separated from his beloved home state, New Mexico. So it came as a bit of a surprise when news spread last October that he would step down as president and CEO of Presbyterian Healthcare Services to take the helm at Baylor Scott & White Health, a 48-hospital system based in Texas. Hinton said he wants to build on the legacy of his predecessor, Joel Allison, and make Baylor Scott & White “a source of consistency and innovation.” Six months into his term, Hinton announced last week that he was dropping the title of president and handing those duties off to Peter McCanna, who spent the past 15 years at Northwestern Memorial Healthcare in Chicago. Hinton recently spoke with Modern Healthcare Editor Aurora Aguilar. The following is an edited transcript.
Modern Healthcare: Why leave the top spot at a system you were with your whole career?
James Hinton: I wasn't looking for a job, but obviously lots of jobs are coming up around the country as an era of CEOs are transitioning into retirement. When the call came from Baylor Scott & White, it was just too good to not explore. I had known my predecessor here for many years and knew the system and thought it was a place I could add some value. But it was still a very difficult decision for me. When I told my colleagues, it felt like there had been a death in the family for me. Everyone was very gracious, but it was hard. I underestimated how hard it would be.
MH: What’s been the biggest challenge to date?
Hinton: It's a very large and complex health system spread out over a large and complex state. After being in one place for so long and knowing most things about the system and the communities we served, it's been a steep learning curve. Healthcare is a local service and so it's not enough to just know the names on the map. You have to know about the communities and even within the Dallas Metroplex area, it's a very diverse area. So it's been a geography lesson, sociology lesson and an economics lesson. You can understand the anatomy, but it takes a while to completely grasp the physiology of how the system actually functions. It's been fun, though, and I've learned a lot. People have been very gracious and helpful.
MH: How did Allison’s legacy affect your initial work?
Hinton: It's an interesting parallel because I was CEO at Presbyterian for the same amount of time as Joel Allison was CEO at Baylor and then Baylor Scott & White. How do I honor him and his contributions, but recognize that healthcare is in a rapid change process?
I don't think Joel or the board or anyone would have wanted me to just carry on as he did, but to build on the system's strengths and help it become more resilient in the long term.
MH: How have market dynamics dictated your vision for Baylor Scott & White?
Hinton: Our strategy is all about making choices. We're in the process of deciding how and where we want to extend our mission in the state and understanding what our competitors are doing is part of that.
Healthcare is interesting in that competitors are also often your partners. There's a lot of opportunity for collaboration in Texas. Vital services that would be beyond the grasp of any one system can be provided in a more collaborative model.
MH: What partnerships do you think would most benefit healthcare organizations given the current political climate?
Hinton: The first and most important partnership that we have to define and inform is the one between patients and this organization. Healthcare is no longer a “do to” kind of service. It's a service that is a partnership of shared decision-making between
“The information and perspective that payers have is very helpful in stimulating . . . change.”
the people who come to us and the technical services that we provide. Deepening that trust and partnership is challenging in the midst of so much federal and state uncertainty about insurance and accessibility. We want to be the part of the healthcare system that people can count on regardless of what’s going on externally.
MH: You oversaw integration of a health plan at Presbyterian. What do you think is the key to a successful integration?
Hinton: Payers are not enemies. They perform an important function in our world and, in most cases, they perform something that is beyond the capabilities of health systems. At Presbyterian, the health plan was a source of innovation and exploration that was really important to how the system evolved. Here in Texas with the Scott & White Health Plan, we also work collaboratively to try things that are more difficult to attempt with an external payer. In most cases, external payers are willing to experiment and innovate if they have partners they can count on. I think it’s time we checked our weapons at the door as it relates to historical biases and assumptions and figure out how to work in a more collaborative manner.
There are emerging opportunities in the total cost of care which is the sum of all of the services a patient receives. It’s the payer’s responsibility to ensure that there is an adequate premium to cover their services, or in a self-funded relationship where the employer has the primary insurance risk, to ensure that the employers’ needs are being met. The best example of that for Presbyterian was the partnership we had with Intel. Their desire for more responsive, more cost-effective, higher quality healthcare on their campus was achieved through a creative partnership. There are other programs like that in Texas that we’re working on both with the Scott & White Health Plan and with some of our independent payer partners. That involves insurers providing claims data and hospitals reporting encounter data to begin to realize a more analytically driven system of the future.
Large employers in Texas are interested in finding ways to customize healthcare services for their employees and make sure access, cost and quality are all aligned for the people they employ and their dependents.
MH: How has that impacted your service lines?
Hinton: This system is involved in multiple locations with high-complexity, low-volume services, such as some surgeries or other treatments. We have been working with payers to achieve the benefits of having more volume of those complex procedures done in fewer settings. Payers, through their medical directors, have been responsive to that.
MH: Delivering care at home is something you’ve championed as increasing quality and lowering costs, but payment has been a hurdle. How do you see this playing out?
Hinton: We have to get out of the business of paying for doctor’s visits, hospitalizations and home care separately, as if they were independent of one another. They’re all connected. If we don’t think of these services as connected, we will optimize one part of the continuum to the detriment of the other. On the front end of the care cycle, how do you avoid doctors’ visits that shouldn’t happen in the first place through technology like video visits and email communications? On the back end, how do we partner with post-acute and home healthcare providers?
That’s what’s fun about the current transformation. It’s increasingly causing us to focus on some things that have been harder to justify based on the old fee-for-service model. Now that Medicare says we’re going to pay you and your collaborators based on the total cost of care, it removes the barriers to doing what’s right for the patients.
MH: Presbyterian was a Pioneer ACO, one of the most challenged. What options are available to create successful ACOs in this current landscape?
Hinton: The primary lesson is that the information and perspective that payers have is very helpful in stimulating health system change.
If you’re in a hospital, you’re seeing one slice of healthcare; if you’re in a doctor’s office, you’re seeing another slice—the same for ambulance services or home healthcare. The payer perspective on health delivery costs and quality is more complete.
Many payers are signaling that they want to deepen relationships with systems. Prior to my arrival at Baylor Scott & White, there was a commitment to create an ACO that is now one of largest in the county and that entails payers working to exchange data and drive a higher-value system. I don’t think there’s any magic bullet. It’s relationships-driven, it’s built on trust and consistency and creating some value, and I think Baylor Scott & White has done a phenomenal job.
Over the past five years, the Baylor Scott & White Quality Alliance has put its population health management infrastructure to work managing the health of enrollees in Baylor Scott & White Health’s North Texas employee health plan to the tune of $37.5 million in savings, a zero percent medical cost trend, 13% fewer hospital admissions and a 19% increase in network utilization over a five-year period. Similar results were experienced managing the health of enrollees of a large selfinsured product model as demonstrated by a 1.1% savings in medical costs.
MH: What is your vision for the future of Baylor?
My role is to help reveal the parts of the system that are most consistent with what patients and members and payers want. We can be a source of consistency and innovation. •