‘Pay­ers are not en­e­mies'

Modern Healthcare - - Q & A -

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. •

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