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Hi, everyone. Thank you so much for tuning
in to this episode of the Becker's healthcare
podcast series. I'm Erica Carbajal, an editor with
Becker's Hospital Review. And today, we're joined by
(00:42):
doctor Tim Johnson,
vice president of clinical integration at SSM Health
in Saint Louis.
The health system has really positioned itself as
a leader in value based care in recent
years. So excited to chat with you, doctor
Johnson, about the health system success here.
Well, thanks for having me.
Yeah. Well, before we get started, do you
(01:02):
mind just sharing a little bit about your
background in health care and the scope of
your work at the health system?
Sure. So I am an internal medicine physician
by training,
and I've been here at SSM Health for
the past six years.
My my title is system VP of clinical
integration, and people ask, well, what does that
actually mean?
What that means for us is I'm responsible
(01:23):
for
our medical group across the system across four
states,
and I'm also responsible for all of our
population health efforts
and making sure that the care that's provided
in the acute care facilities and the ambulatory
facilities
is integrated
and,
that it makes sense with our value based
care journey.
Thanks for sharing that context, doctor Johnson.
(01:46):
Well, value based care
has been a buzzword in health care for
years,
but it's really taken hold at SSM Health
with more than 600,000
patients who are now in alternative payment models.
From your perspective,
can you start by sharing what has allowed
SSM Health to really break through and meaningfully
(02:06):
scale value based care?
Yeah. I would I'd say
one of the key factors in our success
in value based care starts at the very
top. So when Laura Kaiser became CEO of
SSM Health in in 02/2017,
She came from Intermountain Healthcare and really had
a a value based care or population health
(02:27):
mindset.
And what she noticed here at SSM is
there were pockets of
individuals
or parts of the system that were working
on population health, but there wasn't really
a system approach to it. And she wanted
to apply
standardized thinking or a system approach to value
based care.
And so she put together a leadership team
(02:49):
that believed in value based care, and she
let out
and then brought in other leaders that could
help help us standardize our approach to population
health or value based care. So I I
think having
CEO support and executive leadership support for value
based care is a really important factor. It's
hard to move forward
(03:09):
meaningfully if if your CEO or your executive
team isn't isn't on board. So that that
to me was is one of our factors
that plays into our success.
I think it also matters that we're an
integrated health system.
So integrated in that, it's not just you
know, we're not just a bunch of hospitals
or a bunch of ambulatory facilities, but we
have our own health plan up in Wisconsin.
(03:31):
And when you have your own health plan,
you are financially responsible
for all of their costs.
And in in that
market, you know, roughly 250,000
of our lives already were at full risk.
We were at full risk for those lives.
So moving into value based care when you
already have those lives that you're at risk
for, that makes it a little bit easier.
So that, I think, also helped us and
(03:51):
is helping us be successful and keeping us
focused on value based care.
Another factor would be just the the types
of patients we care for. So we care
for a large number of Medicaid and Medicare
patients.
And CMS and the federal government is moving
in this direction of paying for value rather
than just
we're seeing more patients or doing more procedures.
(04:12):
So that's that's also been a factor in
us being being successful. And
and then I think
our vision, our mission, our vision actually plays
into value based care as well. So our
our our vision statement is
peace, hope, and health
for every person, family, and community,
especially those most in need.
And that last little part, especially those most
(04:34):
in need, I think really aligns with value
based care
and the types of care we want to
provide for our patients and our families and
our communities. So these some of the factors
I think about that helped us be successful
in the value based care world.
Yeah. Super helpful to hear, and, you know,
I appreciate what you said at at the
start of just a tangible example
(04:54):
of really how this focus all starts at
the top and having Laura Kaiser as a
CEO really focused on this being the foundation
and and helping lay the groundwork for the
health systems focus here. I know you mentioned
that when she came on, she helped put
together a leadership team that is really focused
on value based care, including yourself.
What are some of the roles that you
(05:15):
work closely with on this work?
So at this at the system level, we
we're not very heavy in a population health
leadership. We we work really
closely with our regional team, so we have
we provide
health services in Wisconsin, Missouri, Illinois, and Oklahoma.
And in each of those regions, we have
(05:36):
leadership teams, population health leadership teams that really
help guide the work. And so my role
and and I have a dyad partner, administrative
dyad partner. The the two of us, our
role is to work with those regional teams
to make sure that the programs that are
being implemented are standardized and and effective,
which is the work we've been doing over
(05:56):
the past few years. We're we're now to
a partner journey where
we've done a good job of standardizing the
care management programs across all the different regions.
But now we're working on differentiating the programs
a little bit so that the needs that
Wisconsin has are being addressed,
because the needs in Wisconsin are different than
the needs in Oklahoma.
So I think over time, what we're doing
(06:18):
has has changed, but there's the standard approach,
and now we're differentiating in each of the
regions.
But, really, it's those regional teams
that work with our care managers and our
care teams,
our payer contracting teams
to help move the work forward.
Yeah. It makes sense. Thanks for sharing a
little bit more on the structure there.
(06:39):
Well, Doctor Johnson, if you had to pinpoint
the most significant win so far in SSM
Health's value based care journey,
what would they be, and and how are
you really thinking about defining success internally
as you move deeper into value based care?
Our biggest success.
Well, I
I would say, to start, we've done a
(07:02):
really good job of standardizing
what care management looks like in the pop
health space or in the value based care
world.
Once again, as I mentioned before, there were
lots of care managers in our ambulatory spaces
in particular
who are working with patients, trying to do
a good job of taking care of them,
really focused on team based care. But because
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there wasn't a standardized approach to it,
we were doing a good job, but we
weren't doing as as
as good as we are now from a
clinical perspective or a financial perspective. So
we started by developing seven core care management
programs
to take care of patients,
and just and standardize the work that the
care management were doing and then started tracking,
(07:44):
you know, how are we doing with these
different outcomes, clinical outcomes in particular.
So I would say just the standardization
and being able to say, yep. We've got
a program that works across all four
states. I I would consider that a real
success.
I think some of the outcomes we see
from that standardization,
clinically, when we think about our ambulatory
quality metrics,
(08:05):
our eCQM metrics that
that most health systems are tracking. You know,
when we started on our on our journey,
we were doing well. I mean, we were
in the
to percentile in all these ambulatory quality metrics.
So we are doing well.
Fast forward four years later, and in every
one of those
ambulatory quality metrics,
you know, we're in the to a percentile.
(08:28):
Right? So we we've taken all the good
work and made it even better by standardizing.
Same thing when we look at the what
we call value based revenue gains. So the
money that we're
receiving from the play from the payers
for the value value based care work we're
doing,
we tripled that in about three and a
half, four years. So that's we we consider
(08:48):
that a success.
One of the things we're proud of is
the number of lives that are now either
in some type of shared savings, partial risk,
or full risk plan.
When we started this journey in 2019
is when we really got going. But in
2019,
we had about 320,000
lives in some type of shared savings, partial
risk, or full risk plan. And then now
(09:09):
we're about 615,000.
So not quite doubled,
but basically doubled. So that that's been a
real success for us.
So I'd say some of those some of
those measures would would be things that we're
proud of.
Yeah. Really terrific measures there. Such
major growth in just in just a few
years. Interesting to hear how how it's really
been built.
(09:30):
Doctor Johnson, we often hear that clinical financial
teams speak different languages, you know, when we're
talking to health system leaders.
So when you think about that, what have
you found most effective in getting c suite
peers in finance and operations
on board with taking on more risk in
value based care contracts?
(09:52):
I'll go back to where I started, and
that is CEO and executive leadership support. That
absolutely makes a difference.
And we've had that, so that support's really
important.
In addition to that
c suite level support,
I think the way we talk about value
based care helps our administrative
or our finance leaders.
(10:13):
And I I actually
got this idea several years ago from Greg
Paulson, who used to be the chief strategy
officer at Intermountain.
And he talked about value based care and
compared it a little bit to being a
catamaran.
And I think all of us have heard
over the years that it's hard to have
a foot in both canoe. Either you're in
the value based canoe or you're in the
fee for service canoe. But if you have
(10:34):
a foot in both canoe, it's really unstable,
and it's hard to to manage.
But if you think about a catamaran, a
catamaran actually is
two canoes
connected by a really solid board.
And because they're connected by a solid board,
you get a really stable ship.
So that's actually what we acknowledge and how
we adopt value based care at SSM Health.
(10:55):
We we're not saying to our administrative leaders
or even to our clinic teams, hey. It's
all value based care. We realize there's a
role for fee for service. We just wanna
make sure that
the service they are performing is necessary and
at the most appropriate cost. But it's a
it's a catamaran. It's not it's not a
foot and bolt canoe.
And that concept has really helped
(11:16):
our administrative leaders get on board understanding that,
yeah, we do care about
our hospital volumes or we do care about
the number of patients that our providers are
seeing in the clinic.
We just want it to be the right
patients and doing the right procedures.
Not surprisingly, we also talked a lot about
network integrity.
So if we're doing a really good job
(11:37):
of keeping patients out of the emergency departments
or not having me admitted unnecessarily because we've
done such a good job in the ambulatory
setting,
in theory, you could worry about, you know,
reducing
or reduction in ED volumes or admissions.
But the truth matter, plenty of patients out
there that are that are sick and should
be in the hospital or should be seen
(11:58):
in the EDs. We just need to make
sure that patients that are attributed to us
are being seen within our health system.
So network integrity or keeping patients inside of
our health system is also an important focus,
and it's a way of saying
we can do value based care,
and we can do well with appropriate fee
for service.
So that those types of conversations have helped
(12:21):
have have really helped all of our leaders
at SSM get on board with value based
care.
From a clinician perspective, you didn't really ask
me this,
but sometimes our clinicians, our specialists in particular,
worry about value based care, and they don't
understand, hey. If we're on a value based
care journey, what does that mean for me
and my surgical volumes or,
you know, my specialist volumes in ambulatory setting?
(12:43):
And
and once again, it's a similar conversation of
when we so I'm a primary care doc.
So when I refer a patient to a
surgeon, you want those patients to be appropriate
so that you can actually take them to
the OR because that's what you really love
to do anyway. So part of value based
care is I wanna send you appropriate patients.
And when they get to you, they are
(13:04):
ready to go
because they need a surgical intervention, and you
can go to the OR and do what
you love. So once again, we're not trying
to take volume from you. We just wanna
make sure that the value of the referrals
or the consults we're sending to you are
higher value
and actually do need something that only you
can provide that I can't provide in a
primary care setting. So it's it's not just
(13:25):
administrative leaders, but it's also clinical teams.
Yeah. Thanks for touching on those aspects, doctor
Johnson. And it's interesting just to hear the
value and kind of the transparency and communication
there of not abandoning the idea or communication
around the importance of volumes in patients, but
really just elevating
(13:46):
the message around,
you know, making sure that,
as you mentioned, the referrals we're sending you
are are high value, and we are driving
better outcomes for patients.
Yeah. I I call it the both and.
So it's not either or. It's it's it's
both and, and that that seems to resonate.
Yeah. Absolutely.
And it does sound like I mean, by
(14:06):
and large, that
the kind of either or mindset is is
still quite prevalent, it seems, when when you
talk to to folks about this.
I I agree. And I think the other
challenge with the either or is that it
makes it hard to step into the value
based care world. Because if you're thinking either
or
or, hey. I can only have my both
(14:27):
feet in one canoe, not not both,
canoes through a catamaran model.
It becomes really scary, especially when you start
looking at health care finances. Like, how how
is this actually gonna work? I don't currently
have enough lives and a value based care
contract.
And even if I did,
if I don't keep my hospitals full, I
can't
I can't make it work financially. And and
(14:49):
so there is a way forward. You just
it it's it's a it's a both and.
Yeah. Certainly.
I wanna talk about
leveraging data, something we hear a lot about
as well. How is SSL
Health using its clinical and cost data to
demonstrate value, particularly
in conversations when you are taking on more
(15:10):
risk or asking payers to recognize performance?
This is an interesting question.
So I'm gonna back up again. When Lara
came in in 2017
and then we decided to move forward,
2018,
one of the things we recognized is we
didn't have great visibility into what was happening
to our patients, which patients did we need
(15:31):
to intervene on.
We already mentioned we didn't have a standardized
approach. And
so back in that time frame, we we
had to make a decision of
about whether or not we are gonna build
our own population health infrastructure
and from the ground up and and start
moving forward or if we want to look
around in the market to see if there
was, and I call it an accelerant, but
(15:51):
somebody, a company that could help us accelerate
our population health efforts.
And,
ultimately, we settled on
partnering with a company called Navis
to accelerate our pop health growth. And part
of that's because they had a platform called
Choreo
where they could take all of our data
and they could aggregate it.
They could do the analytics and then develop
(16:13):
some reports to help us understand what do
we do with our
patients and which patients do we need to
do x, y, and z with.
There were other reasons, of course, we went
with Navis. They helped us develop the core
programs and do some cultural things to help
us our Amerigroup groups in particular be ready
for value based care. But
but the data platform was really important because
it's hard to do pop health if you
(16:34):
don't know what's what's going on.
So that's been,
a really important part of our journey.
I'd say that's also part of the journey
where we're we're both maturing. When I say
we are both maturing, Navis is maturing, we're
maturing, and how do we actually do even
a better job of telling our story?
You know, where are we being successful and
(16:54):
where do we need
to pivot and put more
focus on to improve in the population health
space by looking at data and analytics. I
I am
certain that that's not unique to SSM Health.
I'd say most health systems are excited about
improved data, improved analytics,
to guide our population health efforts. So ongoing
(17:16):
effort there. I don't know if I actually
answered your your question, Eric, other than say,
yes. It's important.
We've got something in place, and we're continuing
to work on improving it so we can
do even better job of taking care of
patients.
Yeah. Certainly. It makes sense, doctor Johnson.
Well, to end us out,
looking ahead to the next two to three
years, what's the biggest opportunity
(17:38):
and the biggest challenge that you see on
SSM Health's value based care journey?
Part two, two parter questions. That's part one.
And part two, maybe a piece of advice
on what you would tell other health system
leaders who they're bought in. They're committed to
the idea of value based care, but they
they do still feel stuck in a fee
for service world.
(17:59):
I'd say our biggest opportunity is
now that we've got the standard work in
place,
it's
recognizing the unique nature of each of the
states that we're in and
working with those
regional leadership teams to design
so we've got a common framework. We're not
changing the common framework. But inside that common
(18:20):
framework,
designing programs that
specifically address the needs of the patients in
Wisconsin or address the needs of the patients
in St. Louis
or in Oklahoma City,
that's a real opportunity for us.
And,
once again, that's the next stage in our
own evolution
of developing differentiated programs for our different our
(18:42):
different regions.
Along with that comes this idea of
moving patients from, you know, shared savings types
of contracts to partial risk to to full
risk be because a lot of those 615,000
lives are in shared savings types of programs,
and we're starting to move them into at
least partial risk.
And when you move them into partial risk,
(19:02):
you have to be even better
at managing
patient populations.
Everybody in the pop health space focuses on
ED per thousand and
hospital admits per thousand and SNP utilization.
We'll still focus on that,
but how we address
ED visits or hospital admissions in Wisconsin
(19:22):
to do better on our average per our
average at risk contracts may look a little
bit different than it does in our other
states depending on the conditions of the patients
we're taking care of and some of the
SDOH needs
that differ from community to community.
The other
it's a partial answer.
I think if you're getting into this and
(19:43):
you're starting on your value based care journey,
you have to demonstrate patients.
So we're so used to in the health
system,
we're so used to results and and you
see the financial results a month later, three
months later, even six months later,
and we become uncomfortable waiting longer than six
months. And that that doesn't really work in
the pop health space. If you're looking for
(20:05):
immediate
return on your investments in the value based
care world,
you may bail on a really important effective
program
just because you haven't seen it in six
months. It can take
a couple years. It can take three, four
years, and that's frankly what we saw ourselves.
So if if you had to judge our
performance in 2020
(20:27):
after only a year of doing it,
well, it would have been difficult because it
was a COVID.
But if it hadn't been COVID, even a
year later, you're not gonna see the results.
It took us three or four years to
start to see the real results of the
programs we put in place. And so I
I encourage
health care leaders to be patient
when they start this journey.
(20:49):
Advice for those who want to get going
on the value based care world
but haven't yet. I I would just go
back to this concept of
it doesn't have to be all
or nothing.
You can still focus on fee for service
care
and step into the value based care world.
And the way you do that is you
start thinking about, hey. We've got there are
(21:10):
plenty of patients that that can be admitted
to our facilities,
or there are plenty of patients that need
the appropriate surgical procedures or other interventions.
Let's just focus on keeping the appropriate patients
in our health systems,
which will keep our hospital beds full, keep
the finances healthy as you move forward on
the value based care world or value based
(21:30):
care journey.
And the finances on the value based care
side will get better and better, which does
take pressure off the fee for service side.
But once again, I I think it's both.
I think you can do really well with
value based care world and the fee for
service world.
Some really great closing thoughts from you there,
doctor Johnson. Thank you so much for joining
(21:50):
me on the podcast today. It's really insightful
discussion.
Welcome. Thank you for having me. Yeah. Absolutely.
And listeners, you can tune in to additional
episodes of the Becker's Healthcare