June 24, 2025 • 25 mins
Why Reducing Variation = Better Outcomes
In this episode of ShiftShapers, host David A. Saltzman welcomes Kate Grohall, co-founder and Vice President of Value-Based Solutions at Holista. Kate shares her powerful journey from working with patients in a teaching hospital to building a transformative platform focused on reducing variation in care, cost, and outcomes.
She unpacks how Holista restores trust in the provider-patient relationship, leverages real-time communication tools to improve outcomes, and helps employers drive change by demanding value—not volume.
🤖 Sponsored by BenePower
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🔑 Key Takeaways from This Episode
📌 Quality = Reducing Variation
Kate defines healthcare quality as reducing unpredictability across cost, outcomes, and patient experience.
📌 C Still Equals MD
Most consumers can't distinguish between top- and bottom-tier physicians. Holista’s proprietary vetting process closes that gap.
📌 Restoring the Provider-Patient Relationship
Holista rebuilds what’s been lost by re-emphasizing relationships and collaboration across care teams.
📌 Real-Time Care Prevents Crisis
Through a patient app and nurse engagement, Holista helps patients avoid unnecessary ER visits and complications.
📌 Incentives That Actually Change Behavior
Forgiving copays and reducing premiums for high-value care choices gives patients immediate financial benefits.
📌 Employers Take the Wheel
Employers are stepping out of the back seat and demanding better results—and Holista helps them drive smart, sustainable change.
⏱️ In This Episode
00:00 Introduction to Better Health Outcomes
00:47 Kate Grohall’s Journey into Healthcare
03:12 Understanding Quality in Healthcare
05:19 Challenges in Reducing Variation
06:50 Provider and Patient Experience
08:57 Quality Metrics Beyond Standards
13:13 Real-Time Communication in Healthcare
14:41 Changing Behavior and Incentives
21:31 Future of Healthcare and Technology
22:56 Employers Taking the Driver's Seat
24:53 Conclusion and Final Thoughts
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
How can advisors help clients and plans deliver
better health outcomes,outstanding member experiences
and healthier, happier lives?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:13):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industryshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:35):
And to help us answer that question, we've invited
Kate Grohall, co-founder andvice president at Holista.
Welcome, Kate.
Speaker 3 (00:42):
Thank you Good morning.
Speaker 1 (00:44):
Good morning.
Thanks for being here.
We appreciate your time.
We always like to start withthe question of how your journey
began and how you ended updoing what you're doing, because
everybody's story isinteresting, so would you share
some of that with us please?
Speaker 3 (00:56):
Sure, I'd love to Thanks for asking my journey.
Let's see here.
I would say my healthcarejourney as a career started when
I was doing my undergrad at astate university here in
Wisconsin and I was fortunateenough to land a student
position in this very largeteaching hospital, UW-Madison
(01:19):
Hospital and Clinics, andstudents sort of roamed around
and went from department todepartment, being helping hands
in whatever way thosedepartments needed.
We were cheap labor at thatpoint and it was on campus so I
could get there on the bus andthey paid really well and I
could eat in the cafeteria.
It was a good deal and I wasexposed to just a plethora of
(01:45):
different specialties and, mostimportantly, exposed to the
patient experience.
A lot of times I was escortingpatients here and there in this
huge hospital.
They were nervous, they werefeeling a little lost and that
hit home with me Fast forward.
(02:09):
I took that sentiment intoadditional career stepping
stones of mine.
I got my undergrad actually inindustrial psychology, which is
basically corporate culture.
It's not even a degree anymore.
I now hold my master's inquality theory and as I was
(02:33):
going through healthcare anddifferent career positions,
quality became a huge area ofinterest for me.
And as I got my master's degreein quality.
That was due to what I sawpatients experiencing along the
(02:54):
way, either from thecomplexities of their insurance,
the complexity of receivingcare, wanting to be able to
trust and understand quality,but having no idea how to
identify it.
And so what I learned is verysimply, this Quality is reducing
(03:19):
variation and making somethingof value more predictable.
Lots of other definitions outthere in the highways and byways
.
I think everybody wants to puttheir spin on it, but that's the
true definition of quality, andyou can apply that to variation
in cost.
(03:39):
We know the US healthcaresystem.
The variation in cost is 15standard deviations from the
mean.
It's huge, which makes itunpredictable.
And the same thing with quality.
I have worked with physiciansthrough my entire career and I
have come to understand and thiswas told to me by an orthopedic
(04:02):
surgeon that C still equals MD,meaning that there's huge
variation and the consumer hasno clue whether their provider
is the C student or the Astudent.
Speaker 1 (04:21):
It's like the old story about what do you call a
person who graduates last intheir class at medical school?
Speaker 3 (04:27):
Yes, I've heard that one too.
That holds true.
So over the years I've taken myobservations and my learnings
and the skill set that Iacquired from my education and I
have applied it to healthcareand I've been blessed to take
(04:47):
all of that and bring it forwardinto Holista as a co-founder.
So it's all built on reducingvariation of cost, reducing
variation of clinical outcomesand reducing variation of that
patient experience.
That package comes together andbrings forward not just high
(05:10):
quality but immense value atyour fingertips.
Speaker 1 (05:20):
When you talk about reducing variation, it seems
that this entire industry andremember, I've been, as we
discussed offline, I've been onthe TPA side of this as well so
this entire industry is onegiant pot of variation.
What's the problem you set outto tackle first?
How do you even?
(05:40):
Do you just eat that the sameway?
You eat an elephant one bite ata time?
And if so, how do you figureout what the first bite ought to
be?
Speaker 3 (05:47):
Yeah Well, I not to use a cliche here, but I really
I do approach it as athree-legged stool.
I couldn't choose, is my answer, david.
Choose is my answer, david.
(06:08):
I couldn't choose where tostart because to me the patient
experience, the providerexperience and quality and the
cost of healthcare are allequally important and
interdependent.
And so I chose all three at thesame time and I'm so glad I did
, because of theinterdependencies.
(06:29):
If we're reducing the variationin the quality of care and we're
reducing risk associated withclinical outcomes, then we're
inherently going to affectpatient experience and the cost
of care, going to affect patientexperience and the cost of care
.
So if I had to say where did Ifocus first, keeping the other
(07:01):
two at my shoulders, wasproviders.
Providers have becomedisenfranchised, providers have
been commoditized and that hasaffected the cost of care and
the impact on patients and theirexperience.
So remember, at one point intime folks were talking about
the value of theprovider-patient relationship,
(07:24):
the provider-patientrelationship, and then we eroded
it and I think that's atravesty.
So we set out to pull that backtogether, looking at quality
metrics for providers that gowell beyond NCQA standards.
Most folks, ncqa is an insurancerequirement, right, and it's a
(07:46):
check the box and when we checkboxes, we check boxes.
We really don't impact anythingfurther than that.
So, according to NCQA, you needto credential a provider in
order to bring them into yournetwork.
And if you looked at the NCQAcriteria if I were to sum it up
(08:08):
you haven't killed someone inthe last 90 days and you have an
active license, you're in,you're good Holista.
As a licensed TPA, we are heldto the NCQA standard, so we go
through and we check those boxes.
But then we say, okay, that'snot good enough and we dig
further into how providersfollow best clinical practice
(08:33):
and we have all kinds of qualitymetrics that we have available
to us and about 15% of the timethat we are pursuing a provider
to participate in our network,they don't make it into the
network because of missing thequality metrics.
But they would have gotten intoour network if we stopped at
(08:56):
NCQA.
Speaker 1 (08:57):
So what are some of those additional quality metrics
that you're looking at thatNCQA isn't focused on?
Speaker 3 (09:02):
Yeah.
So folks will say oh okay, kate.
So you look at things likeMedicare and what Medicare puts
in place for quality metrics,and the answer to that is yes,
that's a piece of our scorecard.
Simple things like infectionrates, readmission to the
hospital after a procedure, allof those things that are already
(09:25):
being measured.
But again I said, but that'sstill not good enough.
So NCQA, medicare, and nowKate's proprietary formula pulls
all that in and says but youknow what else?
(09:46):
Quality matters when it comes tohow providers work as a team or
co-manage patients.
Quality matters in howproviders schedule patients.
Quality matters where thatprovider is willing to engage
their team, their nursing team,with the holistic team to
(10:09):
shepherd patients along bestclinical practice.
We can have all the clinicalprotocols in the world, but if
we don't help patients do theirpart to reduce their risk of
getting an infection, reducetheir risk of falling in their
kitchen after they've had theirrotator fixed, then we're
(10:29):
missing out.
We need to bring the providerand patient experience together
as a team to drive down risk anddrive down variation, and so I
have devised a system formeasuring that stuff too.
Now we have a set of metricsthat really capture reduced
(10:50):
variation and improved memberexperience, reduced risk of a
poor outcome and reduced cost.
Speaker 1 (11:05):
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Find your power with Benapower.
And now back to ourconversation power.
And now back to ourconversation.
The average human being mightthink that reducing cost and
adding focus on those servicesis an oxymoron.
Why isn't it?
Speaker 3 (12:56):
Well, you know what?
And yes, it sounds like commonsense, but it's a lot of work
and folks in this industry arenot interested in doing that
hands-on work.
To be quite frank with you, wehave an entire call center of
(13:17):
nurses and MAs that are workingdirectly with patients.
We've invested in an appbecause everybody has this thing
in their hand.
It's the best communicationtool for real-time care.
And so, if you think about theexperience outside of what I'm
describing to you, that we dohere in our episodes of Care at
(13:40):
Holista, well, oh sure, you cantalk to your provider about geez
, my pain is significantlyincreased.
I can send a MyChart message,or I can call and go into
voicemail and then maybe hearback from the nurse at 7 pm,
because that nurse has beenrooming patients all day long.
Or I can answer a pain questionon my app that was sent to me
(14:04):
in the morning time and say, ooh, it's increased now and get an
immediate feedback.
We are a soundbite societylooking for immediate feedback
and if we don't get that, we'regoing to end up in the ER.
And then, when the nurse callsus at seven o'clock at night, I
want to say, oh well, thanks forgetting back to me, but I
already got my prescription fornarcotics and I'm resting
(14:27):
comfortably on my couch now.
So it's real-time communicationand that's hard work and it's
an investment.
Speaker 1 (14:38):
It's also changing behavior, isn't it?
Oh yes, it's also changingbehavior, isn't it?
Because a lot of folks I'vesaid on this podcast before, a
very wise physician back in theold old days when I was still
selling, said something to methat I've never forgotten, and
he said David, doctors will getoff their pedestals when
patients get off their knees.
We're so accustomed to gettinga call back at 7 o'clock because
(15:03):
the nurse has been roomingpatients all day long.
How do you go about helping tochange the behavior at the
employee level?
Speaker 3 (15:12):
Yeah, that's a difficult one.
Speaker 1 (15:16):
Behavior always is.
Speaker 3 (15:18):
Yeah, it is.
Folks are really upset by howexpensive health care is, how
many dollars they see coming offof their paycheck and still,
when they go to receive care,having to pay even more money.
But wait, I paid my premium.
Well, that's just to get youaccess.
Yes, to go to the provider, notnecessarily the provider of
(15:43):
your choice, the provider whereyou're being told you have to go
without any quality backing, soon and so forth.
And so still today, money talks.
Working with folks that arebenefit consultants, folks that
(16:13):
are benefit consultants, helpingthem put plan design in place,
removing co-pays and deductiblesfor accessing high-value care,
such as what we offer, reducingpremiums.
We're coming full circle, david, right, this is starting to
feel a little HMO-y, right?
Speaker 1 (16:23):
I'm sure that's where we got in trouble in the first
place.
Speaker 3 (16:26):
Exactly so.
We need to be careful aboutthat slippery slope.
We want patients to be engagedand to change behavior, but not
make it so arduous and scarythat they slip into old habits.
(16:47):
So I call that shepherding andeducating and being at someone's
fingertips when they need you.
So it's quick access, it'seducation and helping them get
where they need to go and savemoney.
I will tell you, the mosteffective incentive today,
(17:13):
beyond forgiving copay anddeductible, is, if they
participate in the value-basedplan or the value-based option,
that the money coming off oftheir check, as in premium
dollars, goes down.
They see that as an immediateraise, and it is.
It's putting dollars back ontotheir kitchen table.
(17:34):
Right, but there are thingsthey need to do to receive those
premium concessions.
So we work with brokers and ourTPA and PPO partners to make
that happen.
Speaker 1 (17:48):
HMOs weren't inherently evil.
The whole notion of having amedical home is something we're
still talking about.
It was really, wasn't it, whenthe quants got involved and the
accountants got involved andstarted saying, okay, well, we
can make more money if we denythe care, if we don't give
authorizations for referrals etcetera.
Is that kind of where thaterosion that you talked about
(18:09):
earlier started?
Speaker 3 (18:11):
Yes, it took the care experience away from the
patient and the provider andthen, as you said, put it in the
hands of those that had avested interest in stakeholders.
I'll call them stakeholders.
Speaker 1 (18:27):
So give us an example of how a value-based network
like what you folks are doinghelps kind of reverse that trend
.
How does that maybe start tomend that relationship a little
bit?
Speaker 3 (18:56):
Yeah, from a financial standpoint.
One differentiator is I am nolonger a believer in the
financial mechanism called aPEPM, which means folks in the
ecosystem, a stakeholder.
Maybe it's a PPO who holds thenetwork, maybe it's the TPA, but
that PEPM means they're gettingpaid regardless of producing
any work product.
(19:16):
Right, that is a number oneslippery slope.
It also muddies the water ofbeing able to measure work
product and the quality of thatwork product and the value of
that work product, because nowit's just this is what you're
going to get paid.
Everything else is kind ofloosey-goosey underneath and
(19:38):
you're incentivized to do lesswork so that you get more
headroom between your paymentand your cost.
Speaker 1 (19:44):
Which makes it actually, in a way, worse than
what we usually point to, whichis capitation being the fulcrum
on which this seesaw startedgoing downhill.
You believe the PEPMs are evenworse.
Speaker 3 (19:58):
I do.
We do not charge a PEPM, whichhas been a huge differentiator
for us, so the employer will sayso in order to get access to
better care at a reasonableprice.
We are not a race to the bottom, but better care at a
reasonable price and happyemployees because it was a great
(20:19):
experience.
We only pay for that when weuse it.
True statement when do we sign?
Actually, don't have to signanything, so it's really
realigning incentives accordingto, as you mentioned, david,
(20:40):
behavior change.
Speaker 1 (20:42):
That's really the key to all of this, and I suspect
that some of it is going to begenerational.
Baby boomers like myself have acompletely other than those of
us who've been in the businessthat are jaded.
Baby boomers have a verydifferent view of the system
than some of the younger folksdo, especially when it comes to
using technology.
They were born with a mouse intheir hand.
(21:03):
They were born with a mouse intheir hand.
They were born with asmartphone in their hand.
You know I saw a graphic theother day that if we had to
carry around all the gear that asmartphone has replaced, we'd
probably need trailers on ourcars.
It's really crazy, but they'reused to it.
It's their way of communicating.
Fast forward.
You know five years.
(21:24):
What do you see when you lookout over your horizon?
Speaker 3 (21:32):
Well, that's an interesting question because
everything is happening soquickly.
Five years ago I would have notimagined we are where we are
today, and that's a good thing.
It's accelerated, yay.
So five years from now, as faras the healthcare landscape,
healthcare doesn't move quickly.
We're able to move quicklybecause we've used technology.
(22:00):
But the rest of the healthcarespace, I mean we still have
providers using paper charts.
Okay, we have value-based folksthat are still asking providers
who are participating in abundle payment arrangement to
submit a paper invoice a paperinvoice.
(22:26):
So while the concept of havinga bundle payment arrangement is
kind of new, it's been aroundfor a long time.
We're still not leveragingtechnology.
So I would say my hope is thatthere's more integration with
technology and there are somealignments of incentives.
That's my hope.
(22:48):
I think five years is a shorttrajectory for that.
I also believe that employersare going to go from being in
the back of the bus to thedriver's seat and that is going
to force everything in betweento change their behavior.
(23:09):
Employers have been on thereceiving end of horrible
renewals year after year afteryear, maybe getting a
fee-for-service-with-lipsticksort of proposal that, by year
two, looks the same as theprevious plan they were on and
(23:31):
that's not good enough, andemployers are finally voicing
hey, this is not good enough.
Employers are starting to dodirect contracts with providers.
That's making a statement.
It's also dangerous.
There's been some not so goodthings happen with that because
employers that are, let's say, aprinting company what do they
(23:52):
know about holding a provideraccountable to quality of care?
They're really just trying toget a provider that will sign
for something that they feel isaffordable.
So that's a slippery slope, butI understand why they're doing
it.
They're just so fed up.
So hopefully we'll get somecritical mass in the next five
years of folks that are greatpartners in the value-based
(24:15):
space, supporting employers'ability to be the decision maker
and have folks like ourselveshelping them make really wise
decisions versus desperatedecisions.
Speaker 1 (24:29):
Well, as somebody once said, power is never given,
power is always taken.
And hopefully we're coming to aconfluence of events where that
kind of change that differentseat on the bus, to use your
analogy will actually happen,because it's way past due.
And if it doesn't, I wonderwhere the bus is going to end up
.
Speaker 3 (24:48):
Yeah, it's concerning , but I remain hopeful.
Speaker 1 (24:53):
And hopeful is a great place to end our
conversation for today.
Kate Grohalk, co-founder andvice president at Holistic Kate,
thank you so much for a reallyengaging conversation.
Speaker 3 (25:03):
Thank you, david, my pleasure.
Speaker 1 (25:10):
I want to give a quick shout out to our sponsor
and our producer, hatcher Media.
Hey, if you need podcastproduction or professional
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information.
Visit him at hatchermedianet.
That's H-A-T-C-H-E-R medianet.
Speaker 2 (25:28):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
How can advisors help clients and plans deliver
better health outcomes,outstanding member experiences
and healthier, happier lives?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:13):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industryshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:35):
And to help us answer that question, we've invited
Kate Grohall, co-founder andvice president at Holista.
Welcome, Kate.
Speaker 3 (00:42):
Thank you Good morning.
Speaker 1 (00:44):
Good morning.
Thanks for being here.
We appreciate your time.
We always like to start withthe question of how your journey
began and how you ended updoing what you're doing, because
everybody's story isinteresting, so would you share
some of that with us please?
Speaker 3 (00:56):
Sure, I'd love to Thanks for asking my journey.
Let's see here.
I would say my healthcarejourney as a career started when
I was doing my undergrad at astate university here in
Wisconsin and I was fortunateenough to land a student
position in this very largeteaching hospital, UW-Madison
(01:19):
Hospital and Clinics, andstudents sort of roamed around
and went from department todepartment, being helping hands
in whatever way thosedepartments needed.
We were cheap labor at thatpoint and it was on campus so I
could get there on the bus andthey paid really well and I
could eat in the cafeteria.
It was a good deal and I wasexposed to just a plethora of
(01:45):
different specialties and, mostimportantly, exposed to the
patient experience.
A lot of times I was escortingpatients here and there in this
huge hospital.
They were nervous, they werefeeling a little lost and that
hit home with me Fast forward.
(02:09):
I took that sentiment intoadditional career stepping
stones of mine.
I got my undergrad actually inindustrial psychology, which is
basically corporate culture.
It's not even a degree anymore.
I now hold my master's inquality theory and as I was
(02:33):
going through healthcare anddifferent career positions,
quality became a huge area ofinterest for me.
And as I got my master's degreein quality.
That was due to what I sawpatients experiencing along the
(02:54):
way, either from thecomplexities of their insurance,
the complexity of receivingcare, wanting to be able to
trust and understand quality,but having no idea how to
identify it.
And so what I learned is verysimply, this Quality is reducing
(03:19):
variation and making somethingof value more predictable.
Lots of other definitions outthere in the highways and byways
.
I think everybody wants to puttheir spin on it, but that's the
true definition of quality, andyou can apply that to variation
in cost.
(03:39):
We know the US healthcaresystem.
The variation in cost is 15standard deviations from the
mean.
It's huge, which makes itunpredictable.
And the same thing with quality.
I have worked with physiciansthrough my entire career and I
have come to understand and thiswas told to me by an orthopedic
(04:02):
surgeon that C still equals MD,meaning that there's huge
variation and the consumer hasno clue whether their provider
is the C student or the Astudent.
Speaker 1 (04:21):
It's like the old story about what do you call a
person who graduates last intheir class at medical school?
Speaker 3 (04:27):
Yes, I've heard that one too.
That holds true.
So over the years I've taken myobservations and my learnings
and the skill set that Iacquired from my education and I
have applied it to healthcareand I've been blessed to take
(04:47):
all of that and bring it forwardinto Holista as a co-founder.
So it's all built on reducingvariation of cost, reducing
variation of clinical outcomesand reducing variation of that
patient experience.
That package comes together andbrings forward not just high
(05:10):
quality but immense value atyour fingertips.
Speaker 1 (05:20):
When you talk about reducing variation, it seems
that this entire industry andremember, I've been, as we
discussed offline, I've been onthe TPA side of this as well so
this entire industry is onegiant pot of variation.
What's the problem you set outto tackle first?
How do you even?
(05:40):
Do you just eat that the sameway?
You eat an elephant one bite ata time?
And if so, how do you figureout what the first bite ought to
be?
Speaker 3 (05:47):
Yeah Well, I not to use a cliche here, but I really
I do approach it as athree-legged stool.
I couldn't choose, is my answer, david.
Choose is my answer, david.
(06:08):
I couldn't choose where tostart because to me the patient
experience, the providerexperience and quality and the
cost of healthcare are allequally important and
interdependent.
And so I chose all three at thesame time and I'm so glad I did
, because of theinterdependencies.
(06:29):
If we're reducing the variationin the quality of care and we're
reducing risk associated withclinical outcomes, then we're
inherently going to affectpatient experience and the cost
of care, going to affect patientexperience and the cost of care
.
So if I had to say where did Ifocus first, keeping the other
(07:01):
two at my shoulders, wasproviders.
Providers have becomedisenfranchised, providers have
been commoditized and that hasaffected the cost of care and
the impact on patients and theirexperience.
So remember, at one point intime folks were talking about
the value of theprovider-patient relationship,
(07:24):
the provider-patientrelationship, and then we eroded
it and I think that's atravesty.
So we set out to pull that backtogether, looking at quality
metrics for providers that gowell beyond NCQA standards.
Most folks, ncqa is an insurancerequirement, right, and it's a
(07:46):
check the box and when we checkboxes, we check boxes.
We really don't impact anythingfurther than that.
So, according to NCQA, you needto credential a provider in
order to bring them into yournetwork.
And if you looked at the NCQAcriteria if I were to sum it up
(08:08):
you haven't killed someone inthe last 90 days and you have an
active license, you're in,you're good Holista.
As a licensed TPA, we are heldto the NCQA standard, so we go
through and we check those boxes.
But then we say, okay, that'snot good enough and we dig
further into how providersfollow best clinical practice
(08:33):
and we have all kinds of qualitymetrics that we have available
to us and about 15% of the timethat we are pursuing a provider
to participate in our network,they don't make it into the
network because of missing thequality metrics.
But they would have gotten intoour network if we stopped at
(08:56):
NCQA.
Speaker 1 (08:57):
So what are some of those additional quality metrics
that you're looking at thatNCQA isn't focused on?
Speaker 3 (09:02):
Yeah.
So folks will say oh okay, kate.
So you look at things likeMedicare and what Medicare puts
in place for quality metrics,and the answer to that is yes,
that's a piece of our scorecard.
Simple things like infectionrates, readmission to the
hospital after a procedure, allof those things that are already
(09:25):
being measured.
But again I said, but that'sstill not good enough.
So NCQA, medicare, and nowKate's proprietary formula pulls
all that in and says but youknow what else?
(09:46):
Quality matters when it comes tohow providers work as a team or
co-manage patients.
Quality matters in howproviders schedule patients.
Quality matters where thatprovider is willing to engage
their team, their nursing team,with the holistic team to
(10:09):
shepherd patients along bestclinical practice.
We can have all the clinicalprotocols in the world, but if
we don't help patients do theirpart to reduce their risk of
getting an infection, reducetheir risk of falling in their
kitchen after they've had theirrotator fixed, then we're
(10:29):
missing out.
We need to bring the providerand patient experience together
as a team to drive down risk anddrive down variation, and so I
have devised a system formeasuring that stuff too.
Now we have a set of metricsthat really capture reduced
(10:50):
variation and improved memberexperience, reduced risk of a
poor outcome and reduced cost.
Speaker 1 (11:05):
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And now back to ourconversation power.
And now back to ourconversation.
The average human being mightthink that reducing cost and
adding focus on those servicesis an oxymoron.
Why isn't it?
Speaker 3 (12:56):
Well, you know what?
And yes, it sounds like commonsense, but it's a lot of work
and folks in this industry arenot interested in doing that
hands-on work.
To be quite frank with you, wehave an entire call center of
(13:17):
nurses and MAs that are workingdirectly with patients.
We've invested in an appbecause everybody has this thing
in their hand.
It's the best communicationtool for real-time care.
And so, if you think about theexperience outside of what I'm
describing to you, that we dohere in our episodes of Care at
(13:40):
Holista, well, oh sure, you cantalk to your provider about geez
, my pain is significantlyincreased.
I can send a MyChart message,or I can call and go into
voicemail and then maybe hearback from the nurse at 7 pm,
because that nurse has beenrooming patients all day long.
Or I can answer a pain questionon my app that was sent to me
(14:04):
in the morning time and say, ooh, it's increased now and get an
immediate feedback.
We are a soundbite societylooking for immediate feedback
and if we don't get that, we'regoing to end up in the ER.
And then, when the nurse callsus at seven o'clock at night, I
want to say, oh well, thanks forgetting back to me, but I
already got my prescription fornarcotics and I'm resting
(14:27):
comfortably on my couch now.
So it's real-time communicationand that's hard work and it's
an investment.
Speaker 1 (14:38):
It's also changing behavior, isn't it?
Oh yes, it's also changingbehavior, isn't it?
Because a lot of folks I'vesaid on this podcast before, a
very wise physician back in theold old days when I was still
selling, said something to methat I've never forgotten, and
he said David, doctors will getoff their pedestals when
patients get off their knees.
We're so accustomed to gettinga call back at 7 o'clock because
(15:03):
the nurse has been roomingpatients all day long.
How do you go about helping tochange the behavior at the
employee level?
Speaker 3 (15:12):
Yeah, that's a difficult one.
Speaker 1 (15:16):
Behavior always is.
Speaker 3 (15:18):
Yeah, it is.
Folks are really upset by howexpensive health care is, how
many dollars they see coming offof their paycheck and still,
when they go to receive care,having to pay even more money.
But wait, I paid my premium.
Well, that's just to get youaccess.
Yes, to go to the provider, notnecessarily the provider of
(15:43):
your choice, the provider whereyou're being told you have to go
without any quality backing, soon and so forth.
And so still today, money talks.
Working with folks that arebenefit consultants, folks that
(16:13):
are benefit consultants, helpingthem put plan design in place,
removing co-pays and deductiblesfor accessing high-value care,
such as what we offer, reducingpremiums.
We're coming full circle, david, right, this is starting to
feel a little HMO-y, right?
Speaker 1 (16:23):
I'm sure that's where we got in trouble in the first
place.
Speaker 3 (16:26):
Exactly so.
We need to be careful aboutthat slippery slope.
We want patients to be engagedand to change behavior, but not
make it so arduous and scarythat they slip into old habits.
(16:47):
So I call that shepherding andeducating and being at someone's
fingertips when they need you.
So it's quick access, it'seducation and helping them get
where they need to go and savemoney.
I will tell you, the mosteffective incentive today,
(17:13):
beyond forgiving copay anddeductible, is, if they
participate in the value-basedplan or the value-based option,
that the money coming off oftheir check, as in premium
dollars, goes down.
They see that as an immediateraise, and it is.
It's putting dollars back ontotheir kitchen table.
(17:34):
Right, but there are thingsthey need to do to receive those
premium concessions.
So we work with brokers and ourTPA and PPO partners to make
that happen.
Speaker 1 (17:48):
HMOs weren't inherently evil.
The whole notion of having amedical home is something we're
still talking about.
It was really, wasn't it, whenthe quants got involved and the
accountants got involved andstarted saying, okay, well, we
can make more money if we denythe care, if we don't give
authorizations for referrals etcetera.
Is that kind of where thaterosion that you talked about
(18:09):
earlier started?
Speaker 3 (18:11):
Yes, it took the care experience away from the
patient and the provider andthen, as you said, put it in the
hands of those that had avested interest in stakeholders.
I'll call them stakeholders.
Speaker 1 (18:27):
So give us an example of how a value-based network
like what you folks are doinghelps kind of reverse that trend
.
How does that maybe start tomend that relationship a little
bit?
Speaker 3 (18:56):
Yeah, from a financial standpoint.
One differentiator is I am nolonger a believer in the
financial mechanism called aPEPM, which means folks in the
ecosystem, a stakeholder.
Maybe it's a PPO who holds thenetwork, maybe it's the TPA, but
that PEPM means they're gettingpaid regardless of producing
any work product.
(19:16):
Right, that is a number oneslippery slope.
It also muddies the water ofbeing able to measure work
product and the quality of thatwork product and the value of
that work product, because nowit's just this is what you're
going to get paid.
Everything else is kind ofloosey-goosey underneath and
(19:38):
you're incentivized to do lesswork so that you get more
headroom between your paymentand your cost.
Speaker 1 (19:44):
Which makes it actually, in a way, worse than
what we usually point to, whichis capitation being the fulcrum
on which this seesaw startedgoing downhill.
You believe the PEPMs are evenworse.
Speaker 3 (19:58):
I do.
We do not charge a PEPM, whichhas been a huge differentiator
for us, so the employer will sayso in order to get access to
better care at a reasonableprice.
We are not a race to the bottom, but better care at a
reasonable price and happyemployees because it was a great
(20:19):
experience.
We only pay for that when weuse it.
True statement when do we sign?
Actually, don't have to signanything, so it's really
realigning incentives accordingto, as you mentioned, david,
(20:40):
behavior change.
Speaker 1 (20:42):
That's really the key to all of this, and I suspect
that some of it is going to begenerational.
Baby boomers like myself have acompletely other than those of
us who've been in the businessthat are jaded.
Baby boomers have a verydifferent view of the system
than some of the younger folksdo, especially when it comes to
using technology.
They were born with a mouse intheir hand.
(21:03):
They were born with a mouse intheir hand.
They were born with asmartphone in their hand.
You know I saw a graphic theother day that if we had to
carry around all the gear that asmartphone has replaced, we'd
probably need trailers on ourcars.
It's really crazy, but they'reused to it.
It's their way of communicating.
Fast forward.
You know five years.
(21:24):
What do you see when you lookout over your horizon?
Speaker 3 (21:32):
Well, that's an interesting question because
everything is happening soquickly.
Five years ago I would have notimagined we are where we are
today, and that's a good thing.
It's accelerated, yay.
So five years from now, as faras the healthcare landscape,
healthcare doesn't move quickly.
We're able to move quicklybecause we've used technology.
(22:00):
But the rest of the healthcarespace, I mean we still have
providers using paper charts.
Okay, we have value-based folksthat are still asking providers
who are participating in abundle payment arrangement to
submit a paper invoice a paperinvoice.
(22:26):
So while the concept of havinga bundle payment arrangement is
kind of new, it's been aroundfor a long time.
We're still not leveragingtechnology.
So I would say my hope is thatthere's more integration with
technology and there are somealignments of incentives.
That's my hope.
(22:48):
I think five years is a shorttrajectory for that.
I also believe that employersare going to go from being in
the back of the bus to thedriver's seat and that is going
to force everything in betweento change their behavior.
(23:09):
Employers have been on thereceiving end of horrible
renewals year after year afteryear, maybe getting a
fee-for-service-with-lipsticksort of proposal that, by year
two, looks the same as theprevious plan they were on and
(23:31):
that's not good enough, andemployers are finally voicing
hey, this is not good enough.
Employers are starting to dodirect contracts with providers.
That's making a statement.
It's also dangerous.
There's been some not so goodthings happen with that because
employers that are, let's say, aprinting company what do they
(23:52):
know about holding a provideraccountable to quality of care?
They're really just trying toget a provider that will sign
for something that they feel isaffordable.
So that's a slippery slope, butI understand why they're doing
it.
They're just so fed up.
So hopefully we'll get somecritical mass in the next five
years of folks that are greatpartners in the value-based
(24:15):
space, supporting employers'ability to be the decision maker
and have folks like ourselveshelping them make really wise
decisions versus desperatedecisions.
Speaker 1 (24:29):
Well, as somebody once said, power is never given,
power is always taken.
And hopefully we're coming to aconfluence of events where that
kind of change that differentseat on the bus, to use your
analogy will actually happen,because it's way past due.
And if it doesn't, I wonderwhere the bus is going to end up
.
Speaker 3 (24:48):
Yeah, it's concerning , but I remain hopeful.
Speaker 1 (24:53):
And hopeful is a great place to end our
conversation for today.
Kate Grohalk, co-founder andvice president at Holistic Kate,
thank you so much for a reallyengaging conversation.
Speaker 3 (25:03):
Thank you, david, my pleasure.
Speaker 1 (25:10):
I want to give a quick shout out to our sponsor
and our producer, hatcher Media.
Hey, if you need podcastproduction or professional
graphic design, josh Hatcher isthe expert to contact For more
information.
Visit him at hatchermedianet.
That's H-A-T-C-H-E-R medianet.
Speaker 2 (25:28):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
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