The Value-Based Healthcare Podcast is back with episode 15! Our guest Patrick Conway discusses how he started in the healthcare industry, his time as the President and CEO of Blue Cross North Carolina, how value is one of the most important metrics for patient care and more!

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Podcast transcription: 

Jay Ackerman:
Hello, I'm Jay Ackerman, CEO of Reveleer, a software company committed to providing health plans with innovative technologies to maximize their return from quality, risk adjustment and compliance initiatives. We're back again with yet another installment of the Value-Based Healthcare Podcast, where we engage with thought leaders and visionaries working across the healthcare ecosystem. Through our podcast, we aim to widen the visibility and voice of people working to change how healthcare is provided, and the impact it has on all those who participate in the care delivery chain. Let's get started.

Hey Patrick, let's begin with a few questions regarding your career journey. Why don't you first talk to us about how you found your way into healthcare?

Patrick Conway:
Yeah. In high school and college, I thought I wanted to be a doctor. Actually, I was president of our student union in college and then that got me interested in store management. After college I was going to do McKinsey Consulting, Peace Corps, Teach for America, sort of an odd three choices, but went and worked for McKinsey Consulting and Healthcare, spent a couple of years there as an analyst and then an associate, and then really wanted to go back to medical school. I went back to medical school and have been in healthcare ever since, always sort of working on the interface of; how do we deliver better quality and better experience at lower costs for patients and populations of people?

Jay Ackerman:
What's the current chapter that you're writing for yourself in the area of healthcare? What are you focused on?

Patrick Conway:
Yeah, so Blue Cross North Carolina, we were really focused on being a health plan that delivered better quality, better experience and lower costs, and really being a model of transformation. That had been my focus for the last few years, and then now sort of doing some work in investing and healthcare and really starting to contemplate what comes next for me.

Jay Ackerman:
I bet in that role of looking across the healthcare kind of ecosystem for investments, you're seeing probably a lot of innovation. Anything you want to kind of highlight in kind of how fast you think that market's moving?

Patrick Conway:
Yeah, I mean, I think a lot of those models in advanced primary care are really exciting, where you have different organizations taking on risk and really driving change in care. I think in the data and technology space, I think a lot of interesting companies in healthcare data and technology. The last area where I think we need more investment, you're seeing some, but I think we could see hopefully significant increase, is in the mental and behavioral health space. I think increasingly it's recognized that our sort of system for mental and behavioral healthcare delivery is fundamentally broken, so I'm hopeful you'll see more players enter that space on really delivering effective and efficient high quality mental and behavioral healthcare.

Jay Ackerman:
Yeah. That's probably a perfect lead into the next question, which is I'm really interested in your thoughts on industry trends that you see as beneficial to healthcare organizations.

Patrick Conway:
Yeah, I think the trend that's particularly beneficial to healthcare organizations is I think the sort of value-based payment trends, which I've been in and out of government a few times. I've worked in Republican and Democratic administrations in government, the last time at running the CMS Innovation Center and then acting Administrator of the Agency for Medicare and Medicaid. I think the public payers across administrations, you're seeing this trend towards value-based payment that just continues to increase, and then I think private payers, similarly, are driving towards value-based payment, and I'd say real value-based payment and partnerships now. At Blue Cross North Carolina we got where over 50% of our payments were in advanced alternative payment models, including two-sided risk with health systems and doctors.

I think the opportunity there is for organizations to deliver on that value. You're now really past the tipping point, if you will, of moving away from fee-for-service volume-based payment and really rewarding those providers, those companies, those organizations that deliver on value-based payment, better quality at a lower cost. I think that's a huge opportunity for innovation and for companies in the space.

Jay Ackerman:
You just mentioned that Blue Cross Blue Shield North Carolina, that you have 50% in alternative payment models. Any thoughts on if we look out over the next couple of years, how rapidly you see that continuing to move across the entire industry?

Patrick Conway:
Yeah, I think you'll see other payers reach that level. I think all the big national payers and sort of regional blue players increasingly are announcing goals and sort of moving in that direction. I think if you look at like the Health Care Payment Learning & Action Network, which I started a number of years ago now, you've got heading towards 50% of payments that are value-based, but then they just recently announced an additional goal to get over 50% of those payments in significant value-based arrangements like I described for Blue Cross North Carolina. I think you're going to see across public and private payers, within the next two to three years, that people start getting the majority of their payments in these advanced value-based payment models.

Jay Ackerman:
What do you see as the greatest barriers or challenges that affect patient improvement in today's environment?

Patrick Conway:
Yeah, it's culture and the complexity, I think. What I mean by that is you're turning a multi trillion-dollar industry that historically has been oriented around volume and fee-for-service and you're like turning a gigantic ship right towards value. That's challenge one is sort of cultural, if you will, and historical. I think challenge number two is what I call the gap issue. Even if, let's say, a large healthcare system says, "Yeah, that's where we want to go," they often... They'll use the analogy of a foot in both boats. They go through the transition period. It's, "How do we maintain enough volume, if you will, where we have fee-for-service reimbursement while we move to more full value-based arrangements, and how do we navigate that gap, if you will?" I think payers can help with that.

The last challenge, going to the patient side of this, which you named, is I think we've really... We have not yet fully captured like, what does full patient consumer engagement look like? What is the set of tools that people need to drive change in the system? I think you're starting to see, for example, more both public and private payers pushing on transparency and sort of consumer engagement tools, but I think we're at the real early stages of what's real consumer engagement look like? Then if we achieve that, what does that do to the quality and the cost of care?

Jay Ackerman:
What do you think is required or necessary to kind of really accelerate that level of consumer engagement?

Patrick Conway:
Yeah, I think it's a few things. I think one, we're getting to a place now where the data and technology is more advanced, where they can really have the information at the point of decision, which I think historically had been a challenge. I think two, you're seeing more organizations use what I'll call more sophisticated engagement tools, certainly behavioral economics, financial incentives, but also sort of a broader suite of sort of incentives and engagement tools. I think the other sort of overarching factor you're seeing here is I think; there was a thought if you move people to sort of high deductible health plans, they'll just make wise decisions because they'll have so-called skin in the game. I think we're seeing that those could have had some effect, but they probably increased and decreased both high and low value care. That's a pretty blunt tool. Now I think you're seeing employers and healthcare payers saying, "What's the next generation of sort of tools we would put around this?" We don't just put skin in the game for the consumer, we actually enable them to make better and higher value decisions.

Jay Ackerman:
That may be a good lead in. If we look forward from today, how do you think we should plan to address some of these barriers and challenges that are facing patients in this market and also facing payers? Is there a transition to this value-based care model?

Patrick Conway:
Yeah, so on the patient side, I think it goes back to sort of the digital tools that they need to navigate care. I also think, how do we put those together into what I'd call a seamless care journey? I think you often have sort of niche solutions, if you will, that help a consumer with decision X or decision Y, but the reality of people, they're individuals, they're families trying to navigate healthcare along with everything else in their life. How do we really sort of put together an ecosystem, if you will, that allows them to navigate the healthcare system that's virtual, that's also in-person care navigators, et cetera?

On the payer side, I think where payers have an opportunity is really in testing and learning what really works in this space. If you look across sort of patient and person navigation tools, I think a fair number are sort of in the market, but I'd say less clear which interventions are really driving the highest value for the payer and for the patient. I think for payers it's really, how do you test that next generation of tools and technologies, and then how do you deploy them at scale?

Jay Ackerman:
Do you think the timeframe kind of required to test and roll out has shortened with more of the cloud-based products kind of being sold straight to business owners and kind of with IT being less of a gatekeeper?

Patrick Conway:
I do. I think with more of the cloud-based products, payers testing in more of a cloud-based app environment, sort of real-time development including consumer-centered design, I think you're seeing a lot of trends sort of converge, if you will, where I think your pace of change and your cycle time for change is getting shorter and shorter.

Jay Ackerman:
How do you think that is causing the kind of internal orgs inside of a payer to work together?

Patrick Conway:
Yeah, it's challenging. I mean, I had to lead a legacy payer. I think this is true across payers. I think it's you've got a legacy IT environment; at the same time, you're trying to develop those sorts of next generation of tools and analytics. We made major investments in data and analytics at Blue Cross North Carolina. I think those were starting to show benefit, but more needed. I think in the IT space, things like Innovation Garage and other things, we were sort of innovating both in the cloud environment and the app environment and with AI and other advanced sort of analytic tools. Yeah, I think your traditional payer is going to have to do more and more of that type of development work while maintaining, because they all have it, a legacy claims-based system that has to function and function well.

Jay Ackerman:
I imagine now you're spending a lot of time talking to kind of a lot of companies trying to innovate in healthcare, but also talking to healthcare executives across a wide variety of organizations. In those conversations, what advice might you have for healthcare executives and navigating the industry at this point in time?

Patrick Conway:
Yeah. I'll say a couple things. One is relentless focus on the customer, the end user, the patient. We sometimes struggle with that in healthcare. I think if you focus on that customer, that patient, that consumer, and sort of what are the set of services that person, that family needs, I think that will generate the value in the long-term. Blue Cross North Carolina used to talk about on my first day, "We focus on our people and our customer." There's lots of other complexity we could think about in life, but if you get those two things right, normally companies are successful.

I think the other thing is there's just there is this pace issue, which is challenging to navigate, but when you travel around America, or a state like North Carolina, you hear from people, "Healthcare is too costly and the quality and experience are uneven." I've been a person for a long time that pushed for more rapid change. I think as a healthcare system we need to do that. I think the legacy players are either going to have to innovate and deliver on that or be disrupted and displaced by new entrants and people that... Because what you hear from employers, from individuals and families is they can't tolerate the cost of care and the cost of care increases, especially given the quality and experience is uneven. Just like other industries, we've got to make the quality and experience much better while we lower the cost of care, which healthcare frankly has historically failed in doing so. How do we do that and how do we do it quicker?

Jay Ackerman:
Why do you think that's been a struggle for healthcare? The two points you just called out, focusing on the customer and kind of pace of change, are challenges that all industries are facing. Those companies who address it well and create the models internally to do that will shine. Those who don't kind of find themselves in the scrap heap, but within healthcare, what do you think is at the heart of the struggle?

Patrick Conway:
Yeah, I'd say there's probably a host of issues, but I'll name two. One is the finance system, historically, was sort of often separated from the real end user. Just with employer-based insurance and the way it functioned, you had this issue that actual individuals and families historically did not see the costs as much hitting their pocketbook. I would say that's changing and changing rapidly. Then I think for employers, yes, there was a growing cost center, but they sort of tolerated it, and I think that's changing as well. I think you have sort of a financing issue where I don't think you had as much of a burning platform in this industry as you did in some others. Part of it probably is even related to healthcare is so personal you always worry about, "Well, if I do a cost cutting, if I have some cost cutting issue that literally damages people's health or prevents somebody from getting the cancer treatment they need, there's like a natural sort of cultural concern in this area."

Yeah, I think the other issue is the financing mechanism, historically, it just wasn't value-based. If you think about cars, computers, other things, you pay a given... There's a quality and a price. You know it, it's transparent and its value-based decisions. Healthcare, you often didn't know the quality or the price or the cost. Then even if you did know some of that information, it was more of a fee-for-service volume system. Obviously if we bought cars, computers or other things in that way, I don't think we would have seen the changes that we saw in those industries. I think as healthcare moves to a more value-based payment system; I think you'll see increasing changes in the healthcare sector.

Jay Ackerman:
Yeah, pretty hard to imagine picking up a car, driving it off the lot and then getting your bill 30 days later and kind of hoping it lined up with your expectations.

Patrick Conway:
Yes. Yes, for 48 different parts and 16 different copays and a month later another bill. I mean, like nobody would tolerate that, right? A TV, a car, like name your product, like that would be like, "Well, that's ridiculous." Yet in healthcare, we get 29 EOBs and 16 different payments, and at the end you're still like, "Wait, what is this all stuff and what did I buy?" Yeah, exactly.

Jay Ackerman:
All right, well, probably a good transition to this question, and I think it's a good one to you since you had spent time there yourself, so what regulatory changes would you like to see from CMS that would most beneficially impact the member?

Patrick Conway:
Yeah, I'd call out a couple, which I think CMS is doing, but it's, how do you turn the next level of the crank? On this value-based payment, and now really shifting to advanced value-based payment models through the CMS Innovation Center, which I used to lead, and CMS broadly, I think you've now got 90% of payments tied to quality in some way. Terrific, but now it's like, how do you make it not 1 or 2% or 3% sort of an incentive on the margin? How do you make it a significant incentive where you really drive change? I think that's starting to happen, for example, an accountable care organization program pushing people to higher levels of risk. That's on the value-based payment arena.

Two, I'd call it the data and transparency, which this administration and the last administration have pushed hard on data and transparency and getting data out into the ecosystem and getting transparency into quality and cost and price. I would continue to push on those and double down there. The last area I'd note that doesn't always get a lot of recognition, but actually in the last administration and the current administration, there's been focus on reducing regulatory burden. How do you simplify regulations? How do you remove red tape? How do you really allow people and entities to deliver care without sort of limiting them through overregulation? I think that focus as well is appropriate and needs to continue.

Jay Ackerman:
Did you see us moving in a better place on that front or do you think we've been over the last couple of years making it more challenging?

Patrick Conway:
Yeah, it's always hard. I mean, the natural tendency is for regulations to pile up. I mean, that's like how regulations work, but I think there is a recognition increasingly that that regulation in healthcare is limiting our innovation. I think you're seeing sort of a more work to do. I don't want to like overplay this, but I think you're seeing an increasing realization that if we move regulatory burdens, if we remove red tape, I think the current name, it's gone under different names, I think they talk about patients over paperwork right now, that actually does enable people to really focus on patient care. I'm still a practicing physician. It is true that I spend a lot of time documenting as opposed to just patient care. I think we've got the sort of balance there not quite right. How do we really allow people less time for documentation and things that are not necessarily adding value to patient care, and more time for sort of direct patient care, care coordination, investing in better health?

Jay Ackerman:
Patrick, since you mentioned that point, I've heard that for many doctors they might spend twice the amount of time documenting that they spend providing care to patients. What's that look like for you when you're in there practicing?

Patrick Conway:
Yeah, so I think that's about right for my personal practice. I'd say I've seen some of those same studies. If I had to guess what the right percentage is, I would guess it's the opposite or more so, 80% on patient care and sort of 20% on documentation, which would be 4 to 1 the other way. I think we've got the paradigm out of whack, if you will.

Jay Ackerman:
We talked about healthcare executives and advice for them and then CMS. How about recommendations you'd have for the public regarding their own empowerment and ownership of their health and wellbeing?

Patrick Conway:
Yeah, so I mean, I do think for the public, I mean, a lot of healthcare costs are, whether you call them social determinants or drivers of health, which is both for individuals and for us as a society, how do we address things like eating habits, exercise, transportation, housing, all these things? I think there's a societal role there to invest in drivers of health, including payers, et cetera, but I also think there's a personal role, especially for these behaviors, whether it's smoking, diet, exercise. We know these are the major contributors, actually, to healthcare outcomes and costs. I think the public has a large role there. I think the other role that the public has is really embracing this change to value-based payment. All the tools in the world only matter if consumers, patients, people are willing to use them and really focus on themselves and how they get the best value out of the care delivery system.

Jay Ackerman:
In your days as a practicing physician, do you see patients coming in more informed and with kind of greater understanding and ownership and using the tools that are out there?

Patrick Conway:
Yeah, I think it's increasing, but I also think it's still not where we need to be. Yeah, increasing, but I don't think at the level we need.

Jay Ackerman:
Yeah, still way off from where it should be.

Patrick Conway:
Yep.

Jay Ackerman:
All right. Well, hey, Patrick, this has been a great discussion. We're going to start to kind of bring it towards the finish line with kind of five rapid fire questions. First off, what keeps you up at night?

Patrick Conway:
Yeah, so it's been the same for a while. I've had the opportunity to lead large systems on the provider side and government and on the private payer side for a while, and it's that somebody's fallen through the cracks. Whether it's Blue Cross North Carolina with 4 million people or CMS with 130 million people, every night going to bed, more often than I'd like to admit, I'd think about there's somebody today that fell through the cracks, meaning either they had some horrible health event and we didn't catch it, or fell through financially, a bankruptcy or a death from a health event. I mean, literally that's the stakes in healthcare, right?

When you run a large organization, you know that there's somebody who fell through the cracks that day, because that's the nature of a large organization. How do you minimize and try to eliminate that so you're caring for everybody like you would your mother, your brother, your family member? That's the language I used at CMS, and it's the language I used at Blue Cross North Carolina, and it's the language I'll use with whatever comes next. At the end of the day, you want your care system that you're responsible for to function in a way that you'd be willing to send your own mother through that care system.

Jay Ackerman:
Yeah. Well, that's pretty weighty, but if you're carrying that every day, you're clearly trying to make a big impact in the world. In those nights when that's weighing heavily and you're having trouble going to sleep, what book might you grab from your nightstand and why are you reading it?

Patrick Conway:
Yeah, first, for better or worse, I fall asleep in like a second every night, which probably means I'm not getting enough sleep, but I'm trying, for lots of reasons, trying to do better on that. I'm actually reading a book right now called Broken Open, just started it. We could also talk about books that I've recently finished, but Broken Open is about when you go through challenges in life that can either break you down or can break you open, if you will, to like what the next iteration is. The other book I just read a little while back that was quite good is The Road to Character by David Brooks. It had some similar themes, interestingly, about two mountain life. You sort of climb your first mountain, which often is around achievement, money, et cetera, often people have a valley in life, and then you have your second mountain. That is really, what is most meaningful to me? What is it that I work on in the second chapter of your life, if you will, that is most meaningful to you? Those are two of the books I've been reading recently.

Jay Ackerman:
Two good ones to add to my reading list. What is one thing that few people know about you?

Patrick Conway:
I've done standup comedy in my past, and I've traveled to over 80 countries. I used to be more interesting than I am now.

Jay Ackerman:
Any chance we still might find you out on stage?

Patrick Conway:
No, not at all. No, but yeah, I used to be more interesting than I am now.

Jay Ackerman:
That chapter is done. You hit the comedy valley and decided not to climb the next mountain.

Patrick Conway:
Exactly, exactly.

Jay Ackerman:
All right. What's the favorite app on your mobile device?

Patrick Conway:
This one is not that exciting. It's Uber and Lyft. I'm a big fan of Uber and Lyft, which I know isn't as exciting as probably a lot of apps that people use.

Jay Ackerman:
All right, well then here's the follow-up, so which one gets opened first?

Patrick Conway:
Yeah, I know Lyft is supposed to be cooler. I still use Uber more than Lyft. In my area, it's still cheaper most of the time. I know that probably varies too. I use them both. I actually will price check each one sometimes. That's just... I grew up with not a lot of money, which made me very cheap. It's still part of who I am to this day. I wear JoS. A. Bank suits.

Jay Ackerman:
Yeah, well, no, I'm the same. Uber is my go-to, I suppose, but I do find myself price checking, particularly on well-defined routes. All right, last one, how do you invest in yourself?

Patrick Conway:
Yeah, the biggest change I've made recently is what I'd call self-care. Tried to be focused on family and career for a long time, but got away from things like meditation, exercise, time for self-care and reflection. Then I've been making those investments recently and I think they'll pay long-term dividends.

Jay Ackerman:
Yeah, fantastic. It's easy for your own needs to get put to the back seat when you've got a big company and kind of driving fairly ambitious goals. I get it. As my team knows, I've been actually looking at my own calendar trying to slot in a bunch of personal wellbeing days between now and year end just so I can take care of some personal health, but also a little bit of emotional kind of recharging.

Patrick Conway:
Good. That's great. It's a good thing to do.

Jay Ackerman:
Patrick, thanks again for your time and your openness. This has been great. This brings our Value-Based Healthcare Podcast to a close. Thank you for joining us today. Listen to more episodes at reveleer.com or find us through your favorite podcast platform. For episode updates, follow Reveleer on LinkedIn.