David 0:00

What's being done by some of the major players to align incentives in this crazy current ecosystem? We'll find out on this episode of Shift Shapers.

Announcer 0:11

Change either paralyzes or energizes. The choice is yours. You're listening to the Shift Shapers podcast. You're about to learn firsthand from businesses and entrepreneurs who have successfully shaped the shifts in their industries. Get ready to become the change you want to see. This episode is brought to you by Shift Shaper Strategies. In sales, if you confuse, you lose. Clarify your message so you win more clients, crush your sales goals, and build your practice. Learn more at ShiftShaperStrategies.com. And now, here's your host, Story Brand Certified Guide and Chief Transformation Strategist at Shift Shaper Strategies, David Saltzman.

David 1:03

And we've invited Megan Cassidy to help us learn. Megan is Senior Director of Sales and Product Development at the Cleveland Clinic. Welcome, Megan.

SPEAKER_02 1:12

Hi, David. Thanks for having me.

David 1:14

It's our pleasure. So tell us a little bit about your professional journey. How do you end up doing what you're doing?

SPEAKER_02 1:19

Well, it's kind of an interesting story. Uh when I graduated from college, I went and worked at a chocolate company, Lake Champlain Chocolates in Burlington, Vermont. And it was a great company. I ended up doing wholesale sales for them. And I worked with food brokers. So food brokers are pretty cool people, right? They rep, it was like a specialty food company. So they would rep wine and cheese and chocolate. I traveled my butt off in that job and I pretty much burnt out. And when I moved to the Albany, New York region, I returned home. I saw a job that was working with insurance brokers. And I was like, oh, well, I know brokers. I've worked with food brokers. I didn't really realize the difference between food brokers and insurance brokers, but that's how I got into the industry. I worked for a health plan, a regional health plan in upstate New York for about 15 years and then came to the Cleveland Clinic.

David 2:12

Well, you know, it's interesting. There is a similarity. When food brokers, when people get tired of food brokers and people get tired of insurance brokers, they're both fed up.

SPEAKER_02 2:20

So there you go.

David 2:24

Couldn't resist. It was a softball. And I appreciate softballs. I'll take all of those you you have to get. So let's level set. What's the problem?

SPEAKER_02 2:32

So where I work at the Cleveland Clinic, we work under the finance umbrella. And most of the team that I'm on is focused on payer relationships, right? Hospital negotiation contracts, what's going on with the government? How can we help the plan grow? How do we make sure that everybody, all patients have access to the world-class care at the Cleveland Clinic? And my role within that team is really focused on solutions for employers. And I respect that the Cleveland Clinic has a focus like that because employers handle a lot of the burden, the cost burden of healthcare. And so that's the problem, right? The problem is that value-based care design, while we all have faith in it, has not happened as quickly as we all would like it to. And employers are now kind of leading the way on different innovations and pursuits to make healthcare more equitable and more affordable for its own employees.

David 3:33

So that's the problem. How big a problem is it? What do you perceive as the scope of that problem and how pervasive is it?

SPEAKER_02 3:41

I mean, it's pretty darn pervasive. When large employers who have relied on their payers, have relied on health hospital systems to provide them care forever, have now had to hire people and step in to say this is too much of is too big a budget line for us to leave it in others' hands. We need to kind of get more innovative. We need to think about how to solve it on our own. I think that says a lot. Employers are, that's not their main business objective. That's not what they do for their competitive differentiation. But now it is, and now they're all hiring it as a big component of these are very large companies right now that are doing it, but that's a big burden and it's a big area of expertise that has to be shared. But I think it's also a sign of altering the collaboration in a way that maybe we need. We might need the employer, who really is the payer, right? We might need the employer to be at the table, to be asking for more innovative solutions, to be willing to try different things, because maybe the government's going too slowly, maybe hospital systems are going too slowly, maybe the insurance companies don't have all the right incentives lined up. But if we all sit at the table together, we can force the we can force the issue.

David 5:05

And that that kind of begs my next question, which is, you know, I ask advisors this all the time and people from this side of the industry, but from where you sit, how did we get here? What happened?

SPEAKER_02 5:17

Oh, it's a tough question. I don't really know how we got here. We probably got here through a lack of communication and a hyper focus on competition, not just among all the insurers, all the hospitals, but then also when those two parties come together and trying to think about how the old days of what was the best deal that you could strike, right? We weren't all rowing in the same direction. So I think that's how we got there. And then let's be honest, cost is how we got there. I mean, it is not inexpensive to deliver medical care. It is a beautiful thing that we can have, you know, car T surgery and we can have all these types of treatments that focus on, you know, your own genetic makeup and what is going to be the best for you. But creating those, you know, researching those and creating those and then deploying those into the system is not inexpensive. So I think we've come to such a point where costs have just gotten so high, everybody's got to put their best foot forward and their best minds together to come up with a solution.

David 6:26

Yeah, and I mean I think pharmacogenomics is going to help a bunch of that. It's also going to create a lot better patient experience because it's not going to be, you know, hey, let's try this drug and see if that works. Oh, it didn't work and it made your condition worse and you suffered for another three months. Well, let's try this drug and see if it works, et cetera, et cetera. You mentioned a term a little while ago, and I'd like you to define it again from your kind of side of the aisle, which is value-based care. I think a lot of people have different definitions of what that means. What does it mean from the Cleveland Clinic's perspective?

SPEAKER_02 6:56

I think probably put the most simply I can, it's sharing risk together, right? It is understanding the right formulas to incentivize our physicians and our sports staff and everybody on the clinical side to focus and learn a little bit more about cost and understand how to drive better cost outcomes while not impacting the patient journey and patient results, of course. And I think on the payer side, it's sharing a little bit more data on between the parties on how to make the patient care more effective. So, you know, we're sharing risk, you know, share when when someone says value-based payment, I think it's all about risk sharing. How you do that and the right formula that you achieve, which in each each contract or overall, I think all of that has a lot of nuance in it, depending on the patient population, the compensation, the motivations.

Announcer 7:54

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David 8:54

Yeah, I think one of the interesting components of that, and it's often overlooked because we do focus solely on cost. And I know it's something the Cleveland Clinic has always been synonymous with, which is the quality of care as well as cost. It's one thing to run the cost down, but it's another thing to do that at the expense of quality of care. And you know what's interesting is, and we've talked about this a lot on the podcast with various guests, in an awful lot of things, if you spend a ton more money, it's reasonable to assume that you're getting better quality. But in medical care, that's most often not the case. If you're spending less, you're oftentimes likely to get better quality because there are, you know, organizations like Cleveland Clinic and some others have procedures in place that help create efficacy of care, and that drives the cost down while also keeping your readmit rates down. How do you guys track all that stuff and how do you put that into the equation for value-based care?

SPEAKER_02 9:50

It's quite extensive. So we have obviously we have a quality team, right, that has been around forever that focuses on that. And, you know, some of the metrics in the game are changing, and people are looking at quality metrics in a different way than they ever have before, and more people are looking at them. So that's in place. We also have value-based care optimization and performance teams that look at the specifics of how things are arranged and try to focus on whatever metrics we might be striving for in that particular endeavor. You know, you mentioned quality, which that is a really fundamental component of these conversations. And that is where I think the Cleveland Clinic has a significant differentiator. So the Cleveland Clinic top-ranked in so many things. I was just reading through Newsweek this morning about, you know, their latest rankings and checking the Cleveland Clinic on all the all the different uh topics and such. And, you know, you take for granted, I've only lived in Cleveland for three and a half years. I'm already taking for granted the things that are done at the Cleveland Clinic, but that's not done in every single market. And we do firmly believe that every life deserves world-class care. So if there is something that can only be done best at the Cleveland Clinic, or the quality is the best and the outcomes are the best, and the total cost of care is the best, it's my job, it's all it's our job here throughout the clinic to make sure that folks know that and that we make it easy for them to come to the Cleveland clinic. So that's really what we work with a lot of employers on is identifying sometimes really sort of esoteric cases that nobody can help. You know, they haven't been able to find help for the patients in the right way, and making sure they can land at our door, you know, safely, get what needs to be done, done, and get them back home.

David 11:42

Well, and you're also a team approach, which I think brings its own efficacies and efficiencies of scale, doesn't it? It's not, you know, you'll you'll swarm a group of doctors from different disciplines on a particular patient to try to find out what a diet what the differential diagnosis is. Whereas with a lot of other places in in the healthcare universe, especially physicians' offices, just by their nature, it's one physician with an MD at the end of their name and a cloud of smoke, and they they end up you know trying this and trying that.

SPEAKER_02 12:10

Yeah.

David 12:11

One would think that that would increase costs exponentially. Do you find that? Or do you find that at the end of the day it actually decreases cost and increases patient satisfaction?

SPEAKER_02 12:20

Well, we're also a salaried model. So I think the cost is going to be, you know, it's pretty much set in stone from that perspective. But that facilitates some more of that collaboration across the institutes to make sure that the right, you know, types of specialists or subspecialists get involved in the conversation.

David 12:37

You mentioned large employers, which is kind of where your focus is now. And that makes sense because a lot of the change in the system starts with large employers, and then those things trickle down to the mid-size and the smaller groups. There are a few components of that. And one of them, I wonder kind of what your position is in terms of networks. What are you seeing in terms of narrow networks, broader networks, specialty networks, et cetera? I know it's something that you touch.

SPEAKER_02 12:59

Yeah. So in Northeast Ohio, so the Cleveland Clinic has a big presence in Northeast Ohio and in South Florida. And during the pandemic, if you wouldn't believe it or not, we actually launched uh what I guess you call a narrow network plan for our commercial lines of business. So this is for the employer groups. I say I guess you call it narrow because there are 10,000 providers in the network just by having the Cleveland Clinic and its affiliated doctors involved. So we launched it. I've never launched a product in the middle of a pandemic before. I do not recommend that. It is not good for the ego. It's not good for the community. But we went live with the product then. And we have really been working closely with brokers and consultants to help them understand the value of it and to help make sure we have the price point and everything worked out. And the idea is if you come to one integrated system and everything is stored in one place, there's just so much efficiency that can happen there because our systems, you know, talk throughout everything at the Cleveland Clinic. So we have done that on the commercial side. We've also done a ton on the, I'll say direct-to-consumer side. So for Medicare Advantage, we have a partnership with Humana. We also have a product out there with Anthem. And in the ACA market, we have a relationship with Oscar Health. We have a Cleveland Clinic plus Oscar program. So we've done a bunch in the narrow network space. But as I said, we're sort of waiting. We think this will be the year in the commercial group space to see the results of that and then be able to start tracking how effective it is.

David 14:33

How do those hybrid programs, you know, with insurers come along? Do you guys have an active outreach to insurers? Are they reaching to you? Some of both.

SPEAKER_02 14:42

It depends. For the group business, for the employer business, we actually did a big, it wasn't an RFP necessarily, but we did a questionnaire. And we went out to all the major payers that are in our area, Northeast Ohio, and they had their executives in, and we sat around the table and we talked about what are our objectives, shared objectives, what do we want to get from this? How do we think it can transform healthcare in the region? And that's how we ended up choosing. We chose Aetna in their whole health network as our option there, but that's how what that ended up happening.

David 15:14

That's interesting. And now, are you seeing an awful lot of change in the area of second opinions and stuff? Is that part of what you guys are are offering?

SPEAKER_02 15:22

Yeah, so it's interesting because for a while I feel like every employer group wanted to have a second opinion offering. Then they were kind of frustrated with the PMPM offering. And now I think maybe it's because of COVID, I don't know. There's a new resurgence in interest in second opinion. So there's actually two ways you can access that with the Cleveland Clinic. So the first is we have a partnership with Amwell, and that company is called The Clinic by Cleveland Clinic. And so that is how you get a formal, written, virtual second opinion. And that's great. It's really in cost, that's cost, that saves a lot of cost for employers. And there are just so many beautiful patient testimonials that come out of that that have helped reshape their treatment plans. We also are just launching directly from the Cleveland Clinic something called the clinical review. And so that's not a full-blown second opinion. It's more of a, can the Cleveland Clinic help you? So we'll take a peek at your medical records and then we'll say, you know, it kind of looks like for patients like you, you're on the right track. There's no reason for you to worry, you know, keep doing what you're doing. Or we'll say, actually, we think we might have a specialist here who can help you out more. And then we set up a virtual visit, or if they want to come into town, come into town and help them gain that intimacy and knowledge that you would need to get from a physician face to face.

David 16:48

Aaron Powell On the pure second opinion plate, do you have any idea how often the second opinion differs from the initial imp uh I'm sure they email me that stat routinely.

SPEAKER_02 16:58

I know it's pretty often.

David 17:00

Surprising or not.

SPEAKER_02 17:02

It is surprising. Yeah.

David 17:04

Do you find that within certain modalities? Is that mainly with cancer patients or is it across the board?

SPEAKER_02 17:09

I think it's been with cancer, neuro, and cardiac.

David 17:12

Interesting. And and when second opinions are given, do they also include a suggested treatment plan?

SPEAKER_02 17:18

Yeah. So it will be like for patients like you, we suggest something like blah, blah, blah, blah, blah. And sometimes they do end up becoming patients too. It depends on the patient.

David 17:27

Who comes to you, the patient or the physician?

SPEAKER_02 17:30

We have models for both. So the one I was just referring to is a patient model, but there are e-consults that we make available for physician-to-physician.

David 17:40

That's great. That's great. We've got just a couple of minutes left. I'm interested and curious to see what you think the future holds. What do you see in the near and midterm in terms of the trajectory of the work that you guys are doing?

SPEAKER_02 17:51

Yeah, I am an advocate for the business group on health. We're members there. I read practically everything that they put out. And they just wrapped their employer survey up and published it a couple of weeks ago. They're really focused, employers are really focused on cancer. This year has become a bigger spend to them than the more routine orthopedic things that you would see in a commercial group. So I anticipate that there will be an even more, you know, we talked about narrow networks, and I was kind of talking about global narrow networks. I think there's going to be more specialized networks and centers of excellence that emerge and compete against each other. I think to the betterment of the patient experience and to the it will just make costs go down.

David 18:37

And costs going down is a great place to end our conversation for Megan Cassidy, Senior Director of Sales and Product Development at the Cleveland Clinic. Megan, thank you so much for sharing your time and your expertise with us on this first part of our two-part episode. And next week, we're going to be talking to David Zimmerman from Mount Sinai to see what they're doing as well. Megan, thanks a million. We appreciate it.

Announcer 18:59

Thanks for having me. The Shift Shapers Podcast is a production of Shift Shaper Strategies and may not be reproduced or quoted in whole or in part without our express written permission. Copyright 2020, all rights reserved.