Program co-director calls for more ‘skeptical evaluation’ of industry

Published September 22, 2014 by Emily Kubis

Recruitment has opened for the third class of Nashville Health Care Council Fellows, a senior leadership group created by the Council in response to the nation’s changing health care landscape.

Bringing together approximately 30 leaders from various health care sectors, the program focuses on industry challenges and business strategies, and is co-directed by former Senator Bill Frist and Larry Van Horn, executive director of health affairs at Vanderbilt University’s Owen Graduate School of Management.

Van Horn spoke with the Nashville Post last week to discuss the Fellows program, health reform and Nashville’s health care leadership.

What opportunities does the Fellows program provide for health care leaders?
I think the thing that folks have found to be valuable was being able to step out of their organization for a bit. We can pull them out of their environment and put them with a bunch of really smart people where we can engage in conversation and roll ideas around. We do that through policy updates and bringing people into the classroom, like policy makers or CEOs, and getting them to understand what’s new and interesting and innovative. The nature of the classroom conversation is really exciting, and something Senator Frist and I look forward to every time we get together with these folks.

Who would you like to see in the Fellows program this year?
We’re looking for people who have demonstrated a track record of success. Existing leaders in their organizations with career trajectories such that they are going to be thought leaders in health care regionally and nationally. We want to provide them a forum to deepen their professional relationships and networks to make them even more successful.

In a class representing so many sectors, does the conversation ever become contentious?
I think, in a way, we breed contention in the room sometimes. We don’t want everybody to be parroting the same line. In terms of constructing the class, we think about the diversity of perspective and their ability to add to the conversation. That’s an important part of it. The way to address the problems and fiscal challenges in health care is not to keep doing what we’ve done in the past. How do we become successful in the new model? Change is painful.

What topics will be especially relevant this year?
Definitely the uncertainty regarding the implementation of the Affordable Care Act. Everything about legislation being implemented or not implemented creates business uncertainty around what you should do. The more you understand what those uncertainties are, the better you can configure your organization’s response.

Another thing is price pressure and the changing role of the consumer. Setting aside the ACA for a moment, the reality is 155 million Americans still get their insurance from their employers. The changes in that space and the evolution of the employer model is probably as important, if not more important, than the marginal impact of the ACA or Medicaid expansion.

We’ll also be looking at what we can learn from other countries. By looking around the world to see how other countries have responded to health care pressure, there are lessons that can inform how we think about our future. So we’re going to focus on a more global perspective. I use examples about Singapore, or Switzerland, or the United Kingdom and Canada, which have some common characteristics, not the least of which is you know what you’re buying when you receive health care there.

So those countries have better price transparency?
Price transparency is something people are very excited about in the United States, but there’s a more fundamental question around pricing, which is what you’re actually getting. You don’t know what you’re buying up front, and other countries have solved that. So we have to redefine what we’re delivering and how we talk about it. Now we talk about it in terms of bundled payments and ACOs, and maybe there’s traction to be had there, but first we have to redefine the unit of purchase.

The U.K. and Canada have single-payer systems. Can we achieve that transformation within the U.S.’ insurance system?
There’s always tension between someone buying a service and the person providing it. You want the lowest price, and the seller wants the highest price. That’s true of all goods and services. So we can talk about aligning interests, but that economic tension is necessary to maximize value. Part of the challenge is we’ve had too little economic tension at the right points in our health care system. The U.K. and Canada have government payers, but also a robust private sector that is producing goods and services that people want to buy. That holds great hope for innovation. We have to take our $2.9 trillion spend and come up with products and services that are more valuable to people.

I don’t think there is near enough skeptical evaluation on what’s happening in our industry among thoughtful people on the business side. So much of health care is chasing the current fad-what’s on the cover of Modern Healthcare this week? Nashville should be the leaders, rather than the followers. We have the smart people with the track records of success, so the Fellows program is getting them to be the leaders who craft that vision for others to follow.

Can you point to game-changing ideas that have come out of the Fellows program?
There’s a lot of anecdotes. One of the things we’re discussing right now is a class project. That would be a tangible synthesis of the lessons learned that would be returned to the community. We would get them to work, bring together their experience to address an issue of importance, say, to the state of Tennessee. We’re still in the process of crafting what that might look like. How do we harness this brain power for good? We could point to this and say, “The 2015 Fellows produced this analysis that fundamentally changed how we in the state go about solving this problem or that problem.”

https://www.nashvillepost.com/news/2014/9/22/van_horn_talks_fellows_program_health_reform_0