In this episode, we hear the second half of the conversation between CHESS Vice President of Value-based Operations, Josh Vire, and Wilson Gabbard, Advocate Health Vice President of Quality and Condition Management, who discuss the importance of partnerships with payers and implementing value based care practices with all patients, even if they aren’t in a value-based arrangement.

Wilson, thank you so much for being willing to stick around and continue this conversation. I really appreciate it. Wilson, you had just talked about on our last episode, you, you talked about clinician engagement, that relationship management and that activation. And, and this is something that I think you guys have been leaders in for a while in the Midwest. You your team not only supports the Medical Group of Advocate, but also support a large CIN that includes a significant number of aligned independent physicians in the area. Can you talk a little bit about the challenges of supporting aligned physicians versus the Advocate Medical Group?

Well, absolutely. And thanks again, Josh for inviting me to participate in this forum. So, I think, you know, we certainly don't have all of this figured out. I'd be lying if I said we did, but I think many of our listeners will probably appreciate the challenge that it is to operate in both of these worlds. And in our space, especially here in Illinois, it's especially pronounced. I think we have over 830 aligned clinics that participate in our clinically integrated network. And so the challenge that we talked a little bit about last time or about the data exchange and data exchange barriers is incredible, especially at that scale. But I think true clinical integration is really hard to accomplish without strong data and handoffs. And so I think we've leaned into this space of trying to bridge that gap with data exchange efforts. Again, time back to some of the work we're doing in ECQM reporting to kind of bridge the gap between those aligned DMRS and our data warehouses so that our reporting is as accurate and as timely as possible. That we are reaching out to patients for Medicare Wellness visits, annual Wellness visits. But when we can go in and see in an electronic means that they're already scheduled for those Wellness visits that we aren't, that we build off of care plans when we're doing care coordination activities that their PCT and their instances of EMRs have already documented. And so that is very hard work. And again, we're not completely there yet. If anyone listening has figured it all out, please add me on LinkedIn and give me a call because I'd be happy to hear from CIN who has figured it all out from the provider-based space. But anyway, it's certainly a challenge, but I think that it has applications across what we do in quality or condition management or utilization management. And I think that all of the principles about clinician activation that we talked about last time and kind of building out those teams and points of contacts are critically important to translate those messages that we do. I call it internally, I call it we have one strategy with different flavors, right. We have a flavor that is applicable to our internal clinicians on their instance of their EMR. And we have a different flavor that is applicable to the clinicians who maybe are on dozens of different EMRs.

Yeah, that's, that's great. It's I will accept your modesty, but also toot your horn a little bit. That why you guys may not have it figured out. You, you guys just evidence here in this conversation are pretty good at it and are probably more advanced than a lot of the other folks. And, and really impressed every time I talk with you guys about how you approach and work with your line providers. It's not an easy thing to do. We've been at this for a long time as well at CHESS and, and, and I think you highlighted accurately some of those challenges. So I appreciate that, Wilson. I wanted to pivot a little bit and we've talked a little bit about the importance of accurate timely data, the reports engagement. You guys are doing this at a large scale, I believe you said 108 value-based contracts. I know you guys have lots of different types of relationships with payers there in the Midwest. Everything from probably quality and performance programs all the way up to capitated arrangements that you guys have speak about how Advocate your approach maybe has changed or your view on that about collaboration with payers within a large health system.

I think that I'm not going to go into the specifics maybe of, you know, lots of payers, lots of relationships or few payers that you know, I think there's lots of debates I've heard from my colleagues in the industry of how you lean in. I feel very fortunate that we have some really wonderful payer partners and I use that word specifically as they are partners. And I think partnership is key and something that both health systems and payers maybe don't always lean into the value of those partnerships effectively. And it's certainly something I've learned over time, quite frankly. And I think about when I, when I got here to Advocate four years ago, I was sort of building some work for some programs from scratch and bringing others together. And one of the things I spent a lot of time doing with our payers was listening, listening to the questions they were asking and the suggestions they were making. And the reason I thought that was important is that under the reason that understanding the reason they were asking a question helped me create so much of the strategy that we created four years ago and that we still live by Josh. You've seen it today that we've really worked in aligning and doing that kind of listening session and understanding the core solves that they were trying to get at through strategies that they were recommending or conversations we were having in our JOCS or breakout committees or things of that nature, helped me understand the breadth of gaps that are, you know, potential in value based care, whether that's data or clinician activation or, you know, patient engagement or outrage or whatever. And so I, I think that that would probably be the big thing I would focus on is leveraging the strengths of the partnerships. And you know, not all payers have the same strengths, not all clinician providers have the same strengths. And so I think leaning into those relationships, trying to reduce unnecessary overlap between programs that you're operating, having some co-accountability or delegation of the work that you're doing so that you have that division of responsibility of hey, I'm going to do this and I need you to do that. And I think it's OK for either party to say, hey, I think you're doing, you can do a better job with this than I can. You know, whether that's, you know, in home assessments or, you know, patient outrage or whatever, trying to assess which partner has what strengths I think is really key. Being honest with yourself and building those trusting relationships to partner together.

I love, I love that answer. I love the, the concept of leveraging the strengths of the payers. They're they, you're right, they're each have their own strengths and and weaknesses. No one, I don't think has it perfect, but I wanted to ask you all that question because obviously you're, you guys have been very successful, not only in, in terms of the work that you do and how you set it up, create it, but actually in your performance of your contracts. And, and I like how you talked about that payer partnership. We think of it the same way here at CHESS because it, it really is important that you're working together to improve the, the lives of the patients that are that are in those contracts. It's it's not just a assign it and be done. It really takes working together. And so I, I really appreciate that.

And I think Josh, to add on to that, I mean, you're right, it, it, it, well, the, I think it's we're, we are here in population health to serve our patients ultimately, but also, again, our clinicians and care teams. And you know, I was, I went to my PCP yesterday for an annual visit. And when I go into the exam room, he isn't thinking about what payer I'm a part of, right? Or what, you know, who my insurance payer or value based agreement is and if he's going to treat me differently because of that, right? So, I think that's the other thing that we've tried to be very intentional of, of again, let's transform the transform the whole the whole operational model so that it's applicable to all patients and all payers. Sometimes even if they're not in a value based arrangement. How do we flex those muscles around quality care and top desk, you know, again aiming toward that top decile performance. Again, I think that helps us avoid any even kind of credibility issues with our clinicians that we're really aiming about improving care for all.

That's all right. Yep, very well stated Couldn't said it better myself. I think also an advertisement for those that listening that it more operations folks should be included in in the development of value based care going in the future because it, it is about focusing the right thing and helping folks to in the clinicians in particular to drive that outcomes and improve it. That's that is what it is all about. And having people who know how to get that done is, is, is a challenge, but you guys are doing it, doing it very well. So, and to that, to that point, Wilson, I wanted to ask, what, what advice would you provide to a clinician, practice company, whatever the case may be, who's looking to advance in value based care and, and particularly as they move into and value based care progresses into risk and even to capitation. What, what advice would you give them?

I think that if you're not in risk already, if you're not taking some pathway to getting there, you should. I know, again, I probably have a bias of this. I've been doing it for over 10 years now and been an advocate for taking risk and enabling it. Really to me, I think it's so much about enabling this care model transition from back to what I talked about in the last episode of Counting Widgets to improving the health and well-being of the patients, again, we have privilege to serve and I think obviously CMS has that onus trying to drive their participants into value based models, which is super exciting and has certainly changed over the last 15 years. And I'm glad to see it. But I would also say tactically, outside of like, hey, like, yeah, this is something we should do. I'd say go find the partners who can help you do it. You know, and this is Josh didn't ask me to do this. This is not an advertisement for CHESS. That might be CHESS. That might be a payer partner who's really good at value that you have knowing and trusting relationships with that you feel like can maybe help you bridge into an upside shared savings or a shared risk or a pathway to risk. I do think that there's a lot of it again, and I have the bias as a former op, a practice operator and an operator at heart. You know, it's also really core about laying the groundwork of operationally executing and you know, if your physician compensation models, if you're a Medical Group operator are really completely focused on fee for service and work RVUs, that's probably the that's what you're going to get out of it, right? If your models are not focused, if your operators, if your physician leaders or clinical leaders are not also accountable and motivated to also deliver high quality, that's something that immediately I think you can work to implement. So again, those are just a few things that I think of that you're not at this alone. Listen and partner with your payers. Like I think I mentioned on the last question, they have a lot of really good ideas. They also have a lot of resources and expertise. So try to borrow shamelessly, share shamelessly from them to learn those best practices and then again start to begin to transform your operations and develop the relationships with payers and value based models that allow you to do so.

That's a great advice, Wilson, thank you for, for sharing that and would encourage folks to, to listen to that advice. So one last question, Wilson, again, really appreciate your time and, and all that you do for the movement to value and for joining us on the podcast. But is there anything that I haven't asked you about that you feel would be really meaningful or informative to the conversation? Just want to give you last word and let you add anything that maybe I haven't asked about.

Yeah, I don't think anything super say Josh, but I think that I'm can't just help but be really excited for the future of value based care, especially for that future here at Advocate and the work that we're doing together with partners like CHESS. It's a super exciting time. It is never easy. So for those of you out there, I probably haven't said this enough through that the podcast, this work is not easy. It's not for the faint of heart, but man, when we tie back to our connect to why, our connect purpose, it sure is. It sure is meaningful to me about the patients. Again, like people like I grew up in rural Eastern Kentucky where health disparities were not hard to spot. And, you know, people like my grandmother who had, you know, less than Ideal Care and, you know, quality care gaps that kind of fell through the cracks. And I think that I'd encourage us all to kind of keep that remember our why, what our true north is and why we're doing all this work. And ultimately, it's serving people like our loved ones and people in our communities.

Perfectly said. No need to say any more. Wilson Gabbard, thank you so much for joining us on the Move to Value podcast. Loved having you.

Thank you so much, Josh. Good to be here.