HJNO Sep/Oct 2022

CHANGING HOW CARE IS DELIVERED 16 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF NEW ORLEANS   dictably, the cost of care for that employer went up modestly in three areas: primary care, behavioral health, and physical therapy. How- ever, total cost of care for that employer went down 46% overall, with decreases in spending on emergency room visits, hospital admissions, surgeries, and specialty visits. Measured health outcomes improved considerably as did ex- perience of care for both patients and provid- ers. In a move that should raise the eyebrows of every healthcare executive in the country, Amazon reached an agreement to acquire One Medical in July 2022. I’m quite certain many healthcare executives will immediately cast doubt on the ability of Amazon to disrupt the healthcare industry. I’m also quite certain that the executives of the motion picture industry never dreamed that a company that started as a small online book seller would one day be making Oscar-nominated motion pictures. CHANGING THE CULTURE For this third article in this series, we stay at a very high level but at least come down into the stratosphere. Changing the fundamental economic model of healthcare is an essential prerequisite to achieving the most efficient, equitable, and effective healthcare system pos- sible but is far from the only change that needs to take place. A culture change in healthcare will be equally necessary. Physicians will need to embrace changes regarding their own roles, especially with regard to evolving concepts in professionalism, interprofessional education, and leadership. As outlined by former Supreme Court Justice Louis Brandeis, characteristics of a profession include the following: 1) possess- ing a special set of knowledge and skills that sive, does not produce anywhere close to the best health and health outcomes in the world, and is too often characterized by poor experi- ence of care for patients and providers alike. While economies of scale will continue to ex- ist in healthcare, business model reinvention will intervene with increasing frequency, of- ten driven by economies of scope. Business models oriented around scope-driven solu- tions seek new ways of creating and captur- ing value by starting with the customer and then working backward to figure out how to deliver value propositions that alleviate pain points, solve problems, and meet customer needs. This newly envisioned way of delivering value has been exactly how Amazon became one of the world’s most valuable companies. In that same article, we mentioned how Iora Health, a company of only 600 employees — comprised solely of primary care physicians, behavioral therapists, health coaches, and sup- port personnel serving approximately 38,000 Medicare beneficiaries — sold for over $2 bil- lion by creating and capturing value very dif- ferently than traditional health systems. The company that purchased them was One Medi- cal, a novel primary care company that first began exploring alternatives to traditional fee-for-service financing mechanisms as far back as 2007. In 2020, a study was published in JAMA about how One Medical worked di- rectly with a large innovative, self-insured em- ployer in southern California to deliver care to that company’s employees very differently than traditional transaction-based primary care. Utilizing a different economic model to cap- ture value, One Medical deployed reinvented team-based primary care to create value. Pre- In the first article of this series, we began with a view of the world — specifically the world of healthcare — from the 240,000-mile level, quite literally a view from the moon. From that view we explored our “moon shot” and imagined a different world of healthcare where the un- relenting focus of our healthcare system is to improve the health and health outcomes of the patients we serve, while measuring and hold- ing ourselves accountable for those results. We envisioned a world where healthcare is af- fordable for everyone and no longer the lead- ing cause of bankruptcy in this country. We dreamed of a future where the experience of care for patients will be as seamless and fric- tionless as ordering a purchase from Amazon, while simultaneously cultivating an environ- ment where patients can spend enough qual- ity time with their physician or care team to have their questions answered, their concerns addressed, and where the focus of each inter- action is aimed at helping them achieve the health goals that matter most to them. And lastly, we looked forward to a day when all pro- viders and care team members come to work every day to connect with the deep sense of purpose of why they entered healthcare, expe- rience all the joy that our profession can offer, while also strongly recommending it as a ca- reer path to idealistic youth without hesitation. In the second article, we came down to more of a 240-mile view of the world — about where the International Space Station currently or- bits — and explored the economic models that have resulted in current U.S. healthcare system performance falling dramatically short of the idealism expressed above. Indeed, our current U.S. healthcare system is wildly expen- Kenny J. Cole, MD, MHCDS, began his role as system vice president over clinical improvement for Ochsner Health in New Orleans in September 2019. He is a practicing primary care internist with advanced degrees from LSU Health Sciences Center and Dartmouth, as well as executive training from Harvard Business School. Prior to joining Ochsner Health, Cole was the chief clinical transformation officer for Baton Rouge General Medical Center, where he designed, developed, and implemented a completely reimagined multidisciplinary team-based model of primary care that focused on aligning clinical with financial outcomes. His current work at Ochsner Health builds on that prior foundation where he is now scaling new care models across the state that specialize in improving health outcomes for older adults. Kenny J. Cole, MD, MHCDS System VP, Clinical Improvement, Ochsner Health