Brian Lobley, Executive Vice President, Health Markets, Independence Health Group
This episode of Tuning Healthcare features Brian Lobley, Executive Vice President, Health Markets at Independence Health Group, the parent company of Independence Blue Cross in Philadelphia. He is also a founding member and the board chair of Quil, a newly formed joint venture between Independence Health Group and Comcast. Brian shares his perspective on the opportunity for payers and providers to collaborate in improving health outcomes and the consumer experience. Particularly in the age of COVID, the acceleration of healthcare innovation and the move away from fee-for-service will continue to spur industry transformation.
“I think what is emerging is a recognition across all stakeholders that the fee-for-service marketplace needs massive, massive transformation. Customers are demanding it. Providers are looking forward to it on how they earn incentives and help drive adherence, and quality and costs down, and payers as the intermediary need it. We need to be able to get to equations where we’re able to do partial or full risk deals.”
– Brian Lobley, Executive Vice President, Health Markets, Independence Health Group
In this episode, Brian and Lumeris Senior Vice President Nigel Ohrenstein discuss:
- How a large commercial payer is helping its members through COVID-19
- The market dynamics encouraging industry transformation that have emerged during the pandemic
- What successful payer-provider collaboration looks like in the future
- The complexities of the healthcare journey for patients and caregivers
- Rethinking the consumer experience in healthcare
- How payers and providers can help drive value-based care outcomes together
- The need for innovative partnerships in healthcare across all verticals
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Nigel Ohrenstein: In this episode of Tuning Healthcare, I’m joined by Brian Lobley. Brian is the executive vice president of Health Markets at Independence Health Group, the parent company of Independence Blue cross in Philadelphia. He’s also the founding chair of Quill, a newly formed joint venture between Independence and Comcast. In this episode of Tuning Healthcare, Brian and I discuss how IBC is dealing with COVID, taking care of their members during this difficult time. We get his perspective as a Blue on value-based care and how the Blues must collaborate with providers to drive superior healthcare outcomes in their local communities. We also discuss how payers need to innovate and Brian’s view of Quill as the Avenue by which IBC is doing that. Join Brian and I as we tune healthcare. Brian, thanks for joining me today. It is an absolute pleasure to have you on. We’ll get into this, but have a unique role in helping Lumeris really get off the ground and so we appreciate that and truly appreciate you taking the time. So thanks for joining us today.
Brian Lobley: Yeah, thanks for having me, Nigel, looking forward to it.
Nigel Ohrenstein: How are you? How’s the family? Tough times as we all know.
Brian Lobley: Yeah. Hanging in there, I’m still home, believe it or not. Everyone’s doing really well. I was thinking about, that’s the most common question when you haven’t spoken to someone in a while. So I was reflecting on it prior to us hopping on this podcast, and I thought, there’s been tough times, there’s been frustrating times, but I’ve had more meals with my family since the middle of March on the evenings than I could have ever imagined during this time period, the spring into the summer given all the commitments that we all have externally. I’m trying to look on the positives versus just weighing down on the negatives. Everyone’s healthy and everyone’s happy. We got our next milestone, at least on the personal side, which is that school’s coming up. So we’re just anxiously waiting and anticipating what’s going to happen there, but we’re doing great. How about you? Everyone doing well?
Nigel Ohrenstein: We’re doing well. I think similar to you, we’re fortunate to have a number of silver linings. One of them is the abilities for me to sleep in my own bed every night and see the family as regularly as we do. I think my wife and I appreciate it more than perhaps the kids do, but-
Brian Lobley: Same.
Nigel Ohrenstein: -there’s been enormous amounts of family time that I think we will look back on with an element of enjoyment even though what’s obviously going on around us and what went on around us in New York is incredibly difficult.
Brian Lobley: Yep.
Nigel Ohrenstein: What about Independence? How’s it going?
Brian Lobley: We’re doing well. I think despite everything we’re trying to make sure from a business standpoint that we’re obviously managing all of the risks that come with this pandemic. So there are some unanticipated risks, like making sure all of our group and member customers know and understand their benefits, understand what happens if they’ve gotten sick. We’ve taken a lead in the Philadelphia market with a Beat COVID campaign. We brought other employer groups and business partners together with that. But Dan, who I know you know well, our CEO, so Dan Humphrey has been front and center messaging. One of my favorite ones is Behind the Mask. So we took a bunch of pictures of people with their masks on and posted all over social, and three days later, four days later remove the masks and then had everyone from Gritty, our iconic Flyers mascot all the way to Dan and other folks.
Brian Lobley: So just trying to reinforce the messages that there’s things that we all need to be doing just as citizens. From a corporate standpoint, we’ve tried to make sure we’re, as all the Blues are really, taking account of our role as corporate citizens and corporate leaders. We have a community-focused role there. Then from a business standpoint, it’s been interesting, obviously we’re on the payer-side. So if you take a look at everything you’re reading or just thinking about people not going to elective surgeries, et cetera. So we’re trying to make sure we understand that there are some aspects of that, that we need to take into account when we look at how the business is performing and we’ve accelerated some rebates out to group customers. We’ve offered payment flexible terms, we’ve accepted credit card payments into group payments for the first time.
Brian Lobley: This upcoming month in September, we have premium discounts going out across the board. So we’re really trying to weigh everything. And then working with those group customers to understand what they’re doing relative to furloughs and extending underwriting guidelines and things like that. It’s real proud of the effort that we’ve put in to make sure that our customers and our members understand what they have and understand what additional benefits or offerings we can do. The hardest thing is really managing the operations of the world. So we essentially closed our offices on Friday, March 13th. We have had limited essential personnel in there, less than a hundred people a day. Great people that are going in and processing payments, and mail room and facilities and security and things like that.
Brian Lobley: But the vast majority of the associates have been at home. So, call center people having to relocate from a work environment to take calls at home and they’ve done a great job. We were ready, we did some early planning the end of February, early March, as we thought, hey, this could really happen to make sure we’re ready and available for this from a system standpoint. And since then we’re just fine tuning it. Upping our game from Skype to Teams. So everything’s become a little bit more easier from a video standpoint and making sure all the different platforms, Zoom and WebEx and everything’s supported. It’s been a challenge, but I think I look back and think of the opportunity that it presented us from a company I’m really proud of the way we responded. I hope our customers and our members are too.
Nigel Ohrenstein: Yeah, that’s great. Some of our clients actually have noticed that in jobs like call center, there’s been a higher turnover than historically. Have you noticed that with some of those jobs or have you managed to maintain-
Brian Lobley: Yeah, actually, we’re at our lowest turnover levels that we’ve seen in some time. I’d be remiss not to say with the fall coming up. Again, we talk about the school schedules and shift to work and things like that. We could see some impact there on staffing levels and turnovers, but really through right here, August 20th, our turnover levels are probably at the lowest they’ve been in a number of years. We’re happy and fortunate that, because it allows our experienced people to stay engaged with customers. That’s really across operations, it’s not just call center.
Brian Lobley: I think claims processing and groups like that who it’s hard to be in an office at home and maybe it’s a spare bedroom, maybe it’s the dining room, maybe it’s a basement, and your job is making sure you’re productive, and making sure you’re hitting those productivity measures without having the in-person scrum meetings or having the coffee break where you can talk to a colleague. We’ve been holding steady though, so it’s been great.
Nigel Ohrenstein: That’s great. What about plans? I think I remember reading when your building was purchased, that it was the most expensive building in per square foot in Center City. I don’t know if it’s still the case. And so the plan just to wear this out and come back into the building, or do you think there’ll be some long-term changes to how Independence operates?
Brian Lobley: It’s a great question. Prior to COVID-19, I made the decision to actually purchase our building. We owned it all the way through the late 80’s, sold it in the 90’s. There was an opportunity to make a purchase back. I’ll tell you that I think from a single site building, and we’ve seen this on the real estate analysis, actually, those values are holding steady, if not increasing. It’s multi-tenant buildings where you’re seeing a property value hit. So just think about a return to work scenario, whether that’s this fall or after the new year, because we’re measuring this almost in 30 to 45-day increments. We want to give our associates enough planning time, childcare issue, elder care, dealing with parents, et cetera. So we’re not going to rush anyone back in and we’re going to have safety and security at the forefront of everything we do, but let’s fast forward and say after the new year, we begin to return to work.
Brian Lobley: The footprint’s going to change. The days I think of cubicles where it was the open floor plan, and you could talk to someone right across, I think that’s going to have to change, regardless of the pandemic ending or COVID vaccines, et cetera. For us, it reinforced our position, so now we have the footprint, the floor plan. If we have 5,000 people in the building today, even if we have 4,000 tomorrow, because a thousand jobs go virtual, we’re also going need that full footprint.
Brian Lobley: So I don’t think it really… if anything, it enhances our plan and gives us a little bit more control over what we want to do. It’s a great question. I was explaining to someone the other day, if you take the analogy of a baseball game. We haven’t reached the seventh or eighth inning yet. We’re still probably in the second or third, maybe the fourth inning. Certainly, you and I are fortunate living in the Northeast corridor. So we’ve had a more compliant population, it seems like, and maybe we’ve already weathered our storms, hopefully. I certainly am praying that New York has, and I think Philadelphia already dealt with a couple mini peaks. So now we’ll just wait to see when it’s safe for all of us to resume some sort of normalcy.
Nigel Ohrenstein: Yeah. And so switching to healthcare, obviously, which is the business that we’re all in. How does the pandemic change the strategy for IBC? What changes as a result of this?
Brian Lobley: How much time you got, Nigel?
Nigel Ohrenstein: It’s all day, right?
Brian Lobley: Well, here’s the most interesting part for Independence. We had started our strategy at the end of last year. So we were embarking on what we were thinking about what was a five year strategy. It’s a pretty big pre-pandemic inflection point in healthcare. You think about everything from value-based care being a major thrust, to digital tools, consumerism, crazy valuations of startups, et cetera. We were in the midst of planning Independence’s place in that environment. Well then COVID hits, so we pause, think back to those March timeframes. I don’t think many of us, and I’ll be the first one to say it. I didn’t think in mid-August, end of August, we’d be in basically the same exact environment.
Brian Lobley: I thought it would be a little bit different. So, we paused appropriately. And then as the pandemic began to worsen and understanding of some certain seismic shifts that just happened, I think virtual care as one of them, telehealth. We’re seeing a sustained 23X increase in telehealth services. We don’t turn back the dial on that. So, when we restarted strategy a couple months ago, it was in this new paradigm. And we are, we’re not complete yet, but we’re looking at it and saying, what’s steady, what’s not going back? Virtual care, I think you and I can agree that that environment finally has accelerated in healthcare. We think financial services, retail, all these other industries are five, seven, ten years ahead of healthcare pre-pandemic. Well, we’ve been forced to play catch up. I think as an industry, we’ve done a really good job. I think as a market, Independence has done a phenomenal job.
Brian Lobley: We made some interesting bets before that with Quill, for instance, our joint venture with Comcast, that’s very much in the digital health space. So, if I think about that environment, we feel like we’re positioned. And if anything, we’re going to put more chips into that side of the table and really figure out how we can be an enabler of digital health, virtual healthcare assets. So you take that piece over there. And then if you look at the traditional business that we are, which is ensuring members, ensuring groups, that’s the one where there’s a lot of questions. So, you have a political environment coming up that could have massive consequences on the Affordable Care Act business. Insured business in general, for group customers, Medicare, Medicare Advantage Expansion, Medicaid. We have a large managed Medicaid business as you know.
Brian Lobley: I think our greatest asset is our ability to diversify, which we’ve done as a health plan. I think we’re one of the most diversified Blues plans out there, with all the different assets we have. And then our ability to partner. I think, when Dan became CEO 10 years ago, I think by now, he really brought a partnership ethos to us that has held fort. So Blue Cross Blue Shield in Michigan is our partner in the AmeriHealth Caritas managed Medicaid business. I mentioned Comcast. We have an asset Tandigm that you’re very familiar with, that started as a partnership with DaVita, now we own fully, but we’ve shown that ability to, I think, do unique things in the marketplace.
Brian Lobley: I think that’s where healthcare is going. I think that’s the seismic shift that’s going to sit right there with virtual care, is that plans, payers, providers, payviders, things like that. I think it’s going to look at abilities for us to work in nontraditional ways across each other. We’ve restarted it. I think if you look at the asset base, we feel really great at where we’re starting from. But we’re also going to take some bold moves and think about behavioral health. If there’s anything, I think that we’re concerned about from a plan perspective and talking to providers, we know they’re concerned as well is, the consequences of a pandemic. The consequences of loneliness, the consequences of a fear factor of going outside. It’s going to play its hands into not necessarily diabetes and heart disease and things like that. It could be behavioral issues.
Brian Lobley: So, we have a real focus right now to figure out what an integrated behavioral health strategy can be. How can we partner with the provider community in the Philadelphia market, but nationally as well as we think of our national account customers. That’s really been something that we were tugging at pre-COVID, and now instead of tugging at it, we put everybody, every executive put a hand on the rope. We’re tugging in the same direction now on that one.
Nigel Ohrenstein: Yeah. It’s a massive space and it’s incredibly important. Let’s come back to that. I’d love to chat a little bit about Quill. I think you were a founding member. You’re the chair of the board. Tell us a little bit about Quill. What is the strategy and what success look like if you roll the clock forward for Quill?
Brian Lobley: Yeah, no, I appreciate the opportunity. That’s my favorite thing to talk about besides Independence right now. Quill was a joint venture we started with Comcast in 2016. When I say we started, you think back four years ago, that was the early stages of figuring out what we were going to do with Comcast. What was a unique partnership with our largest customer of which Comcast is. We started a process with them where we actually were going to do a joint venture fund. In the midst of 2016, as we were having a lot of planning meetings and figuring out a capital contribution model, we’re in a conference room, back when we were allowed to be together, and we had this giant whiteboard, and we had all these Independence assets on one side and all the Comcast NBC versatile assets on the other side.
Brian Lobley: Not ashamed to say their whiteboard was bigger than ours, Nigel. So we looked at this and said, okay, there’s all these digital health, how about we invest or take positions in a few companies and really scale along the membership base and use assets like content production that NBC has and build it to reach the home that Xfinity has, and experiential design, think of theme parks. What really happened is, we came up with a thesis statement that really has underpinned Quill from its beginning, is that: anybody in the healthcare journey, whether it’s for yourself personally, it’s for a child, in a caregiver role, it’s for a parent, it’s for a friend that’s calling you. Every single time that you’re in that healthcare journey, you’re going to have one fundamental question that’s going to override everything else. Is what do I do next? I’m at a point in my journey, what do I do next?
Brian Lobley: So that became a rallying cry, and we said, wait a minute, instead of taking our assets, financial, human capital, IP, et cetera, pushing it into a startup, why don’t we create our own? By the end of ’16, we started creating a loose business plan. It took a little bit into ‘18, as you can imagine, two really big companies trying to settle on a joint venture. I say to my friends at Comcast all the time, we’ve become, not only great partners, great friends, it’s unique to do a JV with Comcast. They typically don’t do that right there. They’re typically an owner of an entity, think NBC, way back, think Sky, think all these other acquisitions. So it was a unique process here on our way through.
Brian Lobley: Once we reached the, “This is what we’re going to do”, we started building a technology base. We did a CEO search and we hired a wonderful CEO, Carina Edwards, who’s been in now I think a little over a year. We started on this model where we are going to be prescribed essentially through the provider. So we’ve signed contracts with Rothman. We have a contract with Penn Medicine, Move, and some others that are near finished. We’ve really digitized the healthcare journey for those providers. We started with orthopedics, so we could prove there’s a stage gate process. There’s a diagnosis, there’s preop, op, post-op, therapy, new normal, and you can be guided through that journey. It helps lower admission costs, readmission costs, pardon me. It has adherence built into it.
Brian Lobley: It’s really allowing that consumer to get that prescription from the provider to navigate. The beauty of the partnership is, we can be on any piece of glass in your house, iPhone, iPad, TV. Pre-pandemic, we’re down that path. Pandemic kits, and it’s wow. What do we do? We’re paused, right? Well, great thing about this startup is it’s well-funded because the two parents are all in on the digital health mission here. Carina and her team pivoted quickly, they built a COVID journey, and an aha light went off where we figured that actually the backend technology is ready, built. We can stand up journey’s really, really quick.
Brian Lobley: So now Penn Medicine has come to us and said, okay, we’re going big. Let’s go big. So we’re going to put Independence and Comcast members in and really go department by department with Penn and try to work as best as possible, digitize those journeys and bring the power of payer information, the power of provider information and the technology from Xfinity to power this. And at the same time, AmeriHealth Caritas came to us and said, we have these caregivers. In the LTSS population I have one person as the key central point for taking care of others. So we signed AmeriHealth Caritas. And we’re rolling out a caregiver journey with them for all the Pennsylvania managed Medicaid LTSS patients.
Brian Lobley: That’s going to be super powerful to have that at your fingertips and we’ve become fortunate in some ways during COVID as we’re at home and realizing that our entertainment’s connected. We haven’t missed a beat shopping. There’s probably Amazon packages I have to get from the front door today. Where that rest of that world was digitized, [in] health there’s still a gap right. Telehealth’s happening, but not necessarily all that access to information. Quill’s the mortar between the bricks and we’re continuing to build. We’re bullish about the opportunity. We want to make Philadelphia that demonstration market and we have these great things coming from caregiver, the care delivery journey. The third part of the business that we’re exploring right now is also the sensor business.
Brian Lobley: So if you think about passive monitoring and things you can activate through the home that’s, I would say the third frontier. We’re just early in the exploration phase there, but another kind of homage to COVID, because you’re realizing your home and wow, wouldn’t it be nice if you had an alert pop through at 9:00 AM if the refrigerator didn’t open at mom’s house yet. So the ability to put passive monitors as well into the home is something we’re exploring now. So, big plans for it. Anchor part of Independence’s strategy, great team. We’re very fortunate because the team hasn’t missed a beat, so could talk about that all day.
Nigel Ohrenstein: That’s great. To talk a little bit about the Philadelphia market, we, as I mentioned at the beginning, owe an element of a debt of gratitude, to Independence and to you in particular, because you’re Lumeris is first foray out of… We’ve done some work in Florida, but our first serious foray out of our home market was into Philadelphia. As I say, Independence sponsored us, and so we owe you a debt of gratitude as we started the Lumeris journey. So, a market that we know well, but tell us how’s the market going to evolve? What is the relationship now between the different health systems, the independent practices like Tandem, which obviously you mentioned before. You’re obviously the 800-pound gorilla in the market. How does the market evolve and in particular, given Lumeris’ look at the world and purview. What do you think that fee-for-service is going to move away quicker, or do you think that the systems will still looked to hang on to that model for longer?
Brian Lobley: Yeah. It’s a great question. If I think about the market first and your question specifically, relative to that, I think again, maybe one of the positives of COVID, and I don’t want to downplay the negatives that are there and the impact that it’s had to people and families and careers, and the like. It’s been tragic, but a positive that has come out of it is, it’s forced in-market conversation, I’ll say. I believe that conversation has led to a tremendous opportunity in collaboration. For us you know, it’s our hometown market. So we have the Blue brand and the five counties around Philadelphia. We look at our customer base as really being anchored there from the Comcasts of the world to the Urban Outfitters of the world, and companies like that, that are national accounts all the way down to all the labor funds that we serve, to individual consumers and MA. We play across the board.
Brian Lobley: We have an ability, I think, to have the right conversations with the IDS-es around, what’s best for our members. And I say “our” meaning ours and those physicians. You mentioned Tandem and its ability from an independent physician standpoint to keep them independent. We believe in the independent physician marketplace. So the market has a lot of diversity. It has Penn Medicine, it has Jefferson, Main Line, Temple, to name a few that are in the city, but again, COVID forced us all to work together to manage the crisis. Dan, I think in his leadership role had stepped up and was able to engage dialogue at the CEO level across the health systems and really forge a partnership in tackling what COVID was potentially going to bring. Collectively, the hospital systems united together to have Temple’s Liacouras Center, be available as a triage hospital.
Brian Lobley: Tony Coletta, who I know you know, stepped up as the chief medical officer out of his role at Tandem and we helped put together a CEO and a COO. We didn’t need a lot of the beds, thankfully. But that type of dialogue is, I think a Philly theme. We always call ourselves the biggest small town in America, because it’s a… You’ve been to the city, it’s a close-knit city. I grew up here. I could walk from my office to city hall and I’ll bump into someone from grade school or high school or something like that. So we have this collegial partnership, birthplace, if I will go back to history here. It’s the birthplace of America. So we have, I think, an ability to fall back on that.
Brian Lobley: I think what is emerging is a recognition across all stakeholders that the fee-for-service marketplace needs massive, massive transformation. Customers are demanding it. Providers are looking forward to it on how they earn incentives and help drive adherence, and quality and costs down, and payers as the intermediary need it. We need to be able to get to equations where we’re able to do partial or full risk deals. We’ve signed a few; Tandigm is full risk. We have ChenMed in through the dedicated senior centers. They’re in market with us. We have elements of value-based contracts with the IDS-es in place. I think really the next three to five years, you’re going to see a pretty big shift. I don’t know that I am confident enough right now to say that the market will be full upside, downside risk in five years.
Brian Lobley: I don’t think that’s going to happen in the Northeast. If you look at the DC, to Washington, to Philly, to New York, to Boston bubble, I think we would both agree, that’s not going to happen. That’s not going to change over the next five years, but over the next decade, absolutely. I think it’s a step function. I think our role then is to be flexible in the way that that journey has to happen. I don’t think it’s going to be the same at each IDS. I don’t think it’s going to be the same for each clinician. I don’t think it’s going to be the same for each specialist or urgent care and virtual care provider that comes into the market. So what we’re focused on is looking at each of those contracts and those relationships, quite frankly, independently, as opposed to saying, here’s what the left is doing, let’s get this on the right.
Brian Lobley: That’s not what we’re looking at. We’re like, here’s where you’re at today. Here’s the patients that are carrying this Blue card, whether it be Independence or our Blue brother, and that have members that live in the Philadelphia area that come in and get services at Penn, and Jeff, and Main Line, and Temple and others. And we’re approaching that and saying, here’s the volume of patients that we collectively want to have the best quality and lowest cost so that they’re continuing coming into your facility to your doc, et cetera. I think that has been the role that we have taken with them and it’s been transparent. It’s not been a forced hand. I think it’s been dialogue and partnership oriented. So each of those relationships have evolved into different conversations around even different patient populations.
Brian Lobley: One of those providers, maybe a larger MA player, which has more risk components because of Stars and everything else that you maybe can look at differently than the ACA marketplace, that there’s a net sum revenue game for payers. It’s not a net increase. But I think the market is going to continue to be a multi-provider market in our ability to navigate that and partner effectively with each of those institutions. Because as you know our geography is set up in such a way that there’s also not a lot of overlap in service area between those hospitals, for instance. So they are a geographic entity in some regards. I think we’re able to effectively manage that. But that’s to put the little note in the bottle. Toss it on the Jersey shore and pick it back up in 10 years and see if we were right. But I think it’s going to be a partnership-driven market that’s going to be a lot more risk bearing and fee-for-value than fee-for-service in three to five years.
Nigel Ohrenstein: Right. Interesting. And definitely something that we’re seeing from the health system side across the country. Really a desire to move faster. Most of them had a strategy anyway to move out of fee-for-service. The pandemic has illustrated to many that safety in fee-for-service was clearly not there-
Brian Lobley: Correct.
Nigel Ohrenstein: …they’ve sped up.
Brian Lobley: Yeah. Nigel, that other point there, that I make that I think there’s still an education that’s happening around the provider community on the self-funded business. So 65% of our commercial business is self-funded. So we need to enable value-based programs with those providers into those self-fund customers, especially if they’re national. So Comcast does not have all its members in here in Philadelphia. They have a portion of them. There’s been an education as well because as you move away from fee-for-service, or as customers ask for a different value equation, we have to go back and educate providers at saying, at every 100 Independence patients you see, 65 of them, we’re not the fiduciary. We’re enabling care and access to them and we’re enabling services. So that education’s not complete yet either.
Nigel Ohrenstein: I’ve always thought the name payer is an odd term because the payers are in the colloquial term of the word payer, the government, employers and individuals, right?
Brian Lobley: Right. Yeah. Absolutely.
Nigel Ohrenstein: One of the things that, again, I’m not talking Independent specifically here, I’m talking more nationally, that has frustrated me over the last few years is that I’ve watched a number of payers really block the move to value and do in many times often the exact opposite of what you just said, which is treat each system, each physician differently and realize their own unique needs and often like put out a contract and say, so this is the contract, everyone in the state has to sign it and this is it. So using the power of and weight of the market leader to do that. Do you think something will have changed and in payers nationally that if we were to pick up your bottle off the Jersey shore in 10 years, that will change? What do you think it will change? Because over the last three to five years, I’ll be honest, I’ve been frustrated at payers not willing to partner more quickly.
Brian Lobley: I couldn’t agree more with what you just said. I’ve been frustrated too. I think it’s very different when you’re a national contracting entity than when you are a local contracting entity. So, I absolutely believe that the Blues will drive fee-for-value transformation, more so than any other payer, and they have to. That to me is mission imperative, brand imperative, to our ability to local… Healthcare is local, so you have to localize markets. You get healthcare where you live and where you work. When you’re activating a market or when you’re incentivizing a market, which we would be in this Philadelphia five county, we uniquely understand the needs of those geography situations that I just mentioned. We’re able to look at the cohort of patients and say that the differential patient experience and even patient demographics that come in require differential contracting.
Brian Lobley: So we have value-based care steering committees that are different with each health institution and entity. So again, I’ll speak very Blue here. It is the uniqueness of the Blues and the Blue Cross Blue Shield Association to be able to work collaboratively in that marketplace. Now I’m not going to sit here and tell you that everyone does because I’m sure they don’t. I run into situations where I’m trying to enable a national account member in another market for something unique, but we started high-performing networks for the Blues and we knit it together out of the 36 Blues plans. All of our unique high-performance networks to put together a national network plan. I think that a fundamental and intrinsic question for payers holistically are, if you’re going to be cookie-cutter, what incremental value are you providing for a customer? What incremental value are you providing, think of the MA space, which is government reimbursed, largely.
Brian Lobley: How can you get into a differential value-based relationship if you have a cookie-cutter approach and a senior who lives in one of our suburban counties is very different than a senior who lives in an inner city. Transportation needs alone are different. So you got to get very unique in those contract structures. So, I’m with you. I get frustrated as well when the nomenclature has always been fee-for-value. And then some of the templates are, well, this is the template to fill out to get there. We’re not going to have the same experience also in Philadelphia that we’re going to have in North Jersey where we do business under AmeriHealth brand.
Brian Lobley: That’s a very different market for us to contract in. It’s a very different market for us to put products and services. By the way, we’re in the ACA business in New Jersey and Philadelphia five county. AmeriHealth, New Jersey brand, Independence Blue Cross brand, our approach to those markets are vastly different, vastly, vastly different. That’s from a product standpoint, but that’s also from a provider standpoint. So, we’ve seen it firsthand that cookie-cutter doesn’t work. There can be a framework on value, how much risk can you share and things like that, but there can’t be the specifics below it. If you and I are having this conversation even three years from now, and you have to ask the same question, which I hope you don’t, but if you have to, that’s got to mean that we’ve had a lack and are stalling of progress, because it just should not happen.
Nigel Ohrenstein: We’re also big believers in forming these collaborations and helping to form these collaborations-
Brian Lobley: Yeah, absolutely.
Nigel Ohrenstein: – which obviously are our clients and the payers. I agree with you, and going back to conversations, we’ve had almost a decade ago. We did a great business trip out to the West coast once upon a time. The Blues are uniquely positioned as local entities. Their tentacles into the community are deep. As you say, you live there, you grew up there. It’s a very different relationship to some of the nationals that can come and go from markets with greater ease. Maybe you could come out of New Jersey, but you definitely can’t come out of the five counties.
Brian Lobley: No.
Nigel Ohrenstein: But that’s home. I think the Blues have an enormous opportunity and we’re doing things like that. I’m not too far from you with Hackensack in Northern New Jersey. I think that’s a real pathway. What would you like to see more from health systems? What would you like to see how systems do? What frustrates you that they’re doing that you’d like to see them do better, differently?
Brian Lobley: Yeah. It sounds a little bit of a cop out, but I think it is the experience side. I think we all think about opportunities that we’ve had in care situations and it’s been confusing, complex, and sometimes probably misunderstood. I always say to folks, I have the utmost advantage being in this industry to understand how to navigate the experience of healthcare. I think that is something where I believe that it pays dividends on the bottom line. That if we improve the patient experience, improve information sharing, improve access to information, that it’s going to improve the bottom lines for providers, and payers, and customers for that matter and individual consumers. To me, I think about the brands we all love. The brand you turn back to whether it’s… Again, we joked on Amazon, with the packages, but things like that where there’s a repeatability to it, because you’re not frustrated.
Brian Lobley: If I had a wand and I could wave, I would say, “Let’s make sure that when someone’s in a care continuum, that the experience is seamless, that it’s pleasant to an extent”, which obviously, necessarily can’t be pleasant if you’re in acute situation, but it can be pleasant for the family. It can be pleasant for the caregivers. That to me is probably, as I think about the digital world that we live in and how we consume entertainment, and again, retail, or even… Again, I go back to financial services, you can get a check today in the mail. You can take a picture and the funds are available later that day.
Brian Lobley: Who would have thought that 10 years ago, but it happens. Think about from a care aspect, is it really that hard for me to understand that you don’t have to show up at this hour? This is what I have and, oh, by the way, I didn’t have to take notes doing it. And I come home and I open an app and it says, all right, this is exactly what I have to do. This is my treatment plan. Look, there’s going to be issues with us as consumers, just consumer behavior adhering to it. But I think too often the experience is fragmented, frustrated and unclear. By the way, we have a role in that too. One of the biggest issues out there is still understanding your financial obligation. So copays, deductibles, co-insurance. How many people know what co-insurance is? None. I can tell you back when the ACA launched, we did surveys. It’s the one thing that’s also expressed in the opposite.
Brian Lobley: Everything else is expressed and member liability. Co-insurance is expressed in provider liability. People don’t understand that. So we have to simplify, I think the transaction of healthcare. I think that to me, if I would ask on the provider side, and again, not as cop out commercial for Quill, but that’s why we said that’s the business to focus on. I think that’s what I would say is number one for me. The second one, which I think we’re hitting on a little bit in this fee-for-value piece, is just aligned incentives. The idea of the transformation of care out of a patient room into an alternative care site or into your home, I think is here. So I think a willingness to partner and accelerate that and we have to come to the table as much as the providers on this one. But I think that would be, I don’t know if it’s a 1B or a number two, but it’s up there as a second thing.
Nigel Ohrenstein: The whole area of consumer engagement is one that I know is dear to your heart and something you spend a lot of time on. One, we don’t really have time to get into in much depth, but I don’t think we ever really feel like a consumer in any part of the healthcare system today.
Brian Lobley: Correct.
Nigel Ohrenstein: If you and I were to walk into a hotel, the way we’re treated, the way they talk to us, the interaction we have is completely different to the interaction we have in the healthcare system. Rick and I actually did a podcast in a studio in Midtown Manhattan. At the end of the podcast, normally when we’ve done them in studios, no one really listens, and the woman came out at the end, almost in tears saying, “I really hope you are successful-“
Brian Lobley: That’s great.
Nigel Ohrenstein: “-in healthcare.” You mentioned co-insurance. She didn’t even realize that her deductible resets 1/1.
Brian Lobley: Wow. Yeah.
Nigel Ohrenstein: And so suddenly she found herself in a massive financial situation to afford her care. She had a number of chronic conditions that she shared with us, and you sometimes lose the fact that this is real people that we’re impacting and it’s so important, the work that you do and the work that others do, and we’ve got to be successful.
Brian Lobley: Yeah. We sometimes look at it as a transactional business and it’s not. It’s an emotional experience business. The stakeholders, I think have to come together. I think your point around the hotel is so spot on. Even the fact of you get the thank you. You get the checkout as thanking you for your business. I think, yeah, we have a ways to go. Consumerism, this is my 20th year at Independence, and I think in healthcare there’s consumerism every year. This is the year of the consumer. Well, it is right now because we filter more phone calls for people and layoffs and trying to understand someone who’s gotten insurance from their employer for 30,40 plus years don’t understand what to do next, or people that are retiring early, given the pandemic. It’s, wait a minute, I have to now think about insurance. I think it’s a necessity. I just hope that it’s not one entity or one stakeholder solving. I hope it’s the industry thrust that really unites us off.
Nigel Ohrenstein: Yeah. So we like to end with what we call the quick fire round.
Brian Lobley: All right.
Nigel Ohrenstein: Couple of quick questions, easy ones, so we’d love to get your perspective. Best piece of business advice you’ve ever received.
Brian Lobley: Hire people smarter than you.
Nigel Ohrenstein: That’s a good one. What’d you do for fun when you want to take your mind off?
Brian Lobley: Play golf.
Nigel Ohrenstein: Play golf. And then finally, if you could change one thing right now about healthcare, what would it be?
Brian Lobley: Whoa! That’s not a quick fire question. If I could change one thing about healthcare right now…paperless. So monetary paper, everything. I would like it to be fully digitized. Click button. Yeah. One click.
Nigel Ohrenstein: Excellent. Great was to end. Brian, really appreciate you taking the time as ever, always incredibly insightful. Thanks.
Brian Lobley: Thanks so much, Nigel. Thanks for having me. This was a blast.
Nigel Ohrenstein: Thank you for joining us today. Please follow us on your favorite streamer, and don’t forget to rate us, as it helps others find this podcast. As we move to tackling the next phase of this pandemic, we’re going to continue to bring you leaders throughout healthcare that are at the cutting edge of what to do next. Please join us next time as we tune healthcare, this is Nigel Ohrenstein in New York.
The opinions of the podcast guests are not necessarily reflective of those of Lumeris.
- Text Message Alert 1 Sound. Available at http://soundbible.com/2154-Text-Message-Alert-1.html.
- ECG Sound. Available at http://soundbible.com/1730-ECG.html.
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- Intro music. Gordon Household. August 2019. WAV File.