Tuning Healthcare Podcast: Episode 18, Anthony Del Rio

Tuning Healthcare, Episode 18: The Health System Model of Care

This episode of Tuning Healthcare features Anthony Del Rio, the President of Rush Health, the Clinically Integrated Network of Rush University System for Health (RUSH). As Senior Associate General Counsel and Managing Director at RUSH, Anthony also oversaw the Business Development and Transactions team, where he managed multiple hospital affiliations and joint ventures with large healthcare entities.  Prior to joining RUSH, Anthony represented healthcare clients at an international law firm with a focus on mergers and acquisitions. He also worked as a management consultant for large healthcare systems, helping develop and manage hospitals in multiple states.

Anthony discusses RUSH’s pivot to value and how the health system clinically integrated network controls costs, supports the mission of managing populations and delivers better outcomes for the patient.

“And then the pandemic hit, and all of a sudden, having risk and capitation-based reimbursement versus fee for service reimbursement became very attractive.”

–Anthony Del Rio, President of Rush Health

In this episode, Anthony Del Rio and Lumeris Senior Vice President Nigel Ohrenstein discuss:

• The expanding significance of value-based care and how RUSH is accelerating the transition to risk
• How health systems have the scale, network and marque to deliver superior care in every market
• Why the health system clinically integrated network is positioned for greater long-term impact on healthcare than primary care aggregators
• The importance of taking chances and deviating from the conventional approach

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• Read Transcript Below:

  Nigel Ohrenstein (42:52): I’m joined today by Anthony Del Rio. Anthony is the President of Rush Health, a clinically integrated network of Rush University System in Chicago. Prior to joining rush, Anthony represented healthcare clients at an international law firm with a focus on mergers and acquisitions. In this episode of Tuning Healthcare, Anthony and I discuss the movement to risk and how he is focused on enabling Rush to take more risk. How health systems deliver the scale and network to aggregate thousands of physicians and hundreds of thousands of lives. How he believes the health system clinically integrated network will have a greater long-term impact on healthcare than the primary care aggregators. And the advice he would give to his younger self would be to take chances. Join Anthony and me as we tune healthcare.

  Nigel Ohrenstein (01:01): Anthony, thank you for joining us today. I’m really delighted to have you on the Tuning Healthcare podcast. Really excited to get your perspective of somebody who runs a large clinically integrated network of free primary care aggregators and the evolution of sort of, what at Lumeris we call the accountable physician, has really gathered steam. And so, your perspective is going to be fascinating. And also, the first time I think we’ve had a fellow lawyer, and definitely a fellow reformed lawyer on the podcast. So, Anthony, welcome. And thanks for joining us today.

  Anthony Del Rio (01:37): Absolutely. Thank you for having me, Nigel. I’m happy to be here and I’m happy to share our experiences of suffering through law and moving on to greener pastures.

  Nigel Ohrenstein (01:46): Excellent. So, before we jump into topics that are currently facing the industry and challenges and opportunities that you see in front of rush, tell us about your background. Obviously, we’ve covered that you started in law, and how did you end up in healthcare?

  Anthony Del Rio (02:03): Sure, absolutely. And so, entry into healthcare actually did predate my time in law. As an undergrad, I studied business and my focus was actually healthcare. And at the time, full transparency, my focus was healthcare because in my head, I was thinking as a 20-year-old, I was like, well, healthcare is nearly 20% of our GDP. If I go into healthcare, surely I’ll have a good job. And so, that was a big area of interest, I studied a lot. I did finance specifically and I did pretty well, but coming out, I had a lot of professors that were encouraging me, “Hey, you should go to grad school. You’ve done very well. I think you should go into kind of a higher level graduate degree.” And at the time, it was like, well, do I go on to get an MBA, and said, well, no, because you really need to have some really good work experience before you go get an MBA, and I had some management experience, but not really stuff that I would view as criteria to go to an MBA program.

  Anthony Del Rio (03:06): And so, someone kind of steered me towards law, because I had some interest in policy along with kind of the business side of things. And so, I went to law school, and out of law school, I had a great time in law school, learned a lot. I also spent some time with HHS general counsel’s office, and also the CDC, center for disease control and prevention, because I’m originally from Atlanta, Georgia. And from my time there, it was really great. But as with most of my classmates, I didn’t go into government or into a kind of private law firm. And I had your traditional healthcare clients, tended to be more community hospitals, large physician groups. And it was great experience.

  Anthony Del Rio (03:53): But my wife, who I met during law school, was actually MDJD. And so, she was finishing up her MD while I was practicing. And she went through the whole kind of match program and ended up matching at University of Chicago for residency. And I was in Atlanta at the time, my firm was in Atlanta, we didn’t have a Chicago office. And so, I started looking for jobs, and unfortunately, this was right around the downturn. And so it was 2010 and finding legal jobs during that window was a little challenging, as one might expect.

  Anthony Del Rio (04:28): And I lucked out that there was a consulting firm that did healthcare consulting that I saw, and I sent in my stuff and they called me in and they flew in and did an interview, and it was this nice alignment of, they were looking for someone with regulatory expertise, but also, kind of business side finance management expertise. And it was kind of a unique marriage of that. And so, they made me an offer, I accepted, and so I went into consulting for a few years doing that work. And it was a nice hybrid of legal and business. And I was on the ground working with a lot of AMCs, doing kind of development work and management work, and healthcare’s so heavily regulated that my legal background was very helpful in that. And I developed several hospitals, developed new programs, helped manage programs. And it was a fantastic experience.

  Anthony Del Rio (05:24): But then after a few years, as tends to happen, my wife and I, we had a child, and suddenly flying around the country doing consulting work was a little more challenging. And so, I did the thing, which I still get made fun of by some of my law friends, was I went to a big law firm because I had a kid, which is normally not the course you go. But then I went back to a large healthcare firm doing healthcare M&A and regulatory work for several years after that. And I did a lot of deal work. And at first, I was doing hospital work, but then over time, and you guys are probably very familiar with this, a lot of private equity money started flowing into the healthcare world. And so, my kind of work started pivoting more to private equity, in a position aggregators, actually. And so, I was doing a lot of kind of physician roll-up work with various PE backed, VC backed platforms and getting away from hospital kind of centric work. And as I shifted from hospital work to more PE work, it was just less interesting and more rote. And I just, I lost touch with it.

  Anthony Del Rio (06:39): And so, I started looking again and I interviewed with kind of several large AMCs. I ended up going with Rush University Medical Center. At the time, it was Rush University Medical Center. And I joined Rush and the legal department, and ahead of their healthcare transactions group, and Rush became a system. And so, Rush University System for Health, and now it has three hospitals. And one of the final deals I did in my legal role was acquiring our clinically integrated network, which is Rush Health. And so, I led the deal of acquiring Rush Health into the Rush System. And once we did that, there was kind of a search for leadership to take over that role.

  Anthony Del Rio (07:24): We did an external search and I got several people coming to me within our organization saying, ” Hey, you did this deal. You know so much about this, your prior experience in consulting really aligns with this. Is this something you’d be interested in?” And again, it goes back to being kind of that nice marriage of a lot of regulatory things, but then also kind of the business operation strategy side. And I said, “Absolutely.” And that was a little over a year ago.

  Anthony Del Rio (07:50): So it’s funny, actually, because part of my pitch during my interview for why I’d be good, is my vision of what we could be. What this clinically integrated network could be and our pivot to value and risk. And a lot of that was kind of more theoretical at the time, and people were like, “Yeah, that sounds cool. Yeah, let’s have them explore that.” And then the pandemic hit, and all of a sudden, having risk and capitation-based reimbursement versus fee for service reimbursement became very attractive.

  Anthony Del Rio (08:23): And so, it kind of supported my thesis there, but it’s been a great journey. We’re very strategically focused on how we’re going to grow our network, how we’re going to be successful and kind of where healthcare needs to be. And so, this move away from fee for service to value. But that’s been my journey here. It’s been great. I’m so happy to be here. And I don’t miss my days of doing healthcare M&A work, but I think the legal background was a great building block to be successful because healthcare is so heavily regulated and there’s so much going on that it was a good framework, but I’m happy to be more focused on business and strategy now.

  Nigel Ohrenstein (09:09): So, I always find that the legal training, I obviously didn’t stay in law anywhere near as long as you did. But I always found there were three main things in my legal training that have held me in really great stead during my business career. And I would say the three are, first of all, there’s an analytical capability that is sort of ingrained in you through both the study and practice. And so, that I think, the ability to sort of take in data and analyze it, I think is a great skill set. The second is just attention to detail. And we know when we execute, it’s all in the detail. And so, I remember the first partner I worked for, being really pedantic about every piece of grammar, where a stop was, where a comma is. And I mean, even to that level of detail, which might sound boring and a waste of time, but it sort of trains you in attention. And the third is negotiation. You’re involved in negotiating almost every single day of your life, which is just critical because you know now, as the leader of your clinically integrated network, you’re negotiating every single day of your life, whether it be with physicians, whether it be with colleagues, whether it be with payers. I mean, it’s a massive part. I always felt those three things have, and you added a fourth, which is sort of a comfort with sort of the whole regulatory environment, have really held me in great stead. And so, perhaps sometimes undervalued, I actually think it’s, in many ways, some great skill sets as you move into your role.

  Nigel Ohrenstein (11:05): So, you touched on a lot of great things that I would love to delve into. So, let’s delve into one of them first, which was the move to value. And I’ve said on this podcast before, healthcare has always had the reputation for being recession proof, but it turned out not to be pandemic proof. And so, as you correctly said, if you have a greater percent of your reimbursement in value-based care, you were much more protected through the pandemic than if you were reliant on fee for service. So, tell us a little bit about, obviously, you staked your claim for the job on the move to value. Where’s your clinically integrated in this journey? How much risk do you take? How did you see the evolution? Tell us a little bit, delve a little bit deeper for us into sort of value-based care.

  Anthony Del Rio (12:01): Absolutely. And so, where we’re at, where we currently sit at Rush Health, we’ve got probably a little over 2000 providers that are in our CIN, 2,200-ish. We’ve got four hospitals, three of them are Rush owned -so Rush hospitals. One of them is an independent hospital. That’s still in the Illinois market. And so that’s our network side. We have other various kind of ambulatory facilities and things like that too, kind of around the edges. And we’re a little unique in that we have all of the contracting function sit within our CIN. And so that includes our fee for service contracts for the commercial payers, includes our value-based contracts with their payers and then also our government programs too.

  Anthony Del Rio (12:52): So right now, we’ve got in terms of value, we have our Medicare ACO, which has roughly 30,000 lives in it. We’ve got MA, so MA contracts in place that have about another 5,000 lives. We have a commercial ACO with a major payer in the market that has about 60,000 lives. And then we also have a Medicaid product through a Medicaid MCO that we’re at risk for, that has about another 15,000 lives. And then we also manage our self-insured employee population that’s covered under our system. And so total together, it’s probably 120, 130,000 lives. They’re all at different points though. So on Medicare, we’re at risk, but there are various kind of caps and protections around upside and downside. And we split that with Medicare. It’s not full risk, it’s not capitation. It’s kind of somewhere in between. On the commercial side, we’re also at risk, but again, we have kind of buffers for upside, downside. That one is benchmarked based on prior year costs.

  Anthony Del Rio (14:09): And so we have kind of a PMPM that’s assigned to that population to say, okay, last year it was this, this year our target is… It’s mainly on the commercial side is to control costs. And so we’re not looking to say, “Hey, spend less this year than you spent last year. But if you keep it below X increase in percent, then we’ll see upside shared savings.” Or if we just blow through it and we end up having an increase in cost of 8% or something, then we would owe some kind of a downside payment back.

  Anthony Del Rio (14:44): Medicaid population is more similar to that of your Medicare ACO in that we’re at risk. We have some PMPM dollars around care management and then our self-insured employee population is really, that one is capitated in a way because it’s our money. And so we try to manage that one similar to how we manage our Medicare population. So try to make sure they stay out of the ED, get appropriate site of care, manage chronic conditions. But there’s a lot of really cool opportunities to leverage, our pop health care management resources with our own employees. Because really, if we’re not comfortable that it’s going to be successful with our own staff, we probably shouldn’t be using with other populations.

  Nigel Ohrenstein (15:29): Right. And where do you see it going? Do you see yourself taking more and more risk and a greater percent of the premium dollar? How do you see that evolving for you guys?

  Anthony Del Rio (15:41): Absolutely. In the 18 months I’ve been here, I’ve made a big push to get into pathways to risk. And so we’ve flipped to downside for both on commercial and our Medicare populations this year. We’re going to push more aggressively. So on our MA products right now, it’s upside only for the most part, but we’re pushing those into downside over the next couple of years, as we get to, what I’d call critical mass in terms of kind of lives attributed to those programs. We’re also still want to make sure we pick the right MA partner. Because there’s a lot of obviously… Well you’re well aware, there’s a lot of MA players. And so right now most of our Medicare sits in our ACO. Once we feel like we have good contracts in place on the MA side, I think we’ll start saying, yeah, here’s who we’re going to work with. We have shared risk, shared premium dollars, kind of aligned interest on what we’re trying to achieve with the population and how we think we’re going to get there.

  Anthony Del Rio (16:50): But yeah, then I would see us getting into more downside risk. And the goal too is, where we sit structurally within our system is my company Rush Health is a direct subsidiary of the system. So the system parent. And then the hospitals are kind of sister corporations to me and the physician groups too. So our ultimate goal is to have Rush Health be a value generator for the system and so a diversification of revenues. And while the hospitals are predominantly reliant on fee for service, as we’re successful in our pivot to risk, Rush Health will generate dividends for the system through this value proposition and being successful in managing populations.

  Anthony Del Rio (17:39): And so that way, knock on wood, if there’s ever another pandemic or something along those lines. And we actually, we saw this, this year too. Rush Health, my numbers looked great because I already had risk populations within my product and my programs, but obviously our hospitals suffered a great deal. And so the system as a whole, had a very rough year because of the pandemic and care avoidance. But the goal would be diversify our revenue streams, but also create different value for our hospitals to serve. And so recognizing that as the Rush Health network grows and our at-risk population grows, no matter what, there are still going to be patients that need brain surgery or heart surgery, things are still going to happen and the hospitals are going to be there and they’re going to be fully aligned with that value proposition to make sure you’re bringing the highest quality and the best value care to those patients.

  Anthony Del Rio (18:36): So I think that’s where I would differentiate ourselves from like aggregators. So, Oak Street, for example, there’s not a hospital that’s a part of their system. And so you can only do so much to align when you don’t have a hospital that’s really contributing to that mission. And here, because we have this great mix of hospitals and our network, we can all become fully aligned with saying, “Yeah, here’s how we deliver the best care at any level.” So any level of acuity, because within our system, we’ve got everything from, you got a cough, you’ve got sniffles to you have an aneurysm, we’re going to have you covered in your whole journey. And I think that’s the real value we can bring and that’s our push. So yeah, over the next five years, we plan to very aggressively expand what portion of our overall revenue is accounted for under risk-based programs.

  Nigel Ohrenstein (19:34): So it’s fascinating. I love your perspective here. You touched on the primary care aggregators. Obviously, they have garnered a lot of attention in both the media and from public investors recently. And some obviously, some high valuations. It’s an interesting model. Because in effect, you’re delivering the same business. You manage physicians, you manage lives, but in one market, you’re doing it at larger scale than probably any single one of them, and you do it with obviously, what I consider the network to support you. The health system and other pieces of the network, ambulatory you mentioned before.

  Nigel Ohrenstein (20:37): So tell us your thoughts. Because you’re in the same business, but you’re doing it in one market at greater scale, to obviously what they’re doing in multi-markets. So a bit on your thoughts from just a business model, model of care, what’s your perspective?

  Anthony Del Rio (20:55): I think, I very much respect their model and what they’re bringing. I think it’s important to push all of healthcare towards a greater value proposition. And so I just want to say that. I think the valuations are very high. And so I think looking at the business behind it, just knowing what it’s going to take to get there. And I get it, a lot of it’s probably prospective of we’re buying into this model idea and as they reach scale, the value will match up with where they’re getting to. I think my concerns with the model from, I would say kind of a health care delivery standpoint, are kind of twofold. One is, it’s focusing on a narrowed population and you’re taking primary care doctors out of the larger picture and saying, “You’re going to be focused on these MA patients.”

  Anthony Del Rio (21:58): And so now, this is your sole responsibility, manage these Medicare advantaged patients and follow this model and use this technological solution that we have, and this is how you do it, and we’re going to be successful. And ultimately, I think their goal, and this is rightfully so, for their corporate structure, deliver value to their shareholders. So they feel like they’ve come up with a model that will successfully allow them to take on these patient populations at risk and deliver value to their shareholders. I think most of it is probably through kind of focused on arbitrage at the hospital level. And certainly that exists. I’m a health system executive, but I will absolutely admit, there’s definitely opportunities to do better at hospital utilization.

  Anthony Del Rio (22:53): That being said, once you squeeze that, where are you going? And my concern is their model is so focused on hospital arbitrage. And by that, I mean, let’s do everything we can to keep these patients out of the hospital. That only gets you so far. Then also, what does that do to the larger continuum of care and patient needs? Because again, sometimes patient needs to be there and sometimes… I’ll use this as an example. I won’t name names, but I’m aware of a patient in another market where they were a part of one of these programs. And they had an ongoing condition. It was a very unique condition and it was related to the brain -so neurological. And the aggregator did the best they could to keep that patient from having to go to an AMC. But that led to a waterfall of issues where, when that patient did eventually end up in an AMC, the AMC immediately said “Whoa, this is X, Y, and Z. This is how we need to handle this.” But that was after literally weeks of suffering, because they were trying to do their best to keep the patient in the lowest cost level of care, rather than saying, “Wait, this actually does need that academic medical center touch,” because the reality is, there are things that come up that need that and these physician aggregators are so focused on leveraging that hospital arbitrage and keeping patients out of the hospital, that things are going to get missed and it’s going to negatively impact the patients.

  Anthony Del Rio (24:37): And ultimately, and this goes back to the kind of the mission question, my corporate mission is delivering care to the community and making sure we successfully do that. And we’ve been doing that for 150 years. We’re going to keep doing that. And so, there’s just different alignment, but I think that’s my biggest concern, but I their model is important and it’s pushing the envelope and it’s pushing the narrative, but I do see higher value in managing the whole continuum of care for the patients’ needs.

  Nigel Ohrenstein (25:09): No, it’s a fascinating topic and like you, I respect anybody that gets up every day and is in the business of trying to improve healthcare in the country and so, I’m reminded of a story. Once the company came to meet with us in St. Louis and after a day of discussing how we might be able to partner, the CEO of this company said, “We’ve been considering it and we think we’re too competitive.” And we looked to them and said, “In a multi-trillion-dollar healthcare industry, you really believe that that your $50 million company and our company have more room to compete, then we have to partner.” And so, from my perspective, my mindset is, anyone who gets up every day and is in the business of trying to improve healthcare, all respect to you.

  Nigel Ohrenstein (26:16): But as we think about… I’ve spent the last 12 years thinking about value-based care and what are the models, right? And how do we scale this to the country? The reason that I think that what you’re doing at Rush and what are the health systems are doing and what more health systems need to do and I think we’ll do, over the next few years, is more both scalable and impactable to healthcare in this country. To me, it comes down to four things. I think one is the scale, right? We’ve already just touched on the fact that in your one market, your scale is bigger, right? And so, the impact that you have and the ability for you to have a continued impact is enormous, right?

  Nigel Ohrenstein (27:06): Today you’re servicing 130 or a thousand lives, right? Everybody that comes within the rush network and if that network continues to grow, it’s going to be significantly greater than that, as you roll the clock forward, right? And so, the scale is one. Second is, you’ve got the best brand in healthcare, right? And in every market you go to, the health system is almost always the best brand and where would you rather receive your healthcare from than Rush, right? Or pick another healthcare system in another market, right? So, the brand you have is excellent. The third is a really critical one, a topic that’s close to my heart. You sort of touched on health equity, right? And you’re in the business of really managing populations, not segments of populations, which I think is the mission of the health system.

  Nigel Ohrenstein (28:06): And then, the third… Sorry, the fourth and also really critical is, to manage populations, you need a network, and the more you… There’s so much research on this, the more that you keep care within a high performing network, the better the outcomes are for the patient. And so, you have that network ready to go, because you’ve got three hospitals. You’ve got an ambulatory system. You’ve got whatever it was… What’d you say? Was it 2000 physicians, right? So, you have this network ready to go. You’ve got specialists who are absolutely needed as part of the delivery of complete and excellent health care. And so, to my mind, total respect for the aggregators and we need as you say, people to push the envelope. I think the model you’re on, for some of the reasons you said, plus the four that I added, I think is, we’re going to see, have a much greater impact health care nationwide rather than in market A and B. That’s just my perspective?

  Anthony Del Rio (29:20): No, absolutely. And I think a big part of it too is, going back to the question about the health equity in different communities. If we start segregating populations in terms of, “Okay, we’re going to aggregate, [inaudible 00:29:39] hundred PCPs in this market and those PCPs are going to be the highest performers, and we’re going to focus them on these inmate populations.” It negatively impacts everyone else and also negatively impacts the doctors. And so, my wife who is a PCP… It’s so funny, I’m lucky to have her perspective, because I always can draw on her to understand what the needs of the providers are and what will help them be successful. And she’s actually med-peds trained, so internal medicine and pediatrics board certified.

  Anthony Del Rio (30:14): And so, she sees the entire gamut. So, from the three-year-old, to the 80-year-old. And it’s so important for her to see those wide range of populations, because there are all these different problems that come up, but it shapes you as a physician and it also shapes your happiness, because suddenly that’s all you know about the healthcare continuous, that sole population. And as you follow patients throughout their whole life, you’re able to see the bigger picture and all the things that are impacting them.

  Anthony Del Rio (31:01): And it’s more fulfilling for the physician provider and it’s better for the patient too, because then they have this whole track record of, “I’ve been with this. This has been my PCP. This is my PCP.” And I can’t imagine taking our providers and our PCPs and saying, “I’m sorry, your panel is only going to be Medicare Advantage patients now.” And there are people in our market doing that. Literally only Medicare Advantage, so if that patient is on a Medicare product, is just Medicare Free Care service, you’re not going to see that patient anymore. And you’re commoditizing healthcare and that relationship between doctor and patient, to a degree that I don’t think is healthy for anyone, other than I guess the shareholders potentially.

  Anthony Del Rio (31:48): That’s my other concern there, because what our network does is and this is helpful is, we leverage our success on our Medicare population and say, “Okay, how do we apply that to our Medicaid population, or how do we apply that to our commercial population, or employee population?” Often, they’re there all these things we can learn from these different populations and we can apply across the spectrum and say, what works and what doesn’t and “Let’s make everyone healthier. Let’s make everyone healthier.” And ultimately, that’s our goal.

  Nigel Ohrenstein (32:17): Right, and which is why over time, you’ll be impacting hundreds of thousands of lives, which is obviously incredible and something we need across the country. Obviously, not just in Chicago. As you look at these trends that have been catalyzed if you like, by the pandemic: more access digitally, some care moving to the home, obviously you mentioned before the sort of care avoidance, which is obviously a major concern, mental health is the concern, so it just exploded. We had a crisis before the pandemic. We probably now have a real national crisis around mental behavioral health. And so, a lot of things have sort of evolved. Which trends do you see being boomerangs and which ones do you see being frisbees? So, which ones will be just pandemic flash in the pan and we’ll revert back to the way we were, and which ones do you see being things that will last through healthcare as we move into the next three, five, 10 years?

  Anthony Del Rio (33:41): So, the ones that are boomerangs have already come to become pretty evident for us. And so, a lot of the surgical based procedures tanked, because people stopped… For a lot of reasons. Part of it was care avoidance. Part of it was people weren’t doing things that injured them. And so, orthopedics all of a sudden just completely fell off. Part of that was because people stopped playing sports. All of that type of stuff I think is bouncing back, as people return back to their communities and engage in these activities again. The downside on that stuff though and which is kind of scary, is around oncology and neurological issues and some heart issues. And we’ve seen a lot of that is, care avoidance in those spaces led to more acute issues surfacing.

  Anthony Del Rio (34:34): And looking at our current data, we’re seeing this spike in the level of acuity, because people were avoiding care. I hope that’s a boomerang. I hope people become more comfortable at saying, “I need to get this checked out. I’ve had this ongoing issue. I need to go see someone about this.” And we’ve done a lot of work on our side of trying to engage with our population and say, “Hey, you haven’t been in touch on this issue. We can even do telemedicine. Well, let us know.” We’re seeing data that’s saying that’s going to be a boomerang. And so, those are being addressed and it’s slowly coming back and people are getting more in touch on these ongoing issues, that can avoid further acute things.

  Anthony Del Rio (35:18): In terms of the frisbees, I’m hopeful on behavioral health, because I think… Obviously, the pandemic led to a lot of issues on behavioral health, but it also was an impetus to say, “Hey, we need to come up with a better way to manage this remotely through telehealth.” Because there’ve been a lot of thought and I’m not a provider, but just engaging with my providers on this discussion that behavioral health through telemedicine would not be effective. And what we’ve seen is, it actually works in a lot of cases. And so, even talk therapy, through telehealth, we’ve seen it being effective. And so now there’s this interest that maybe this solution can work and let’s figure out how we leverage this technology in ways to take these issues that are just throughout all of our communities and try to triage them. And so, one thing I’m really excited about is how do we make sure we’re leveraging the right level of care through various technological solutions to address behavioral health needs. And so some of that might even be we’re exploring potential abusing, like a chat bot AI program to triage behavioral health needs. Say, what is it you do? Do you need talk therapy? Do you need psychiatric support through pharmaceutical intervention or do you have an acute need where we need to take you to an inpatient setting or even an outpatient behavioral health solution?

  Anthony Del Rio (36:58): And I’m excited for those because really on behavioral health side the restriction is the supply of providers. And so if we can come up with effective ways to triage those needs and make sure you’re matching up the need with the right level of provider or the right level of service, it’ll open up access for everyone to the right level of care that they need. So I’m excited to see that. I hope that it’s a Frisbee.

  Anthony Del Rio (37:23): So, broadly telemedicine has been a little bit of a boomerang, but not, I’d say a boomerang that’s still kind of fell a little bit further down and we’ll probably throw it again and hope it’s a Frisbee. Our state, Illinois, has a lot of restrictions around telehealth delivery. Those were loosened through our engagement with the state legislature and the governor during the pandemic. Right now, we actually have a bill going through our legislature to make a lot of those changes permanent. But I think there’s a lot of concern from the payers about what impact it could have on the bottom line. I think there’s a lot of data available now though, to show that telehealth is a good option. It’s not going to necessarily increase costs and it may actually control costs a little bit, but it has to be provided correctly. What I’ve heard informally from payer feedback is the large providers like my health system. We’re not the offenders, so we used telehealth appropriately, but they had other groups that may have been more profit-driven that did kind of just rack up telehealth encounters that a little questionable. And so I think that’s something we’re going to have to work through, but the adoption at the patient level was good.

  Anthony Del Rio (38:44): Providers, I think are more open to it. And we just have to give them an effective solution because right now there are all these solutions in the market and some of them work better than others. And so if we can match up the best kind of telehealth solution with the providers and the patients, and then get the payers on board, I think we’ll have a great program. And, and so I’m cautiously optimistic that that’ll turn into a Frisbee, hopefully. So that’s my take on kind of where we sit right now.

  Nigel Ohrenstein (39:11): Thank you. We’d like to end with what we call the quick-fire round, which is just a couple of questions just to get your perspective. The best piece of advice you’ve ever been given?

  Anthony Del Rio (39:29): Don’t be afraid to be wrong.

  Nigel Ohrenstein (39:31): That’s a good piece of advice, particularly for young people. What do you do to relax, have fun when you’re not negotiating physician salaries?

  Anthony Del Rio (39:42): I used to play a lot of board games. I used to go to the gym a lot. Now I’ve got two kids. And so, I guess I lift them and pick them up. And then I also try to get them to play games. But I’ll figure that one out. It’s a five-year-old and a two-year-old. So I’ll figure that one out as they get a little bit older I think.

  Nigel Ohrenstein (40:04): Every age is a great age, but at least that’s my experience so far. What advice would you give to your younger self?

  Anthony Del Rio (40:12): Oh boy, take chances. I mean, It’s always challenging and this goes back to being wrong. In a world there’s always this entropy and always this kind of gravitation towards not moving down that path and just kind of meandering a little bit. Because maybe you feel safer there, maybe it’s scary, but you got to go. And so, I mean, going back to my career, when I made that jump from law to consulting, that was a big change, but it was the right way to go.

  Nigel Ohrenstein (40:58): Great advice. And lastly, if you could change one thing about health care, what would it?

  Anthony Del Rio (41:03): Oh boy, I think we’re going to need another hour or two. I would change reimbursement more. I mean, that’s what I’m trying to do. I’m trying to get us to this kind of value-based proposition, because I think if we can get some more value focused it’ll create alignment across the whole system. And it’s less about churning your cog and it’s more about how do we improve the overall health of that patient.

  Nigel Ohrenstein (41:38): I couldn’t agree with you more. Anthony, thanks so much for joining me today.

  Anthony Del Rio (41:42): Absolutely. Thank you Nigel.

  Nigel Ohrenstein (43:51): 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 our podcasts. Summer has arrived in New York City, and I hope you listen to this podcast while enjoying the health benefits of walking outside. Please join us next time as we tune healthcare, this is Nigel Ohrenstein in New York.