DC conference speakers shed light on healthcare's blind spots

Some of the most compelling speakers at the 16th Annual World Health Care Congress this week in Washington, D.C., were those who see healthcare from the outside looking in, extending an opportunity for hospitals, health systems and legacy players in the industry to take a good hard look in the mirror.

The event — running April 28 through May 1 — featured more than 300 speakers from health systems, employers, health plans, biotech, venture capital firms and the government. The following individuals took an unconventional approach in their remarks.

Take Lisa Woods, senior director of U.S. Health Care at Walmart, who spoke Sunday afternoon on a panel and Monday afternoon solo. Responsible for managing $6 billion through the company's medical plan, Ms. Woods is an influential member of the group that several conference panelists consider the most likely change agent for healthcare — major employers.

Ms. Woods made her 2019 conference debut by calling upon attendees to raise their hands if their hospitals or hospitals in their markets have billboards advertising ER wait times, noting such roadside advertisements promote ERs as destinations for conditions or health needs that do not require high acuity care.

"I'm going to challenge you all to go home, talk to your hospitals and tell them to take it down," she told attendees during the keynote panel Sunday evening. "We talked to [our local] hospital about why that's not a good idea. It's about communication and collaboration with the community and the hospitals. We don't have those billboards anymore in northwest Arkansas." 

Walmart's Centers of Excellence program has received a lot of attention —  note the extensive Harvard Business Review piece detailing its form, function and outcomes — and for good reason. The detailed anecdotes Ms. Woods shared about the inappropriate care her associates have received across the country from their local (non-COE) health systems raise the question of why any major employer would tolerate such inefficiency, unnecessary cost and less-than-optimal outcomes for one minute longer. Read more about Ms. Woods' remarks during the conference here.  

Craig Samitt, MD, CEO of BCBS of Minnesota, hinted that the state's largest commercial insurer is looking to move into primary care. As in, providing primary care. While Dr. Samitt did not share specifics, he noted that this is a larger trend nationwide and BCBS of Minnesota is open to it.

"We are seeing a remarkable phenomenon — and I would watch Minnesota because it will likely happen there as well: Payers are getting into the primary care business, because if systems won't change — maybe we should create a new system. … I think we will see a resurgence of primary care, to potentially work in opposition to the provider consolidation we're seeing if that consolidation doesn't result in transformation."

BCBS of Minnesota covers 2.6 million lives in every county in the state. To the south of Dr. Samitt, a related payer is doing something similar: BCBS of Texas in April announced its rollout of 10 advanced primary care medical centers in Dallas and Houston in partnership with global primary care provider Sanitas.

Dr. Samitt said the payer-to-provider leap is largely in response to hospital and health system consolidation, which gives him pause.

"Evidence would suggest we are not seeing transformation when it comes to consolidation, especially on the provider side," he said. "Prices go up; they don't go down. So it's not like we see organizations come together and say, 'All right we're large enough now, let's transform ourselves to value.'" 

Dr. Samitt expressed his impatience and irreverence with the pace of how hospitals and health systems are adopting value- or risk-based agreements. If he had his druthers, Minnesota would have more providers on global payment plans tomorrow.

"I think we need to convince our state to have a waiver to require all health systems to take global payment," he said Monday morning.

"We've been talking about value transformation for 25 years," he said. "We're really good at admiring our problems and not really good at making progress. … I came to the plan side because I feel I can have greater influence on instigating statewide transformation in value, if not leading the nation in transformation to value — by being a bit more forceful, disruptive and innovative than our industry has been previously. I applaud innovation. I just want us to get on with it, and I want to do it everywhere."

Tyler Shultz, who blew the whistle on Theranos at age 25, knows how former diplomats and billion dollar companies can get duped. Mr. Shultz had to navigate carefully when bringing his concerns about Theranos' validity to light, including his relationship with his grandfather, Theranos board trustee and former U.S. Secretary of State George Shultz.

The younger Mr. Shultz took time during his remarks Monday afternoon to point out how FOMO — or "fear of missing out" — is much more than a social media hashtag used by millennials on photos of music festivals they didn't attend. It was a major force allowing Theranos' ungrounded claims to go undetected for as long as they did.

Why did Walgreens partner with Theranos in 2013 even though it never once saw its "groundbreaking" lab equipment that was never tested? Because Walgreens, the company with $72 billion in revenue in 2013, felt FOMO and did not listen to its own employees, said Mr. Shultz.

"Walgreens actually hired an expert in lab sciences to do due diligence. He essentially said, 'Don't partner with Theranos.' But Walgreens was afraid Theranos would make a deal with Safeway or CVS, so they ignored the guy they hired and made a deal with [Elizabeth Holmes] anyway. Fear of missing out is a very, very powerful thing."  

Mr. Shultz also demonstrated a healthy understanding of governance, despite having a familial connection to a board member. Describing the board of directors as an "Elizabeth fan club" that collectively saw her more as a daughter than a CEO, Mr. Shultz noted that board member and former U.S. Secretary of State Henry Kissinger wrote and recited a limerick for Ms. Holmes' 30th birthday. In his verse, he said Steve Jobs was a protégé of Ms. Holmes — not the other way around.

"I don't think that's the role of a board," Mr. Shultz said, met with applause.

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