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This is Gracelyn Keller with the Becker's Health
Care podcast, and we are live at the
2024
payer issues roundtable.
I'm currently joined right now by Eric Witty,
who is the chief operating officer at Genesis
Orthopedics and Sports Medicine. So, Eric, thanks for
joining me today. I'd love to have our
conversation start with a brief introduction about yourself
and your role.
Yeah. Great. Thanks so much, Grace. Delighted to
be here with you.
So I come from the payer world originally.
So starting out with a clinical doctor in
physical therapy before moving into kind of management
roles, it's been nice to come to the
payer issues,
and see all the great collaboration that's happening.
Now that I work for Genesis Orthopedics and
Sports Medicine as the chief operating officer,
it's great to come into a context like
this
and,
collaborate with all the work that's happening on
the on the payer side. So, Genesis Orthopedics
and Sports Medicine
is a private orthopedic
multi specialty group that has, you know, orthopedic
surgeons,
advanced practice providers,
physical therapy, and occupational therapy across Chicagoland area,
and has been doing a lot of really
amazing stuff across the area with a lot
of growth that's underway.
Wonderful. Well, thank you for being here. And
let's start our conversation
talking about growth goals. So from improving member
experience and expanding value based care to controlling
costs, payer executives have ambitious growth goals for
the rest of this year and looking ahead
into 2025.
So in your role, what is your top
priority, and how are you planning to get
there?
Yeah. That's a great question. Thanks so much
for asking. So Genesis has one of the
more interesting organizations I've ever come across in
my career. So
organization decided about 6 years or so ago,
based on their values that they were going
to see all patients and payers regardless of
their ability to pay
and regardless of the payer type that they
had. So it's made us a really great,
I think, opportunity to collaborate with health plans
who have a great vision for their community,
to build these kinds of partnerships.
So one of the ways in which I
think we're most excited about is advancing,
value based care strategies.
Having seen a lot of waste across the
industry, I think Genesys is well poised to
to partner with
the great intellectual capital that's been put into
value based care in recent years.
So most of this has started out with
primary care based opportunities.
And the whole industry seems right to figure
out how specialists can move from fee for
service and to help collaborate with identifying ways
and opportunities within their communities
and advancing that out. So that's one area
in which we're particularly excited for the opportunities
ahead.
Absolutely. And going along with that at an
industry level, how would you describe the biggest
barriers to effectively serving and engaging members?
What opportunities do you see for larger scale
improvements, and how are you applying all of
this to your current strategies?
Yeah. That's great.
And this is a
a huge problem that exists across the industry.
So, you know, as most of us have
realized, when you get sick, your first phone
call is usually not to your payer to
figure out what they're gonna do with you.
And so, having struggled with these kinds of
programs on the health plan side, our providers
are really adept at engaging with their members,
you know.
No one's more interested to,
you know, solve problems as when they're sitting
down and talking to their doctor dealing with
an active illness.
So I continue to think that
provider risk delegation is the best way for
us to solve these kinds of issues. And
so rather than have the payer struggle to,
pull certain levers that are very hard, rusty
levers for them to pull on, if they
can delegate the risk over to the provider
side and leverage the tools that they have
through,
existing in the communities that they live and
work in. That, I think, is gonna be
the,
the best opportunity for for health plans and
partnerships to deal with the, kind of engagement
quandary that we all have.
Absolutely. And let's shift gears here to health
equity. So as this becomes increasingly cemented in
payer strategies,
how is your organization
addressing health disparities? And can you share specific
examples of measurable successes to date?
Yeah. Thanks for the question. So
I loved years ago, I was on the
board of directors with the National Association For
Healthcare Quality,
and Stephanie Mercado had done this very interesting
thing on all of our, board placards as
we would sit down in our meetings.
And they put the values at the back
of them. So when we sat down, it
was front and center for all of the
decisions and conversations that we were making.
And so I've loved being here at Genesis
and having the values not just be some
ethereal,
theoretical construct that we have, but something that's
front and center for the decisions that we
make. And so, in line with that,
values first mindset of saying, what would it
look like if we actually believe that all
patients mattered and had equal dignity and worth
and to see them regardless of, kind of
payer type?
Genesis has gone in and said,
Not only do we want to just open
the door and allow any patient to be
able to come to us, they realized after
doing that experiment for a little while, despite
going, you know,
significantly
higher Medicaid payer type for our orthopedic practice,
they said, if we really cared about this
work, we wouldn't just sit out here and
wait for these patients to come to us.
We would go and move into the neighborhood
for people who are struggling with access. And
so, one of the best measures that we
found to help inform this work is something
called the area deprivation index,
which, if you've not heard of this before,
is, it was considered by Health Affairs as
the most powerful tool in advancing health equity.
And so, this practice that started out years
ago with, with an area deprivation index of
1.5,
that essentially means
wealthy,
healthy
individuals.
We started planting clinics in the areas that
were underserved,
and our health equity, index has now gone
to to 5 out of 10, which is,
you know, a significant advancement that we're really
proud of in trying to mitigate this issue.
Absolutely.
And how is your organization ensuring equitable access
to care across diverse member populations?
And what strategies have worked well for you
or on the other hand have been challenging
for you in this?
Yeah. As far as what's going well, you
know, when you move clinics into neighborhoods that
are have vulnerable populations,
it becomes
easier to recruit people to staff these clinics
too. So,
when you care about a community
and you start by asking questions, you can
find out what are the issues and you
can recruit,
providers
and staff,
to go in and start to listen. And
the more connected you are into the community,
I think the more able you are to
solve the challenges that are unique to those
populations.
There certainly have been a number of challenges
that we've had too, and including,
you know, this issue that exists across the
payer world. There's member churn. Most of our
quality issues that we're looking for are risk
adjustment. These are annual based kinds of things.
And so as much as,
we found some tremendous payer partners out there
who are willing to collaborate with us on
data, help us figure out where
access is poor, where quality is poor,
you know, because most of our economic models
are built around annual constructs
with the Medicaid redeterminations
and annual enrollments,
churn issues,
it's hard for us as an industry to
figure out how to create these healthy communities
over a longitudinal basis.
And so I look forward to finding innovations
that are gonna let us get out of
this 12 month cycle of figuring out what
success looks like and figuring out how we
can collaborate in these communities
and agree on what success looks like. And
I think it's gonna mean something that's a
longer term view than just,
teaching to the tests and dealing with annual
process based measures that,
won't give us the kinds of outcomes that
I know that we want for flourishing communities.
Wonderful. Well, thank you so much for taking
the time to join me today on the
Becker's Healthcare Podcast and share these insights. Again,
we are recording live at the 2024
payer issues roundtable.
My pleasure. Thank you so much, Grace.