From Provider to Payer: A DGTL Transformation Journey (ft. Dr. Adam Myers)

Thanks for tuning to Digital Voices podcast, where we chat digital transformation challenges and opportunities across healthcare and life sciences. And now, your host, Ed Marx.

Ed here with Digital Voices, and it's always like double exciting whenever the guest is a friend, colleague who I've served with before, and that's the case with Dr. Adam Myers. Dr. Adam, welcome to Digital Voices.

Great to be here.

And you may hear some— we'll see what we edit out as you all listen to Digital Voices, but I'm recording from New York City, and so the sound you might hear is the city in action and live. So if you hear something, that's what it's like. I served here in New York City for several years, and it was always interesting. You just kind of got used to it and became part of just the fabric of the city. But anyways, Adam, you are the Chief Clinical Transformation Officer for Blue Cross Blue Shield Association and President of Blue Cross Blue Shield Institute. And we're gonna dive into what those are here in a second. But first, I just wanna like reminisce like when the first time it is that we met. And I think it was at Texas Health.

It was, yeah. It was quite a little while ago.

Yeah, so it was, I don't know, I hate to guess the years, but probably 10 to 15 years ago timeframe. And you were there and I was there and I just—

I think that's about right.

Really enjoyed, yeah, really enjoyed just demeanor and your approach to life and approach to work. And I remember we worked together quite well and then we had other things in common. And it was funny because then I had left, eventually making it to the Cleveland Clinic. And then lo and behold, you arrived as well to serve there. And I remember fondly our times Serving together there as well. So we've been sort of colleagues as well as friends for all these years.

Absolutely. We've shared a couple of tours of duty.

Yeah, it was fun. But one thing everyone wants to know, Adam, who's on Digital Voices, is what kind of music do you like to listen to? So like when you're chilling or whatever, what's your favorite type of tunes?

Yep, very eclectic. Everything from funk to fusion to classical. But lately it's been acoustic guitar and 2 particular artists I've been listening to a while, Tommy Emmanuel And Michael Dawes, just really pushing the envelope on what a guitar can do. And it's just like, I mean, they give one-man band the meaning. It's incredible to watch and listen. I would, I would encourage you to watch it, not just listen to it, because it's pretty impressive.

No, I was writing, I was writing those down. I love acoustic guitar and always looking for new jams. So definitely look at that. And do you have any words that you sort of live by? You know, some people have phrases or quotes that inspire them in their daily activities. Is there something like that that sort of inspires you?

Yeah, there's a couple of things I'll throw out there. One is just be faithful in the journey. And what I mean by that is, you know, sort of if you take your measures of success and what does success look like, as always, we focus on outcomes and outcomes are absolutely critical for us to move towards impacting the outcomes. But frankly, we just can't always control the outcomes. I learned that as a physician. I could put sutures where they needed to be. I could perform a surgery or a procedure in exactly the way I was taught to, in a way that was in line with the best evidence. But in spite of all that, sometimes there would be an untoward outcome. And so I kind of had to reframe for me what the definition of success was. And it was about faithfulness in the effort and the journey, not simply outcomes. And so that's hearkened to that With great regularity.

Yeah, I liked it a lot. I like that. So you've had a very— just like your music interests, you were saying were eclectic— your journey and your career hasn't been the norm, normal curve, if you will. It's been quite eclectic, right? You've had a lot of experiences in different areas into where you are today. Can you share with us sort of your journey? You can go as deep as you want, personal, professional, but just Sort of tell us how you got to where you are today.

Yeah, it has been kind of a fun journey, and as circuitous or random as it might seem at times, it all seems to make sense at the end. I was not your traditional person in pursuit of medicine. I wasn't born knowing I wanted to be a physician. In fact, I didn't know until after I finished undergraduate school. I tried a variety of different things. I was a psychology major with a minor in English. Thought about being a professor, thought about being a minister. I did a lot of performing arts, musical theater, classical dance, classical singing, opera, and did a lot of performance, frankly. And it was really only after I had tried a couple of different things, working as a disc jockey, working as a recombinant DNA tech in a lab, working as a variety of different roles, that I decided to help open and operate a shelter for homeless men. In one of the poorest areas of Louisiana. And that foundational experience right there really changed my whole paradigm. That's when I learned that so much of the privilege that I had taken for granted simply wasn't available to others. And I also learned that access to equitable healthcare, or the lack thereof, was a rate-limiting step for so many in achieving and maintaining independence. And so I purposed and really drove toward pursuit of medicine at that point. Never did all the pre-med curricula, studied for the MCATs with an MCAT study book from B. Dalton Books and went through medical school. It was all brand new. You know, I'd never had anatomy or physiology or any of those coursework. So it was a fast and furious clip of learning, but I enjoyed it a lot. And all throughout my career of family medicine, obstetrics, Work in quality, risk, safety, delivering thousands of babies and being privileged to do that. Work in child abuse as a medical examiner in that space. Working through different roles in clinical leadership, operational leadership, all throughout that journey, trying to make a difference, trying to improve the systems, working toward transformation, not just in individual lives, but in the systems of care. has been a driving force for me, all with health equity, all with producing better outcomes for all, and transitioning the healthcare system from predominantly the treatment of disease toward moving upstream and the promotion of health has been a real driving force for me all along. So it's been a great journey. Again, a lot of different opportunities and experiences along the way, but a great journey.

It's super fascinating, as I'm sure our listeners are like, wow, that's quite a lot to pack in, and you're still A fairly young person. And so to have done all those things in that short amount of time is pretty spectacular. And the fact that you did the MCAT without like a traditional pre-med and that sort of study and preparation, that says a lot as well. I do remember sort of the art— the arts part of you as well when we worked together formally. And that's pretty, pretty cool. So tell us a little bit, because I know our listeners are curious. So you've crossed over. So You don't see a tremendous amount of crossover of physicians going from the provider side to a payer, but tell us about how that came about. And then I wanna dig a little bit deeper once we hear your answer to that.

Yeah, I'll say, you know, I have been privileged to work in a lot of different organizations that are more forward-thinking and really seeking solutions. And I think, you know, wherever I've been, teams that I've been a part of have been part of making some significant transformation and improvement. In spite of that, what I have found over and over again is that the primary resistance to change for any organization rests inside that organization, and that sometimes it takes getting outside of that organization or system in order to bring about change. Another realization occurred to me along the way, and it's kind of one of those duh moments. You might hear what I say next and go, Yeah, that makes sense. But what gets paid for tends to happen.

Right.

And what gets paid for with greater regularity or more liberally tends to happen more often. And so, you know, if I'm finding that the constraint to change and improve is sometimes within the system, and that phenomenon of what gets paid for tends to occur, if I'm wanting to take change and be a change agent, not just for change's sake, but for true improvement to the next level, sometimes getting outside of that system and being a disruptor of sorts in a constructive way and controlling, getting a little closer to those purse strings is another venue, another seat at the table that I think is valuable. And so when the opportunity came to join the Blues, which is a federated system of 34 independent Blues plans all together, in aggregate serving 115 million Americans. So I get to be the senior clinician at an organization in service of 1 in 3 Americans. And so that's just a phenomenal opportunity to impact members in every single zip code in the US. I said, sign me up. And, you know, by the way, transformation is in my title. I mean, I'm the Chief Clinical Transformation Officer, not the Chief, keep everything the same officer, preserve the status quo.

Right.

It's about change, constructive change. And that was a purposeful decision on the part of the new leadership at the association as well, to change the title of the clinical leader from Chief Medical Officer to embrace transformation. That's the why behind the transition. And I think specifically what I can bring to the table is a an understanding of the complex environment and interplay from a provider standpoint, both health system, independent physician standpoint, a patient's perspective to this space, and bring all that together in bringing about change from this seat at the table.

That's incredible and very exciting. And not all the audience knows you as well as I do, but they're getting, I think, a pretty good glimpse of you right now. To have someone like yourself, not only the professional background, but I can just hear it in your voice, Adam. I'm sure our listeners can as well. You're a very empathetic person and a very caring person. And to have someone like that in the role that you have with all that influence, like you said, 1 in 3 consumers in our country are impacted by some of the decisions you make. It makes me feel really good and really happy that you're in that role. And You know, all the other positions that you've had leading to this have helped prepare you for this. So that's just awesome.

Well, it's humbling, to be sure.

Yeah. So question I have, and it's not specific to the Blues, just take payers in general. So you have extensive experience, obviously, on the provider side. You have quite a bit now on the payer side as well. Who is one more digitally advanced than the other? Because I think sometimes we point fingers at each other like, oh, you guys are so far behind. But But have you seen a difference or is it about the same? What do you think?

Yeah, I think it really depends. When I was on the provider side, one of the things that I was doing when I was at Cleveland Clinic was trying to push toward more prospective payments for larger portions of what we do. I mean, I'm gonna use a word that's gotten a bad rap, capitation. It's prospective payment upfront for provision of care. And there's some freedom associated with that from a provider perspective. was really pushing the payers to say, hey, we want to do this. Can we do this? And many of the payers found that their mechanisms, their IT infrastructure, their payment infrastructure wasn't able to accommodate that in its current state. And frankly, I was astounded by that. So it just really depends. In certain areas, we're very advanced in that we Do have access, pretty great access to data on a tremendous amount of people. However, we're just now at the Blues really moving a lot of our data into the cloud and making that more actionable, more dataable, more accessible. That transition has occurred at many providers, and we're now just sort of making that. So I think it really depends and varies, but— No one clear winner.

Yeah, I think it's probably an expected answer. Like you said, it's gonna depend on the specific organization, but yeah, I think we all have a long ways to go, generally speaking.

Absolutely. It's a journey.

Yeah, it's a journey. So how do payers and providers work more collaboratively? So I also have worked at many different health systems and I have some payer experience. And there seems to be friction. And again, not talking about the Blues specifically, just in general, how might payers and providers work more collaboratively in the future?

Yeah, I think it's great. I think there are some misconceptions. I think providers tend to view payers as sort of the evil empire creating hoops and barriers to care. And some of that's earned. I would say that payers tend to view providers as essentially trying to figure out how to Utilized for personal gain and sometimes not necessarily with the best interests in mind for patients. And certainly I have seen that being on the provider side as well. And so I think what gets missed is that frankly, all of us who entered into the space of healthcare, all of us, the majority of us anyway, come to this from a true sense of mission. A true sense of commitment to helping people live more prosperous, healthy lives. And I think if we start in that place and begin to sort of give each other benefit of the doubt, try to achieve some shared pool of meaning where we can combine our forces and collaborate, I think that that's really that virtuous sweet spot. And the Blues are doing that in collaboration with many different providers. We have Very creative systems of care that we're supporting now, where payment models have changed, where payment is there present for outcomes, not just for volumes, where we're providing extra support to patients, providing extra support in collaboration with providers in the way of care management, behavioral health backup support. Electronic tools, connection to social determinants of health type support within the community. So, you know, I could list many, many collaborative arrangements, but I think it starts with trying to find a place where there can be a shared commitment. And I think there's a lot there to find.

I agree with you. And to your point that if we start on the basis that, yeah, the majority of us have gotten into this into our roles because we really wanna do good and help others in health and wellness. And that's something we can all agree on and then work from there. So yeah, those are some good ideas. Since you have such extensive experience on both sides, what's one thing you wish, and of course I'll flip this on you here in a second, what's one thing you wish payers knew about providers?

One thing I wish they knew about providers, you know, one is that there's not always a great understanding of sort of the economic reality on the payer side and sort of that greater sort of transparency would be virtuous there, greater communication about those realities, that there is a real opportunity for everyone to be in a collaborative relationship. I think both payers and providers have a misunderstanding oftentimes that this has to be, by necessity, a contentious or antagonistic relationship. It doesn't have to be. Certainly, it gets there sometimes, but it doesn't have to be. And I think that's the virtuous spot for all of us to be in. So I think that's the thing I wish that both sides knew about each other is that there are a lot of good hearts involved and that that mission is, I think, more shared than not shared.

Yeah, that's good. Yeah. And you really did cover the flip side too. It's really the same. understanding of each and understanding the economic models for each as well, because they are different. What's your opinion and thoughts about this trend towards payviders? So obviously, this is where—

Yeah.

I know you know this, but just to make sure for our audience, where a provider might create a payer arm. It's been around for a while. Kaiser is the model of that, but a lot of more and more organizations Typical hospitals are starting to move into that as well. So I was curious what you thought about that. And are you seeing it as a trend? I call it a trend, but I'd be curious if you see it as a trend. I am.

It's absolutely a trend. And then the other trend that is very, very real is the flip side, which is payers essentially getting into the provider space. Now, I think it can be very good. It's certainly disruptive to the existing paradigms and the existing traditional lines of demarcation, which can be good and can be virtuous. I'm supportive of the trend in general because there can be enhanced alignment that way. I don't think that alignment requires the merger of the different camps necessarily. I think there's space for alignment without that merger. The part that gives me pause, and I have some concern, is the trend that I see amongst some payviders To commoditize health systems and hospitals. I think that's problematic. Hospitals and health systems in the traditional sense serve a critical mission for healthcare in the United States, and to sort of own the physician groups and commoditize the traditional health systems can be problematic from a sustainability standpoint for health systems. And I don't think that's necessarily a service for— for any of us long-term. Certainly, that's not the approach that all payviders would take, but I do see that with significant regularity, and that's a concern for me.

Yeah, I think those are all valid points. Adam, I think you actually already sort of answered this question that I had prepared in advance, and, you know, if so, we can move past it pretty quickly. But given your perspective, how would you, if you had that magic wand, How would you fix healthcare in terms of— we have the cost-quality, high cost, but our quality may not be as high as other comparable nations, that sort of thing. So I'm not saying it's broken, but how would you make it better?

To the degree that we can shift toward paying for outcomes, not simply volumes, I think is the degree to which we'll find improvement in alignment. The degree to which we can focus on health and not simply the treatment of disease and ensure equity along the way, I think we'll find a virtuous space as well.

I wanna spend a few minutes talking about the blues, but before we get there, you had mentioned earlier, kind of back to the personal side, you know, this bent in theater and your extensive experience there. How has that helped you in the office? So in your career, I'd be really curious 'cause I'm sure it's had an impact.

Pretty developed sense of reading a room. When you've been in the performance arena and knowing your audience and reading the room, you're picking up on those cues, which may be pretty subtle otherwise. I think you learn to communicate well and communicate with confidence and authenticity. I think the other thing that I've learned from a background of performance is the ability to stay calm under pressure, and that ability to stay calm under pressure allows you to create a space between a stimulus and your response so that you're responding, not reacting. Because frankly, all of us face things that can press our buttons, that can be unexpected, that can get our cockles up a bit. And the degree to which we can create space between that sort of stimulus And however we choose to respond and sort of breathe deeply inside, focus, and then be purposeful about what we do, the better the outcomes are. And so I think the ability to stay calm in tense situations, to a significant degree for me, come from both that space as a clinician in very acute situations, but also from stage experience.

I know one of the best trainings I had, you know, I've done all the classical trainings that people in our type of positions would have been through, but I did comedy improv.

Oh, absolutely.

And I did it not because I wanted to take stage, but to learn the different skills that you just mentioned. And it was an amazing course. It was fabulous. I would love— I would love to do it again sometime. But—

Yeah, finding that beat in the middle and pausing that beat can make a difference. The whole approach of improv is the yes, and sort of approach to improv. It's like, yes, there's this, and so-and-so. And the same thing works in Negotiation and dialogue as well with people in the healthcare space.

Yes, and actually that was one of the exercises they had us do to keep a joke going or a routine going is the and. So that's really interesting. We'd probably do a whole episode. I think that would be actually pretty interesting. So, but I do wanna talk about the Blues. So, you know, we talk about your role as Chief Clinical Transformation Officer, but you also have another role. Can you share a little bit about That, and then tell us anything that you can about some interesting things that your team is working on.

Yeah, at the Blues right now, currently we have a Blue Cross Blue Shield Institute, which is a wholly owned subsidiary focused on the promotion of health equity. You know, there are partnerships there that we have. We have partnerships with a broad number of academic institutions as well in allowing access and sharing of data to answer very meaningful questions. That's our research alliance. These questions focus on things like affordability, on outcomes, on what are the realities and how are we going to grapple with long COVID, what policy changes need to take place in order to better ensure outcomes for more people. Also, our focus at the Blues right now in large part is on a couple of different things. One, health equity, and then on this behavioral health challenge that we find our nation in. And so, I mean, that's where a lot of my time is spent is on those 2 areas. If you add affordability to that, I think you filled out the majority of my time. And so the transition toward value-based care, the transition of measurement and performance to include principles of health equity, the building of partnerships to those ends, such as partnership we have with March of Dimes to offer implicit and unconscious bias training for all providers in our networks, partnering with the American Diabetes Association on the same, partnering with, you know, it's all about partnership, frankly, and building partnerships at a national level is part of what myself and my teams are focused on. We have some real crises going on in the United States right now, and the outcomes that you and I experience in healthcare are not shared by all. even if they have commercial insurance. Maternal health outcomes, there's significant disparity and commercial insurance is not the buffer from those outcomes that we might think it is. And so some of this is about calling awareness to those inequities and then targeting solutions. And we did a broad search across the literature, across all of our members across the country to figure out what are some solutions that we could bring to bear specifically to improve maternal health outcomes. We formed a compendium of over 150 different types of programs that could be brought into place, distilled that down to the most impactful, and created a top 10 set of things that can be implemented across the healthcare landscape to best impact health outcomes and reduce disparities in maternal health. And now we're about Sort of propagating that and working with policymakers, regulators, provider groups, and other payers to ensure the best and most maximal uptake of those things so that we can all enjoy better outcomes. So that's really what we're focused on. The same thing in the behavioral health space. How do we— I mean, the reality is right now we have a tremendous gap. We have real behavioral health Deserts, and we have maternity care deserts in the US. The reality is it takes a while to fill some of those gaps. And so in the meantime, what do we do? And if you think about it and look at the research, primary care is providing the majority of the behavioral health support nationwide. So how do we better partner with and equip primary care providers to do that through collaborative care models? where we have behavioral health support for the primary care offices in order to try to meet the real needs that people have. So those are just some of the things that we're working on right now. And it's a great time to be in healthcare because the challenges are real. People are rowing in a very similar direction, and there's a lot of focus on getting better at these things. So it's a great time.

And again, like I said already, I think it's awesome that you're in the role that you are And the things that you just mentioned, that your sort of business and clinical imperatives, really trying to take care of people and the populations that you serve. And sometimes I'll just say, I think sometimes payers get a bad rap, but actually doing a lot of good in our country and trying to take care of the disparities you talked about and the other social issues that we have and mental health that's become a crisis, as you mentioned. I really applaud you for the fact that that's what takes up the majority of your calendar. So Adam, you touched on so many things that we could have gone so deep on, but unfortunately we're coming to the end. So I wanna leave you with the last word. Is there a topic that we did talk about that you wanna double down on, or is there something that we didn't cover that you'd like to say in closing?

Not a topic per se, but I just wanna encourage people to be human and allow the others around them to do the same. We are human beings, we're not human doings, and I think we sometimes forget that. And then the final element of it, and I think this will resonate with you too, Ed, because I know you and I know the kind of leader that you are, be the values that you want others to espouse. You have to be it first before you can ever sort of imply that others should espouse those things. So that's it.

Yeah, no, that's a great way to close out this podcast. It makes me long, Adam, to, to work with you again. So maybe someday we'll be able to work, work with one another because, you know, you're, you're truly one of the good people in healthcare. I'm glad you're in a position of influence as you are, doing great things. So thank you for being on our show.

You bet, my privilege.

All right, that wraps up Digital Voices.

Thank you for listening to Digital Voices podcast with Ed Marx. If you If you enjoyed this episode, subscribe on your preferred streaming service and leave a rating and review. And most importantly, thanks again for listening. Thank you.