Payer vs. Provider - Who‘s more DGTL? (ft. Christine Seals)

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.

Today we're talking digital voices from the health plan perspective. As you know, Digital Voices is all about the digital voice of the payer, And the provider and the patient and big tech. And it's really important that we focus on all those. And so today, really thrilled to introduce you to a friend of mine, Dr. Christine Seals. We'll bring her in in a second, let her talk about her journey and her roadmap into her career. So, it'll be really great to get Christine's perspective today because she not only works for a health plan, but she's a practicing physician. And so, brings that point of view with her as the medical director for Denver Health Medical Plan. So, really quick on Christine, is we met probably around, I don't know, Christine, was it Thanksgiving time?

It was like 6 months, maybe the spring. I can't remember. But we're really good friends with—

I've been longtime friends with her husband, Darryl. He was the Vail CIO for quite some time. And so, I met him many years ago and we both have a love for the high country. And so we climbed and practiced, climbed some mountains and did a lot of adventuring together. And so it was great to meet his wife and we all met up, went snowmobiling in the backcountry.

Yeah, I think it was spring break maybe. And it was just a great time. And we were talking about digital and all things around the payer side.

And so we thought, wow, what a great guest. Plus, It's a small, small world. So she knew my wife Simran, and they had a lot of friends in common. So they knew a lot of people that they had in common that they may have gone to school with and things like that. So it's such a small, small world. But anyways, Christine, welcome.

We're so excited to have you.

Thank you, Ed. And we had a blast. That was probably one of the most fun snowmobiling trips ever. Your wife was amazing. Yeah. She faced her fears.

Yes. Yeah, no, that was—

yeah, it was—

that was intense. Yeah, we, uh, the trail—

there was a trail part, but certainly when you go off trail, it can be a little intense. And you guys were great instructors for both Simran and I, so thank you so much.

So one question, Christine, we ask all of our guests, and that is your favorite music. What kind of music do you like to listen to?

Oh, I'm from the '80s, so '80s rock and roll. Though I'm not that great at knowing the band and when they were made, I can recognize that they were from my era.

Yeah, no, I love the '80s too. And in Fort Worth, so when you guys come visit us in Fort Worth, Texas, there's a great '80s dance place. That's all they play is '80s music, and it's so much fun. So we'll definitely have to do that. You know, the second question we ask before we kind of riff and freestyle is, is there a life mantra that you have or a life message? You know, what, what may be a guiding principle? What sort of things like keep you grounded?

It's a really great question, and I'll share with you first the mantra that, that Darryl has shared with me, and I think it's how we've always lived our lives. I just didn't have a phrase for it, but his mantra is safety third. If it were first, we would never leave our houses. We wouldn't go outside, but fun and adventure are first. Safety is third. And I do believe that's how we live our lives. We work hard, we want to make a difference in the world, we care about people, but we also want to explore, have fun and adventures. He'll say we want porch stories.

Yeah.

So when we get old, we want to sit around and tell the stories of the experiences that we've had and, and not pass up any opportunity to do so.

Oh my gosh, I love that so much. I want to steal it really bad and claim it as my own. I'll have to, I'll have to figure out, see if you have it trademarked yet. No, I love that way of life. We're certainly kindred spirits with that. So, tell us about your story. You know, you're a physician, you live in the Rocky Mountains, you know, why did you become a physician? All those sorts of things.

Sure. You know, I get asked that a lot. You know, when did you decide you wanted to become a doctor? And for me, it was actually when I was 7 years old. So, I have wanted to be be a doctor all my life. But like many things in life, it's because I had a mentor. My aunt was an intern. She was in residency in her first year when my young cousin was born. So my younger brother and her son are actually the same age. My mom— this is down at Loma Linda in Southern California. My mom was taking care of both of them while she would run off to the hospital. And I'm 7 years older. So my aunt says, will you come to the hospital with me and watch Daniel? So she'd him in this little car seat and I'd come and I'd sit at the hospital and you know what you do at 7, you just watch the kid while he sleeps. But I'd watch my aunt rounding and interacting with her patients and the people at the hospital and I knew that's what I wanted to do. I knew that's who I wanted to be like. So all of my life I've had my aunt in it, including she was an attending in my residency program. So she'll tell you as well, she is the reason I went into medicine and when I watch— and she's the reason I chose family medicine as well. She was an amazing mentor, an amazing teacher, and I love the way that she taught me about things. Anything. It could be the plants growing on the side of the road, or when we're swimming in a pond, teaching me about the fish. I loved her perspective and way of interacting and, and, and took that on. I think of myself in many ways as a teacher rather than a physician. It's what I spend my days doing, motivating and finding an opportunity.

Yeah, very cool. And I know on the personal side, like, you actually met your husband like in high school, and then you got reacquainted later in life and got married. That's pretty cool.

Oh, yes. So he is my high school sweetheart. We dated when we were 16 for a year. We were torn apart, and it's one of those dramatic stories. We were torn apart and didn't speak again for 32 years.

Wow.

And then reunited just about 5 years ago.

Yeah, that's really cool. You guys have a great porch story there for sure. So you practicing a physician and now you're on the payer side. Can you share a little bit about that transition?

Like what got you interested in being a medical director and those kinds of things?

Sure. You know, these things just happen. If I'm bored, I clean out cupboards. If I'm not finding that I'm learning something every single day, I find something new to learn. And You know, not everybody enjoys the administrative world, and so what I think happens is that we rotate, and as others have done the job before, they sort of step back and you're the one left sitting there. So it started by taking leadership roles at the hospital with different committees, projects, things like that that nobody else wanted, and then it quite quickly actually moved into the payer space, again with committees. So for physicians or providers, there are all these activities where you need expertise, and I would just happen to enjoy it or be available. So I moved from hospital leadership then into payer leadership, really, just because of opportunity, what was available, and because I was good at it. I actually can say no, and I understand why I do so, and that's hard for some people to do. So I think it's a role that's perfectly fit for me. And I also have a very strong belief, and that is that physicians need to stay at the table. We can sit and spout off about how things are broken and how they're not working well, but if you don't stay at the table, somebody else is going to. And if you don't— if you aren't willing to take the risk and understand how it works, I guarantee there are other people out there that will that don't understand medicine. So it's one of my fundamental beliefs. So it's kind of kept me in that trajectory. And again, because I enjoy it, I have slowly but surely gotten asked to do more and more, and that's my full-time job.

Yeah.

That's awesome. So, since you have both perspectives, right? You've been a practicing physician and now a medical director. What are maybe, I don't know, 1, 2, 3 things that you wish all providers knew about payers now that you've been on the payer side?

I was thinking about this one a little bit. There's one thing I wish they knew, and this is gonna sound a little saucy to begin with, but I wish every provider had to balance their budget in their household.

Right.

Hairs are like, this is a budget issue. There's not infinite money. And it's always about making decisions. Are you gonna buy the brand name shampoo or the generic? Do you spend money on a trip or do you spend it on, on a car? Those are decisions we make every day at home. And I'm not sure that every individual has had the opportunity to be in charge of that budget. So first off, I just wish everyone, let alone physicians, could understand that healthcare is a limited resource. The dollars in healthcare are a limited resource and we do have to have some stewardship around them. I love the idea of, you know, what do you say to your teenager when they ask you if they can buy a pair of shoes? How do you figure it out? What rules do you use?

Right.

So that would be my number one. The second would be that the person holding the purse isn't the enemy. So if you've been in charge of your budget at home, just because you're the person who holds that purse doesn't mean you're an enemy. There may be some things that we don't agree with about the person holding the purse, but they are the person holding the risk. They have to exist unless we're willing to take risks. So, the last and most important thing I'd say to physicians is you got to stay at the table. You got to be willing to take risks. You have to understand what people are paying for or someone else will. And I wish they would understand that piece.

Yeah. Those are really 3 strong lessons that I think apply beyond, right, medicine, just in general. And I'm sure all the CFOs who might be listening are applauding as well. But yeah, understanding the balanced budget, right? We get that too as a chief digital officer where everyone wants everything, but unfortunately there's not enough resources to do everything. So you definitely have to prioritize. And then I love the fact what you said about staying at the table. You've mentioned that a couple times now, Christine. And it's true in whatever you want to remain engaged. If you want to control, if you want to have a— be engaged in a process to help sort of make decisions and making sure the best decisions are being made, there's nothing better than getting involved yourself and being at the table. So that's really good. Now, let's flip it, because part of the reason for Digital Voices is really to break down barriers between all of the key parts of health and life sciences. And so, You just speaking about what you wish all providers knew was really good. What about if we flipped it? What are 2 or 3 things you wish all payers knew about providers?

Well, being a provider myself, of course, it's how hard being a physician is and that business and administrative information is not taught in medical school. Now, we're getting better at it, but first and foremost, I'd like for payers to all understand what a provider goes through. What their day is like, how hard it is to understand the impact of all of these decisions. This is tough stuff. The learning curve is unbelievable, and medical school didn't prepare a provider for what they're going to experience. The other part, of course, is that physicians, providers, mid-levels, they're teachable and they're rational people, right? But they are currently being pressed from all sides. We're asking too much, and we're not providing enough support. And we have to, if we're going to maintain the provider network that we have. I mean, you've heard some of the data around aging out and the number of individuals going into residency or going into medical school. So, we're creating our own problem if we don't make life easier for our providers. So, I'd like payers to have some empathy for what the situation providers are in.

Yeah, that's really good. No, those are excellent points. Since we are talking digital and all things digital, what about digital in terms of the business? Like in your business as a— on the payer side, how do you all leverage technology or digital capabilities in your business?

So, not surprisingly, especially with COVID I'm going to say telemedicine or telehealth, both in my practice and as a medical director. And we have about 120,000 lives at at Denver Health Medical Plan of all different commercial, Medicare, Medicaid. But we're looking to how can we optimize telemedicine for members? Where can we use it in our network? For which types of scenarios? How can we support our providers into not just transitioning because they did it in COVID, but what stuff stays? When do you continue to use telemedicine? In my practice, we pivoted in a week. Mm-hmm. It was unbelievable. And the challenges are unbelievable as well.

Right.

The cultural challenges, my staff perspectives, the, you know, the training that it took, just the ideology that people have about what works with telemedicine or not. And yet here we are almost a year and a half later, and there are some pieces that stick. We have to get more creative and meet our patients where they are, and digital is the way to get there. We're working on some digital communication with our members for our care managers. How could they text and chat. Believe it or not, we don't do that. Healthcare is notorious for being behind. So number one, I would say, is trying to understand where telemedicine fits in using it. Number 2 is measures and metrics. The whole world of medicine is being impacted by how we measure what we do. Physicians, we hate that, right?

Oh, yeah.

Don't measure us. We don't like to be— Digital, however you want to term it, is driving the way in which we collect measures, what we view, how we analyze it, electronic clinical data systems reporting with HEDIS. You know, how do you collect data out of the electronic health record and how do you use it? So, there was a time years ago when Meaningful Use came out where I would— I had this mantra of, let's make Meaningful Use meaningful.

Right.

I would say the same now. Let's, you know, using digital platforms, digital technology, let's make it meaningful. Let's make KPIs and measures and metrics mean what they say.

Yeah, those are all really good points about how you currently use digital and how we could do more with digital on the payer side in the future. So let me ask you this provocative question. It seems like payers are starting to compete a little bit with providers? You know, I understand that some payers have— are larger in terms of the number of PCPs that they have on their payroll than most healthcare systems.

Right.

So, and then I think on the payer side too, pretty progressive, I think, like you were describing with virtual care.

Do you think— where do you think we're headed in overall payer-provider type relationships?

Well, remember that part about risk and staying at the table? If the providers aren't willing to hold risk and the payer is, then you end up being employed by the payer and not, not a part of that payer. Although there are a bunch of IPAs, and I was a part of an IPA up in Oregon that I think holds a lot of weight. And you've seen nationwide that there are some provider groups and large Well, they're large provider groups that are taking on some risk. But that's a challenge because I don't think traditionally physicians like risk. So, you have to have some buffer in between or somebody who's willing to help you understand it. You're aware, of course, that Medicare has rules around transparency and interoperability, and that those first apply to providers in general, provider groups, hospitals. Those now apply to payers in some settings as well.

Right.

So, payers are taking on risk. They're using data and wanting to analyze that risk and make better decisions. And now they're trying to be transparent and will have to do— have some interoperability measures met. So, my belief is payers are where it's at. If I was going to say, you know, where am I banking my money, they're the entities I think that are going to hold the most responsibility and have some of the most growth. So, again, back to my bottom line, then we better stay involved with them. If they've got the purse, they're controlling my life.

I want to stay in control of it.

Yeah, words of wisdom. And it's one of the key messages, Christine, that I share as well for all of my friends. And I come up from the provider side primarily, is that we need to really double down on how we enable the patient experience, how we enable the clinician experience, And really get more involved with what's happening on the payer side, the reimbursement side. And again, having some sort of say, sit at the table and control of your own destiny. Because if you do nothing, then I think you're right. It's really in favor of the payers because of all the reasons that you were talking about. So, I think that's— it's provocative, but it's honest. And I think it's true. I mean, you see it happening all the time. In fact, I would say at least half of the companies that I work with today are on the payer side, where I think a few years ago would've been primarily providers. But the payers are wanting to do the same thing that providers are, right? Reach out, virtual capabilities, the digital capabilities you spoke about, reach out directly to patients and really take care of them because they're holding the risk. And the more proactive they can be in wellness and things like that, the better off everyone is.

I was going to say, you know, that leads me to talk a little bit more about analytics and better understanding of how our members work. It's a gap that will have to be filled, and payers are in the right position to do it. If you go to Target and you buy something, there's all of these analytics about your purchasing routines that we use to proffer you and advertise to you. I think that's where healthcare is headed. Where it will use AI, predictive analytics, will use the data around your habits in some way, shape, or form to help better offer options and alternatives. Like, for example, if only someone who's feeling suicidal is searching for something that might indicate they are and an offer to get care pops up in front of them that offers them maybe a phone call with someone who may talk to them through their challenge. I know we're headed in that direction, but we're so far behind the commercial industry that it is striking. But it will happen.

Yeah, I think you're right. That hyper-personalization, and as you said, we see it in other industries today, whether it's on Facebook or you suddenly get these ads for things that you've been talking about or texting about with someone else. And they're using a lot of analytics to kind of be very predictive and personal.

And we need to get there.

And as you said, that is part of the future of healthcare because it can do so much good for wellness, overall wellbeing. We can take— make interventions a lot sooner than being reactive and being all about, you know, sick care versus well care.

So, yeah, any other thoughts about what might be happening in the future?

Oh, lots of thoughts, Ed, but probably not safe to share. It's a challenge. You know, one of the things I was going to share is it's a word that people don't necessarily like when I say it, and that is that we have— we're, as physicians, we're perversely incentivized. By nature, I treat you when you're sick. I am perversely incentivized in that sense alone. And with the way in which we're paid, different specialties and primary care included, we're paid fee-for-service, or if you're paid by widgets, You are perversely incentivized whether you believe it or not. And doctors don't like me to talk about that at all. It's very offensive. We're good people, but we don't understand our own incentives. I think the direction we're heading is really to try to find ways to align incentives so the patient, the provider, and the payer are all aligned to go in the same direction.

Yeah.

That's our biggest challenge, I would say. Well, you know, it's that Venn diagram of where we all align and going in the same direction.

Yeah.

I, I agree with you completely.

It's all about Aligned incentives.

And yeah, you know, the burden on the provider side too is they have a lot of fixed assets, a lot of— many times lots of debt related to building buildings and things like that. So, one of the reasons I think we've gone backwards in terms of telemedicine compared to where we were a year ago is that we want people to come into our facilities. Again, not because we're bad people or anything like that, but one, culturally, that's the way we're comfortable. And that's the way we learned our practice, number 2. But the 3rd thing, too, is the realities of the financing. And, you know, we've got these fixed assets. We want people to come and use those fixed assets. But the world is definitely changing. And I think with aligned incentives between payers and providers, government, I think that, you know, value-based care, I think that is definitely the solution for us. So, I always leave the last comment to my guests, Christine. So, I know we covered a lot of ground here in 30 minutes, but maybe we left something out, or maybe you want to double down on something we already spoke about, but I would love to leave you with the last word.

Sure.

I like that you brought up value-based purchasing. We want to be paid for value, not just for the thing we did. And that is a transition and a different way of thinking for providers, but it is not only the way of the future, but the way to actually align with our patients and with the payer. So, I've said it 15 times now, stay at the table, figure out what's valuable, not just for you, your practice, but for where we can align in that value.

Thank you so much for being our guest. Thank you for what you do as a medical director and helping to improve the lives of the members in your organization. And look forward to skiing or snowmobiling or something in the near future.

Fun and adventure. They're number one and two.

All right.

This pod, thank you.

Thank you, Ed.

Hi, this is John Lynn from the Healthcare IT Today podcast. If you like the latest rumors, insights, and happenings in healthcare IT, you'll enjoy hearing my colleague Colin Hung and myself debate and share the latest happenings from the world of healthcare IT. Find the latest episodes or dig into our archive at healthcareittoday.com. Or search for Healthcare IT Today on your favorite podcast application or YouTube. When it comes to healthcare technology, we love this stuff, and we can't wait to have you join in on the discussion of everything health IT.

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