Steven F. Schutzer, M.D. is involved in the Connecticut healthcare industry in many ways. He is a Physician Executive for Orthopedic Service Line at Trinity Health of New England, Physician Director of the Connecticut Joint Replacement Institute at Saint Francis Hospital and Medical Center, and President of Connecticut Joint Replacement Surgeons, LLC. Dr. Schutzer also chairs the Committee on Centers of Excellence for the Moving to Value Alliance (MTVA). He recently spoke with MetroHartford Alliance Content Manager Nan Price about value-based healthcare and his involvement with the Connecticut Health Council.
NAN PRICE: What does it mean to provide value-based healthcare?
STEVE SCHUTZER: The principles of value-based healthcare certainly aren’t new; they’ve been espoused for at least 10 years. The architects of the value agenda, both of whom deserve substantial credit, are notably Professors Michael Porter and Robert Kaplan from the Harvard Business School.
The basic precept is simple—create a market where providers compete on healthcare value. So, what is healthcare value? A mathematical quotient where the numerator is the outcomes that matter to a patient for their specific condition—and the denominator is the true cost of delivering these outcomes.
At Connecticut Joint Replacement Institute (CJRI), we started our value journey in 2009 by implementing an alternative payment model known as a “bundled payment.” At the time, it was a novel idea to offer purchasers a single package price for a comprehensive and defined set of healthcare services delivered by multiple providers over a full episode of care—and with a warranty.
It took a year to finalize our bundled payment program but ultimately three parties—Saint Francis Hospital and Medical Center, Woodland Anesthesiology Associates, and the arthroplasty surgeons at CJRI—signed what we called the “Basket of Care” agreement. That then began the long journey to get the payor community accustomed to this new payment model and a willingness to contract for these services.
Looking back, when we launched the program in August 2010, we naively thought since this was such a great opportunity for payors to save money and improve value that the phone would be ringing off the hook. But that never materialized. It was more of a challenge than we anticipated to implement disruptive changes after years of fee-for-service was hardwired into the core of payor-provider relations. So, it took time and patience to gain traction, trust and get everyone on board with this new model.
NAN: How has the approach evolved since then?
STEVE: It’s interesting, so often it comes down to timing. With any form of complex endeavors and desirable changes, external forces can appear serendipitously that seem to build inertia going in the right direction. Few Americans today don’t appreciate that our healthcare system is critically ill and that we need to fix it—and soon. Every one of us is impacted in one way or another. Healthcare debt for many American households is mounting.
At the same time, the public is demanding a better user experience, better quality, more transparency, and ease of access and convenience. Some social and political forces are moving this agenda forward both in our state and even nationally. Finally, in 2020, those of us who have been in the trenches working on the healthcare transformation for many years are now sensing some momentum.
NAN: Did that momentum encourage the formation of the Moving to Value Alliance?
STEVE: That’s a great question. Let me provide some historical context.
CJRI has been sponsoring an annual Connecticut Health Council Forum and keynote speaker for years. In April 2017, CJRI hosted David Lansky, then President and CEO of the Pacific Business Group on Health, a San Francisco-based, forward-thinking consortium representing large employers, as our guest speaker. At the welcome dinner prior to the lecture, there were about 25 people around the table, including stakeholders representing many different constituencies. The discussion turned to a common theme: that we were all expending resources, both financial and human capital, and were regretting that no one was seeing any return on investments.
I remember thinking: If everyone is saying the same thing, has the same complaint but wants to move to value, why don’t we ask people to come together, sit down, and figure this out?
About a month later, a core group of interested and motivated folks who had attended the Lansky dinner met for the first time: Paul Grady, Principal at Alera Group; Maureen Geary, Program Manager of CJRI; Jeff Hogan, Northeast Regional Manager for Rogers Benefit Group; Christine Arnold, Operations Manager at Rogers Benefit Group; and me [shown in the photo, left to right]. The five of us decided to launch “the moving to value employer – provider working group” and to organize a forum specifically dedicated to these issues. We the Connecticut Health Council if they would collaborate with us on co-producing the Forum.
So, CJRI, the Council, and the Connecticut Business Group on Health (which stemmed from Paul Grady and the Alera Group), organized the first Moving to Value Forum in December 2017 focusing on High-Value Provider Networks. We anticipated maybe 40 attendees and were surprised at the interest level. 130 people from various stakeholder communities were present. The forum was so successful, we held our second one in December 2018. This time our focus was pharmacy, primary care modernization, and centers of excellence.
NAN: During the COVID-19 pandemic, how is the MTVA leadership group adjusting to the emerging healthcare landscape and moving forward with your mission?
STEVE: The chronic and recalcitrant problems that plagued healthcare before the pandemic are not going away. In fact, they will only exponentially accelerate from the COVID-19 crisis, regarding access, affordability, accountability, transparency, and cost. So too, however, are the myriad opportunities to finally and decisively transform the very foundation of healthcare delivery—exciting, new primary care models, armed with enhanced telemedicine capabilities.
We’re pleased that the MTVA now has several hundred committed members in our network. Now that we seem to be at the summit of the COVID-19 crisis in our region, the MTVA’s Executive Committee recently reconvened. We unequivocally recommitted our energies to moving ahead with our overarching agenda and specifically to advance the Connecticut Compact initiative and the creation of Centers of Excellence models for our State’s purchasing communities.
NAN: How and why did the MTVA become involved with the Connecticut Health Council?
STEVE: After the first Moving to Value Forum, our working group discussed what else we might do to have a greater impact on the much needed healthcare transformation in the State. At the time, the Council had already established five healthcare-related working groups. None of them, however, were specifically focused on the needs of the employers, which was our niche.
After presenting this to the Council, we were accepted as the sixth Council working group providing us with an opportunity to focus specifically on self-funded, self-insured employers.
NAN: What do you gain from your involvement in the Council?
STEVE: Achieving measurable progress toward our collective goals of providing our citizens with convenient access, excellent quality, and affordable healthcare continues to face major headwinds. Our relationship with the Council has served to align our energies, resources, and strategies and help propel the MTVA from a five-person grassroots effort to an organization with more than 200 participants—all committed to the urgently needed changes.
The Council is spectacular and been a supreme stalwart for this movement. The collaboration with the Council has fueled and even accelerated progress toward meeting our goals and objectives. She and the Council have provided boundless support and resources for our meetings, webinars and forums. With everyone swimming in the same direction and with key leadership at the top—folks like MetroHartford Alliance President and CEO David Griggs—we predict an even greater impact in 2020.
Of course, we need all hands in this collaboration including the Connecticut Business Group on Health, CJRI, Saint Francis, Trinity Health of New England, the Council, and the MetroHartford Alliance to build on our early successes.
NAN: You mentioned the Moving to Value Forum was just one arm of the Moving to Value Alliance. Tell us more about the Alliance.
STEVE: One year ago, we sensed we needed to be more than a working group to realize our full potential. We learned of the concept of a “Value Alliance” (based on a book by Michael Leavitt, Finding Allies, Building Alliances: 8 Elements that Bring—and Keep—People Together) and we decided to reorganize under those principles and rename our group the Moving to Value Alliance.
The first step was to find a convener of stature who could bring together the diverse perspectives of all stakeholders and help them see the greater purpose of this collaboration. We extended an offer to Karen Gee, Senior Vice President and COO at OptumCare Network of Connecticut, who graciously accepted the role. Karen is, arguably, one of the most influential people in the State aligned with the entire value framework. We subsequently established four subcommittees: the Committee on Centers of Excellence, which I chair; the Connecticut Compact, which Paul Grady chairs; our annual Moving to Value forum; which Jeff Hogan and Christine Arnold chair; and the Committee For Primary Care Modernization—which is currently on hold. This is a totally volunteer-focused grassroots “army” of very busy people, all committed to building a value agenda for the State of Connecticut.
NAN: The next Moving to Value Forum is planned for fall 2020. What can attendees expect?
STEVE: The forum this year is going to be gangbusters. Dr. Marty Makary will be our keynote speaker. His recently released blockbuster book “The Price We Pay: What Broke American Health Care–and How to Fix It” is an unabashed rendering of the current state of our healthcare system exposing the dark side of this industry and the challenges we face in trying to remediate these recalcitrant problems. Dr. Makary will be giving a keynote presentation and moderating a panel discussion.
NAN: Final thoughts?
STEVE: Our healthcare system is on life support. Despite being a $3.3 trillion-dollar industry, we fail to compete with other Organization for Economic Cooperation and Development (OECD) countries on most health outcomes despite more than twice their per capita spend. Embarrassingly, healthcare debt is also the number one cause of personal insolvency in the United States. The time for each of us to step up and do our share to move the value agenda forward is now—we are at watershed moment. Either we join forces to disrupt entrenched incumbents from all of the stakeholder groups and pivot to a true value-based healthcare structure or succumb to a nationalized government-run system.