Oak Hill President and Chief Executive Officer Barry Simon is Executive Lead of the Medicaid Innovation Working Group for the Connecticut Health Council. He spoke with MetroHartford Alliance Content Manager Nan Price about healthcare innovation, how healthcare reform impacts Connecticut, and the important role of The Council.
NAN PRICE: Give us a little background about Oak Hill and why the organization became involved with The Council
BARRY SIMON: Oak Hill is a 125-year-old organization that has redefined itself as Connecticut’s largest provider of services to people with disabilities. The bulk of those services are paid through Medicaid directly or indirectly.
My entire career a healthcare professional, it’s been a passion of mine to serve individuals who fit into the general realm of profound, prolonged, complicated services that tend to be lifelong. When I joined Oak Hill in 2013, the board asked me to get the message out about Oak Hill as a specialty provider.
I connected with the MetroHartford Alliance, thinking: If you’re going to be in Hartford, where better to go? The Alliance introduced me to The Council, which was a natural fit. I liked that it really represents the greater service organizations in all components.
Six years ago, Oak Hill became an Alliance investor. I became involved with both components—the economic development realm of the Alliance made sense and then, as a business that’s in specialty healthcare, becoming a member of The Councilwas a no-brainer.
NAN: What do you gain from your involvement in The Council?
BARRY: What’s amazing to me is that The Council members represent the entire continuum and infrastructure related to healthcare—the insurance companies that pay for the care providers, including major players like Aetna, Anthem, ConnectiCare, and UnitedHealthCare; care coordinators; and the research component of care, whether it’s a Visiting Nurse Association, a hospital, or a local college. Everybody’s in the room, which you don’t get anywhere else in any kind of representative organization.
Through The Council, people collaborate to understand that healthcare as we know it is changing. As a Connecticut-based healthcare system, how we’re able to grapple with that is something I feel very passionate about. That’s why I became involved with The Council at the start.
NAN: Let’s talk about your role in The Council’s Medicaid Innovation Working Group.
BARRY: The different working groups came out of a collective effort of trying to find out: What kind of economic impact does this industry have on Connecticut and on Hartford? And why is it that other parts of the country can identify themselves as healthcare meccas?
Council members meet with policy people throughout the United States in Washington, D.C. We learned that places like, Nashville, TN, have been identified as hubs where healthcare innovation is happening at an incredible rate. Representatives shared that one component of the secret sauce was they had people around the table from all different parts of the system creating a safe environment to talk about the differing interests.
We decided that if we set up these Working Groups and included people with different backgrounds, we could encourage conversation—the more you learn about each other, the more you develop trust. You’re able to talk about what’s been holding back the system or what could be brought in that could be innovative in the system.
NAN: It helps break down the siloed approaches.
BARRY: Exactly. That’s where you start to get change. If you’ve got people all rowing in the same direction, it’s easier to accomplish those goals. But when everybody’s in their own silo, it’s hard to accomplish those goals because people have different interests.
That’s where the value of these Working Groups really comes in. Everyone’s communicating. They’re all on the same page. When they’re standing in their own silos, it’s easy for everybody to say: We’re all about quality and good outcomes for the patient. The Working Groups help members break out of their silos and ensure those silos are coordinated and connected in a way that they can all support that same vision of what it means to be providing good outcomes. Working together, we can help ensure everybody is getting the healthcare they need and it’s coordinated so that, overall, they’re living a better life—and somebody who’s living a better life is generally less costly in the healthcare system.
NAN: So, it’s creating a community of people working toward the same goal.
BARRY: Yes, absolutely. As national healthcare is changing rapidly, national healthcare payment is also changing rapidly. How can we provide quality healthcare at a reasonable rate with good outcomes that present value to the payers? Especially in the Medicare/Medicaid world, the payers in the end run are the taxpayers. It’s really a system that self-perpetuates. It starts with the individuals who are paying the taxes, then the federal government reimburses the states, and then the states reimburse the providers.
NAN: As you said, healthcare throughout the country is constantly innovating. How can Connecticut stay on track?
BARRY: It’s a great question. What’s happening in other parts of the country does impact or predict the way things are going. Hospitals in the Hartford Region are a part of these larger networks and have national partnerships that are bringing in best practices right here into the Hartford Region.
For instance, Oak Hill is an Easterseals affiliate. Through that, we receive information from a national network of providers. Other states have gone to what’s called “managed Medicaid services” for long-term services and supports. I can look to states that have already implemented that strategy to predict how things are going to be happening here in Connecticut.
NAN: You’re actively engaged in the healthcare reform initiative statewide and federally. What role does Medicaid play in healthcare reform?
BARRY: The healthcare reform initiative is coming out of Washington. It’s designed to improve the overall quality of healthcare services. From a Medicaid perspective, it’s challenging because, in general, people unfortunately don’t have a positive view of Medicaid. They don’t see how Medicaid deals with so many different populations. It reimburses complicated special education kids in school. It compensates for veterans who need services. It compensates for the chronic and complicated mentally ill. The developmental disability community has a lot of services that are paid for out of Medicaid. So, it’s a really important reimbursement system that’s put in place to help support people who we want to be living a healthier life.
As a society, we’re in a place where we want to ensure people can live the best life possible. These initiatives enable that to happen. For example, if you need a hip replacement, we live in a place and a time where we can do research to find out which hospital has the best outcomes for hip replacements—and for many of us with high-deductible plans, we can find out which hospitals have the best rates. If you have the best outcomes and the best rates, then that’s a good thing.
The best hospital with the best rates could be right down the street in Hartford. People may think the best hospital for what they need is in Boston or New York, but it’s really right here. We’re able to provide that information and, when information becomes available to people, it’s empowering.