In this episode of Shift Shapers, David interviews Ross Bjella, founder and CEO of Alithias, Inc., to discuss the challenges of changing health care behavior and the inaccuracies in measuring those changes. They explore the complexities of helping patients understand their health care options and costs, and advocate for transparent, actionable data to aid in more informed decisions.

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Transforming Health Care Behavior: Insights from Ross Bjella, CEO of Alithias, Inc.

Ross shares his journey into the health care sector, the importance of data-driven strategies, and how incentives can help patients choose high-value care providers. He also delves into the impact of consumer-directed health plans and how different company cultures affect health care engagement.

Key Takeaways

**Carrots Over Sticks:** Positive incentives (carrots) work better than punitive measures (sticks) in driving desired behavioral changes in healthcare.

**Challenge of Accurate Data:** Current tools and survey methods for measuring behavior changes in healthcare are not as accurate as desired. Ensuring accurate data collection and utilization is critical.

**Impact of Cost on Patients:** High deductibles and out-of-pocket responsibilities can lead to patients being functionally uninsured, causing them to delay care and potentially leading to more severe health outcomes and increased costs.

**Importance of Actionable Data:** Access to clean, normalized data that is understandable and actionable for patients and their families is crucial for making informed healthcare decisions.

**Effective Communication and Incentives:** Effective communication strategies and financial incentives (like waiving deductibles or providing cash rewards) can significantly improve patient engagement and lead to cost savings for both providers and patients. Tailoring communication and benefits to the culture of the organization is essential for success.

In This Episode

00:00 Introduction to Healthcare Behavior Challenges

00:47 Meet Ross Bjella: Journey to Healthcare Solutions

01:03 Understanding the Problem: High Costs and Insurance Issues

04:43 The Role of Data in Healthcare Decisions

08:33 Actionable Data for Patients and Plans

16:02 Engaging Employees and Employers

21:20 Measuring Success and Future Outlook

27:15 Conclusion and Final Thoughts

In this episode of Shift Shapers, we explore strategies to enhance the growth and adoption of Direct Primary Care (DPC) with Dr. Bernard Bubanic, CEO and President at Integrated Source One. Dr. Bubanic shares his journey and insights into creating a multidisciplinary approach to healthcare, ensuring access to comprehensive care without the financial hurdles. We discuss the integration of various services such as telehealth, behavioral health, and musculoskeletal services, as well as the importance of building relationships with patients for better health outcomes. The episode also covers how this model can provide measurable savings for employers and improve plan designs.

Key Takeaways

• Multidisciplinary Approach: Dr. Bernard Bubanic's practice, Integrated Source One, focuses on direct patient care rather than just direct primary care. This includes primary care, health coaching, musculoskeletal options, and behavioral and mental health services, all offered under one umbrella.
• Employee and Family Coverage: Integrated Source One covers not only the employees but also their dependents at no additional cost. This approach is helping with better engagement and substantial cost savings for employers over time.
• Brick-and-Mortar and Virtual Care Integration: The practice combines onsite, near-site, and mobile clinics with telehealth services. This ensures continuity of care and immediate attention, making sure patients get timely and efficient care without the traditional wait times.
• Savings and ROI for Employers: By integrating direct patient care services into employee benefit plans, employers witness reduced healthcare costs and premiums over time, with a higher engagement rate by the third year, leading to significant long-term savings.
• Future Expansion and Technology: Moving forward, the practice is looking to incorporate new technologies, including AI, to enhance patient care quality and efficiency. This will continue to lower costs while improving health outcomes for patients.

In This Episode

00:00 Introduction to Direct Primary Care

00:37 Guest Introduction: Dr. Bernard Bubanic

01:15 The Journey to Integrated Source One

02:59 Challenges in Traditional Healthcare

04:11 Direct Patient Care: A Multidisciplinary Approach

05:35 Innovations in Healthcare Delivery

06:11 Seamless Integration of Onsite and Virtual Care

09:11 Measuring Success and ROI

12:30 Plan Design and Employee Benefits

19:54 Future of Direct Primary Care

21:14 Conclusion and Final Thoughts

Join us on this episode of ShiftShapers as host David Saltzman sits down with former New Jersey Congressman Rob Andrews, one of the key authors of the Affordable Care Act (ACA). Fifteen years after the ACA's passage and ten years since its implementation, Rob shares his journey from aspiring sports writer to influential lawmaker, his role in drafting the ACA, and thoughtful reflections on its successes, shortcomings, and future prospects. We delve into topics such as healthcare coverage expansion, consumer protections, cost control, value-based healthcare, mental health parity, and the ongoing provider shortage. Currently serving as the CEO of the Health Transformation Alliance, Rob continues to advocate for value-based health arrangements. Don't miss this insightful conversation for a deep dive into the evolution and future of U.S. healthcare.

Key Takeaways:

• Journey to Congress and ACA Involvement: Rob Andrews initially aspired to be a sports writer but ended up in politics, driven by a mix of early professional exposure and personal family experiences. He was significantly involved in drafting portions of the Affordable Care Act (ACA).
• ACA Achievements: The ACA successfully expanded coverage to millions, with Medicaid expansion and subsidies being critical components. It improved patient rights, eliminating pre-existing condition exclusions, extending coverage for young adults, and removing lifetime and annual policy limits.
• Shortcomings and Future Goals: ACA did not sufficiently address healthcare costs. The prevailing issue is that the system rewards the number of procedures over the quality of outcomes. There's a need for more focus on preventive health measures, behavioral health services, and better alignment of payment to performance.
• Healthcare Provider Shortage: There is a significant shortage of primary care providers and behavioral health professionals. Proposed solutions include increased compensation and incentives such as debt relief programs for medical students who work in underserved areas.
• Value-Based Healthcare: Value-based healthcare is crucial for better outcomes, involving rewarding providers based on risk-adjusted, clinically sound outcomes Both quantitative metrics (e.g., reduced A1C levels in diabetics) and qualitative measures (e.g., patient self-evaluation) should be considered to assess quality effectively.
• Current Role: Rob Andrews is the CEO of the Health Transformation Alliance, focusing on pooling resources to buy healthcare more efficiently and promoting value-based arrangements among member companies.

In This Episode

00:00 Introduction and Guest Welcome

00:41 Rob Andrews' Journey to Congress

03:14 Involvement in ACA Drafting

04:53 ACA Successes and Shortcomings

07:03 Future Improvements and Value-Based Healthcare

10:07 Addressing Primary Care and Behavioral Health Shortages

16:13 Measuring Quality in Healthcare

17:47 Rob Andrews' Current Role and Conclusion