Episode Transcript:
Susan Dentzer
So it's really a way of restructuring a model to make it much more person-focused, patient-centered, and frankly, much more able to rise to the level of the care that is needed today
Robert Traynham
First of all, welcome, welcome, welcome, Susan. This is a long time coming. I've really enjoyed reading your bio. And the one thing that stood out for me is you've been a groundbreaker all throughout your career. I think one of the things that I would love to start off with is that you've given back to your alma mater. You serve on the board of directors or trustees, and you're the first woman to do so in a leadership capacity. No?
Dentzer
That's right, Robert. And thank you for recalling that. Yeah, I was a graduate of Dartmouth College. I was in the second fully co-educated class. So-
Traynham
Wow. Trailblazer.
Dentzer
. . . got there back in the 1970s class.
Traynham
Whenever you got there. Yep, yep.
Dentzer
Yeah. And loved the institution. Ended up through a series of accidents really, becoming involved in alumni affairs and eventually became the first woman who was elected by the alumni body to serve on the Board of Trustees. Enjoyed that immensely, was on the board for 11 years, eventually became the chair of the board, the first woman, elected chair of the board. Again, pretty much of an accident back in the day, but very much enjoyed that role as you know, because you're involved in university and governance affairs, too. It's one thing to be sort of at the ant level as a student. It's another thing to be at the 30,000-foot level looking over the breadth of the institution and all its glories and frankly some of its foibles and some of the challenges you encounter along the way. So, it was a very gratifying experience to serve in those roles.
Traynham 02:02
Yeah. What's interesting about that is I too serve at my alma mater's board, and it's like the full circle of giving. In many ways, it's like, "Oh, I walked down that hallway 30 years ago as an undergrad. Now I'm walking down this hall as a trustee." And the ability to be able to shape people's minds is really impactful. Very much so.
Dentzer
Absolutely right.
Traynham
You know, you also have a very storied career as a journalist, former journalist, as well as now the president and CEO of an organization. Can you walk us through your journey and how you went from where you are now to where you were 5, 10, 15 years ago?
Dentzer
Absolutely. And again, a series of happy, happy accidents, I would say, Yes, I was a journalist for many years, I started off in print and moved into television, I was the first person to be the full-time health policy correspondent at the PBS NewsHour back in the day
Traynham
So, you really should be sitting in this seat. Let's just be honest.
Dentzer
Hardly. Hardly. I enjoyed my time in journalism. But frankly, covering health care and health policy, which I did in depth for many years, I learned a lot. I realized I was pushing up against the limits of what you could actually do to cover those very important issues on television. So, when the doorbell rang one day – metaphorically – and people came to recruit me into the role of being editor in chief of Health Affairs, I said “Yes” because I thought it would be a good opportunity to delve even a level deeper than I was able to do in, sort of, ten-minute television segments. So, I ran Health Affairs for five years. So, I then went on to a series of other roles. I was a senior policy advisor for the Robert Wood Johnson Foundation, major philanthropy exclusively devoted to health and health care in the United States. I then ran a nonprofit that was involved in innovation and health care. Spent a couple of years with my colleague Mark McClellan at the Duke-Margolis Institute for Health Policy. Wrote a lot about Covid for a couple of years as we know. And then when the doorbell rang again, looking for a successor to the founder of America's Physician Groups, I decided to take it, and here I am.
Traynham
There you are. Here you are. You know, Susan, I love what you said a few moments ago. And I really want to be really clear about something that struck me last night and again this morning. And that is the motto for America's Physician Groups is, quote, "Taking responsibility for America's health" end, quote. Pretty profound stuff. That's a bold statement. I mean, leaning into taking responsibility and put it in writing, tell us more about that. What does that mean to you?
Dentzer
It is bold and it's aspirational because as we know, there are a lot of entities who in theory could make the same claim. They want to be held accountable for the health of Americans and particularly the health care of Americans. And we know health care is an important route to health. It's not the exclusive route to health as we know, but it's the one that matters for people in our society who encounter disease and who are blessed enough, frankly, to have health insurance coverage, which as we know is another very important route to health. Thank you very much AHIP and the AHIP organizations. I think what we are trying to express there is that our members, physician groups – about 360 physician groups across the country – are deeply, exclusively committed to value-based health care models. They want to be held accountable in terms of the costs and the quality. We think about value, the classic definition is that it is outcomes divided by cost, right?
So, it's essentially the two factors are extremely important. You want to get the maximum outcomes for reasonable costs and sustainable costs and affordable costs, and that's where our groups sit. They want to be engaged in value-based models, whether those are the models brought out by the federal government, for example, the Medicare Shared Savings Program, or all of the models that have been brought out by the Innovation Center at CMS or those that exist in the commercial sector, the value-based care models that a number of AHIP members have been instrumental in bringing to bear and that we wish even more we're bringing to bear. So that's where we sit, and that's the desire expressed in our motto of being responsible for America's health.
Traynham
It very much feels like, Susan, you're holding yourselves accountable to a really high bar and just striving every day to make sure that you're at least trying to meet that bar every day. That's what it sounds like.
Dentzer
Absolutely right. And in contra distinction to much of U.S. health care, which as we know is largely still floated on a fee-for-service payment platform, thankfully, we've begun to hold even the fee-for-service system accountable at least to some degree for quality but not fundamentally to cost. And as we work our way through an era where we've got many, many in the population who are aged, getting more and more subject to chronic disease and multiple avenues of treatment, if you have a whole system that is driven by volume, which we think our system still is here in the country, and not accountable for the cost of that, and frankly not even accountable fully for achieving the best possible outcomes for the money expended, then we really are running the system the wrong way. And that's what we exist, again, to work against and address different ways of delivering that care.
Traynham
Susan, you and your team have created some really interesting vignettes, I call it, or video highlighting real patients and physicians to really demonstrate the value of value-based care. Can you elaborate on that a little bit more?
Dentzer
Absolutely. We know from a lot of research that's been done over the years that if you say value in the context of health care, to general Americans, people on the street, they think you're talking about something that maybe exists at the corner of Kmart and Dollar General, which is where you think about value. And we know fundamentally, Americans particularly tend to associate higher cost with quality, which of course is a really flawed presumption. But so, if you are using the word value and throwing it around with a sense that people will innately understand what you're talking about, that's wrong. So, we decided we had to show in a video what value-based care means, what enabling physicians to operate in a system that pays them on a value basis. Often that is something that looks like capitation or population-based payment and gives them the responsibility and the accountability to provide care within a particular payment envelope and really drive to those maximum outcomes and get off the fee-for-service hamster wheel.
Traynham
That's right.
Dentze
The 12-minute visit with a discreet office-based payment as opposed to, "No, here's a capitated payment. Here's the incentive to take care of somebody with multiple chronic illnesses." If you need to see them three times a month, you've got the capacity to do that. If you need to bring other people onto your team other than the physician who's going to do the billing, you have the capacity to do that. So, it's really a way of restructuring a model to make it much more person-focused, patient-centered, and frankly, much more able to rise to the level of the care that is needed today, particularly for people with multiple chronic conditions who are going to need a longitudinal care system over time.
Traynham
Yeah. It's funny when you were speaking, Susan, I was thinking of two things. One, a different way of thinking, and then (my words.) And then secondly, it really is trying to be comprehensive or collaborative, whatever you want, 360, however you want to phrase that around the patient and meeting the patient where they are. I'd love to chat for a few moments about just the collaboration between your organization and, frankly, health insurance providers and the dance or the sheet of music that we all need to be singing from to make sure that we're providing that comprehensive care to patients.
Dentzer
Well, a common sheet of music obviously would be the best of all circumstances.
Traynham
You'd think, right?
Dentzer
You would think, yeah. And we are partners in care. The financing of health care is an extremely important function, so is the provision of health care and the delivery of health care. And unless our two segments are working closely together, we're not going to get to these. First of all, this value-based care environment is only possible if we're true partnerships. We are partners with the federal government in Medicare Advantage on that end, but the intermediaries are obviously Medicare Advantage plans. We need to be very closely aligned in providing care in that perspective.
Traynham
And then last question is, I ask all of our guests this, and that is the next big thing and health. What does that look like for you?
Dentzer
We think the next big thing in health is for all of us to work toward taking out waste in the system, which we know is considerable. By some estimates, it could be as much as 25% of the expenditures annually. And we know a lot of that expense is on the administrative side, right? We know we can work together on that. We can take advantage of new technologies, newer technologies such as artificial intelligence to take out some of the bad aspects of prior authorization. Together, we know we can achieve some benefit to people by doing just that, and certainly in terms of cost. So, I think as we think about the future, how do we take these tools that are now available to us and put them to work in a system that needs it now more than ever, right? We need to get maximum bang for the dollars expended in health care. We need to use whatever we possibly can to improve health. And we're going to have a tidal wave of older individuals, older adults with multiple chronic diseases. And we know from our plan partners, they're seeing now increases in utilization that were frankly unexpected at this point in time. Is that an unusual phenomenon or is that the wave of the future? We've got to get ready for it if it is the wave of the future. So, working together in all the ways I've described is of paramount importance to us.
Traynham
Thank you so very much for being on the show. We really appreciate it.
Dentzer
My great pleasure, Robert. Great to be with you.
