Who is health care's general contractor?

Dennis Bolin, Health Plan Alliance

12/07/2017

 

A phrase has stuck with me since our Fall Leadership Forum in Asheville, NC: Who is taking responsibility for the total health care experience?  I credit Chris Fanning with Geisinger Health Plan for raising the question.  Several Alliance members have repeated it to me since, so it resonated with a number of executives.

The idea of total responsibility reminds me of when I remodeled my townhouse a few years ago.  I went through the process of hiring the general contractor.  I had never completed a major renovation so I had no idea about the critical role the general contractor would play.  Everything from identifying the various specialists like carpenters, electricians and painters, to ordering materials and timing their delivery, to making sure we stayed on budget.  Every night he and I would get together to walk through and review the progress made that day.  Amazing how many details would need to be corrected—everything from moving a wall plug to reconfiguring cabinetry.  

The analogy of the general contractor was used by Governor Michael Leavitt recently at Cognizant’s Executive Vision Summit which Cathy Eddy and I attended along with several Alliance member executives.  Leavitt's point is that someone in each market (markets can be defined in a variety of ways) will take on the role of general contractor. As consolidation intensifies, the pressure is on to care for populations and adopt value-based payment models as the most reasonable solution to address the industry’s economic pressures.  

Leavitt sees a single “general contractor” taking control of a market or segment of a market. 

 

There are four candidates who could take the role:

• A physician group or network
• A provider delivery system
• A payer
• A “strategic integrator” such as a drug store chain, or venture capital entity—or maybe an entity that is formed by the other players.
  
  

A successful “general contractor” will have specific capabilities:

1. Ability to shape and change patient and physician behavior
2. Have a well-known, respected and trusted brand name
3. Control or have access to significant capital to make needed investments and weather financial ups and downs
4. Have the ability to “aggregate lives,” that is, bring a significant number of members and patients into the health management entity to achieve economies
5. Have experience managing risk
6. Control or network with a “clinical footprint” that covers a sufficient geography (i.e. access to aggregate lives) and the full continuum of services, including those that impact social determinants of health
7. Possess a “collaborative” IQ: have the ability to put together the structure and players in a win-win environment where everyone is working together—very different from a “negotiator” or even a “cooperator”

Few organizations have all seven of these capabilities.  Some entities may be subcontractors while others are “piece-work” (hired for only very specific contracted work).  What organizations don’t want to be are “commodities”.

As the industry reshapes itself, opportunities are there for organizations who are able and willing to take on the responsibility for the total health care experience. 

 

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