As CEO of Cleveland Clinic Florida and an orthopedic surgeon by trade, Wael Barsoum has seen where attempts to deliver value-based care go right—and the hurdles it faces—right in the operating room.
One of the best examples, he said, is from back when he running surgical operations in Cleveland that included overseeing about 120 operating rooms.
"Operating rooms are literally the most expensive real estate in a hospital. You want them to run as efficiently as possible," Barsoum, M.D., told Fierce Healthcare. He focused on building a sense of camaraderie around making the operating rooms more efficient, such as starting cases on time and decreasing the turnover time between patients, while hitting quality metrics. And it worked, he said.
At the same time, they faced hurdles aligning stakeholders' motivations.
"As an orthopedic surgeon, you come to work in the morning to do surgery, you don't work a shift. You're there in the morning, you're there until the work ends. So you're highly motivated to work as efficiently as possible," Barsoum said. "Not everyone has that same endgame in mind. For some folks, they may be working a shift so if my shift ends at 3:30, perhaps I'm not as aligned as efficiently as the surgeon who wants to get out at a reasonable time after doing high-quality work for a patient. Trying to align a lot of the same motivators across the same group is a big help."
Now, he said, after building Cleveland Clinic Florida into a nearly $2 billion health system, he's resigning his post as CEO to take the lessons learned to a new role: president and chief transformation officer the Healthcare Outcomes Performance Company (HOPCo).
The Phoenix-based, largely physician-owned company partners with health systems and specialty groups such as Phoenix-based Banner Health, Porretta Center for Orthopedic Surgery and Northern Arizona Orthopedics to provide value-based care platforms, including an integrated suite of IT platforms, to improve the quality of care while also reducing costs. Barsoum will be working to help develop new partnerships and continue scaling the company.
"There really aren't many organizations like HOPCo that have taken such a pro-active view of what can really be a win-win," Barsoum said. "Patients win. Providers win. And actually, most importantly, society wins because you take cost out of healthcare but at the same time you improve the quality and outcomes get better. This is a unique area. I think most people today in healthcare feel if you win a little in one area, you lose a little in another. The reality of it is, true value-based care is a win-win for everyone."
Fierce Healthcare caught up with Barsoum recently to chat about the new gig. Here's a look at what he said, edited for length and clarity.
Fierce Healthcare: What hurdles and successes with value-based care did you experience as a health system leader?
Wael Barsoum: When I came to Florida, one of the challenges that we recognized early on was we just weren't big enough. I came down here to be president of a single 155-bed hospital in the tri-county area of Miami-Dade, Broward and Palm Beach Counties, which has over 80 hospitals. You don't have scale at that number. That was both an opportunity and a challenge. Recognizing that you had to get to enough scale and separate yourself out in a very crowded field was a big step for us.
The first thing I did when I got here was, working with our Chief Strategy Officer in Cleveland, put together a strategy to differentiate Cleveland Clinic in Florida from all of our competitors. The way we did that was recognizing there was a real need for differentiated, high-quality tertiary and quaternary care: things like complex joint replacements, neurosurgery, transplant programs. We started all these programs and expanded on the foundations that we had here in Florida to set up a system that was differentiated from our competitors in that it was a true academic medical center and not a high-quality community hospital.
To do that and to get to scale, you still need to grow out the rest of the system. That's where we brought in the Indian River Hospital and Martin Health System and ended up, literally overnight from December 31, 2018 to January 1, 2019, increasing the number of beds we had in the hospital across our system here in Florida by a factor of five and increased our number of sites by a factor of four. That allowed us again to have a larger footprint, to be a more meaningful health system in South Florida and it continues to pay off here for our patients.
FH: How is COVID-19 changing this value-based care conversation?
WB: There are clearly some things we have learned. Let's just take access for a moment. If we look at access and the fact we've shifted so much care now to people working from home, patients being given high-quality access to their provider team from home, that's a big plus. I think more and more patients are really comfortable with this model. I think more providers are comfortable with this model.
We can actually do a really good job of monitoring patients from home so they get the same quality of care, the same sense of safety they would have, many times, in a hospital environment or a doctor's office from the comfort of their own home. So in the end, everyone wins again. Your care team has more time to care for more patients, the patient is able to get high-quality care from the comfort of their own home without having to get into the car and drive to their doctor's office to be seen and then the health care system does well in addition because it is a lower environment to deliver that care in terms of cost. Everyone kind of wins in that model. So COVID has actually taught us that we can provide high-quality care remotely for many patients.
FH: But realistically, with some of the financial harm COVID has wrought on so many providers, is the shift to value-based care threatened right now?
WB: I actually think it's the opposite. I actually think people will recognize more and more that you've got to figure out how to take more cost out of the healthcare system. In the United States today, we spend more than any other country in the world per capita for our healthcare. Today we spend around 20% of our gross domestic product on healthcare delivery in the United States. The average Medicare beneficiary gets around $10,000 spent on them in the United States. That is significantly more than any other developed country in the world.
Sadly even with that spend, we do not rank as the best healthcare system in the world. Our infant mortality rates are too high. Our readmission rates are too high. Our preventative care and our wellness care is not nearly as good as it is in other countries in Europe, in Asia. These are all areas we can improve on. We have got to figure out how to make our healthcare system leaner and more aligned and that's exactly the kind of thing HOPCo works on. It's aligning the stakeholders so that the payers, the patients and the providers are all essentially on that same team to be able to provide that high-quality care in a high-value way. COVID is forcing everyone to think more and more about taking down cost and improving quality and improving access.
FH: So what tangible steps can you take to do that?
WB: The key for a company like HOPCo to be successful is this whole idea of aligning all the stakeholders. If you look at healthcare from a patient's perspective, it's: What does a patient want? The patient wants access to their care team, they want confidence they are getting the highest quality care. And today, when 40% of Americans are using high-deductible insurance plans, they want to know that they're getting it for a price they can afford.
So HOPCo, from a patient's perspective, does that. How do they do that? They encourage all providers and incentivizes all providers to use appropriate clinical care paths that are proven in the literature to offer the highest quality care at the lowest cost. If I'm a physician in private practice or working for the Cleveland Clinic, I can pretty much deliver healthcare however I want unless someone is giving me kind of a play-by-play playbook that says: "This is the HOPCo way of doing a knee replacement that is appropriate for your practice that we believe will get the very best outcomes based on all the data out there." You can do whatever you want. But having that playbook puts you in a much better position to ensure that your patient gets the highest quality care for the lowest cost.
From the provider's perspective, healthcare data today doubles every 100 days. Just think about that. There is no human being that can keep up with that amount of data. So having access to playbooks that tell you this is the best way to deliver this healthcare is great because it relieves that requirement from the clinician to have to constantly be figuring out, how has a knee replacement or shoulder replacement or a cure for lower back pain evolved over the course of the last month, or two months, or six months or year. Because nobody can possibly keep up with all that literature.
WB: Think about when you take your car to a mechanic. The mechanic might come out and tell you, "Oh, you've got an issue with your transmission." The reality of it is, you may have no idea that you have an issue with the transmission. But the mechanic tells you that and you trust the mechanic. It's going to cost you $1,000. You write a check. You get your car back. From a payer's perspective, having a partnership with the provider to say, "You're at risk for the care of this patient just as we are at risk for the care of that patient" ensures the patient is getting the best care, the appropriate care for their problem, just like you might imagine the situation with that same mechanic. So now, they're providing you with a warranty. The mechanic is a lot more likely to tell you exactly what's wrong with the car and fix it perfectly and correctly the first time because they're now at risk for having to fix it again if it's not right the first time.