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Let\u2019s cut to the chase. You\u2019ve gotten to the point where you have a gang of physicians/clinicians/physician practices who have expressed a desire to work together. What do you need to know right now?

Eric Gallagher, CEO of the Ochsner Health Network, is my guest in this healthcare podcast; and I largely asked him the same question that I had asked Amy Scanlan, MD, from the UCHealth/Intermountain clinically integrated network in Colorado in episode 402 a couple of weeks ago. The question I asked both Eric and Dr. Scanlan is: What are you doing to help align physician practices into an integrated model? How are you going about that?

Now, let me remind you, Ochsner Health Network is practically long in the tooth when it comes to clinically integrated networks; and it also exists in an environment that is unique, as are most local markets. But Ochsner\u2019s local market is mostly Louisiana, which has an older population and a huge Medicare Advantage penetration. That is quite a different local market from what\u2019s going on in Colorado, which is the location of Dr. Scanlan\u2019s joint. As we all know, different stages of any journey require different solution sets; and different local markets certainly require different solution sets.

But what was so interesting to me was to notice that despite the market differences and the where-are-we-in-the-transformation-journey differences, how many of the things that you\u2019ll hear about in this episode are in the same spirit as the stuff that we talked about in that earlier show with Dr. Scanlan.

Eric Gallagher lists three things that he says are essential in the transformation journey:

1. Making sure that physicians, care teams, and those working directly with patients are part of the transformation process, both from a practice standpoint but then also from a financial standpoint.

This makes so much sense when I state it explicitly here, but so frequently, it doesn\u2019t happen. So frequently there\u2019s a value-based care team that tinkers around in a silo and then an announcement comes over the loudspeaker one day that henceforth we shall add some more clicks \u2026 but trust us, it\u2019s important for some reason we aren\u2019t going to bother to tell you about \u2026 you\u2019d be bored by it or you wouldn\u2019t understand it. Even if this was not the intention (and it probably wasn\u2019t), the result is going to be the bad taste in your mouth that I just left you with.

Eric Gallagher\u2019s #1 here, that everybody be part of the transformation, might be the umbrella really over the first thing that Dr. Scanlan talked about in that earlier episode, which was to make sure to give practices the tools that they need to succeed\u2014not what you think they need but what you\u2019ve discerned they actually need because you\u2019ve listened to them. It\u2019s a bidirectional exchange here with everybody working together.

Eric adds some new ground to that. He says that to make sure that everybody can productively contribute to this transformation process (and probably know what tools they may need), it\u2019s vital that everybody understands the \u201cwhy\u201d behind what the organization needs to do, meaning educating physicians and other clinicians in the business of medicine and the financial reasons for the \u201cwhy\u201d with the whatever. Insulating docs from the real world here helps no one, and it\u2019s not really viable actually in the world that we live in today \u2026

\u2026 which is a callback to the point that Denver Sallee, MD, made also in episode 402, which, in a nutshell, was that he thinks that unless docs, as a gang, start learning a lot more about the business of medicine, that we\u2019ll continue to see this value extraction and financial toxicity and moral injury\u2013inducing environments that we see right now. Dr. Sallee wrote, \u201cI needed more education in order to truly help patients.\u201d

So, let me posit that this \u201ceverybody works together and gets educated together\u201d step can help the practice and help patients in a myriad of ways, both at the practice level and at the patient level and also probably at a national level.

2. A recognition that practice transformation requires process transformation and thinking about things very differently. Now, all of a sudden, we are getting paid to coordinate care. We must work as a team because there are people on staff who can influence social determinants of health, for example. We have a vested interest to create a community board advocating for food banks and sidewalks and air pollution controls so all the kids who play soccer don\u2019t wind up with asthma. Ochsner actually set up a school because they realized educated communities are healthier communities.

Dr. Scanlan\u2019s clinically integrated network? They\u2019re much earlier in the journey. They\u2019re at the point where they\u2019re working hard to get participating practices the tools that they need to succeed and help doctors and other clinicians help patients through what Dr. Scanlan calls the \u201cin-between spaces\u201d\u2014the times between appointments.

But all of this really rolls up to the point that Eric Gallagher is making about everybody working together and recognizing that practice transformation requires process transformation.

3. The culture change that\u2019s necessary among physicians and other clinicians (pretty much everybody), and Dr. Amy Scanlan leaned into this one, too\u2014hard. Both brought up the same nemesis: inertia. And the requirement to change culture can\u2019t be underestimated, and the change management that\u2019s required here cannot be phoned in. Culture eats strategy for breakfast, lunch, and dinner, as they say.

My two macro-level takeaways after talking with Eric Gallagher today and Dr. Amy Scanlan earlier are that, even though the local market and the nuances of any given particular practice have such a huge impact on what\u2019s going to work at an operational and tactical level, if we stay up in the strategic zone, there\u2019s some best practices and points to ponder which are likely possible to universalize.

Now, emphasis on the \u201cstay up in the strategic zone.\u201d I was just talking to another person today with yet one more story amounting to \u201cit didn\u2019t work because it never was going to work,\u201d wherein, in this case, apparently a very large payer is running around attempting to do a pilot in an attempt to learn exactly and specifically how to operationalize something, and then their plan is to roll out this one model nationwide. So, something works in one local market at one practice, and we\u2019re just gonna assume if it worked there, it\u2019s gonna work everywhere. And, yeah \u2026 good luck with that.

After you listen to this show, listen to episode 402 with Amy Scanlan, MD, as I have mentioned multiple times. Episode 343 and episode 316 with David Carmouche, MD, would be good to check out. Also episode 393 with David Muhlestein, PhD, JD, and episode 394 with Vikas Saini, MD, and Judith Garber, MPP.

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You can learn more at Ochsner Health Network.

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\xa0Eric Gallagher, chief executive officer for Ochsner Health Network (OHN), is responsible for directing network and population health strategy and operations, including oversight of performance management operations, population health and care management programs, value-based analytics, OHN network development and administration, strategic program management, and marketing and communications.

Prior to joining Ochsner in 2016, Eric held leadership positions in healthcare strategy and execution\u2014including roles at Accenture, Tulane University Health System, and Vanderbilt University and Medical Center.

A New Orleans native, Eric earned a bachelor\u2019s degree in human and organizational development from Vanderbilt University and an MBA from Tulane University.

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08:14 What does everyone need to be on the same page about when it comes to clinical integration?

13:42 \u201cFor physicians, we really have to overcome this threat to physician autonomy.\u201d

16:52 \u201cHealth inequity is really just societal inequity.\u201d

19:24 What is the principal agent problem?

20:00 \u201cThere are things health systems can do that are probably outside of their traditional field of responsibility.\u201d

20:09 Why did Ochsner Health Network start a couple of schools?

20:42 What can empower a care team in a value-based care model?

21:53 Why is it important to transform into a team-based model?

23:24 \u201cIn the DNA of our organization, resiliency runs strong.\u201d

26:01 Why is building an effective care model easier than building trust with patients?

26:14 What is Eric\u2019s advice to physicians trying to integrate right now?

28:50 How do you get everyone on the same side of aligning for integration?

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You can learn more at Ochsner Health Network.

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Eric Gallagher of @OchsnerHealth discusses #clinicalintegration for #physicians on our #healthcarepodcast. #healthcare #podcast

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Recent past interviews:

Click a guest\u2019s name for their latest RHV episode!

Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde

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