Healthcare Unbound_Chuck Feerick and Mason Shea: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Intro:
Welcome to Healthcare Unbound, a podcast powered by Clarify Health, where healthcare's changemakers discuss ways to advance care outcomes, cost, and affordability.
Saul Marquez:
Hey everybody! Welcome back to the Healthcare Unbound podcast. I'm Saul Marquez, your host for today's episode. We are recording live from the HLTH 2023 event here in Las Vegas, and I have two outstanding guests. First, I want to introduce you to Mason Shea. Mason is a partner and healthcare consulting actuary working in Mercer's Richmond office. He provides analysis and strategic guidance around healthcare plans for clients across the country. We also have Chuck Feerick with us again on the podcast. He leads growth and product strategy at Clarify. His career has been solely focused on healthcare, working with large payers, as well as helping to co-found a dual-eligible health plan. Welcome to the podcast, gentlemen.
Chuck Feerick:
Thanks for having me.
Mason Shea:
Thanks for having us.
Saul Marquez:
Yeah, it's a pleasure to have you here. First, to kick things off, I just wanted to ask you all, what got you started in healthcare innovation?
Chuck Feerick:
Sure, I can start, and this is Chuck to recognize the voices. I started my career at Amerigroup Corporation, so big corporate healthcare focused on the Medicaid population. Left that to actually, as you read my bio, actually go help co-found a health plan. And in that realized the fun challenge, all the work that comes along with taking a company from idea state into full stage company. Now, this is a services company, right? It's a health plan. So it's not like the sexy product companies that we talk about, and we think about Clarify, or like other digital health startups, but that got me really sort of thinking beyond just the health plan, and what else could we do? How can you scale technology and healthcare to reach more people, have a bigger impact? So started getting plugged in the Chicago tech scene, joined another firm that was just focused on healthcare innovation, and then every step from there has been, how can we do more to create a bigger impact, to create more personalized, accessible healthcare for everyone?
Saul Marquez:
Thank you. And how about you, Mason?
Mason Shea:
I think I would have to say I kind of stumbled into this. I've actually been with Mercer my whole career, and as an actuary, you start to see costs going up and up in the industry, and it's a problem, and it's a problem that doesn't go away. And eventually, you come to a point. I think at Mercer, our clients want us to innovate. They kind of expected of us. We do a lot of innovation internally in terms of changing how we do things, but I just got opportunities to speak up and bring new ideas, and Mercer is a place that fosters a lot of that. We have an innovation council and a whole culture of just like speaking up and bringing up new ideas. And over time, as I became more experienced with my clients and in the industry, I just said, there's a lot of problems here, and maybe we can't solve all of them, but we can start really, let's come up with something new, and it's been kind of a whirlwind since then. As soon as you start doing something like that, one success leads to other things, and you don't always have wins, but it's an exciting thing. So I would say I stumbled into it.
Saul Marquez:
Hey Mason, that's great. And some of the most innovative things just happen to be stumbled upon. And when you have collaborations with people like Chuck, and as well as organizations like Mercer and Clarify, great things can happen. What's the most unique way your organization adds value to health systems and patients?
Mason Shea:
We do a lot of work with employers, and it's over half the population in America gets their healthcare coverage from an employer. We think of ourselves as a way to drive high-value insurance and benefits to really, when I think of patients, I think of like plan members, the people that are going to get care, that needs to be affordable, they need to be able to access it, and it needs to be high quality. I don't think of myself as a health system change person, but when I think of why I do what I do, it is for those to create a stable system for those end users.
Saul Marquez:
Thank you, Mason. Chuck?
Chuck Feerick:
Mason is really the pro here, but what I would echo on top of that is sort of what we do to augment the types of things you're doing is when you are trying to recommend the best network to control costs of care, may help your employers make the best decisions. We're one step further upstream than that and saying, how do we identify the right physicians who are providing high quality, affordable, efficient care and then work with our health plan partners to make sure that they're getting those providers in network, such that you can then bring those to your employers. But when we do see that derivation in performance and unwarranted clinical variation, what insights can we give to the providers to the health plans such that they can get those providers back on track? Because we all know that providers want to do the right thing, but it's aligned incentives, access to insights of how they can improve, and actually getting that to the right person at the right time that's required for them to actually do. And so if Mason operates sort of down here with his innovation, we're a little bit further upstream, I'm using my hands in a podcast, but to get that information to the right place.
Saul Marquez:
Yeah, no, thank you, Chuck. And throughout the conference, we have heard many stories and many examples of the power of collaboration, collaboration as the new currency. Can you guys share a little bit about the partnership between Clarify Health and Mercer, and maybe some of the things that have come out of it as wins?
Mason Shea:
I'll start back in 2020, before COVID, we kind of had a realization that we needed to be thinking about provider quality. I think provider quality is so important, and unfortunately, in a lot of the conversations we were having with our clients, it was overlooked, under-analyzed, and often not brought into some of the important conversations like Chuck was mentioning about total cost of care, network strategy and things like that. But what we realized, too, is that there's no national standard way of evaluating quality, so we needed to find someone who we thought was doing a really good job. We looked out in the market, and we found a couple people, and none of them were doing it the exact same way. But we really liked Clarify's approach, kind of bringing big data and data science, but they also knew healthcare really well. That's kind of where they come from. It's a perfect match-up for us because we know healthcare really well, a different side. We don't work with the payers as much, but on the employers and the consumer side, we know healthcare really well and the things that they want to see at the population level when we're trying to strategize with clients. Yeah, it's been a kind of a journey. Ever since mid-2020, we've been partnered with Clarify with their networks' product and looking at provider quality measurement and efficiency scores and things like that.
Saul Marquez:
Thank you, Mason. And Chuck, as you've worked with Mason and the Mercer team, what things have come out as big opportunities, and what wins could you point to?
Chuck Feerick:
I think one of the things that has helped the success of the partnership is that you have a national customer base in all your employers, and one of the differentiators of Clarify is the data set that we have allows us to look anywhere across the country, and assess the quality of providers, but then how those are grouped into the networks that you may be signing up for as an employer. So I think that's one of the big components of it. But then, Mason, I'm actually curious back to our partnership together. Can you talk a bit about how you've taken our insights and actually built it into one of the innovations that you've created at Mercer?
Mason Shea:
Absolutely. Again, we thought provider quality was really important. And the other aspect, I'll say is we think that it was important for our clients to be able to have a standard language to speak around provider quality, because they're talking to different companies all the time. Different companies are talking to our employers, and they all might say something different or define things, different way. For us to be able to speak that have that common language, to be able to speak with them was huge. We rolled out a tool, we call it Qualpic, very cutesy name, picking quality, right? But the idea is that you look in a market where you have a lot of people and you scan different care categories, the ones that always come up PCP, acute hospital, huge spend and utilization in those categories. But the thing that's nice about Clarify too, is they have lots of different other specialist care categories, orthopedic surgeons, cardiologists, so we can bring in a lot of those other metrics for those types of providers and kind of round out the picture of, hey, which doctors are you using? Which doctors could you be using? And how could the outcomes, both from a cost and a quality perspective, be different? And that was very big for us to balance quality and cost, the value. Some of the things that our clients are getting approached with from other companies, they tout a lot of quality. Now we have a way to try to validate that, and if it's lower cost in the same quality, that's fine, but we'd really like it to be lower cost and higher quality quality, yeah.
Saul Marquez:
That's great, Mason. What has the response been from your clients with this tool?
Mason Shea:
It's interesting because they all come at it with different questions. The Clarify data sets, really versatile. It can be applied to all sorts of situations, like we've talked with clients who have on-site clinics, and they want to understand when the care is referred outside of the clinic into the market where the best doctors to refer to. We have clients who talk to us about using this tool with their network strategy. Maybe they're thinking about going from a broad network down to like a narrower network, so you're kind of pruning that universe of doctors, but is that pruning get, leaving out really good doctors, or is it keeping them in? So we have a way to talk about that. And like I said, a lot of now that we have this tool, surgical centers of excellence, and other solutions and companies that come with our clients and talk a big game on quality, we now have a place to some, that sounds great. Let us go check out some stuff on our own, and we'll get back to you.
Saul Marquez:
Let's validate it.
Mason Shea:
An objective, yeah, a data-driven way. That's right.
Saul Marquez:
And I'm sure that puts you in a position of power and really kind of the ability to work with your clients with validated information that you could confidently say, you guys are going to get value for your dollar spent.
Mason Shea:
And I think the data, the rigor behind it, we do have some clients who really like to understand how the Clarify metrics and the sausage is made, and I never have to worry about that conversation because we can go all day talking about that. It's just a really great method. The data is, Chuck mentioned this before, is a big deal that some of our clients only have one medical carrier, but we want to see that the patient is going to be evaluated across, the provider is being evaluated across everything that's possible, and so that's all that stuff has been really helpful.
Saul Marquez:
Thanks, Mason. And you mentioned something really important, this concept of transparency around how the data comes through the analytics. Chuck, just as far as transparency goes and being able to provide that to clients, can you speak to that?
Chuck Feerick:
What I think makes Clarify unique, among many things, is our approach to benchmarking provider performance. As Mason mentioned, there's many different ways to go about that. There's not necessarily a right or a wrong way, but all of them require enough data to get enough signal into a provider to actually assess their performance. If you have 10-10 patients for a provider, your N is too low to really get statistical significance on their performance. So the first thing we do is have enough data with which we can accurately assess the provider, and then, on top of that, we built machine learning models that look at large set of features that go into every model that are looking at the contribution factors of how acute is your patient panel. Because every provider will tell you, and accurately, is, my patients are different, my patients are sicker. I see all the Medicaid patients who don't have access to transportation, and they all have diabetes and heart failure. And what we're able to say is Clarify is, actually, that is correct. We're actually taking that into account when we're looking at your benchmarking, and you're still doing better or worse than expected, based on a very fair benchmark. And the way the benchmark works is, essentially says, if we ran this model across all the 300 million lines of claims data that we had, if the average provider had taken care of this exact same panel of patients, how would we have expected that provider to perform? And then you can double click in all of that and get to the transparency of which exact patients, what factors were contributing most to that benchmark, but it unlocks the provider saying, I don't trust the data, you don't know who my patients are, you don't know that they're actually sicker, and instead saying like, oh, that's interesting, actually, and you're assessing me fairly, and there is things that I could do better, or a cohort of patients that I didn't realize that I wasn't treating as good as I could be based on what I know I'm capable of.
Saul Marquez:
That's great, yeah. And it's that sort of the multiple sides of transparency to the client in your instance, Mason, the employer, that could see where the data is coming from, the provider, so they could feel like they're getting fairly judged or measured. And overall, everybody wins. There's trench, which makes these types of analytic opportunities a win-win-win. So, as far as, we've talked a lot about outcomes and lower cost, is there anything that you guys want to leave the listeners with as far as calls to action?
Mason Shea:
I'm going to actually key off of the transparency idea in the call for action, because I think we have these, the transparency and coverage files, the machine-readable file price data that's been out for a little while. And it's Mercer's point of view, it was a shame that the price data didn't also come with some sort of quality metric to come alongside it, because we were just really, and still are, concerned that people will conflate a high price with something that must be good. And we know from working with Clarify, and from talking with others and looking at our own client data, that's not always the case. And I think the call to action here is that price is important, and as an actuary, of course, I'm going to say that, right? Cost is out of control in this country, we all know that, but we can't lose sight of quality. And so finding a rigorous way to evaluate that is super important, because otherwise, I really think you're missing out on that balancing the value equation.
Saul Marquez:
Thank you, Mason.
Chuck Feerick:
And I would echo that because what, and you're the expert here, Mason, so I'm going to speak, and you'll probably say this better than I could, but you have to look at efficiency and affordability in that equation as well. You may have a provider that provides a single service that is high priced, but they prevent a lot of unnecessary downstream utilization because they provide higher quality, versus a lower quality provider that is, on paper, cheaper, but patients need a lot more care because that provider is not doing as good as they could be. And so if you kind of look at that overlay, it's sort of efficiency divided by quality to get to affordability, you start to come up with something special that actually lets you know how well a provider is going to take care of that panel of patients. I've one more question for Mason, though, sort of on that topic of innovation. Mason, you work at a pretty big company, right? Mercer is how many people?
Mason Shea:
Oh, I thought you would ask me that question. I don't know, like 10,000 to 20,000 globally, a global HR consulting firm.
Chuck Feerick:
We're 50 at Clarify, so that's pretty big, and I think we're pretty innovative. How do you do innovation in a big company? What would you recommend to people listening about hey, I have an idea, we could do something better. How do you get started?
Mason Shea:
For me, like I said, when I started, I stumbled into, it is a cultural thing. I will say, even when I was a brand new analyst, I was kind of it was implied that if something looked like it could be done better, that I should try to do it better. And that goes from things that we do for clients, like our actual work products to a process or the way we do even our client meetings. And I think just from day one, being at Mercer had this ingrained in my head that if it could be done better, we should try to do it better. And then as my career kept going, and I started having more interaction with clients and thinking about larger-scale policy implications and cost issues in the US healthcare system, it's the same idea, just broader, right? This is not working. Is there part of this that we could be doing better? We do have an innovation council at Mercer that often like people will, we do kind of speed pitches every month where people come in, and we try to get different people to bring new ideas, but then there's a lot of innovation that gets fostered naturally by the like, one person saying to their people, manager, I've got an idea, and then that person brings it to someone else. And all of a sudden you've got it, you've got that idea in the hands of someone at Mercer who could make a change, build something new, has the right connections in the market or in the company to do something. And ultimately, it is a bit of a cultural thing.
Chuck Feerick:
Yeah, you took the words out of my mouth. It sounds like it's been, it's okay to do so. It's okay to try to do the innovation within the company, and it's become part of an accepted practice that's actually rewarded instead of, why are you trying to break the status quo? And I think that innovation council sounds like an amazing way to say, bring your idea here. It might not be good, but we'll listen, and if you have an idea, take a swing.
Mason Shea:
Yeah, I mean, I'm just laughing because I'm thinking of this story. When I was growing up in Mercer, a person asked me a question, why are we doing it this way? It was actually someone who's reviewing my work. And I said, I think that's the way we've always done it. And he sent me a picture of the running of the bulls in Spain. And underneath of it, it said, tradition. Just because it's always been done that way doesn't mean it's also not kind of stupid. And that, it just stuck with me; it was like a very silly thing, but ever since then, if the answer is that's because we've always done it, we probably need to unpack it. It's not to say we're not going to find things where we don't need to change them, and it's constantly questioning the status quo, like especially in healthcare. It is a hugely evolving market, and we need to be ready to change with it.
Chuck Feerick:
That's great. I think that's a huge testament to our work together, that you all think that way and have gone beyond just, how do we pick the best price for our customers, but think more innovatively and actually bring quality and many other things into that equation.
Mason Shea:
And I will just add lastly that one of the other reasons we liked working with Clarify is they have a vision for now, but they have a roadmap for the future. And so we're constantly talking about them with what's next. We just, Chuck and I were just talking yesterday about something new that they're doing and picking each other's brains. It's very exciting, it becomes fun, and when work can be fun, that's a that's a magical thing.
Chuck Feerick:
Yeah.
Saul Marquez:
Definitely is. Guys, this has been a phenomenal conversation. Love the work that you guys are doing together. And for everybody listening, this is an opportunity for you to also consider, how can you do things differently. I just have that picture that Mason shared, the running of the bulls. It doesn't always have to be the same, there's better ways. And Chuck and Mason today, shared the beauty of partnership and the promise that it has. Thank you guys so much for your time today. This was a great opportunity to connect.
Mason Shea:
Thanks. Thanks for having us.
Chuck Feerick:
Thanks, Saul.
Intro:
Thank you for listening to Healthcare Unbound. We hope today's episode was insightful. If you want more information on how Clarify Health can help you, please visit ClarifyHealth.com.
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