"The health system strategy is all about growing our business in this risk space where we are accountable for the whole patient rather than a single visit," says Daniel Styf.
Daniel Styf stepped into the role of senior vice president and chief executive officer of Memorial Hermann Health Plans in Houston on January 4. He comes from Atlanta where he most recently served as senior vice president and head of operations for Piedmont WellStar Health Plans.
I recently had the opportunity to speak with Styf about what he sees as his top priorities and goals as he takes on the challenge of heading up the insurance arm of the largest not-for-profit health system in Southeast Texas. The transcript of our conversation has been lightly edited.
HealthLeaders Media: As you begin this new role, where will you focus your energy?
Daniel Styf: The most important area of focus is helping organize all the resources that our health system has put together and needs to put together to be successful in the population health space. We have an incredibly successful Medicare ACO program. We have a health plan that has just experienced very good growth, which I can't take any credit for, having started on January 4.
HLM: How does having a health plan assist Memorial Hermann Health System with achieving its goals around population health and value-based care?
DS: Combining care and coverage allows Memorial Hermann to take more proactive steps to invest in the health of our community and provide better care for the members we serve. It's my belief, and the evidence points to this, that doctors and hospitals work better when they are focused on taking care of patients and not focused on following silly insurance rules.
We can talk to them directly because they are our colleagues and work with them on providing the resources they need.
We also think offering coverage directly to the Houston community allows us to cut out the financial middle man. When payers, like the federal government, are investing in patients' care for the year, we want to be as close to that as we can so that it becomes left pocket to right pocket.
HLM: As Memorial Hermann continues to take on more financial risk for the health of its patients, what role can you and the health plan play?
DS: Our health system is ahead in some areas and behind in others. This is an area where we are ahead. We have care coordinators and care managers embedded in our physicians' offices and this is a big reason why our Medicare Advantage program has been successful. I'm trying to make sure all of our contracts are in place with CMS or other carriers in the market to take on this risk so there is consistency.
I started my career in Detroit, worked in Atlanta, and now in Houston. This happens to be another place where [social] issues are getting in the way of good health and good care. Inside the care delivery systems around the country, there are people who understand the community resources that are out there to help patients through these types of challenges… My job isn't to come up with ways to connect patients with barriers to the resources they need. It's to enable the care delivery system to do that job on behalf of their patients.
The health plan can pay the salary of that person or those 10 people who are needed to create better health and better value. It's a win/win/win, as far as care, health, and finance.
For example, for patients with chronic illness, we can help our delivery system make investments they want to make in taking better care of these patients… [The health plan] is not necessarily going to hire care managers, care coordinators, and dieticians to work on behalf of those patients, but we can help fund those positions.
It's also about having the appropriate coding in place, which is really important in this space because every payer is paying our health system for the patient for the year and is looking at the risk of these patients, and in the end, it is important to have the coding that appropriately and accurately reflects that.
HLM: How helpful is it to have both the clinical data and the health plan data when working toward population health objectives?
DS: Having the data infrastructure to store claims information and care information that combines it all in a way that enables the care team to provide better care to members is critically important. This is a place where the health system has made tremendous investments. The system relies on the Cerner suite of tools, and it's a place where we have made considerable investments so we have a single database that incorporates claims and clinical data.
Take, for example, something like pharmacy fills. You would think a physician would want to know if the patient has filled a prescription. But almost everywhere in the country, the physician has no idea if it has been filled. And it turns out that this information really matters.
If the patient can't afford to take the medication but doesn't want to say that to the doctor during the appointment, they may take the prescription but not fill it. Maybe the doctor would give them a different prescription or decide on a different course of treatment if they knew the prescriptions weren't being filled.
This is something that can be learned from the health plan claims data. Because of the investments Memorial Hermann has made in IT and the storage of the information, physicians here can access that information.
HLM: Payers and providers typically have an adversarial relationship. How does owning a health plan allow Memorial Hermann to move beyond that acrimony in order to provide better care for patients?
DS: It's about trust and relationships. To the extent that a health plan is at war with physicians and hospitals and trying to win a unit price game, you can't ever have a conversation about taking better care of patients because you don't have that trust. To me, it's all about building trust.
I want to be able to direct resources to the delivery system. That is everything in this type of relationship. I think that is where the magic is in this type of integrated system. If you talk to any physician or clinician anywhere around the country what you will hear is that they are frustrated because they can't spend enough time with their patients and they can't spend enough resources on their patients. What we are doing is bringing those resources and those people together because we are building trust.
HLM: When you accepted this position, what made you feel that you would be able to have a positive impact on the organization?
DS: There are two things that convince me that I can make an impact. One is that the Memorial Hermann Health System is committed to the strategy of being accountable for patients' care. This is true from the board to the CEO to the senior executive team. This system is on the same page and committed to this work. That doesn't mean we understand everything we need to do, but we are committed to working to on it.
The second thing is we have a high-trust environment. The leaders in this system trust each other and are working together to try to achieve our strategic goals. Everyone is humble enough to say, 'I don't know everything we need to do, but let's work together on it.' That may not sound like a big thing, but, actually, it is really important. It is what sold me on this opportunity to make a difference.
Rene Letourneau is a contributing writer at HealthLeaders Media.