The Exec: Interwell Health CEO Bobby Sepucha on Advancing Value-Based Kidney Care

One size doesn't fit all when it comes to payment models, says the leader of the kidney care management company.

Editor's note: This conversation is a transcript from an episode of the HealthLeaders Podcast. Audio of the full interview can be found here and below.

Kidney care "has long been in need of disruption," says Interwell Health CEO Bobby Sepucha.

That's what Interwell is striving for by setting the standard in value-based kidney care through its network of physicians and strategic partnerships, including Providence Health Plan and Oak Street Health.

Sepucha recently joined the HealthLeaders podcast to detail how the kidney care management company is serving an in-need population and furthering value-based care efforts, as well as offering insight into where value-based care is heading and how payers and providers can find middle ground on payment models.

This transcript has been edited for clarity and brevity.

HealthLeaders: Can you tell me about the value-based model Interwell Health uses and how that was identified?

Sepucha: There's long been a desire to move upstream to identify patients earlier and to engage in their care. That fundamentally is what Interwell Health is all about. So if you start with that as the fundamental precept of designing the ideal value-based care model for kidney patients, what that requires then is a multi-model approach to engage patients. We believe that the physician has to be the center point of that. We at Interwell have our own clinicians. We engage directly with patients, with nurses, dieticians, and social workers, but we also exist to support the independent practicing physician. For us, it's about supporting the patient, helping them engage them in their own care, and to do that, you have to be able to touch them where and when they need it most.

HL: How has the partnership with Providence Health Plan been vital to the value-based care effort?

Sepucha: We partner with large networks of nephrologists by making sure that they have the same economic interest as we do so we share savings with the physicians. By working together, if we're able to improve the health outcomes for our patients, as well as drive down costs, then we collectively share in that. The relationship with Providence is exactly like this. And the fun thing for me is there are different pairs across the country, all approaching the problem in slightly different ways, all with different needs for their own geographies and membership. So we're able to be very creative in how we contract with our plans, whether that's Providence or some of the national players. We can take absolute full risk and sub-capitated arrangement or do a shared savings arrangement. There's a bunch of different ways we can contract all to try and make this as easy as possible for payers to finally give their kidney membership access to the merits and benefits of value-based care.

Bobby Sepucha, CEO, Interwell Health.

HL: What has the partnership with Oak Street Health achieved in terms of expanding primary care?

Sepucha: Our collaboration with Oak Street to create this new joint venture called OakWell, for us is really the next foray and the future in vanguard of where kidney care is going to go. We're going to start out small. We're going to start in a few markets and bring Oak Street primary care docs into the dialysis clinic and have them round with our patients. Over time, the idea is to then go upstream so that we at Interwell and nephrology partners can be kind of the kidney care extenders for the primary care patients who are perhaps earlier stage in their in their progression of kidney care.

If you take a big step back, the advent of value-based care across primary care and across all these specialties is unbelievably exciting. It's one of the most exciting things to happen in American healthcare in decades. But I think we all have an obligation that if we are not able to figure out how to coordinate, then we risk sort of reinforcing the siloization of healthcare. And that of course would be a massive opportunity missed.

HL: How do view the landscape right now for value-based care and where do you see it going both in the short and long term?

Sepucha: Kidney care is still very much in the nascent stages of moving towards value. If you put a calendar on it, I'd say we're probably five to seven years behind primary care in terms of moving towards real fulsome risk. But the pace of change here is rapidly accelerating and all those plans who used to focus on dialysis rate are now pushing Interwell and other providers into more fulsome risk, sub-capitated risk, which is terrific. That's the exact right thing to do.

I think the biggest challenge for us as a society and a system is ensuring that we don't do these things independently. I joke around, but it's only half-joking, I think one of the worst places in the world is being at a health plan and trying to make sense of all these different point solutions that they've signed up in the last several years. How do you make them all talk to each other? I think that's the next stage of where this needs to go in terms of making this all work more effectively and more efficiently.

HL: What kind of approach or mindset does it take for providers and payers to find that sweet spot of a payment model?

Sepucha: Mindset is actually a great way of framing it. It's working in collaboration and viewing this as a partnership. We are not at the point, nor can I imagine getting to a point in the near term of walking into a health plan and saying, 'Here's the off-the-shelf contract, sign here.' This is a consultative arrangement. This is trying to understand what this specific population that this health plan is serving. What are their challenges? How has the plan been managing this population, if it's been managing it at all? For a lot of these plans, it's not about making a profit, it's about losing less money. That's a really important distinction. For us, it's about understanding where the plans are. It's is about understanding the unique characteristics of the geography that we're going to serve, the systems that are in place, the healthcare systems that are caring for these patients. Because if you don't understand that at the outset, you're going to fail.

HL: What are some of the financial or operational challenges that you're experiencing right now and what are some strategies that you're using to address them?

Sepucha: Through the lens of labor, a lot of ink has been spilled and a lot of people have talked about the labor shortage that's plagued American healthcare particularly, with respect to skilled nursing. We've had the good fortune of having an awful lot of candidates, incredibly impressive, high-quality candidates apply. But then you have to help them understand what this new clinical model is like, how to engage patients differently, how to engage physician practices differently. And that just requires an awful lot of change management. For us, it's basic operational blocking and tackling. It's making sure we have the clinicians in place, making sure they're trained staff and ready to go, making sure they understand the unique aspects of the geography and the patients they're serving. That's our laser focus because it begins and ends for us in terms of how you engage the patients.