Written by Ellen F. DeCareau
When Jim Hinton, Baylor Scott & White Health’s president and CEO, reflects on what went through his mind the first time he learned about the 2013 merger that created the largest non-profit healthcare system in Texas, he describes it in one word — brilliant.
“You have the prestigious Baylor Health Care System and an integrated health care delivery system based in Temple with a lot of legacy,” said Hinton holding out his two hands. “You’re going to combine these together and try to have the best of both systems emerge. Simply — brilliant.”
Most recent mergers were hospital to hospital and health plan to health plan, explained Hinton. “This was different. This modeled the continuum of care.”
At the time of the merger, Hinton was leading Presbyterian Healthcare Services in New Mexico, a non-profit integrated system with many similarities to Baylor Scott & White Health. Both manage their own health plans, have Accountable Care Organizations, offer a diverse array of care points and have missions rooted in the Christian ministry of healing. He had no idea he would one day soon lead the merged BS&W. Yet, that’s exactly what happened. On October 10, 2016, Hinton was officially named to take the helm of the system, which includes 48 hospitals, 662 primary care and specialty clinic locations and a health plan with more than 245,000 members.
Now seven months into his appointment, Hinton talks comfortably about BS&W’s priorities and vision. While the usual health care topics emerge — quality, cost, efficiency — he has a pragmatic way of addressing the major opportunities and challenges. Even as the topics shift, he maneuvers the responses to one overarching theme: affordability.
Keeping It Simple
How does BS&W explain and show the value to patients of merging two major systems? “I think we sometimes overcomplicate what we communicate to customers,” says Hinton. “Part of our obligation in the health care system is to deliver what we say we’re going to deliver. If you do that, then the fact that you’re merging to get some economies of scale or bring better technologies or lower costs, those become self-evident parts about what patients experience.”
He uses phrases like “it’s all about the product” and “the customer is always right,” phrases more often heard in executive conversations within the retail or consumer goods industries. It’s one of the many examples of Hinton’s pragmatic delivery.
Like most of his answers, Hinton explains using an example, this time with a recent airline experience. He describes his expectations — that he has a seat on the plane; that it leaves and arrives on time; and that it has Internet access.
“But the internet didn’t work and that annoyed me,” said Hinton. This experience with the unnamed airline company was unsatisfactory because it didn’t deliver on its expectations.
“Customers win and they need to win,” he explained.
Clear expectations around affordable, convenient and quality care is central to BS&W’s strategic plan, being developed by Hinton, the system’s leadership team and the board of trustees. But, how does one build a plan in a health care landscape where change is slow and complicated and the horizon is barely visible?
Doubling Down On ‘No Regret’ Moves
“The shelf life of a strategic plan is shorter than it has ever been, in a world that is changing so dramatically,” said Hinton, addressing the conundrum. “Yet, good plans are more about the planning than the plan.”
Hinton says the process allows leadership to rediscover its strengths and weaknesses while identifying what he refers to as “no regret” moves or must-do tactics regardless of what is happening in the world around them.
Part of that is uncovering value in the face of uncertainty, said Hinton, alluding to Texas’ status as one of 19 states that elected not to expand Medicaid coverage.
“Lack of coverage is not without consequence. People still get health care regardless of their ability to pay. And the costs of providing that health care get shifted to the people who do pay,” he said.
With less money, finding ways to remove costs from the system while improving quality is a key focus for BS&W.
Explained Hinton, “What should we be doing that is completely independent of what happens in DC or Austin? We should be doubling down on those things.”
Innovate Where Others Cannot
The BS&W health plan is looked to as a mechanism for identifying cost-saving strategies.
It is why Hinton’s experience running a health plan was a major factor in his selection, said Gary Brock, executive vice president and chief integrated delivery network officer at BS&W. “Using health information from electronic health records, claims information and merging those elements for patient care — it has very exciting potential to better serve our members and patients,” said Brock.
A provider-owned health plan has more flexibility than large payers who are not set up to modify reimbursement approaches.
Hinton refers to a program in place when he left Presbyterian Health as a hallmark of health plan innovation. Working with researchers from Johns Hopkins University, the hospital piloted a program in which physicians were able to admit patients to their home instead of the hospital for certain diagnoses.
“We saw lower infections; people didn’t trip and fall because they knew where the bathroom was, and it cost about $2,000 less for an admission to the home versus the hospital,” said Hinton. “So higher quality care and lower cost – the mantra of health care.”
The pilot program changed what was traditionally considered “at home” care. Yet, while Medicare and commercial payers acknowledged the impressive results, implementation was inconceivable.
“They would say, ‘this is a great idea, but we don’t know how to do it or code for that’,” said Hinton. “So, we went to our own health plan and they said ‘bring it on’.”
Hinton sees BS&W’s health plan, Scott & White Health Plan, acting as an innovation lab, where new compensation models are tested and rolled out.
“We have great relationships with the big payers, but we need payment innovation at the same time as service innovation,” said Hinton.
Medical Care Next to the Bread Aisle
Affordability means doubling down on non-traditional services such as telemedicine, clinics in supermarkets and shopping malls, and “micro” or smaller-scale hospitals.
“We’re looking at how we can better serve our members and patients when they want to be served and where they want to be served,” explained Brock.
Despite BS&W’s more than 1,000 care access points across Texas, there are still big health care gaps, particularly in rural communities.
“Providing medicine in lesser populated areas is a real challenge but something we have on our radar that we can and would like to provide,” explained Jim Turner, chair of the BS&W Holdings board of trustees. “How do you improve quality and reduce cost? It can be done, but it’s not easy.”
He says that BS&W has taken some steps to address access in rural and suburban areas by establishing clinics that take care of 90 percent of the needs versus “full-scale hospitals”.
While these lower fixed-capital access points may help bridge some care gaps, Hinton sees transformative change necessary to achieve that affordability aim.
In a typical patient–provider relationship, “access” generally flows around a sequence of events — make an appointment, drive to the doctor office, sit in the waiting room, visit with the doctor, go home. On the provider side, each physician has an exam room and sees a certain number of patients per hour.
“This same model has been in place for the last 50 years. What other industry is operating the same as it did five decades ago?” asked Hinton.
He points to Uber as an example of an organization that transformed a high fixed-cost industry to a low fixed-cost industry. Central to the change was technology.
“Maybe instead of going to the doctor, you use technology to interact with the doctor. So, you’re delivering quality care but need fewer offices and clinics,” said Hinton. “I think there is huge opportunity there.”
Will offering wellness checks next to the bread department or with a doctor via a video session help to unshackle providers from a fee-for-service model to one based on quality and affordability?
Brock believes convenience is a good bet and, along with Hinton, that it comes down to meeting patients’ expectations. “We hear a lot about waste and often that’s because folks are not getting the care they need when they need it.”
As Hinton leads following his predecessor’s strategy to address the patient continuum dynamic, BS&W will continue to explore how to effectively deliver that care in a cost-effective and competitive way – all while meeting patient needs.