Dr. Jonathan Slotkin, Contigo Health: The Importance of Healthcare Investing and Value-Based Care

DocWire News: Can you provide us with some background on yourself?

Dr. Jonathan Slotkin: Yeah. Sure. So I’m Jon Slotkin, as you mentioned, Chief Medical Officer at Contigo Health, which is a Premier, Inc. company. And I continue at Geisinger, where I’m Vice Chair of Neurosurgery and Associate Chief Medical Informatics Officer. Thanks for having me.

Talk to us about the importance of healthcare investing.

Wow. Yeah, that is a broad but important question. To me, the differentiator of United States healthcare, and it’s not only United States healthcare, but I think it’s a key differentiator, is the innovation that we see in United States healthcare. The drive for advancement to help alleviate human suffering, improve the care of patients, members, families, and improve the health of society, and really start to get upstream with prevention. I think that investing, healthcare investing, is a critical driver of that innovation, because it aligns incentives, so that groups and teams and people, beyond just the government funding, which is important as well, but it aligns groups and teams and people really down that innovation path, I think, for the betterment of us all.

What is value-based care, and how is it shifting? 

So value-based care, really, when people think about value, the basic definition that we all know well is outcomes divided by cost. So that’s the value of the thing that we’re all trying to do, and certainly in care delivery. And over the last probably 15, 20 years, all of your viewers and readers would know a tremendous focus on improving all sides of that equation and particularly striving to improve the delivery of care and outcomes.

But I’ll tell you, the main thing I want to say about value-based care is that I’m worried about its near and midterm future. And the reason is, what I fear is that as we continue in and eventually start to emerge from the COVID crisis, almost all stakeholders are feeling, and I think saying, or thinking, more fee for service is the way out for them, and not disrupting it just yet is how they’re going to safely emerge. Because a lot of these stakeholders have been really beaten down financially in the last two to three years. And I think really, without any changes in the business model of United States, healthcare, they’re right, that they need fee for service to get back on their feet. So then what we’ll have, of course is legacy ways, high and expensive interventions, low and meaningful transformation, low in digital technology.

But I think for me, Rob, what COVID-19 has really underscored is that the transition to value-based payment models needs to be really meaningful and well beyond what we see now in value care, which is modest scale and pilot efforts that are, by the way, really important, and I’m not minimizing, but pretty modest scale and pilot largely driven by the government. So I think we need to think about, “How do we make these value care moves intrinsic in what we do and really making prevention and population health the focus?” And if interesting, we could talk more about even the bigger moves, like moving and changing the business model of United States healthcare that might help some of this.

Talk to us about the need for a new digital technologies, and the importance of compliance and adherence. 

Yeah, sure. Thanks. So this last 10 years, we’ve seen tremendous growth in digital health technologies, whether it be patient facing technologies, provider facing technologies, or things used business to business. And a lot of it, Rob, is just mirroring other verticals. We see this happening in banking, retail, hospitality, travel, the conversion to digital technology to assist in the things that consumers encounter, and to assist the people in the industry. And of course, healthcare is moving along those same lines. But I would say to you and your listeners, Rob, that healthcare is significantly behind these other areas and verticals and has a lot of catching up to do in the digital space. But I think there are a lot of folks leading these efforts in ways that are going to be meaningful.

And for folks that are interested in getting into this area or excited about it, I’d give just a couple pieces of advice, really, for all of us to think about, Rob, which is, one, we can’t just digitize broken processes. So healthcare, if there are aspects that aren’t working and then we make a digital version of that thing that’s not working, it’s still not going to work. And then also, I don’t think we should be striving, Rob, to just make digital replicas of in-person experiences. So telehealth being, “Hey, let’s just put a camera in Rob’s room, and then we’ll talk to him.” There’s so much more value that we’d be leaving on the table if all we think telehealth is, is putting a camera in the room. There’s a lot further value we can bring, and a lot of stakeholders are bringing.

And to your question about compliance and adherence, I think it’d leave it by saying, right now, digital health is in its infancy. There’s so much more to come. And as a consequence, from a quality measurement and outcomes measurement standpoint, it’s really, really early innings, Rob. And I think all of us working in this space need to work to make sure we take the good in conventional healthcare, and there is a lot, and bring it, but bring it further and bring it more in the space of quality measurement and outcomes measurement. And that’s something that we, over at Premier, are taking very seriously and thinking really hard about.

What impact did the pandemic have on elective procedures and routine screenings?

So this has been a really important factor that I know you all have been tracking, and your visitors and speakers talk about. And also, we at Contigo and Premier, for our large employer customers, our medium size employer customers, and for the industry in general, on the Premier side, we focus on very, very heavily. And I think what we’ve seen is consistent probably with what you’ve seen, that is that 2020 volumes were way down, and this was admissions, surgeries, ER visits, outpatient visits. But 2021 volumes, which have been rolling in, in the last couple of months, they were, in fact, on pace to be higher than 2019 pre-COVID volumes, really, probably just until Delta and Omicron brought them a little bit back down to earth. But nonetheless, in 2021, a lot of systems, and particularly the larger and medium and larger systems, had very near, in 2021, Rob, pre-pandemic levels of admissions, surgeries, ER visits, and outpatient visits.

But the problem, from a healthcare standpoint, but also from an operation standpoint, is there continues to be a couple things. There continues to be a lot of deferred demand. So folks that were waiting, putting things off, and you mentioned screening, Rob, which is critically important, and I’m glad you brought it up. So many of all of us deferred screening during the years of COVID, whether it was mammograms, colonoscopies, certain cardiac screenings, or lung screenings many of us need to pursue. The systems were saturated and focused on urgent care. Many of us were deferring it often for very good reason, or what we felt were very good reasons. And I think we all recognize that the societal cost of this may be quite significant and the individual cost as well, and I don’t mean financially, I mean to health.

So I call on all of us, and myself included, that whether it was that dentist thing you didn’t do for three years, and not minimizing dental care with your family dental clinic, critically important, mammograms, colonoscopies, and so many of the other screening modalities really recommended by the United States Preventive Services Task Force. I really call on all of us in healthcare to ease that return of people to those services and really ask and reach out to patients to meet them where they are and try to pull them in for those services.

So I think we all get that the next shoe to fall, that’s already falling, are the staffing challenges that the systems are seeing, and what the impacts of those will be. But as far as volumes, we’re seeing return. Now, we all have our breath held for the BA.2 Omicron variant, and what that’s going to mean for spring and summer, so we’ll see. But I think we’re starting to see closer now, absolutely, to 2019 volumes, Rob.

What are some key takeaways you would like to leave our audience with today?

Yeah. I think… First of all, I want to thank you, Rob, and the team for having me and our group. And I would say that, on the digital health front, which we talked about, the call there is that, first of all, it’s very early innings. And the companies in these spaces are increasingly recognizing the importance of medical leadership and expertise in this work. So your visitors that are providers, doctors, nurses, therapists, there are enumerable opportunities in these spaces to bring your expertise. So if this is a space you want to help shape, reach out, including the opportunities we have over at Premier and Contigo.

With respect to COVID, and I know you were sort of heading there towards the end as well, I think our breaths held, we’re all seeing several cities now, where waste water and sewage are seeing increases in RNA counts of COVID. So I just call on all of us to remain vigilant and mindful in whatever way that you do that, and not being prescriptive in what that means for people, but just that they think about that, because we certainly can have a return.

And I’ll leave it to say that in the area of investing, some of the spaces that I and many folks are most excited about, and not an exhaustive list, but most bullish about, one is musculoskeletal care. I think a really important area where the digital health space and the in-person health space are coming together, powerful ways, women’s health, critically underserved area from a digital health standpoint and investing standpoint, that folks like Chrissy Farr, Deena Shakir, and so many others are working to remedy. And if that’s an important space to you, take a look at those folks, and Alyssa Jaffee and others that are working really hard on this. And I’d leave it to say, behavioral health, a historically really underfunded area of investing and innovation that, thankfully, I think there’s an increasing recognition of the importance of that, and we’re seeing increasing dollars go towards those areas. So those would be the takeaways for me. And thanks so much, Rob and team for having me.