Managed Care - November 2008 - (Page 41)

portant have the efforts of the company been compared with the efforts of the health plans you contract with? SEPULVEDA: We brought our health care partners to the table to describe what this new environment was and to tell them that we expected them to be extremely aggressive in this area. I make a couple of points to all of our health plans. The first is, “Don’t walk in here and tell me how much money you are going to save me. I don’t want to hear that. What I want to hear is how you are going to help improve the health status and the experience of our beneficiaries.” The second thing I say is, “You see these other guys sitting around the table? They’re not your competitors anymore. They’re part of the team that is going to work here with me to accomplish specific goals. We’re all partners and we’re all equal.” That made a lot of people very uncomfortable at first, and some people lost our business as a consequence of their inability to function in that fashion. But if they were able to work with us, they could then go out into the market with some very innovative ideas. MC: So what have health plans and other companies learned while working with you, and what has been the propagation of those ideas throughout the market? SEPULVEDA: Well, I’ll give you an example. Five years ago disease management was very new in the marketplace. Disease management firms were fledgling companies, and many people doubted the benefit of being able to provide this service and realize both health and economic benefits. It was my view then that this made all the sense in the world for the subset of our population with the highest needs for health care and with the highest per capita consumption of care, so we sought a partner to provide the kind of condition management that we envisioned. We then put a lot of our own expertise along with Matria’s for research, development, and execution. Matria Healthcare is now part of Inverness Medical Innovations. We’ve become a very desirable client to work with because we have all of these ideas that our partners end up taking to the marketplace. So we’ve set up a different set of ground rules for our relationships with insurers and other partners. It hasn’t all been smooth — we’ve had a lot of bumps in the road — but we have done a lot of things that have benefited IBM and our partner companies. MC: What current projects are in the early stages now and might turn out that way? SEPULVEDA: You’re asking what’s going on in the R&D lab right now, and because it is an R&D lab, I can’t talk about everything. But let me tell you about a very powerful game changer we’ve been working on for the last three years. It was based on an observation that was so simple and obvious that I was embarrassed when I started to talk to people about it because I’m an internist, a specialist in primary care and public health. When you look at the health of populations and ask, “Who does well?” and “Who doesn’t do well?” and “What are the characteristic environments in which people tend to do better?” one of the recurring themes is that health care systems that are more balanced in terms of primary versus specialty care do better. People have been tracking this for decades, and those populations did better 20 years ago and they did better one year ago. They do better every time. Health outcomes are better, costs are lower, and people are happiest with their care in strong primary-carebased systems. That observation led to IBM talking directly to the primary care provider community about a new form of primary care. There was an enormous amount of synergy between what we were interested in buying and the kind of care they wanted to provide. Those conversations were the spark, if you will, that catapulted the patient-centered primary care reform initiative and the primary care medical home concept that you’re hearing so much about now. That’s another example of working with partners — in this case with their ideas — in a way that benefits us and benefits them, and in this case the “them” is not just the care providers. It’s the health care system in general. MC: I can see where primary care physicians would have been receptive to your pitch. SEPULVEDA: Quite frankly, three years ago no one was listening to the primary care physician organizations because they were erroneously viewed as just wanting higher levels of reimbursement. Their story about transforming primary care practices was lost. Our partnership NOVEMBER 2008 / MANAGED CARE 41

Table of Contents Feed for the Digital Edition of Managed Care - November 2008

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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