Healthy Days at Home: Dr. Bob Wanovich on Partnering with Post-Acute Care Providers

Nick Stupakis: Welcome back to Healthy Days at Home. I'm Nick Stupakis, vice president of Helion. Here today with me is Dr. Bob Wanovich. Bob, where should we start? Ten years ago, can you believe it's been 10 years.

Bob Wanovich: It's hard to believe, really hard to believe.

Nick Stupakis: We got jammed into a meeting together. Tell me your recollection of that meeting.

Bob Wanovich: Yeah. You know, when I think back, it was clear that we had really no knowledge. So I work on the health plan side of our business. Obviously, we have a provider side of our business and we started collaborating. And it was clear that neither side really had insight into the post acute space. And, you know, out of some of those initial discussions, it was clear that we needed to bring in people that actually could help us understand that part of the business that part of care delivery, so that we could engage better and, and so, you know, part of what I was thinking was, hey, here's this guy. You know, I hope he knows what he's doing. And he's getting a job because we don't know what we're doing.

Nick Stupakis: You know what I was thinking? I was going to that meeting with so much confidence because I knew so much about post-acute care. And then I wrote down so many words that I had no idea what they meant that I had to go home and Google them. And I was like, I know nothing about health care. I don't know anything about the payer. So, I think the best thing that they could have done for us back then was pairing us up somebody that had deep health plan knowledge, somebody that had deep post-acute care knowledge and saying, ‘okay, you have to build a comprehensive strategy that's going to meet the needs of our enterprise, but also the needs of the provider network.’

Bob Wanovich: Yeah, that's amazing. I mean, you know, had the same thinking right, what a great collaboration. I learned so much along the way, right? From that early, you know, meeting and every day after that, really digging in, and attempting to manage a space that we hadn't paid attention to for a really long time, unfortunately. But you know, I think we, we rectified that quite well. And I think we've made, you know, amazing advances both on the payer and the provider side through our work and the collaboration with the provider community.

Nick Stupakis: Take me on that journey a little bit. So, if you were to think back now what would you say our network was of post-acute care providers, and then what's the thing that you think really changed that to where we are today?

Bob Wanovich: Yeah, our network was really, we kind of ran it like an any willing provider network if you met our credentialing standards, and you're willing to accept our standard contract. You were in our network. And then we really didn't have much to do with you. It was a transactional relationship. We talked about that. And that's not the best for our members or our patients. And so you know, what happened very slowly, but, over time, was that as we started engaging with the providers, and learned more about what their needs were, about what the issues were, from somebody transitioning from a hospital to the post-acute care space and sometimes through multiple points to going to a skilled nursing facility and then maybe a home health service. You know, we learned a lot and then we started adjusting, right and adjusting not only how we thought about our network, but how we interacted with the providers, how we thought about managing that space utilization management, prior authorization, how we thought about paying for those services, right? And so, we slowly transitioned almost every component of that relationship. And I think, it helped to sort of feed it and serve it with data that nobody had. We didn't have insight from the provider. We started learning what their needs were and understanding them. We started feeding them information back that they didn't have. You know, they didn't understand the readmission rate for their own patient population. And once they started to see it, it created transformation, which, you know, for me is exciting because that's really a big part of the mission of our company, is to transform healthcare, make it more affordable, higher quality, and a better experience for both the provider and the patient. And I think we've done that. It's taken a long time. But I think we've actually accomplished many of those goals, and we continue to evolve and get better. So it's exciting for me.

Nick Stupakis: So funny, I think back to some of those original meetings whenever we first you know, we were just starting to bring out scorecards and figuring out how to have provider facing analytics and share the data with them. And I remember bringing in the providers and them saying to us, you know, ‘come present to us and they would come to us,’ and they'd say, you know, ‘we're taking everybody,’ they said. ‘We're taking the sickest patients. We have the best quality of care and our readmission rates. I don't know how this happened.’ Everybody's readmission rates were 7%, right? And we would bring the data out and we would say, ‘well, that's kind of funny because your readmission rates are actually 40%. Like how do you derive your readmission rates because we're looking at all cause for different hospitals.’ So I think that was, you know, the interesting thing was, it wasn't just a transformation that we were making. We were creating transformation in the provider network, and we were sharing tools with them to say, “We want you to come along this journey.’ I think for me, on the post-acute care side whenever before I came to Highmark, I remember I came right from the post-acute care side. And I remember like, somebody pay attention to me. Nobody was paying attention, right, like, but now I think one of the things that we've done that's the most transformative is paying attention. And these people were actually our partners now and they're going along that journey for us. And when I think about the work that you've always told me, and I'm curious to hear your opinion on this, how do those high performing networks right as you start developing them, tell me a little bit about that journey about developing those high performing networks? Because I think one of the things that I learned along the way from you was that we weren't just building a strategy that was like a point solution. We weren't just trying to fix UM. We weren't just trying to figure out better quality. We weren't just trying to figure out reimbursement. It was a holistic strategy to say we're trying to transform this space because that's aligned to Living Health. Tell me a little bit about how we, you know how we thought through building those HPNs. And what are your thoughts on that?

Bob Wanovich: Yeah, I think, you know, goes back to basically some common goals and objectives right? We should get the highest quality of care for our members. We should try to encourage all providers to perform better at the top of their game, right? That's what our patients deserve, our members deserve. And then the people that do should be rewarded, right? That's an important part. There has to be an incentive to be great at what you do. You should get rewarded and that's with more work right, you should get more patients. And so, it was really important for us because early on, what we realized is the hospitals didn't have insight of where they were sending patients. We didn't, we couldn't give them insight into what, you know, the capabilities of those providers were. Once we started sharing data, and having scorecards and developing networks, we could start sharing that information. So not only did everybody improve, right, and then we helped build incentives and payment plans to help support that right. But then the hospital started acting on that information too. They changed the referral patterns. So, the value to the member is good because they're getting quality care, but the value to the provider is they get rewarded with more dollars and more work, more patients to take care of. And that's exactly how it should work. The best people should get the most work and the most dollars and I think that makes it a sustainable model.

Nick Stupakis: You know what I love whenever I hear you say that, you know, when I first came here, I was always so confused because every time I said provider, I was talking about post-acute care provider, but everybody else thought I was talking about just about doctors and I love it. Whenever you say provider because I know because you're ancillary that you're talking about all of our providers that can create transformation.

Bob Wanovich: Yeah, well, you know, I'm, I'm a pharmacist by training. And so, I know the value of some of those ancillary providers. The people that aren't doctors and hospitals, right, but that are really providing and engaging with patients in a meaningful way. And they didn't know a lot about the post-acute space but I know about durable medical equipment and home infusion and you know, other and laboratory services. As I learned more about skilled nursing and inpatient rehab, home health, you know how valuable they are and how meaningful they are to somebody's overall wellbeing right and getting better and staying at home, which is a goal right? We all want to live and work and be healthy. And so, yeah, for me, it's really important for us to engage those providers at the large block of providers we talk about it and make sure they are seen and heard and getting what they need so that they do a great job. At the end of the day, our members, you know, get the value. And that's what counts. That's why we're here.

Nick Stupakis: So, you open the door for me to ask this. You know, you talked about your background in pharmacy, obviously always with your Duquesne ring on. Tell me about your how you got from being a pharmacist going to Duquesne what was the transition to the health plan and then coming over and saying, you know, I'm assuming that when you went to school, you weren't like I'm going to work at a health plan. Like, how did that transition happen?

Bob Wanovich: Yeah, there wasn't even a job at a health plan for pharmacists I don't think when I was in school. But I came out of school, I actually had a clinical program in a local hospital. I was a clinical pharmacist. I have my bachelor's and my doctorate degree in pharmacy. And I had a clinical practice in adult internal medicine at a hospital. And I transitioned away from there because a gentleman mentor of mine had started a small company a small startup that was taking technology, data and needed clinical expertise. And what we were doing was managing and looking at drug claim data and trying to optimize the use of drugs, pharmaceuticals, to help people right? And there was a lot of growth at that time in pharmaceutical industry and more people were getting access to medicines through insurance. And so a lot of insurance companies were interested in what we were doing as a small startup. And that led to work with the predecessor to Highmark, Blue Cross of Western Pennsylvania at the time. And so ultimately, I ended up taking a job as a clinical pharmacist helping to run some of the clinical programs. You know, what ultimately became Highmark through the health plan. And I had a career there and ended up ultimately becoming the vice president of that division. Because it's such a big company, we're trying to do so many things, it led to an opportunity for me to take what we did in pharmacy and apply that to these ancillary providers, durable medical equipment, and lab and home house and at home infusion and so forth. And I really jumped at that chance and it's been just, you know, a great ride ever since then.

Nick Stupakis: So it just makes me think through like, whenever I hear you talk about that your journey here Highmark, you know, my own personal journey, obviously, as you know, would have never expected that it would have kind of flowed from being a nursing home administrator to working in home health, and coming to AHN. And then obviously, Highmark and Helion, but we met and that was kind of the genesis of how we got to Helion, so as we started thinking about building the company, the automation that we were creating, you were instrumental in thinking through the automation and how we were going to do utilization management for home care. I'm curious, walk me through, if you remember, I don't even know what your that was now, 2015. Tell me a little bit about what our process was, what the thinking was, how we got to the place that we’re at. What's your recollection of that?

Bob Wanovich: Yeah. I remember, just trying to learn as much as we could, right? You were teaching me about what the provider’s view of the payer community was and what that relationship looks like from that side. And that was really helpful. But we also had to learn about what we were doing internally. And one of the things that came out really was clear that we had a very broken inefficient system to do prior authorizations for this kind of post-acute care. It was very manual, very time consuming for both provider and for payer. And I remember we actually really work hard to sell internally. The idea that we could automate this, right because people were saying, ‘well, wait a minute, it takes a lot of clinical knowledge and experience. I'm looking at a lot of data making decisions.’ But you know, so we had a lot of convincing to do, but we felt that that was a really important place to start. Because the providers needed to see that we weren't, it wasn't just about saving money. It wasn't just, you know, about us sort of pushing our way, you know, into the market. It was really about we were willing to change too to make things easier and better. And so, you know, the decision was let's start with the UM process and automate it, because it's, it's helpful to both the provider and the payer. And that, you know, as it turned out, we were lucky we were right. Not only did it work, but it gave us a forum that to talk to the providers and then do the next thing and the next thing and the next thing. So all of a sudden when we're talking about reimbursement changes or network management, it's not so scary because they began to trust you know, what we were doing and that we could get done what we said we would.

Nick Stupakis: Yeah, it's funny, because when I think back to that, those points, and I remember you and I having a conversation and you telling me, ‘Nick, everything just can't be the best for us. If it's not the best for the provider network, if we're not doing something to change their experience. How can you ever impact the member in the right way? If it's just we're just always the one winning?’ And I think for me, just being a post-acute care guy was one of the reasons that I came here. Right was because, you know, those, those conversations with you, those conversations with Dr. Reese, it wasn't always just about, well, what's great for Highmark Health, it was always about if we do things for the provider network, the patient's going to get better care. And ultimately, we're trying to get better care for our members. I mean, that was what sold me coming here. That was so important to me, you guys, you and Dr. Reese were both instrumental in that.

Bob Wanovich: I would say, look, you helped build a team of people that were out working directly with those providers every day. Right? And they created those relationships. That wasn't me. And so it was that combination. We weren't just saying it. We actually had people showing up at their facilities and meeting with them and sharing information. And it's it was, you know, it's really that team that you developed and help groom and put into the market and so, you know, it's great that we work for a company that has the resources and the ability to actually make those decisions and you know, put time and attention and money to actually transforming care.

Nick Stupakis: Just to be clear, I didn't do any of that work. That was Andonia, Monica, Carrie and Kim and others.

Bob Wanovich: They really made on a day-to-day basis, the change happened, you know, because they created those relationships and that trust and shared the information and then got the provider community to believe that change was possible. And it could be good for everybody.

Nick Stupakis: I mean, when you talk about transactional relationships when I was in skilled nursing, right, other national payers would come in once every other year. Right? They would send someone and they would ask a survey and then two weeks later, you find out if you had a contract with them versus a team of people that are coming out and saying, we're trying to raise all ships, right, we're trying to raise all ships and this network and we're trying to get better quality. We want you to be a part of that. Here's how you're going to help you. I think that's like the glue, right? That's like the thing that really created the transformation.

Bob Wanovich: Yeah, and, you know, we make it sound like it was all you know, fun and easy and smooth, right there was there was a lot of twists and turns and not everybody came along right at the same time. That's also the value of having kind of a network management component. Right? The people that didn't want to transform look, okay. But we're looking for people to raise their hands and say, ‘Yeah, we're willing to collaborate and change.’ Or, you know, we'll take a step toward you. You've reached out to us and that there was enough of those folks that really made a significant difference. And I look at, you know, the metrics now that we've been using since 2015. And you know, readmission rates and unnecessarily ED visits and, you know, length of stays and just overall, you know, health of the membership. All those metrics have shown great progress, and great quality of care. And so that's the kind of thing that's why come to work every, you know, that's what I'm proud about.

Nick Stupakis: So it's interesting, so, you know, I think of careers in chapters. Right? Like, I think about my own career. You know, obviously, prior to healthcare, I had a chapter and then the skilled nursing and then AHN, and now we're where I'm at Highmark and Helion. When you think back to this chapter that we just put together for the last six years, is there one thing that sticks out for you that you're gonna be like, I'm gonna remember this when I retire. I'm going to think this is the thing. I'm gonna look at that chapter and say, this is the thing I did.

Bob Wanovich: Yeah, you know, it all comes down to sort of these moments where you realize something is changing. And it was it was two things, you started to mention. It was a meeting that we had with a provider who was you and I, and when we presented information that they weren't sort of quite ready to accept that their readmission rates were much higher than what they thought they were. But the response was, ‘I'm going to get to the bottom that. I'm going to make this change immediately.’ The person took it very seriously. They knew we weren't there to beat them up that we were trying to help but we needed them to understand that they weren't performing nearly as well as they might have thought they were. And you know that they couldn't manage without that information. Once they had it, they pivoted and they said we're going to do it. I knew we had something when they took it seriously, and they made changes and guess what, every quarter thereafter, there was improvement. So, it was real. The other thing I remember your team came back that we were having a meeting it was a follow up in the scorecards were out there and the latest round of scorecards had come out. And a particular provider, the story was in the room was that the provider had exceeded all their goals and ended up being sort of at the top of the, one of the best in the region, the scorecard and there was a picture they had blown up the scorecard poster size and put it on their wall and had a celebration with their team. And then that's another moment when I just it'll stick with me because my thought at the time was this is a success. This works. They're really doing it. This is transforming people are taking it seriously. And it's working there. There's real change happening. And it's not just me being proud of it. The providers are proud of what they're doing. I knew we had something when that happened.

Nick Stupakis: It’s so funny because I know both of those situations. I remember the first one was a homecare agency. He called me that night after the meeting and he was like, emotional, like apologizing to me. And I was like, no need to apologize to me. That wasn't the intention in that meeting. We weren't trying to beat you up. We're trying to help you get better. And the second one is the other part of that story, the second one was, he had the local newspaper come and they did an article on him. And then we were like, I don't know if we're allowed to like it, like showed our scorecard in the newspaper and we were like, ‘wait a second, I don’t know if you can do that.’ But he was a great.

Bob Wanovich: But it's okay. You know, it made it very, very real. Right ? wasn't just a strategy anymore. We were actually changing care. The providers were changing care, we were helping them. Right? And so, I knew, you know, I knew it was successful and I knew we would continue to evolve the program and then look for other opportunities and we're continuing to do that it.

Nick Stupakis: It was important for me, Bob because, you know, everywhere you read right the nursing homes, or, you know, the problem, right. I think our answer was that's not accurate, right? Like we wanted to be a partner with the nursing homes to help them get better, because ultimately our members need them. But our members need to go to those settings. They need home care, they need skilled nursing. And so you know, this is a place where we have to partner and I think that's why skilled nursing facilities appreciated it because it wasn't it wasn't normal behavior for managed care plan to pay as much attention back then. Now. I mean, obviously it's like BAU like our relationship with them, but it wasn't normal for Highmark, or any other managed care companies to pay attention in the way that we were especially back in 2014 and 2015. So, but it was all part of your leadership and you giving us a chance. I don't think Helion would be here today if it wasn't for you and your team because you've been our health plan champion. So appreciate all the effort and mentorship that you've given to me and appreciate you talking with us today.

Bob Wanovich: Yeah, great. Great to walk down memory lane with you.

Nick Stupakis: Thank you for letting me know that I was just that guy. I was your best option but probably your only option 10 years ago.

Bob Wanovich: It’s all right. It worked out. Thank you.