Contributor: David Fogel, MD
To learn more about David, click here.
The Triple Aim - Improved patient experience/Improved health outcomes/Reduced healthcare costs
The Offer
What would you do if someone offered you $30 million dollars and a building the size of a small hospital to create a new model of healthcare? And the only string attached was to do it using integrative medicine.* That is exactly what happened to me and my wife, both practicing physicians, on a surreal day in February 2010. More nuanced and life-altering a decision than we ever imagined, we ultimately accepted.
True to our donor’s single stipulation, we structured an integrative health practice with three primary care physicians, a nurse practitioner, an acupuncturist, a chiropractor, a psychologist, a naturopath, a massage therapist/Reiki master, a wellness coach, and a yoga therapist. We embedded a Wellness Center into the space with classes and workshops geared toward healthy eating, movement, mindfulness meditation, stress reduction, and lifestyle change. We prioritized accessibility by rejecting concierge and membership models and by accepting all major insurance plans, Medicare, and some Medicaid. We established a charity care policy that covered primary care as well as those healing modalities not covered by insurance.
On December 31st, 2012 the entire lump sum of money and the building were transferred to our newly formed public, non-profit 501 (c)(3) named Casey Health Institute (CHI). And we were clear about one thing from the start, our model would fail, a certain casualty of fee-for-service reimbursement.
Were We Crazy?
In researching our model, we traveled the country for six months visiting many integrative practices - private, public, hospital-affiliated, and university centers. During our journey an unexpected and powerful message emerged. The integrative medicine world was surprisingly disconnected from the healthcare policy world. Collaborative, team-focused, value-based population healthcare, which seemed like a natural partner for multimodality integrative health, was strikingly absent from most integrative medicine conversations.
Survival
Early on we decided we would embrace rather than resist what was happening on the health policy forefront by leveraging those programs that could magnify the strengths of integrative medicine. We combined the low tech/high touch, lifestyle-focused integrative modalities with the information-intensive, high tech, population health focused approaches. We charged forward with a conviction that high performing, lean, collaborative integrative teams could bend both the cost and health outcomes curve. Value-based care, the Patient-Centered Medical Home (PCMH), Accountable Care Organizations (ACOs), and metrics-based risk sharing were our friends not foes. We marveled at the power of care coordination and its synergy with holistic, patient and family centered care.
Our plan to survive, our plan to thrive, was to energize and infuse integrative medicine with the strengths of value-based medicine. Then we realized an essential part of the equation was missing. Hidden in plain sight was the insidiously unhealthy culture of healthcare itself.
In 2013, The National Patient Safety Foundation’s report on the healthcare workforce safety warned, “Emotional abuse, bullying…learning by humiliation are often accepted as ‘normal’ conditions of the healthcare workplace creating a culture of fear and intimidation.” How could we ignore the entrenched medical culture I had experienced throughout my career as a physician? Even integrative medicine’s emphasis on balance, healing relationships, and connection couldn’t escape the ingrained hierarchical, fear-driven, competitive, cultural dynamics of healthcare in America.
Stalking John Mackey
In July of 2011, I heard John Mackey, co-founder of Whole Foods, speak at a conference about business in a way that I had never heard before. He used words like purpose, consciousness, caring, and LOVE as pillars that drive corporate success and profits. Shocked and compelled to know more, I stalked him for the next hour waiting for an opportune 30 seconds to give him my elevator speech about Casey Health. I succeeded, and, to my surprise, he talked with me for 45 minutes. That was the beginning of my belief that a sustainable business, even healthcare, could be done consciously, with integrity, and also be profitable. But seriously, Love?
Stumbling at first, without a template to follow, I researched and began incorporating the key tenets of Conscious Capitalism into CHI:
- Purpose, not profit, drives the organization.
- Stakeholder orientation prioritizes win-win relationships with all internal and external stakeholders.
- Conscious Culture and Management intrinsically motivates staff through autonomy, mastery, and purpose.
- Conscious Leadership with servant leaders who are emotionally and spiritually intelligent systems thinkers.
Was I Naïve?
Fortunately, I was also invited to the Conscious Capitalism CEO Summit in Austin, Texas. There I spent hours talking with and listening to CEOs of other successful Conscious companies like Trader Joe’s, The Container Store, Southwest Airlines, The Motley Fool, Panera, Nordstrom’s, and many more. Then I really started to understand the potential for “Conscious Healthcare” at CHI.
“You can find a wealth of data that shows brands that are Conscious Capitalists succeed… research [shows] that these brands’ investment returns are 1025% over the past 10 years, compared to only 122% for the S&P 500 and 316% for the companies profiled in the bestselling book “Good to Great.” Forbes online - Dec 4, 2013 “Only Conscious Capitalists Will Survive” Jeff King and Jeff Fromm
So slowly, bucking the historical healthcare trend, we introduced the Conscious Core Values of Transparency, Accountability, Caring, Trust, Integrity, Loyalty, and Egalitarianism (TACTILE) into CHI. We began shaping an organization where purpose and meaning drive performance, while trust and collaboration drive innovation. Conscious culture is the soul that elevates an efficiently run practice into a powerful healing experience for patients and staff alike. An experience fueled with a sense of ownership by stakeholders pioneering a new path together.
Will We Make It?
Money, policy, politics, and patient care are a volatile mix. Approaching our three year anniversary, we are just now able to plant our feet in the PCMH, ACO, and value-based worlds. In Maryland’s Wild West of healthcare, metrics based reim-
bursement is lagging behind other parts of the country. And, constrained by a still largely fee-for-service world, we are feeling the pressure of time. In the meantime, as Conscious Capitalists, our win-win stakeholder orientation has brought us a number of mission-aligned revenue opportunities with the potential to make us sustainable, even profitable while we bridge the gap.
Turbocharging the triple aim? We believe we are pioneering a potent formula by uniting Integrative health, value-based care, and population health. However, in the end, consciousness, purpose, meaning…even love may prove to be the true secret ingredients for healthcare transformation. Our once in a lifetime opportunity, made possible by Betty Casey and the Eugene B. Casey Foundation, has challenged us in fantastic and sometimes astonishing ways. It has also made us resolute to succeed.
Stay tuned.
Contact David at:
David Fogel, M.D.
Casey Health Institute
800 S. Frederick Ave.
Suite 200
Gaithersburg, MD 20877
www.caseyhealth.org
[email protected]
301.355.2021 direct
* Integrative medicine, as defined by the American Board of Integrative Medicine® (ABOIM) and the Consortium of Academic Health Centers for Integrative Medicine, is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing.