Scaling Value-Based Care Through Strategic Partnerships with Shelby Decosta

- There's a version of AI in health care - that lives mostly in press releases, - pilot programs, partnership announcements, - theoretical - use cases. - And then there's the version that lives in - the work, the CIO trying to get a - model into production without breaking a dozen workflows, - the revenue cycle leader weighing automation against accuracy, - the CISO who knows that every new integration - is a new attack surface. - Becker's eleventh annual IT and revenue cycle conference - is built for the people doing that work.

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- This is Laura Dierdo with the Becker's Healthcare - Podcast. I'm thrilled today to be joined by - Shelby DeCosta, senior vice president and chief business - development officer at Kaiser Permanente. - Shelby, it's a pleasure to have you on - the podcast today. Thanks for having me, Laura.

- Absolutely. Now I'm excited for our discussion. I - know we're gonna talk about a variety of - things that you're doing at Kaiser Permanente, a - lot about value based care and some of - the different, - partnerships you've made over the last several months. - But before we dive in, I I'm curious.

- Can you tell me a little bit more - about yourself and and what you do at - Kaiser Permanente? - Happy to. So if I were to just - sum up my career, it's really been for - me about building partnerships that drive meaningful growth - in health care. And in fact, my career - began right here at Kaiser Permanente.

My first - professional - exposure was as an intern - in the Southern California Permanente group. - And when I think about the partnerships that - I worked on back then, you know, just - having finished school in Los Angeles, - it was all about how to work with - physicians as partners - to increase access - and to meet our members where they were. - So, that was really formative for me early - on and I took that into - what was then Catholic Healthcare West - and, - was in the transition to becoming Dignity Health - for the purpose - of partnering with others more broadly.

- And a lot of the work that I - did in strategy there had to do with - growing our ambulatory presence, you know, working with - ambulatory surgery operators, - starting imaging - companies, working with academics, - building - physician foundations - and partner models, - and that was a lot of fun. What - I realized was - for me, it was not just about the - transaction itself, which is, you know, probably one - of the best - and most creative parts of strategy, but it - was also about the people that were behind - the organizations - leading that work and driving to make impact - in the communities.

And so that story sort - of unfolds, you know, from what was then - dignity. I moved to Trinity Health, - where there was a pretty significant - mission that we - had, which was to save Catholic health care. - I think even today, - you know, forty percent or so of hospitals - are at risk of closure. - That's been the case for a while given - all the pressures and so at Trinity, I - worked really on bringing - like minded - organizations - into - a system of care where they could, - drive efficiencies and and bring scale to benefit - those communities by keeping the hospitals open.

- And then I had a different experience going - to UCSF on the academic side. You know, - similarly, their mission - was really to work on the most difficult - cases and to continue research, continue training, and - they needed to have a network of patients - to access. - They couldn't possibly do it all on their - own. And when UCSF looked around, - there were several community health systems throughout the - Bay Area that really were like minded.

- And so I spent my time building that - network - of care to really expand their mission and - create more - tertiary access - for the Bay and for the West Coast. - Now at Kaiser, it's sort of all of - those things. So, you know, I lead business - development here, which means I'm focused on - helping Kaiser expand our mission, which is to - improve the health - of our members and the communities that we - serve. - And a big part of how we're trying - to do that is through partnerships.

- So partnerships - with other health systems, partnerships with community, - partnerships with other providers, - and and also partnerships in our investment space - to make sure that innovation continues to thrive. - And so, - it's been almost two years here and I - think it's been a great, great ride for - me so far in just, you know, determining - how we can actually bring some of these - goals to life for ourselves and for partners. - I love that. I think being able to - have that partner focused mindset, really brings a - a lot to the organization and then it - continues to drive value overall.

And speaking of - value, I know value based care has become - one of the most talked about concepts in - health care, but it can mean different things - to different people. - When you hear that term value based care, - how do you define it? And just as - importantly, what do you think people get wrong - about it? - Yeah.

It is definitely a popular term and, - you know, I think - everyone means something different when they talk about - value. For some people, it's just a payment - model. It's just a risk arrangement - or it's a contracting strategy. I think for - us, you know, for Kaiser, we kind of - boil it down to - it is health care delivery that is simple, - which we know in a lot of cases - is not what - patients experience in trying to access care.

- It's affordable - and because we know that's one of the - biggest barriers to actually getting in - to - any of the appointments that you need or - care that you need - and it's evidence based which I think is - really critical. You know, one of the things - that we are very centered in here at - KP is exactly - what, - care pathways are proven and have shown results. - And then, you know, it's equitable, which means - everyone gets the specific care that you need. - And for that to happen, - the health care system actually needs to know - who you are.

And so as we think - about value based care, it's those components - that for us at the end of it - are about keeping people healthy - and getting them to the right - place at the right time. And then it's - much more about how we make sure all - the incentives along the way are aligned - from the payer to everybody who participates in - that care. And I think that's something that - we are uniquely positioned to do because of - how we're structured at KP. - That makes a ton of sense.

And, you - know, really cool to have an understanding of - all the different ways that one can define - value based care, but then really narrowing into - the ways that you think about it and - how, you've been going about developing that strategy. - I know for years Kaiser Permanente has demonstrated - value based care delivers measurably better results and - lower costs. If the real challenge now is - scaling that impact beyond your own system, how - are partnerships helping you bring those principles - to more communities without simply trying to replicate - the Pfizer model?

- Yeah. You're bringing up a good point, Laura. - We've been doing this model of care for - eighty one years, - and - this model - works. Right?

I mean, when you look at - KP - compared to the outcomes that are present in - in other insured groups, - our members are twenty percent less likely to - die prematurely of cancer, thirty three percent less - likely to die prematurely of heart disease, you - know, thirty five percent lower mortality - overall. - And so as we think about our partnerships, - it is how do we get those same - outcomes - by really bringing the best of what KP - has - and the best of what others have.

And - and the goal is not really to make - everybody - Kaiser Permanente, - but it's to figure out for each community - how can we express those outcomes? - How do we bring, you know, what I - mentioned the evidence based protocols? I think we - have over 9,000. - How do we bring that to other like - minded organizations - so that we together can figure out how - that works?

And it's different. It's different in, - you know, the way that we work with - health systems. It's different in the way that - we think about new organizations - and new companies that can still get to - those outcomes and we're flexible. - But at the end of it, we wanna - make sure that those outcomes are really what - we're expressing - in partnership and one of the things that - we found is there are many many other - systems, - other providers - across the country - who think about value the same way that - we do and so I think there's huge - opportunity for us ahead.

- I love that. And, you know, really exciting - to hear all of the ways that you've - been able to shift and grow and find - those partners who make a lot of sense - for you and then think about what's gonna - be impactful in their communities as well. So - let's talk about the different ways that you're - approaching this and starting with Kaiser Permanente in - Nevada. Can you tell us a little bit - more about the Renown Health Partnership, why that's - significant, and how, what other organizations can learn - from it?

- Absolutely. We are so excited about the Kaiser - Permanente partnership, - in Nevada that we have with Renown Health. - You know, stepping back, Nevada's - been a region that Kaiser Permanente has really - wanted to serve. - And actually, one of the places where we - have received the most calls from employers, - from former members to say, can you bring - the integrated care that we know and love - to this region?

- But the bottom line is to do it - on our own would take a lot of - time - and would take a lot - of resource and, you know, as part of - our mission, we're really trying to think about - how we bring affordable care. - We got a call from Renown Health understanding - that they were looking for a partner - for their, health plan called Hometown Health. And - that was really intriguing to us because as - we studied Hometown Health and looked at what - they were doing, they were a high quality - plan.

They had been around, you know, since - the early nineties. - And really, what they hadn't been able to - do was bring all the capabilities - to that plan - for the benefit of the members in terms - of digital capabilities, you know, national network and - all the things that a national plan does - have in place. And so we saw a - good fit between the capabilities that exist here - at Kaiser's National Health Plan and what they - had already done with great quality and great - member satisfaction.

- And basically, - we broke down what the whole member experience - was like - and who would be best served to provide - each part of that member's care. And so - I talked about, you know, on the health - plan side, lots of capabilities. - There was also a great team at Hometown - Health - that, - had done a lot of work to put - infrastructure in place. They're continuing on as we - have launched - our partnership earlier this year.

- And then we looked at where are all - the places - that these members receive care within the Renown - system and made sure to keep that as - part of the experience. So while this is - a joint venture plan between Kaiser Permanente and - Renown Health, all of the hospital care is - still provided by Renown Health. - Much of the outpatient care that, was provided - before this partnership remains in place. - KP is bringing more primary care to the - market, which is something that it needs.

- And then we're working with the renowned medical - group to provide specialty services in new medical - offices that we set up. And so it's - really a joint collaboration - around what both organizations - have to offer. And then in each of - these settings, we have joint operating committees that - help to coordinate the care and ensure that - those same outcomes I talked about earlier will - be expressed - over time for this population. - You know, it is, - it is a work in progress for us - to really bring all of the capabilities - together and we're still working - on really making sure all of our systems - talk to each other so that also these - members when they're traveling to other KP regions - can access KP care, which is something that - was really important to Renown as they were - seeking a partner.

- We're moving quickly. Our medical offices are going, - live now, - and we'll be ready with the KP - fully branded, - fully integrated product as of January 1. - That's incredible to hear. And one huge accomplishment - in being able to bring all those parts - together and then, you know, have a a - really meaningful product to launch in the Nevada - market.

And I know Nevada isn't your only - approach. So, - you also have Habitat Health and Resent Health - as well. How should people think about all - of these efforts? How do they all tie - together?

- Yeah. I think the way to think about - them is, you know, there are multiple pathways - to get - to the outcomes - that we all want for everyone, for ourselves, - for our members, for our communities. - So, you know, the keeping up out of - model is one way. It's really centered on - working with a like minded - high quality organization.

- You know, Habitat Health is a little bit - of a different model in that - we looked within Kaiser Permanente and saw that - there were vulnerable - elderly members - that were not getting the precise - level of care that they needed from our - current system. And so we built a best - in class PACE program, you know, with Town - Hall Ventures called Habitat Health to really focus - on this vulnerable population. - And the results have been absolutely amazing even - early on where we, today just have two - centers that are live.

- Those same members are getting day to day - care that have significantly, - you know, increased their compliance - with their care regimen and decrease their readmissions - to the hospitals. - We love this model because, you know, in - the same way that in Nevada, - we maintain access to the renowned hospitals for - those members. - That's what we're doing here within Habitat Health. - So even though a lot of primary care, - physical therapy, - specialty care is happening - within the Habitat Health system, - if those members need hospital care, they are - still - coming back to Kaiser Permanente, the hospital that - they're familiar with, and they're seeing the specialist - that they're familiar with too.

- So we're looking not just, you know, at - new populations - and new communities that we can better serve. - We're also looking - within our own membership to see what else - we can do to better serve their needs. - And then you mentioned Rizent. We're really excited - about Rizent.

You know, it's a newer part - of Kaiser Permanente. - And that model is really about - how do we support those - community health systems - that see, you know, everyone through their community - from all payers - in doubling down on value based care. So - Geisinger - Health in Central Pennsylvania was our first member. - They've, - implemented a series of different tools and capabilities - that's already bringing benefit - to both the members of the Geisinger Health - Plan, but also members of the community.

- We're bringing our, you know, care without delay - program that helps to get members and patients - in and out of the hospital into the - right setting as early as possible. - We have navigation tools for primary care - and for patient directed care so that we - can enable - and more appropriate direction of care in a - faster way - and eliminate what tends to be long wait - times and so some of our capabilities - have driven down - demand for specialty, - demand for inpatient care, - which really means, - not that that care goes away, - but that the people who need it can - get in sooner, because we know there's an - incredible amount of demand for all parts of - the health care system.

- And then Cone Health is our second member - for Ryzant Health. They're in Greensboro, North Carolina. - They're seeing similar results as we're bringing our - value based platform - to the rise in orgs. And the goal - for us really is to get to, you - know, five or six systems over the next - couple of years so that we can have - a meaningful impact on millions of lives.

- The criteria for Verizon is pretty stringent and - so there's a short, you know, list of - health systems - where this model makes sense. - But what we love about it is we - are able to work with systems - that are very connected to their community, - that are actually helping us think about how - to serve broader groups than just our members - and translating - many of the things from KP that have - been successful into these new communities. So we - hope to share more about the future members - of RISE and Health two, - but we are we are making great progress - with the two, - founding members for Verizon.

- That's great to hear. I know it's been - so fun to see Verizon grow and develop - over the years, and, - certainly, we'll be excited to hear about what - comes next when the time comes. - Now, for organizations that are listening to this - conversation, what qualities do you look for in - a potential partner? - Well, for partnership, you know, across all, - dimensions, I think mission is where we start.

- You know, what is this organization - looking for? And does it align with what - we are hoping to do, which is improve - outcomes, - affordability, - and community health? There are so many wonderful - systems across the country. - And as we have these conversations, we're seeing - a lot of alignment.

- We're also looking for those systems who are - willing to do the incentive alignment - and to embrace accountability for what this means - long term. And and a lot of that - becomes very obvious. Right? These are the organizations - that are known to be the leaders - in their communities.

They're the highest quality - organizations and in many cases, they are the - systems that have invested - across the continuum. You know, they have a - robust primary care - network. They have specialists. They have ambulatory - and post acute care services.

- And so then what the Kaiser Permanente partnership - can do is help them to tie all - those pieces together and to further align - all of the care under - a payer model - that, you know, help allows you to do - the right things long term. - And again, as we think about - what we're looking for in terms of doubling - down on value based care, - it's not about turning these organizations - into Kaiser. In fact, we often - shy away from that and we'd prefer to - lean into the local brands where there's much - more, - value already inherently there in the community.

- But really thinking about how do we look - at the opportunities - that they have - to accelerate - value, to accelerate, - some of those outcomes with the capabilities - that we have. - That makes a ton of sense. You know, - it really gets back to health care being - local and and what an important asset is - the community, - and the brain share within those organizations. - Now what have these partnerships taught you?

- Oh, so many things. I think, you know, - as we - are spending more time in partnerships and reflecting - on the ones that have gone very well - for us, I think it's a couple of - things. As long as you are still committed - to your mission, there are things that, you - know, may need to change - between the day to day operation. And so - having - core leadership structures, whether that's a board, whether - that's a steering committee to help shepherd that - is really critical, - especially when you're thinking about long term partnerships.

- I think aligning incentives in critical is critical. - We talked about with, - Kaiser Permanente Nevada, the need for a long - term payer contract. You know, this is a - multi decade contract. That means - we are jointly looking for the same - outcomes versus thinking about - transactional - value in short term, tranches.

And so - thinking about what that means in some of - these relationships and articulating them to ensure that - we are both aligned is really critical. - I think the other thing is, - as we design the partnership, we have to - be really thoughtful about what it means to - operationalize - it. And so I mentioned again, in Kaiser - Permanente Nevada, we know there was a need - for more primary care. We had to think - about how we do that, but how we - connect it to the rest of the system - of care that already exists.

Some of that - is, you know, through technology, - but some of that is really through conversations - and getting the right people - at the table together to help make those - decisions. - I think, - leaning back into - evidence based care is really critical and bringing - some of those - elements into any partnership - and then making it really simple both for - the clinicians that are providing care and for - the members that are accessing care. - Those are all critical to having a a - partnership that works.

And then we've also learned, - you know, we really need to trust each - other. These are big decisions - with the potential for significant - outcomes. - And so having that shared accountability, - knowing who's on the other side and the - type of organization - accepts us up for long term success, - reflecting on the shared purpose, and then regularly - communicating - not just, you know, what the deal is, - but what the impact is and what we - need to do better together. - We're excited to continue to have this journey, - you know, with Verizon, - with KP Nevada, - with some of our other health system partners - in the KP regions and to keep iterating - together.

- I love that. I I think it's so - helpful to understand the partnership and and really - what it means to you, - to take what exists and then make the - strong part stronger, - innovate where it makes sense. Now, before we - wrap up here, I just have one more - question. If you could leave health system leaders - with one message, what would it be?

- I guess the takeaway message for me is, - you know, as as KP is expanding, - we don't believe every organization - needs to - be Kaiser Permanente. - But what we do believe is that value - based care - is the right way to impact - health outcomes - in communities and so we're open to the - ways that we think about how to deliver - that. You know, we've given examples here today, - Kaiser Permanente Nevada, Habitat, - Horizons, - and the message is that we believe this - collaboration - is really powerful - and that there are opportunities - to partner.

And if we do so, we - think we can - get, - to these outcomes faster, - we can lower cost, and we can bring - the benefits of value based care to more - communities who deserve it. - I love it. Shelby, thank you so much - for joining us on the podcast today. This - has been such a fun conversation, so informative - and inspiring too to hear about what you've - been doing and what you see in the - future.

I look forward to connecting with you - again soon, and we'll have to keep the - conversation going. Thank you, Laura.