Scaling Value-Based Care Through Strategic Partnerships with Shelby Decosta

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Speaker 1: 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.

Speaker 2: Thanks for having me, Laura.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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?

Speaker 2: 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.

Speaker 1: 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.

Speaker 2: Thank you, Laura.