Care Reimagined: A Healthcare System's Transformation with Dr. Bruce Meyer

We are delighted to have Dr. Bruce Meyer, Executive Vice President and Western Pennsylvania Market President for Highmark Health Network, joining us today to present Care Reimagined: A Healthcare System’s Transformation.

Since joining Highmark Health in 2022, Bruce has been shaping and executing their payer-provider strategy in the Western Pennsylvania market. Before joining Highmark, he served as President of Jefferson Health in Philadelphia and held key executive positions at Thomas Jefferson University and UT Southwestern in Dallas.  

As a respected author, educator, and alumnus of the Physician Executive MBA program at the University of Tennessee, Bruce brings his vast knowledge of clinical services, academic leadership, and healthcare administration to our discussion today.

Obtaining an MBA from the Physician Executive MBA Program at the University of Tennessee 

Recognizing the shift toward capitation in healthcare payment models, Bruce sought a program focused on the business of healthcare. Pemba stood out for its focus on healthcare management, providing him with a sophisticated toolkit for navigating the evolving healthcare landscape. Their reputation instantly elevated his career prospects, opening doors to new opportunities and leadership roles.

Unanticipated Impact of the MBA Program

Organizational development was an unforeseen but critical aspect of Bruce's MBA experience. Through the coursework and its practical application, he gained insights into the importance of developing people within organizations. That realization reshaped his leadership approach, transitioning from a subject matter expert to a team-oriented leader. 

Addressing Unsustainability in Healthcare Economics

The presentation begins by highlighting the unsustainable nature of healthcare economics in the United States, emphasizing the commonalities among developed healthcare systems worldwide, including service providers, innovators, and administrators, each contributing to the functioning and expenditure of the system. 

Challenges in the Current Healthcare Landscape

Bruce outlines the current economic challenges exacerbated by disproportionate growth in government payers like Medicare and Medicaid, which cover nearly 60% of healthcare costs. Shifting the costs onto commercial payers due to funding shortfalls further complicates the landscape. Additionally, the influence of polarized politics and increased government intervention in healthcare exacerbates existing issues, contributing to growing public distrust in the system.

Transitioning Physician Employment and Financial Pressures on Hospitals

There has been a significant shift in physician employment, with over 70% now employed by larger organizations rather than self-employed. This trend, coupled with private equity funding disruptive models, has led to financial hardships for hospitals, with a substantial percentage operating at a loss. Public trust in healthcare is also eroding due to perceived profit-taking by various stakeholders, including pharmaceutical companies, hospitals, and physicians.

Factors Contributing to Escalating Healthcare Costs

Bruce identifies several contributors to escalating healthcare costs in the US, including technological advancements, inflated drug and device development costs, administrative inefficiencies, and end-of-life care expenditures. Moreover, physicians in the US earn significantly higher salaries when compared with their counterparts in other developed countries.

Addressing Waste and Inefficiencies in Healthcare

The considerable waste and inefficiencies within the US healthcare system encompass administrative, clinical, operational, and social determinants of health costs. Issues such as gun violence, obesity, and homelessness disproportionately burden the healthcare system, highlighting the need for a more closely integrated social safety net.

Disparities in Healthcare Spending and Outcomes

A comparison of healthcare spending as a percentage of GDP reveals the disproportionate spending of the US relative to other developed countries. Despite higher expenditures, the US does not consistently achieve better health outcomes, indicating inefficiencies in the system.

Transitioning Towards Value-Based Care

Bruce emphasizes the imperative of transitioning from a fee-for-service model to a value-based care approach. This shift requires bridging the gap between fee-for-service and value-based models, focusing on reducing unnecessary healthcare utilization while maintaining revenue streams. Collaboration between providers and payers, care coordination, patient engagement, and data-driven decision-making are crucial elements in this transition.

Continuum of Payer-Provider Partnerships

In the presentation, Bruce outlines a continuum of payer-provider partnerships, ranging from traditional fee-for-service arrangements to fully integrated models. That highlights the benefits of moving towards alignment and integration, where providers and payers share financial stakes and work towards a singular bottom line.

Case Study: Implementing an Integrated Model

Bruce shares a case study of implementing a fully integrated model, Living Health, to improve outcomes, member experiences, and cost efficiencies. Results indicate improved outcomes, cost savings, and a virtuous cycle of provider efficiency leading to increased insurance sales.

Addressing Incentives and Alignment

The presentation highlights the importance of aligning stakeholder incentives to drive desired outcomes. That involves redesigning workflows, leveraging technology, and shifting incentives away from pure fee-for-service models towards value-based care metrics such as patient experience and total cost of care.