Risk Sharing to Improve Outcomes
Episode 445

Brian Fuller, Chief Executive Officer at Integrated Care Solutions

Risk Sharing to Improve Outcomes

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Risk Sharing to Improve Outcomes

Episode 445

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Integrated Care Solutions

 

Risk Sharing to Improve Outcomes with Brian Fuller, Chief Executive Officer at Integrated Care Solutions transcript powered by Sonix—the best audio to text transcription service

Risk Sharing to Improve Outcomes with Brian Fuller, Chief Executive Officer at Integrated Care Solutions was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Saul Marquez:
Welcome back to the Outcomes Rocket. Saul Marquez here. And today I have the privilege of hosting Brian Fuller. He is the Chief Executive Officer at Integrated Care Solutions, a post-acute care management company based in the Northeast that partners with physician groups, practices, and hospital systems to manage post-acute care under a variety of payment structures, including bundled payments and ACOs. He's a nationally recognized thought leader on the impact and importance of post-acute care in new healthcare reform environments, and a leading expert on care integration and partnerships development across the continuum, including evaluating and implementing new payment initiatives such as bundle payments and ACOs. This is the era of value based care and what he's honed in on is making value based care work, but also risk sharing programs. And many of you are… could be on either side of the coin there, you know, trying to implement a program at your hospital or maybe you have an innovative idea at your company and you're looking to provide unique solutions to hospitals. Well, today's conversation is going to be really interesting because Mr. Fuller has some really great insights and we'll be diving into those. He's author of publications in the American Hospital Association, NPR, U.S. News and World Report, Hospital and Health Networks and more. So I am truly privileged to have you on the podcast, Brian. Thanks for joining us.

Brian Fuller:
Yeah. Thanks for having me.

Saul Marquez:
So, Brian, talk to me a little bit more about the genesis of it all. What got you into healthcare?

Brian Fuller:
Yeah. So it's interesting. You know what? What initially attracted me to the industry was the balance between the skills, capability and experience of really running a business, which obviously healthcare is a business. However, it also has that altruistic side of it where you feel like that business has a purpose, a greater purpose, if you will, and that the things you do impact people, whether it's their quality outcome, their experience or their overall health and well-being in their life and what they aim to get out of their life. It's that piece of helping people that kind of keeps you grounded in the mission of the everyday, even though the intellectual and other challenges run very much like a… or any complex, multifaceted business.

Saul Marquez:
Yeah. And I totally agree, Brian. It's one of those awesome places to work where you can make a big impact and feel like you're having a positive impact on people. And so as you've spent time both on the provider side and also on the business side of healthcare, today is different. I mean, a lot of things are changing the ACA. It's been a while since it's been implemented. Some things have worked. Some haven't. What do you think is a hot topic that needs to be on health leaders agendas and how are you approaching it?

Brian Fuller:
Yeah. So there's lots of them. You know, that's the complexity of healthcare right, whether it's reimbursement changes or staffing challenges, investments and technology, the push to quality and value and how to pay for that. There's there's no shortage of things that are on health system leaders agenda. The one that I think touches closely to what I spend my day doing is really this pursuit of value. And how do you define value and how did the payment mechanisms follow that definition? The analogy of post ACA was, you know, one foot in the canoe and one on the dock. And unfortunately, as we sit, you know, almost a decade later, we haven't been able to move either foot. We may be stretching a little bit further than we were eight years ago, but most every health system leader I know still balances that reality every day of one foot in the canoe and one foot on the dock. And it's a challenge in it. And it permeates every aspect of strategy, operations, financials, you know, the entire model that makes health care work. If it leaves no stone untouched in that transition. And so, you know, the good part about that is it's challenging and it's it's interesting. It makes the work interesting. The hard part is, you know, I think for many in healthcare, we're kind of ready to move one of those feet, if you will.

Saul Marquez:
Yeah. Yeah. And that's on point. And what do you think? I mean, where we're going to go? Well, if you had a crystal ball, what would you say is the direction are we going to put both feet in a canoe? Are we going to take that foot and put it back on the back?

Brian Fuller:
Yeah. Yeah. So I think we have to put both feet in the canoe. You know, one, we can't afford healthcare at the rate that expenditures have been growing over the last decade or so. And then secondly, we know we have the demographic shift occurring, which is going to make, you know, the total healthcare spend go up even if we don't do anything more efficient. And so that double edged sword, if you will, that more people are entering the system and per capita spending isn't going down. It may be slowing, but it's not going down. Just creates an economic reality where there aren't enough dollars to come out of the budget that we would need to afford healthcare at its current rate. With what we've got facing us in terms of demographic shifts. Having said that, I give several talks throughout the year. I was in D.C. last week actually discussing post-acute care policy, what the long term care pharmacy group. And you know, one of the slides I like to show most recently is, you know, why is today any different? I feel like we've become a little bit immune to the term value based care or value based healthcare, you know, we've heard it now seven or eight years at most, every major industry conference or meeting. And so you get a little bit immune to hearing it in the background. And so I like to point out why today is different. And I do think we're at a different place, there's a couple of things that kind of point to that. So one, alternative payment models are being introduced at their most rapid rate and we're seeing participation greater than we ever have before if you just look at large programs like the Accountable Care Organization Program or bundle payments through SEAMER might now be PCI advanced program participation numbers in both of those now far outpace anything we have seen previously. Medicare Advantage penetration and enrollment are at their highest levels ever so that you know that Medicare Advantage mindset or manage population mindset obviously infuses certain reimbursement and behavior dynamics into a market. And those are at record levels. And then finally, you know, this whole concept of value now is being implemented across almost every sector of healthcare. So if you look back, for example, you know, five or six years ago, it was really only hospitals that had readmission penalties and hospitals that had a value based purchasing program being rolled out. And now here we sit today where most every area of post-acute care either has a value based purchasing program in implementation or in pilot readmission penalties now affect lots of different types of providers. Physicians are now in a program called MIPS under Macra. And so, you know, whatever kind of provider you are, you're not immune to or sitting on the sidelines of this pay for value or the pursuit of pay for value. So I think all of those things collectively have created momentum that now we've reached the tipping point where I don't think it will slow down. If anything, I think it will accelerate and that'll ultimately move us to both feet in the canoe. I think the question is when does that happen? I don't know that anyone has that answer, but I do think that's the direction we're headed.

Saul Marquez:
Yeah, that's a that's a very interesting, you know, lay of the land, so to speak. As you think about what has changed and how has it changed and what programs have been adopted. I think it's a unique perspective, one that that we should all be thinking about. And, you know, the biggest challenge with the value based programs, you know, in my mind, Brian, is the conflicting incentives. And, you know, while the tide has shifted, there's still a lot that is fee for service you know. And so I'd like to get your thoughts on that. You know, because there's a lot of well-intentioned people out there wanting to make a splash in this value-based care realm. How do you get around that still fee for service structure that exists?

Brian Fuller:
Yeah, it's a great question. So and I completely agree on the conflicting incentives. And we actually see them in kind of two major areas. The first is, I think, probably the purest characterization of what you're mentioning here, which is when you pursue a certain reimbursement system or alternative payment model, you may win in one area of your health system that you may lose in another area. For example, you know, I've had the experience where we're sitting in a board room and there's the population health executives on one side of the table and the hospital executives on the other side. And the reality is that the population health executives save money and reduce healthcare utilization, namely through readmission, reduction, and avoiding hospitalizations. The hospital executives can't meet their budget requirements and often can't cover some of their very strict bond and other debt covenants that are built in to funding the physical plant that they deliver their services out of. So I think those very real tangible conflicts do still exist. You've seen some in healthcare, you know, accelerate, kind of getting out of that rather than being paralyzed by it. You know, systems like advocate healthcare in Chicago where they just kind of pushed the gas. All systems go towards value and they took on risk. And that was the catalyst that kind of shifted their entire system. They've probably done it more than other systems in terms of the pace at which they've undergone that pursuit. The second conflict, though, I don't want to lose because it's important and it's almost a cultural or behavioral conflict, which is, you know, how do you go about the day to day? You know, the fires that consume our day to day. Hospital executives are notorious for filling their days with meetings and an inordinate amount of email volume. And so how do you get out of that cycle where you're just running from the next meeting to the next meeting? I'm going through kind of your cycles of business on an annual basis, cleaning your inbox and trying to get it organized. You know, all those things that can in and of themselves take 12 to 14 hours a day. But when you do that, you leave innovation on the sideline. And that's the other challenge we've seen is, you know, just having the capacity, the attention span, the wherewithal to kind of break through some of those cultural and behavioral norms to make room for innovation. And that innovation, at least in today's world, is often defined by or kind of wrapped around some sort of payment innovation or risk based model.

Saul Marquez:
Now, that's interesting. Now, thanks for sharing that, Brian. It's interesting. Right. I mean, yeah, you mentioned that boardroom. And you got the pop health folks on one side and the acute care folks and the other and the conflict and then the culture. There's certainly a lot for us to to think about here. Give me an example of some of the things that that you and your firm has done to help companies get both feet in the canoe.

Brian Fuller:
Yeah. So I think one of the things that we have the benefit of is we're we're not a provider, so we're not constrained, if you will, by the day to day. This is what we do. It's it's what we do every day. It is what powers not 50% but 100% of our business model and our revenue. And, you know, because of that kind of freedom, we can innovate and we can invest in areas that pay us back when this is our payment mechanism. So we're not, we don't have a foot in the canoe and on the dock. We have both feet in in a canoe. And so I think that helps us be a value added partner and an enabler to those that are kind of undergoing this pursuit. And an example of that is we invest in people, nurses in the field, and those nurses manage our patients for an extended period of time. And quite frankly, a hospital doesn't get paid to have a nursing staff sitting out in the field managing patients after they leave the hospital. They're paid for their nurses to do what they need to do to stabilize and treat and operate on, you know, the patients that are sitting in their four walls. And so, again, because our business model is a longitudinal, more value oriented payment structure. In every case, we can invest in those people and we can put them with patients and families as a value oriented navigator, if you will. And our model pays us back for those.

Saul Marquez:
So it's interesting, I mean, I'd love to learn more about your business model, Brian. How does it work?

Brian Fuller:
Yeah. So we essentially partner with any entity that holds payment risk. It is most frequently, you know, today a hospital or physician group practice. But in the future, it could be, you know, a variety of post-acute providers, new providers that haven't really held risk up to this point, like hospice providers, for example. So there's nothing about our model that says this is who we have to serve. It's just our model is predicated on having some sort of payment risk such that, again, you can create the return for the ability to equalize or improve quality and then hold utilization and costs down. So we do that today by partnering with those customers of ours who either hold risk that we can share with them or we hold risk on behalf of them directly with a payer, typically Medicare in today's world. And then we share in our results together. And so, for example, under the BPCI advanced program where what's referred to as a convener. So we take the payment risk on behalf of, again, a hospital or physician group practice. We contract directly with Medicare for that risk. And then we work alongside the hospital partners and physician group practices to put about a whole host of changes, quality improvement initiatives, etc that seek to improve on the things that we know drive costs such as readmissions, expensive utilization of institutional settings, a longer length of stay or more intensity of service than is needed. All of those things. The way we do that and at ICS is we marry people with technology. And so I mentioned a little bit about our nurses. We put nurses in the field who meet a patient at a hospital stay and then we manage that patient, whatever they need, wherever they are, whatever happens to them, good or bad. We manage that patient under the BPI, a program for 90 days after they are discharged from that hospital. So we're there every step of the way, managing their care transitions, interacting with the patient, the family, monitoring status changes if there are others involved in their care. We are working alongside of someone who has the history and the knowledge and the information about what's happened to the patient up to that point. And so that's what our people in the field do that has value to to us, to our customer and then certainly to our patients and families. And then we've invested in technology. Again, this is where, you know, a hospital system where another provider, they invest in technology that helps them manage within their four walls, mainly, you know, an EMR system. And there isn't a medical records system out there today that is site agnostic, that thinks about a patient longitudinally and allows a clinical team to take in information and manage that patient's needs and monitor them over the course of time, wherever they may be. And our patients are often in three, four or five different settings in that 90 plus day period. And so we've had to build that technology from scratch. So we do have a care management platform that we've invested in that interacts with a lot of the other medical records, vendors and or solutions providers out there. But its sole purpose is to enable our nurses to be effective and efficient at managing patients Longitudinally.

Saul Marquez:
Now makes a lot of sense. Thanks for diving into that. And folks, you probably know this, but always worth noting, BPCI, bundled payment, bundled payment care improvements is CMS animation. And it's it's great that you're focused there, Brian, you and your team and you know, the ability to execute on and, you know, the care strategy after after the patients leave the hospital, I think is where the really big opportunity is. And I love to hear from you maybe like one of your biggest wins with the work that you've done.

Brian Fuller:
Yeah. So we've seen huge results from our effort. So it is validating to our approach and our model and to ongoing investments in the things that we started out investing in. You know, we've seen drastic double digit percentage in decreases in calls. We've seen quality stay the same or go up in every category, including a reduction in hospital readmissions.

Saul Marquez:
And Brian, if I can ask, when you say cost, are you saying cost of care?

Brian Fuller:
That's right. Yeah. Cost to the payer. Whoever the payer might be.

Saul Marquez:
Yep. Yep. I just want to clarify.

Brian Fuller:
Yep. Yep. Not cost to the patient in terms of like co-pays.

Saul Marquez:
Right. Right. Right. Right.

Brian Fuller:
Yeah. And then you know, our patients use less institutional care. So you know, we get our patients home more frequently and sooner than they have been home in the past. And so that's obviously another win, not just from the perspective of the financial outcomes, because obviously it's the least expensive setting to treat a patient within. But it's also where they want to be Right. The patients. If you give them any choice to be treated anywhere, mo, the overwhelming majority of them will say, treat me at home. And then we also know by being at home, they avoid other adverse circumstances that happen when they are in an institutional healthcare setting. Whether that's, you know, infections or falls or, you know, other things that just happen in our operational setting. So, you know, our our results across the board have been overwhelmingly positive. And we continue to invest in trying to figure out what's the next innovation, what's the next area where we can see improvement. And that's a bit of an iterative process that sort of never ends. If you're in our work.

Saul Marquez:
Now, it's great. And it definitely sounds like you guys are putting in the innovations to continue improving care and lowering cost. And I'm wondering when your nurses are going to the home, what percentage of the results come from finding problems in the home are like, you know, somebody's carpet is folded, it becomes a faux risk or, you know, where are your medications, that kind of stuff?

Brian Fuller:
Yup. So it's a huge issue. So just to be clear, our nurses today, ICS nurses do not go directly into the home.

Saul Marquez:
Oh, okay. Gotcha.

Brian Fuller:
We do partner with others who go into the home, such as home health organizations. And we also do follow up with our patients, some of which are video enabled. So we can see sometimes that there are issues, you know, in the environment. But those issues you're pointing out are not in significant, you know, whether it's doing a true medication, reconciliation based on which pill bottles are actually in the medicine cabinet. Yeah. Or to the environmental things you just mentioned, like no slip rugs and grab bars. We've also built ramps for our patients. So access into the home. It was a huge barrier. And again, it keeps people in institutional settings when they could be going home if they had access to the home with home health support. So there's a whole host of those environmental and even to add on other kind of social determinants issues like, you know, nutrition…

Saul Marquez:
Right.

Brian Fuller:
Transportation, all kinds of things that are barriers to kind of maintaining an effective life in their communities that we run across. And and we connect our patients to those resources very frequently. And any new market that we go to, we create a market specific inventory of those partners and providers so that we have those resources available because those issues frequently and commonly occur.

Saul Marquez:
Yeah. Now, that's for sure. Thanks for clarifying there. And so, Brian, with the nurses that are on your team. So when you typically start working with the provider, how are those nurses deployed? I mean, do you… tell me more about that?

Brian Fuller:
So we have a defined group of patients that we're accountable for, either based on our agreement with the customer or based on our agreement with Medicare. And so we create a technology feed between the the hospital and our system. That identifies those patients and notifies our nurses that there is a new patient in the system. And so our nurses then deploy to the hospital regularly. They round with case management teams and different floor teams, and they also visit the patient and the family in the hospital prior to discharge. In most cases, we don't catch 100%, but that's our goal is to catch up 100%. And then they follow those patients after they discharged from the hospital. So they are often involved in the discharge decision making in terms of what's the best setting for the patient, who's the best provider given their unique needs? What are the expectations that we have of that provider as we send the patient from the hospital to the next setting of care and then they follow the patient into that setting. So, for example, many of our patients are sent to skilled nursing facilities following a hospitalization. Our nurses round in our high volume facilities attend weekly meetings on our patients in those facilities. We're constantly staying in contact with those care teams. And there's expectations back and forth around how information flows. What happens if there's a care escalation? What happens if, God forbid, the patient is readmitted to the hospital? There's expectations and communication loops that address all of the different scenarios that could happen to a patient while they're there. The other thing, hoping that the patient just progresses according to the care plan is we know when the patient's discharge is the anticipated discharge. And so we are actively working on that discharge from the very first day that the patient shows up in that setting.

Saul Marquez:
I think that's really cool. And why did you decide to tackle this niche, Brian?

Brian Fuller:
Yeah, so it's a little bit like anything in your career. Right. It's a little bit by design and a little bit by luck and a little bit by mistake. So I got into an area of healthcare called post acute healthcare. When I was on the provider side and this was kind of Pre Affordable Care Act, Pre Alternative Payment Model. And so that's where I grew up, if you will, on the operational side and learned those businesses, you know, hands on in those businesses. The strategy that impacts those businesses, the reimbursement systems which are unique in each area of post-acute. And then it just so happened that the Affordable Care Act was passed and it extended kind of payment models from hospital into a lot of those settings. And what slowly became evident and obvious to the industry was those settings now had a different level of importance in terms of coordinating with them, understanding what drives their business, outlining expectations for what happens to patients in those settings. And so it just so happened that that was the area of healthcare where my career began operationally. And so it allowed me a lot of opportunity to pivot, quite honestly, and do the really interesting work that was a byproduct of that elevation of post-acute on everybody's radar screen. You know, everything… I've worked from Wall Street to post-acute policy with CMS to alternative payment models, as we've discussed with payers. Means that there's just a wide range of the entire industry that has really set about to tackle, understand and improve upon post-acute care. And it just so happens that was where I grew up professionally.

Saul Marquez:
Love it. Now, thanks for sharing that. And I was just curious because what a niche. And obviously there's a need and I always wonder how people get started with what they do. So, Brian, maybe you could share a setback. And and what you learned from that setback. We learned most from those, we love to hear from you.

Brian Fuller:
Yeah. So, you know, there's not a big setback, if you will, that I can kind of point to in my career. I will say, you know, what I've learned throughout my career is to try to fail fast and fail small. And I'll give you examples. You know, in our clinical model, for example, you know, we're constantly looking at new things to infuse into the model, you know, whether it's telehealth or should we add a community health worker, should we send clinicians into the home? Do we invest in some other technology on this side? There's a whole host of, you know, do we employ a pharmacist? There's a whole host of questions that come out of, you know, if you're trying to improve care and the experience for patients, what could you do? Blank sheet of paper here. And we're constantly testing and experimenting with all of those things I just mentioned. And some things I haven't mentioned. And they have different results. You know, something's come out and the return, if you will, or the improvement is what we expected and we choose to invest. And then there's other areas where we're surprised by the outcome. And so, you know, what we try to do is get to that conclusion pretty quickly. And then we also try to do it on a small scale. So, for example, you know, if we were evaluating whether or not to hire a pharmacist into our model, we wouldn't go higher pharmacist in every market we work in.

Saul Marquez:
Right.

Brian Fuller:
Across the board and invest in them. You know, we would choose a small, isolated pilot, you know, figure out how the pharmacist resources would be deployed and then test it in a kind of isolated, experimental type of group compared to, you know, another control group within our purview and then compare the results. And by the way, we have not tested the pharmacist model. We've talked about it. So it is just an example for illustration. But, you know, that's some of the lessons I've learned is, you know, fail fast and fail small. And we do that, you know, all the time. We have a clinical strategy leader. Her sole job is to figure out where do we test next and then how do we, you know, either succeed or fail fast and then fail small.

Saul Marquez:
Love it. Now, it sounds like you have a great way to innovate there. And what about the other side of the coin? What's one of the proudest experience you've had to date?

Brian Fuller:
Yeah. So a lot of them. I mean, again, that's why I got into health care, right. It's the myriad of, you know, literally thousands of moments where you see the impact you're making on a patient and family or you're hearing from your clinicians, you know, a really positive outcome that could have been vastly different. So those things keep you going, those kind of things that ground you in the mission of the work. Certainly keep me going and make me so passionate about healthcare. But setting those aside and to talk about something personally, you know, I in 2017, I was honored enough to be named one of Health Care's Rising Stars by Beckers. And I think for me, you know, that was it was important, right? It was validating that, you know, what I was doing was making a difference, that that difference somehow stood out of the crowd and had unique value in the industry. And I think that's what anyone wants out of their professional life is to feel valued and that you're making an impact and that that impact is seen and heard and felt by those that you want to see and hear and feel it. And so, you know, that was certainly a career moment for me.

Saul Marquez:
Congratulations on that.

Brian Fuller:
Thank you. It feels like forever ago, even though it was only 2017. But that's the way things are, right? You kind of celebrate them in the moment and then there's kind of a distant memory.

Saul Marquez:
Yeah. But that's fantastic. Kudos for you and and your team for doing what you guys do to make healthcare better and less costly. What would you say is the most exciting project you're working on?

Brian Fuller:
Yeah, well, we actually have a new batch, if you will. Customers coming online. So for those who may not be familiar with the BPCI advanced program run by CMS, there was an initial application period in 2018 where kind of the first cohort of participants went in. We participated in that cohort. CMS reopened the application period earlier this year and applications were due this summer and we just received the data files to be able to decide which clinical conditions we're going to take risk on and what our partnerships are going to look like. And we have to commit to those by November, the end of November of this year. And we will start with that new cohort on January 1 of 2020. And so that's super exciting. Right.. It's the opportunity to to grow what we do to serve more patients, to achieve the outcomes I've spoken about in this discussion for more of our customers and more markets. And so that's a huge focus of ours right now and will be our priority focus as we go through the rest of this year and then early in the new year.

Saul Marquez:
That's awesome. Congratulations on that. It sounds like going to be an exciting new niche and you guys are working directly with Medicare on that?

Brian Fuller:
We are. Yep again, we're serving in that role that Medicare refers to as the convener. So we are still partnering with hospitals and physician group practices, but we are stepping in between them and Medicare and taking the risk on behalf of them and then working collaboratively to achieve the quality outcomes discussed on this phone call.

Saul Marquez:
Yeah. And so how exactly do you take the risk, Brian? So you… I guess I am trying to understand that better.

Brian Fuller:
Yeah. Yeah. So.

Saul Marquez:
Is that a common question or?

Brian Fuller:
Yeah, it is. I mean, you know, people have different connotations when you say the word bundle payment. Right. Some people think you just get one pot of money and you have to dole it out, if you will. And then once you're out of money, you're out of money. If you never get out of money, then it's kind of a win. So, yes, it is a common question. So essentially, the way BPCI advanced works is CMA, you define a partner. So let's just say a hospital. In this case, CMS looks back retrospectively on a three year period and says, what happened to patients coming out of that hospital? What services did they use? What cost did they incur? And they set a baseline and then they take 3% off of that baseline. That becomes your target price. And so going forward, you have to manage to that target price.

Saul Marquez:
Okay.

Brian Fuller:
And so if you if you can come under that, then you win. Obviously, if you if you cannot, then you owe CMS money back. So it is a two sided risk program and that if you spend more than the target price, you do owe CMS money.

Saul Marquez:
Got it. And so costs, services, baseline over three years, and then the goal is to hit that baseline minus 3%. And that's where you guys come in. So how do you take that risk on, you just managing these patients directly to get there?

Brian Fuller:
That's right. Yeah. So it's the combination of that. People married to technology that I mentioned earlier. So we deploy that in the market around the patients that we have accountability for. And then our model plays itself out with, again, luckily very positive outcomes that we've experienced thus far.

Saul Marquez:
Wow. And if that number. I mean, I don't ever wish this. But what if it doesn't hit? What if you can't hit that 3%? Does that mean you guys pay that spread?

Brian Fuller:
It does. So under our current contracts with Medicare, we owe them that spread. Yes.

Saul Marquez:
Wow. That's brave.

Brian Fuller:
Yeah. Yeah. It's interesting. Right.

Saul Marquez:
It's very interesting and that we went here because I you know, I was as making a lot of assumptions and be honest with you, I was wrong. And when I was assuming so, I'm glad I asked. And I mean, I'm just like, I just think you're that much cooler because of this.

Brian Fuller:
Well, if you think about it, it's the exact opposite of the way fee for service works, right? It is, you know, fee for service. You do more, you get paid more, presumably. And there's really no check and balance that whatever you did was effective and efficient for the patient. And so that's what's cool about these new programs is, you know, there's incentives that are aligned. And then there are mechanisms in place to monitor to make sure that, you know, everything is moving towards this dual goal of being really efficient and the health care that we deliver from a cost perspective, but also really effective from a quality outcomes perspective.

Saul Marquez:
Totally, makes a lot of sense. Appreciate you sharing that, Brian. And kudos to you and your team for the work that you do to make healthcare better. What's next is the lightning round just pretty fast, followed by a book you recommend to the listeners? You ready?

Brian Fuller:
Sure.

Saul Marquez:
All right. Pretty fun and pretty easy. So what's the best way to improve healthcare outcomes?

Brian Fuller:
I think aligning incentives.

Saul Marquez:
What's the biggest mistake or pitfall to avoid?

Brian Fuller:
Not investing in the people that drive healthcare?

Saul Marquez:
How do you stay relevant as an organization despite constant change?

Brian Fuller:
You make learning a part of your daily task list and part of your culture.

Saul Marquez:
What's the one area focus that drives everything at Integrated Care Solutions?

Brian Fuller:
Our patients. It's about making the patient outcomes and experience better than it otherwise would've been.

Saul Marquez:
And what book would you recommend to the listeners, Brian?

Brian Fuller:
Yeah. So it's an interesting book that I actually got exposed to earlier in my career. It's Kouzes and Posner's The Leadership Challenge, and there was a leadership program that was designed around that earlier in my career, which I participated in. And it kind of sets out five different behaviors of a good leader. And I have kept those five behaviors at the forefront of my mind. And, you know, often I even ask myself, am I… fill in the blank with whatever behavior in this instance? And so The Leadership Challenge I highly recommend, it has been very impactful to my professional career, but also to my leadership journey.

Saul Marquez:
Very cool. What a great recommendation. And folks, you want the full transcript, links to the book, links to integrated care solutions and what they're doing. Just go to outcomesrocket.health in the search bar type in Brian Fuller and you'll be able to check that out if you want to just check out Integrated Care Solutions directly, go to integratedcaresolutions.com. So listen, Brian, this has been a ton of fun. I love if you could just leave us with the closing thought and then the best place where the listeners could continue the conversation with you.

Brian Fuller:
Yes. I'll just say, you know, a lot of people use the term disruptive right now in healthcare. And, you know, I would tend to say I like to think about disruption as all the positive that it brings. You know, we grow through disruption. And I think we as an industry will grow through the disruption that we're feeling right now. And ultimately, it will make our sector, our industry, and our patients' better for it. So I think it poses lots more opportunities than it does challenges and drawbacks. But, you know, the challenges and drawbacks are part of the journey for sure.

Saul Marquez:
Love it. And if the listeners want to learn more about you or the company, what's the best way for them to do that?

Brian Fuller:
Yes, certainly. So you can go to our website, which you just mentioned, is integratedcaresolutions.com. You know, they're certainly welcome to check me out. I'm on LinkedIn. Send me messages there. I believe we spelled my name. Brian is with an I, not a Y and Fuller. So I would love to connect with with you on LinkedIn as well.

Saul Marquez:
Outstanding. Brian this has been insightful, informative and so I just want to say thanks again for joining us.

Brian Fuller:
Absolutely. Thanks for having me.

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