Getting More For Our Healthcare Dollar
Episode 451

Jill Yegian, Founder at Yegian Health Insights, LLC

Getting More For Our Healthcare Dollar

There’s so much opportunity to make the healthcare system work better for patients, practitioners, payers, and taxpayers in terms of cost and affordability.

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Getting More For Our Healthcare Dollar

Episode 451

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Getting More For Our Healthcare Dollar with Jill Yegian, Founder at Yegian Health Insights, LLC transcript powered by Sonix—the best audio to text transcription service

Getting More For Our Healthcare Dollar with Jill Yegian, Founder at Yegian Health Insights, LLC 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 to Outcomes Rocket, Saul Marquez here. Today I have the privilege of hosting Dr. Jill Yegian. She launched Yegian Health Insights in 2018 providing consulting services to clients in healthcare and philanthropy. Dr. Yegian has held positions in a variety of healthcare organizations and niche. She has focused on client, health policy, payment and delivery, problems and opportunities. Most recently, she served as Vice President for Public Policy and Strategic Initiatives at Brown and Toland Physicians. A large and practice association in San Francisco Bay area. Her background in Ph.D is in Health Services and Policy Analysis form University of California, Berkeley. And prior to the work that she’s done, she also served 13 years in California Health Care Foundation, where she worked to improve the California’s financing and delivery system for healthcare, which is what we’re going to be talking about today. We’re going to be talking about access, we’re going to be talking about rising costs and things that we could be doing and thinking about as healthcare leaders and making it better so with that, I wanna go head in and open up the microphone to Jill and really give you a warm welcome. And thanks for joining us, so glad you are here, Jill.

Jill Yegian:
Thank you Saul. It’s great to be here. I really enjoy listening to your podcast and I’m really happy to be a part of it.

Saul Marquez:
Awesome. So glad you’re here and so you know one of the things I love asking and curious about is what inspires you with your work in healthcare?

Jill Yegian:
So from my perspective, it really… what gets me up in the morning is collaboration to improve outcomes and increase value. I just feel like there’s so much opportunity to make this system work better for patients, for practitioners, for those who are paying the bill and for taxpayers, too. And that could be in terms of higher quality, more access, lower costs, more equitable, a better patient or even provider experience, lots of different aspects of improvement that are possible in our current system. You know, I’ve always been really interested in systems and in interdisciplinary approaches to solving problems. Both undergraduate and graduate degrees are interdisciplinary, bringing together economics, political science and sociology to inform a systems perspective. And so narrowly, I have an opportunity to work at the intersection of delivery, finance, and in policy. And I think that’s really important because changing policy may not result in the change on the ground. For example, changing… expanding health insurance coverage won’t create access to care if there aren’t enough providers in a rural community or if reimbursement is too low. So it’s really important to think about a system’s perspective that brings together different aspects to solve problems.

Saul Marquez:
Yeah, I really think that’s a great approach and a great way to think about this is you’re right. You know, if if they increase access, there might not be enough people in the delivery aspect. But then there’s the financial piece that I think a lot of people are concerned about in this country. A lot of employers, a lot of even policymakers, right. We’re very concerned about it. We’ll touch on this, folks. So don’t worry. But I’m curious, from your end Jill, what’s the thing that’s held you back in the past that you’ve conquered?

Jill Yegian:
That’s a great question, Saul. I would say that it’s really most recent related to starting, digging at Health Insights. I’ve been an employee for most of my life and the transition to having my own company really required taking some risks. So there is a lot less security and predictability. It’s not always clear what next year is going to bring. And sometimes even next month. Earlier in my career, I would say I probably wasn’t as comfortable with that level of uncertainty. And I also didn’t have the same level of confidence in my abilities. And I feel like all that is really come together at this point where I have a breadth of knowledge and experience. I have confidence. I’m comfortable with the uncertainty. And then the variety in this world is fabulous. Being able to work with a whole array of clients on a whole array of issues and not and make contributions in an array of different areas.

Saul Marquez:
Now, that’s that’s a really great thing to know and share, Jill. I mean, I know a lot of people listening today have had that challenge or are currently experiencing it. And so what is it that got you to make the moves?

Jill Yegian:
It was an array of different circumstances that really led to things falling into place fall, Saul. I’m at a point in my career where I really have a pretty long checklist for what would really make me very excited about getting out of bed. And so the ability to make contribution is really a significant part of that and of the combination of flexibility, autonomy, variety and mission was best when in the seeing with creating my own company. So that’s the path that I’ve taken and I have really enjoyed it.

Saul Marquez:
Congratulations.

Jill Yegian:
Thank you.

Saul Marquez:
So in your journey, Jill, who’s been a mentor that’s made a big impact in your life? What did they teach you?

Jill Yegian:
So it’s actually, it’s pretty recent and related to the creation of my own business, I reached out to a handful of colleagues who were also independent consultants to ask for guidance on whether and how to go out on my own. And I have to say, you saw that every one of them was very generous with advice and resources. They met with me, shared stories, told me about the positives and also the negatives of independent consulting and really encouraged me to make that leap. So they shared things like contract templates, referred me to their accountants and their attorneys. Some have invited me to join teams to bid on work. Others have sent referrals for new clients. So that’s really been gratifying and inspiring in a lot of ways. And I thought I would really miss the team aspect of being an executive and always loved building and leading teams. But it turns out that I just have different teams now. I have a team of… a virtual team of my consultant network. And then I also end up having a team at each client. And that’s been a surprise and really rewarding.

Saul Marquez:
Wow, that’s great. And you know, there are quite a few I mean, many consultant listeners to this. I’m sure what you’re saying is resonating with them. They’re nodding their heads, thinking, “yeah, yeah, go Jill, go Jill. Glad you did it. Welcome.” It’s such a cool idea and very neat that you have felt the support and love that. And so today your… you must have a focus. So what do you think that biggest challenge in health care is that you’re looking to tackle with your work?

Jill Yegian:
Great question, Saul. I would have to land on costs and affordability. Healthcare costs at this point in the U.S. are over three and a half trillion dollars. That’s about three times what it was only 20 years ago. And it’s projected to hit 6 trillion in another 10 years. So when you think about that, it’s really a staggering sum and it’s a heavy burden for individuals and for tax payers as well. You know, the Affordable Care Act resulted in significant progress on access to coverage, some of which is now eroding under the Trump Administration changes. But it had a lot. The ACA had much less impact on managing costs than it did on extending coverage. So in the employment sector, we can see benefit costs are crowding out employee salaries. You know, people often think that their employers are paying for health benefits, but that’s not actually true. Economists have shown pretty clearly that increases in employee compensation go to pay for increasing health benefits more so than higher salaries. And that contributes to wage stagnation. And on the public side, we can see that commitment to healthcare costs for retirees are major liabilities for city and county and even state budgets. And there are other issues that you can see playing out in the national news these days as well. The medical debt in bankruptcy is a huge issue. Surprise medical billing is… has received major national attention lately with stories in the media about people arriving at emergency rooms, sometimes even unconscious, and then receiving bills for tens of thousands of dollars because they received care from a doctor or hospital, not in their insurance network, often without having any idea that’s happening. There’s actually a new series that CBS News is doing called Medical Price Roulette with journalists at Clear health costs to bring some of those stories to light. And hopefully create change.

Saul Marquez:
Well, it’s definitely a problem. And you know, the neat thing about how you look at things Jill with your inner disciplinary approach, the systems approach kind of helps you take a step back and thinking about how the you know, one thing such as increased costs really means in healthcare really means there there’s a wage stagnation. And what does that mean to the economy? You know, we’ve got to be thinking about these things. And so this challenge, obviously, is a big one. But what would you say holds us back from overcoming the challenge and who’s responsible to resolve this?

Jill Yegian:
Well, I think we’re all responsible, Saul. I think it’s a it’s a multi-prong carriage. It’s very complex and we all have a role to play. You know, when you think about it on a per capita level, the on that spending amount is about eleven thousand dollars annually. So if we just pause for a moment and reflect on that, that’s $11,000 for every man, every woman, every child. And that’s actually quite a lot of money. And so from my perspective, we… I’d love for us all to sort of get on the same page about that’s enough money, like we should be able to provide great care and get great outcomes for that amount of money. It’s about twice, more than twice, most other developed countries. And they have better outcomes than we do on some key areas like infant mortality. So the question really is, what can we do differently to get more out of the investment that we’re making? I think some of the things that… go ahead.

Saul Marquez:
Well, you know, where my mind was going and it was because one of the big arguments is, hey, if you curb costs, then your shrinking business, right.. And so I like that you went to “Well, how can we get more from what we’re already investing?”

Jill Yegian:
Absolutely, yes. I think, you know, we definitely don’t want to put the brakes on innovation. And I think that’s something that people get concerned about. But I also believe that we are capable of amazing innovation in this country and that innovation could be pointed at getting more out of the healthcare dollar and not just following this this path of ever increasing costs. I think some of the things that factor into it, because you’re asking what holds us back. It’s a very complex problem. You know, insurance all on its own makes all of us less concerned about price.

Saul Marquez:
Right.

Jill Yegian:
So that’s a factor. Right. And prices are hard to ascertain even when when you aren’t interested in figuring out what they are. The prices tend to be very opaque on in part because of insurance and in part because it is a characteristic that makes it easier often to obtain higher prices. Market consolidation, I think, is getting increasing attention. The mergers, the payers, and providers that… can lead to market dominance and increase prices. And then we have on the policy side, also created our own constraints. So, for example, Medicare’s prohibition on negotiating for prescription drugs, which is something that all the other countries are able to do, but not here in the U.S.. So there are many factors and many other factors as well that contribute. But I think if we all, you know, we can all figure out what our role to play is and contribute to creating that change.

Saul Marquez:
Yeah. And I think it’s a great call to action. And and like you said, a big problem. What would you… give us as an example of, you know, maybe you’ve helped somebody overcome this challenge in their own way? Right. Because there’s like you said, a lot of different people involved, a lot of organizations. But every one of us can have our own way of tackling it. Give us an example of what that looks like for anybody listening.

Jill Yegian:
So I’m going to tell you a little bit Saul about some work that’s underway right now in California that I have the privilege of being involved in. So last summer in 2018, California passed legislation that charges the State Office of Statewide Health Planning and Development with developing a healthcare payment status system. And the legislative intent behind this system is essentially to collect information regarding the cost of care in aggregate that up from many different sources and in other states, this type of system has been called an all payer claims database. And there are around 20 states right now that have such a system in place. And in California, the goal is really to gather the data that would allow for greater transparency and in turn contribute to a more sustainable healthcare system, more equitable access and higher quality care. So right now we have multi-stakeholder review committee, which was defined in the legislation and is meeting monthly to work through these issues and make recommendations to the legislature. And I’m fortunate to be part of the team that is supporting the Office of Statewide Health Planning and Development, which we call OSPAD. And in doing this training work and we’ll be submitting a report to the legislature by July 1st. And to the legislature include on having the data be substantially completed by July of 2023. So the goal is really stand up this database that can support analysis and decision making on topics that include costs and utilization, quality, coverage and access, population health and the health system performance as well. For example, evaluating alternative payment models. So I’ll give you one example of how one might deploy it. So in the prescription drug spending area, that’s an area of increasing attention giving given the cost increases over the last number of years. And there is a potential to bring together in a database like this prescription drug utilization and spending data from pharmacies with data from medical settings such as physician offices in hospitals, and to create a complete picture of prescription drug spending in this state. And that would in turn allow us to identify and address cost drivers to benchmark prescription drug costs, to monitor out-of-pocket costs for prescription drugs and investigate how costs affect health outcomes, and then in turn, to develop purchasing strategies that narrow variation and reduce prices. So that’s just one example on in large on set of potential use cases for a database like this. And certainly California’s policymakers are intending that it be deployed to bend the cost curve here.

Saul Marquez:
Yeah Jill. That’s really interesting. And you know, I’m not very familiar with how government does with these types of benchmarks. So I don’t even want to guess, but, you know, I guess what would your read be on how governments are doing in general to use these types of analysis to bend cost curves, or is it just not really doing it at all? What’s your take on that?

Jill Yegian:
Well. So while the government in this in this scenario and in these all PR claims databases have been instrumental in creating the resource, it is definitely not restricted. The use of the data is not government specific.

Saul Marquez:
Okay.

Jill Yegian:
So all claims it is there. Each of the all power claims databases has a process for accessing the data and criteria and not and access processes. But researchers have made great use of it. I don’t know whether you’ve seen there was a recent report that Rand put out comparing hospital costs paid by employers to what that same set of hospital utilization would cost in the Medicare space, and came up with a finding that got quite a bit of press attention that it was the employers were paying multiple times what the same price if they had been paying Medicare prices and that relied in part on all payer claims databases. So there are sort of policy relevant and industry relevant findings that are coming out from all on all kinds of research venues. They’ve been published in health affairs, ending in lots of different arenas. So the government has the potential to use the data to create government policy. But industry can use it for benchmarking and decision making as well. Researchers can use data to evaluate, for example, you know, a bundle payment or reference pricing model, all different payment arrangements. And so there are a array of different use cases.

Saul Marquez:
Wow. Okay, that’s interesting. Yeah, my thought was this this was being built for the government’s use. But thanks for the level setting. This is actually available to… it’s open obviously with its process to access it and requirements.

Jill Yegian:
Exactly. And generally what States do is have two different categories of data. One is aggregate and de-identified data that is publicly available. Obviously that has been stripped of all identifiers and tested to ensure that privacy is a 100% protected and then a different pathway for the data that may have some identifiers associated with it. And that pathway has lots of other safeguards in place. There’s an application process. There is a review committee to review the application data use agreement. And the reason that it is in some cases available with some identifiers is because being able it is much more powerful in terms of what can be learned from the data. So there’s that balance of the research value of the data versus the privacy protection. But all of this effort is subject to very stringent privacy requirements.

Saul Marquez:
Got it. Thanks for sharing that gel. It’s a great example. And today, you know, I it’s more than just words, folks. It’s more than just talk. It’s happening. You know, data and the use of technologies to clean the data and process. It is becoming a way of making insights to make healthcare better. And so don’t ignore it. It sits here. And so Jill’s just given us a great example in the state of California with her work there. If you had to summarize a solution for the listeners thinking, “How can I do something about this?” What does that plan look like and why would a common pitfall be that they need to look out for?

Jill Yegian:
You know, I think so there’s people who are in such different roles and places. It’s hard to find something that would work for everyone. But in general, the way that I think about the solution, it’s really the whatever role that you’re in. To the extent that it’s relevant, take advantage of the opportunity to analyze whatever cost data you have. Maybe if you’re in a health care organization and in a leadership role, you are actually paying premiums and you have an opportunity to look at the health, health care costs, data of your employees. Maybe if you’re in a provider organization, you have an opportunity to look at it from that perspective or from a payor organization. But really, I think the three generic steps that I think are valuable are to really take a look at those healthcare costs data and identify where the pain points are in what promising opportunities might be, and then to develop and implement a solution and then to evaluate the results and either, you know, double down on something that looks promising, you know, move towards repeating it and scaling it or acknowledge that that perhaps was not a promising pathway and choose a different one. I think my hope for the healthcare payments database in California is that some of our large public payers, such as CalPERS, are state employees and retirees. System that provides coverage for about a million and a half Californians will find value in actionable comparative data here. Same with Covered California. Our marketplace, which covers over a million Californians in our Department of Health Care Services, manages our Medicaid program. We have 13 million Californians covered by Medi-Cal. So to the extent we can pull together the data from across the state and make it available on a comparative basis, the potential to inform decision making is really tremendous. And I’m optimistic.

Saul Marquez:
Wow, that’s great. And so this is the project is has an output that’s due in July, you said.

Jill Yegian:
The first. Yeah, although it certainly those who are interested can follow along. California has great open meeting laws and so the review committee that’s meeting monthly on this project now has has a Web site with availability of all of the odd agendas and minutes and so forth. And then a legislative report will be handed off on not later until I first.

Saul Marquez:
Love it. What a great, great work that you’re up to there, Jill and now and promising for the 13 million plus Californians and maybe beyond. As you know, benchmarking happens and you know, people look for ways to make better decisions with data. So let’s get to the call to action here. What what would you say it is for the listeners today? What’s that call to action?

Jill Yegian:
I’d like to see us all work together to address healthcare costs, Saul. Whether that’s measuring and reporting on total costs of care, whether it’s designing health benefits that reward providers for delivering efficient care, for rewarding consumers, for choosing efficient providers that can move the dial as well in cost sharing should be lower for care that’s cost effective. We can re-engineer care to remove costs from the system. We can identify and eliminate low value care. Choosing wisely is a great example of that created by the American Board of Internal Medicine Foundation and its physician leaders in specialty societies. Identifying the services that from their own perspectives are low value and can, you know, can be dispensed with. And so they can teach their peers about that and disseminate that through this system. There is a significant potential for reducing overuse through physician leadership. There are lots of really exciting opportunities. And the question really is what’s the one that’s relevant. Given where each person is operating in the system?

Saul Marquez:
It’s a great call to action. And folks, if you’re listening, obviously, or if you’re listening, are you listening? How about now, You’re listening? Hope you are now. It’s like, you know, Jill gave us a really great, great way to think about this. And you just have to decide, you know, if you’re part of a large business or even a small business, you have healthcare costs. Most likely, they’re too high. And so, you know, look at the healthcare costs data that you’re dealing with and find an area of improvement, develop that solution around that problem and then evaluate your results. I mean, Jill laid it out for us in a really easy way, whether you’re at a large enterprise or a smaller one. It’s critical that you do it because obviously, you know that the result is we keep getting the same over and over and that’s not what we want. So what what would you say is the biggest cost of not moving forward with that call, that action Jill?

Jill Yegian:
So back in the 1970’s, President Nixon talked about the extraordinary burden of healthcare costs on the American people, when he proposed his comprehensive health insurance plan. But over the last 40 years, cost had just continued to increase. I’m really concerned that if we see costs continue to increase at a similar rate for the next 4 years, we’ll see a very significant crowding out of other social investments that are really critical to our country. You know, education, public safety, infrastructure, defense, healthcare is going to suck all the air out of the room. And so I really hope we can get our arms around it.

Saul Marquez:
Yeah. Now, it’s a great call, right. Because nothing comes without a cost to something else.

Jill Yegian:
Exactly right. We’re making…

Saul Marquez:
This quick we’re already suffering now. Right. I mean, schools are already suffering. I mean, you know, month, you see teachers on strike and, you know, it’s a problem.

Jill Yegian:
Yes. Yeah, absolutely.

Saul Marquez:
It’s a problem. Well, listen, folks, take Jill’s message to heart. I know I am. I’m already thinking about a couple things to do. I got a little post it here, Jill. I got a couple. So appreciate…

Jill Yegian:
Sounds like you Saul.

Saul Marquez:
Hey. It takes a village. Right. And I know the people that listen to this and are listening to your message, Jill are thinking about ways they could do their part. So, Jill, this has been incredible. I love if you could just share a closing thought with the listeners and the best place they could continue the conversation with you.

Jill Yegian:
Absolutely, Saul. You know, I did, my closing thought would just be that we really all have a role to play in bending the cost curve and on… and I encourage everyone to put their shoulder to the wheel. The best way to get in touch with me is on LinkedIn. I’m easy to find. There are not very many Jill Yegian. And I’d love to hear from your listeners.

Saul Marquez:
Outstanding, Jill. And folks, take that call to action. Do your part and also reach out to Jill if you found today’s episode intriguing. So Jill just want to say thanks again for your time. It’s been fun.

Jill Yegian:
Thank you, Saul. Appreciate the opportunity.

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