Episode #123: A Radical Departure - Transforming Healthcare Delivery into Outcomes via a Value-based Vertical Integration - with Ken Silverstein MD

Creating a New Healthcare

Friends,

There are numerous critical healthcare reframes in this week’s episode. First, what Dr. Silverstein makes abundantly clear is that the senior leadership team at ChristianaCare is fully comitted to accelerating the shift to value based payment. Second, they are committed to greatly expanding the use of virtual care as a primary mode of care. Third, they are focused on health outcomes vs healthcare delivery. Underlying these three patient-centered goals is another profound reframe, the notion that in order to achieve the quadruple aim, provider organizations must form vertical integrations and create complementary collaborations with other types of stakeholders in healthcare - such as payers and retailers.

Our guest today, Ken Silverstein, is the Chief Physician Executive at ChristianaCare. He previously served as chair of ChristianaCare’s Department of Anesthesiology, Medical Director of Perioperative Services and as Chief Medical Officer. He received his undergraduate degree from Brown University, his medical degree from New York University School of Medicine and his MBA from the University of Delaware. Dr. Silverstein was a resident and a fellow in anesthesiology at the Brigham and Women’s Hospital in Boston. He completed his clinical fellowship in anesthesiology at Harvard Medical School.

In this episode, we’ll learn about:

• The 10 year value-based collaborative agreement that ChristianaCare and Highmark have launched together.

• The 5 major “vehicles” that ChristianaCare & Highmark are planning to deploy within their collaboration.

• The guiding “partnership principles” that are being used to create a relationship-centered approach to this synergistic collaboration.

• The fascinating independent spin-off virtual primary care practice that ChristianaCare is building out with Highmark, that greatly improves the efficiency and effectiveness of care.

At the beginning of our conversation, Ken states, “we created a new company and the intent is to completely transform healthcare.” That bold remark speaks volumes about the visionary leadership at ChristianaCare. Another statement which gripped me was the fact that the ChristianaCare leadership team is discussing Clayton Christenen’s ‘dilemma zone’’, which the folks at ChristianaCare have relabelled as the “commitment zone”. The point of the concept is that in order to transition to a value paradigm and realize a long-term gain, leadership must accept a short-term loss. It’s amazing to see hospital leadership thinking and acting in this way. But even more amazing is the fact that their Chief Financial Officer was the one who introduced this concept to the leadership team.

In our correspondence prior to the interview, Ken wrote that American healthcare is “facing an apocalyptic forecast…”. It’s a disconcerting pronouncement from a seasoned physician executive. But, what was concerning for me was that I had heard this very same comment from two other physician executives in the prior week. During our interview, I asked Ken what he meant by this statement. He went on to discuss issues such as the worsening unaffordability of healthcare, fragmentation of care, and inappropriate overutilization. He also passionately talked about the unacceptable inequities and disparities in healthcare, using Delaware as an example. In Wilmington, the difference in life expectancy - what Ken referred to as the “death gap” - between white communities and black communities only 2 miles apart is 16 years! He punctuated this statistic by asking how that is acceptable to anyone.

The situation may seem dire but I have to say that I have never been more hopeful, more inspired and more encouraged about the future of healthcare than I am today. The reason stems from listening to leaders like those at ChristianaCare who are not just speaking the rhetoric of reframing, but are taking the very concrete steps necessary to create a new and better healthcare. They are making the painful trade-offs required, and are investing in a better future. They are, as Simon Sinek would put it, playing the generative "long game". ChristianaCare is making a demonstrable commitment to creating a value-based future. They are aligning their resources with their rhetoric. They are doing this not because it’s easy or safe. They are doing it, as Ken states, “because it’s the right thing to do, period.”

Until Next Time, Be Well.
Zeev Neuwirth, MD