“Health care doesn’t work for patients because it doesn’t work for the people involved in it.”
That’s what Dr. Thomas Graf, a former administrator from Pennsylvania’s Geisinger Health System who recently joined Horizon Blue Cross Blue Shield of New Jersey as its newest vice president and chief medical officer, is trying to fix.
Graf said that, although there has been some apprehension about the change to value-based care in parts of the health care provider community, it is a smart way to save money overall.
“If we can just stop spending disproportionately more and more in health care, that’s probably … you know we aren’t going to go back to 10 percent of the, that’s not going to happen. But if we can stop it from going to 20, then it’s bending the cost curve,” Graf said. “Doctors are not really happy with the current system, but change is really hard. The real trick is, how do we value the work that went into?”
While working at Geisinger, Graf designed a shared savings program focused on diabetes patients and, at the end of the day, the savings were shared by the doctors, health system, health plan and the employer paying for the health care.
He similarly wants to look for ways to work in the interest of the insurance company while balancing interests of other parties.
In his new role, he said, he has a “different set of levers” to look at, including designing health benefit plans and the ability to connect with employers as well as members and patients.
With respect to benefit design, Graf said there are a lot of things on the provider side that result in a large load of administrative tasks. This is the in-between calling to check on coverage and approval of procedures between the hospital and insurer which results in a lot of wasted time.
Graf said that, if he could make the computers talk to each other and automate the checklist for approvals, that would be helpful for all parties.
In addition, Graf said, there is room to improve the high-deductible plans that are forcing price-sensitive members to forgo managing their health care properly, and resulting in some of the same problems doctors are facing without insurance.
“It’s like not paying for oil for your car,” Graf said, adding that the goal is to make the “oil” more affordable meaning preventative health care to ensure patients are more interested in using the health system regularly and lowering cost all around.
“Horizon is fully embracing the transformation to value-based care and population health management to deliver better health care at lower costs, and Dr. Graf is the ideal fit culturally and philosophically. Tom brings more than a quarter-century of experience working on the front lines and making health care work better for patients,” said Robert Marino, chairman and CEO of Horizon, in a statement.
“As our senior physician, Dr. Graf will work with our OMNIA Alliance partners, our network of physicians and our health care management team to engineer and execute Horizon’s clinical transformation goals.”
And, with Graf on board, AtlantiCare Regional Medical Center in Atlantic County which is owned by Geisinger and has Tier 1 hospitals in the OMNIA plan is in discussions to join the alliance partners.
Graf has previously worked for Chartis Group as a national director of population health, and has been on boards for organizations that serve the same interest. Graf will report directly to Allen Karp, senior vice president of health care management at Horizon.
Date: February 08, 2017