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Perspectives

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Steven Nelson, president of Contigo Health.

Steven Nelson leads the Contigo Health team as president and was one of the leaders who initiated the strategy behind Contigo Health within Premier. Before joining Premier, Nelson was a leader at Anthem Inc., where he served as vice president of strategy and planning and COO of Anthem’s diversified business group. Prior to joining Anthem, Nelson led strategy, product and marketing at Highmark Blue Cross Blue Shield and helped to build Allegheny Health Network, a provider entity consisting of seven hospitals, 2,000 doctors and various other facilities. Nelson has a deep and personal commitment to giving back to his local community as well as the global community, including leading charity work in Haiti. He holds a bachelor’s degree from the University of Pittsburgh and a master’s degree from Ohio University. He and his family reside outside of Pittsburgh, in Gibsonia, Pennsylvania.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

After spending seven years in the retail industry, including five years spent at GNC as the chief marketing officer, I entered the health insurance market in 2007 when the CEO of Highmark Blue Cross Blue Shield recruited me to establish consumer and retail marketing for them.

At Highmark Blue Cross Blue Shield, I developed a consumer marketing strategy and executed a business plan that helped shift the company to become a customer-centric leader. At the time, this was at the starting point of healthcare “consumerism.”

I worked mostly in the strategy, marketing, innovation, and product areas as a consumer advocate. This includes working on products that we built for individuals who buy their own insurance and employer-sponsored benefit plans. Additionally, I assisted in rebuilding consumer market touchpoints, including retail stores, e-commerce, and consumer advertising.

Looking back, Highmark Blue Cross Blue Shield was an appealing opportunity due to its existing market presence and high-profile status among the Blue Cross Blue Shield community. Its extensive resources — people, process, technology, and funding — provided substantial support for an effective consumer roadmap.

Can you share the most interesting story that happened to you since you began your career?

After spending 15+ years in the health insurance industry, I was ready for something a little different. I decided to leverage my knowledge from previous experiences to assist in creating a startup to diversify a company that wanted to get into the health insurance industry. The key was to find the right partner that had the required existing assets but needed a business plan to crystalize and address the problem they were trying to solve, as well as a team to execute the plan.

I was approached by an industry expert who was assisting Premier Inc. with a plan to diversify its business into adjacent markets and leverage its existing assets and relationships to do so over the next three-to-five years. As a strong data and analytics business with well over 4,400 health system and hospital relationships in the provider market, Premier made for a good fit to explore opportunities with self-insured employers. To be relevant to the employer market, we needed to leverage Premier’s provider relationships yet honor what employers were trying to solve for in their health benefits. Most of the early focus was spent on unit price and inappropriate care; however, as we dug further, we realized that while inappropriate care and patient experience were critical, the focus needed to be on creating and maintaining productive employees. After working through the pandemic, we quickly realized that our third-party administrator (TPA) service and existing product bundles (Centers of Excellence) were not enough to transform the market, so we set out to find ways to build out the network architecture. Our market research led us to secure a network cost containment organization focused on serving health contracts. These health contracts in a cost containment environment helped Contigo Health, a subsidiary of Premier, become a full-fledged network.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

It’s to remember names. For the first year of my first job, I repeatedly called my boss by the wrong name. I would do it in public, including during business meetings. It was a complicated situation because he went by his middle name, and while funny in the beginning, it started becoming a nuisance. I started doing name recall exercises with professional athletes and actors’ names to help jog my memory. It’s important to remember names because it helps you better engage with people.

Anyways, with my boss it ended with me getting a t-shirt with his name on it that I had to wear at a holiday party. Rest assured I will never forget his name again.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Life is 10 percent what happens to you and 90 percent how you respond to it.” — Lou Holtz

No matter what the task ahead — including those we take on as spouses, parents, or leaders — we are all going to face challenges. Looking beyond them for the next or best move to make is always better than staying in a negative moment. Even when the moment is positive: reflect and then move on.

When looking at my career path, up until Contigo Health, every role I took was a title and pay-grade regression, so I had to continue working my way back up the ladder. While some may see this as a setback, I knew it was better for my career path because it was always the right role at the right time and built out my qualifications differently. How I chose to approach these moments was important, especially in leadership.

The personal side of this is about setting, managing, and evolving goals. It’s about understanding that your goals are fluid and it’s okay to change how you work toward them. Adapt. Adjust. Overcome.

Are you working on any exciting new projects now? How do you think that will help people?

At Contigo Health, we are always creating new ways for clinicians, health systems, and employers to work together in an effort to optimize employee health benefits. We recently bought a new health network — a group of healthcare systems and providers — with a goal to bring more transparent health products to the market by starting with areas where transparency doesn’t exist at all (out-of-wrap network markets). The federal government and states have been trying to do this for quite some time now, and I’m proud to be a part of Contigo Health’s effort to build this model for future networking structures from the ground up to help reduce the cost of out-of-network care, should people need it.

How would you define an “excellent healthcare provider”?

Patients all have unique needs. Excellent providers focus on providing not only the right care but also personalized engagement appropriate for each patient’s unique situation. There is greater comfort — and more positive outcomes — in working with a provider who possesses a deeper understanding of an individual’s needs and approaches their recommended care plan through this lens rather than following a “one size fits all” approach.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

When it comes to healthcare providers, many are paid based on the volume of care (you see your doctor, your doctor gets paid for that visit or service) rather than quality (keeping you healthy and out of the hospital). There is no benchmark for quality of care in the industry. By designing networks that are more patient-centric and considerate of both providers’ and employers’ needs, we can overcome this. It will end up being a win-win for everyone: patients, providers, and employers.

There should be a standard of quality set forth to begin with, so we are all working from the same playbook. Care will only improve from there. Contigo Health is actively working toward expanding its network five-fold to leverage those quality standards in more markets across the United States as we come out of the pandemic.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

Overall, the pandemic drove increased demand for healthcare. One area that is changing is employer-sponsored healthcare, or the healthcare benefits organizations provide their employees. Since the pandemic, employers and healthcare providers have been able to increasingly collaborate in this area when it comes to understanding employee needs more deeply, ultimately ensuring better, more appropriate healthcare outcomes for employees by providing the right care.

At Contigo Health, through our partnerships with major employers in the U.S., such as Fortune 100 companies, we administer centers of excellence for their employees, or programs within healthcare facilities that provide agreed-upon standards of quality care in advance of that care being received. During the pandemic, patients were delaying their care; however, our contracted centers remained open to deliver care as needed in an isolated way. For example, one of our contracted hospitals isolated their maternity ward to continue patient care during the pandemic while instituting safety protocols.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

Five changes that I believe need to be made to improve the overall U.S. healthcare system include:

  1. Outcomes tracking and monitoring for patients with similar care needs:This will allow patients to gauge the “what” and “when” of receiving care based on factors that matter, and more importantly, outcomes. It will also allow them to pay for certain levels of care and less if benchmarks or agreements are not met.
  2. Increased pricing transparency: More cost transparency from providers to patients in the industry will allow this “market” (price of products and goods sold) to truly act like a “market.”
  3. Increase quality transparency: More transparency in the quality of care will inform the patient of quality care standards and how they are aligned to those standards.
  4. More purpose-built networks: We must focus on building networks that are centered around employees’ needs. An example of this could be having specialized networks — like a dialysis network — that targets specific healthcare needs and disciplines for those with advanced kidney disease.
  5. Allow more freedom and flexibility for members to engage their network as needed: This will help to expand consumers to access all services lines needed to live a healthier life. An example of this is behavioral health benefits. In the past, this benefit has been regulated and required approvals to engage in. Today, post-pandemic, behavioral health benefits have grown rapidly to the point that trying to control services has significant limitations.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I’d love to bring more volunteers to the healthcare industry. There is an abundance of need from food banks to deliveries of supplies to community hospitals. One hospital I work with is doubling its volunteer staff right now, training them to help work alongside clinicians to help meet patient needs. It’s fantastic.

How can our readers further follow your work online?

Readers can follow me on LinkedIn. They can also keep on top of the latest work from Contigo Health on our website and social media pages:

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.

Source: https://medium.com/authority-magazine/steven-nelson-of-contigo-health-on-5-things-we-need-to-do-to-improve-the-us-healthcare-system-88c7ccdb36d1