Phillip Berry, Author at Northwind Health

“We’ve got a problem.”

That was the opening line to a presentation I made to a room of brokers, advisors, consultants, employers, and clinic management companies gathered at a worksite health clinic conference in January 2020. Though I proceeded to outline a host of health benefits issues facing self-funded
employers, my message was really directed at their advisors and the clinic management companies operating the onsite/nearsite health centers serving their employees.

My message: if you don’t stop playing the status quo, low-value, me-too, race-to-the bottom, game with your health benefits services and instead focus on higher value, lower cost, outcomes-driven solutions, you are going to be replaced.

For those of us spending lots of money to provide health benefits to our employees, frustrations are high. Very high. We’re tired. Tired of the costs. Tired of the complexity. Tired of the obfuscation. Tired of the broken promises. Tired of the annual message that our health benefit costs or premiums will be increasing 10%, 15%, or 20%-plus, with no additional value or improvement of health for our employees. Tired of being told that all we can do to combat those increasing costs is shift more cost to our employees, remove benefits, raise deductibles and co-pays, or somehow restrict access to care.

If you’re like me, you’re asking, “Can’t we do better?” Some might think, “Maybe not,” thanks to headlines reporting on failures like Haven, the joint venture formed by industry titans Amazon, Berkshire Hathaway, and JP Morgan Chase, to combat the issues outlined above. As the venture was dismantled, many thought, “If those massive, well-funded, companies can’t do better, who can?”

More than 150 years ago, French poet Charles Baudelaire wrote, “The greatest trick the Devil ever pulled was convincing the world he didn’t exist.” In many ways, we are living a similar ruse as we look at our $4 trillion health economy and believe there is nothing we can do to change it.

We have been convinced that the seemingly intractable problems affecting our healthcare system are beyond our ability to influence and that we must simply grin and bear its costs and inefficiencies, year after year after year. Well, don’t believe it. We can—and we are—doing better. The movement toward change is happening all around. New ideas. New approaches. New players. New technology. New energy. We’re slowly claiming territory for the change we need, and we, as employers, strategists, advisors, and innovators, must capture, document, and share successes, ideas, and encouragement.

We don’t have to reinvent everything; we just need to reimagine how we engage with and utilize the existing system to remove excess costs while increasing value. Then we need to be willing to do the hard work to foster and sustain necessary change. First within our organizations, and then within our communities. It’s already happening. Best of all, these new ideas don’t have to be high risk, bet-the-farm, all-or-nothing, gambles on the unproven. There is a progressive, more incremental, path. It just takes some vision, some patience, some trust, and some resolve.

Stewardship is a Point of View

First we must understand the barriers holding us back and the real problems we’re facing. Then we need to adopt a point of view that serves as the guiding philosophy toward how we resolve them. For us, it comes down to stewardship.

Most of the myriad issues with our healthcare system, how we pay for it, and the results it produces, can be bucketed into three categories: access, cost, and complexity. These are simple buckets with serious challenges and no simple answers.
Our healthcare system will not be “fixed” from the top down. We will not solve the deficiencies through regulation or consolidation, but through innovation that happens bottom-up, through localized efforts in smaller, targeted populations.
The “fix” must incorporate existing systems but they will need to be enhanced with innovation and reimagined in novel combinations – technology, process, and thinking. We need to think in terms of the “production of health” rather than simply reduced costs, regulation, or single-threaded technology solutions.
The production of health is an act of stewardship – of ideas, of technology, of resources, of organizations, and of systems; all of which are necessary to create better overall outcomes in health, cost, and experience.
Healthcare system innovation will be led by self-funded employers and unions leveraging existing pieces in novel ways while simplifying and unifying the healthcare experience with technology.

Full of Possibility

These are exciting times, full of possibility. The challenges remain and the mountains are high, but the rewards are worth the effort. There are many great options available to address the myriad issues. Start by believing you have choices. Don’t get frustrated by the noise and obfuscation, those are just signs that it’s time to pivot. Recognize the noise for what it is: resistance. Resistance to change. Resistance to innovation. Resistance to anything that might reduce control or margin. Remember, the resistance always uses the same tools to maintain the status quo.

You’ve probably heard some of these before: “No you can’t,” “That won’t work,” “The contract says so,” “That report will cost extra,” “That’s proprietary,” “I don’t know,” or “That’s their fault.” These negative, closed, grasping, and controlling, answers almost always point to systemic points of control that maintain the status quo and cost you money. It’s time for something different.

We can do better. And we are beginning to see it.

If you don’t stand for something, you’ll fall for anything.
Alexander Hamilton

The Power of a Point of View

What shapes how we see the world? Our knowledge of it. Our assumptions. Our experience. These things frame our point of view. They encompass the span of reality as we see it and possibility as we imagine it.

Our point of view is self-limiting as it dictates how we receive and process information. Facts, opinions, and feelings, are put into our internal processor and produce our ideas, conclusions, and reactions. Sometimes we change our point of view based new inputs – new information expands our knowledge and can move us to different conclusions. However, we are slow to change as we tend to be hesitant to accept new facts.

Why would we be hesitant to accept new facts? Many reasons emerge. We might not trust the source of new information. New details may not be well communicated. Data may seem inconclusive based on sample size or polling approach. There are numerous rational explanations for hesitation, but often, we reject new facts or data because they do not align with our point of view.

Whether we recognize it or not, we hold points of view on pretty much everything we encounter: people, places, politics, religion, aliens, entertainment, etc. We also maintain a point of view on the work we do, the industry we work within, the players in our space, and the facts & assumptions of our business.

Healthcare Assumptions

Healthcare is a great example. Consider for a moment some conclusions held about healthcare and health benefits:

Bigger is better as it creates economies of scale
Healthcare is broken
Costs are the biggest issue
Healthcare can be fixed
The safest path is with a BUCAH
Large PBMs give better rebates
Self-funded plan sponsors have limited options
Self-funded plan sponsors have limited influence
Self-funded plans sponsors have little leverage
Hospitals are gouging patients and payers
Change creates risk
We need more regulation

Depending on where you live in the healthcare economy, you may share one or more of the conclusions above. Your conclusions, your assumptions – your point of view, informs every decision you make as it relates to your place in that healthcare economy.

What happens when we’re wrong? What happens when our point of view misses a critical piece of information, a new data point, a recent change, or something shifting in the sand on which we’re standing? Often, missed opportunities mean more cost or less savings. Sometimes, we make the decision to pass over an opportunity from a risk/reward perspective: the potential gain isn’t worth the perceived risk of disruption or uncertainty.

Shifting Risks

However, financial risk is only the simple and obvious side. What happens when our point of view impacts less obvious factors like recruiting, retention, or satisfaction? Or, at the far end of missed opportunities, what happens when our assumptions impact the well-being of an employee or her family? The growing regulatory pressure on plan fiduciary responsibility for members is highlighting direct risk in what is done as well as risk in what is not done.

Status quo approaches to plan management have created real “sins of omission” as they relate to the choices we make on behalf of our members. This is a world in which we may be guilty of the things we did not do as much as the things we did.

Aside from the legal/regulatory risks of living in the healthcare and employee benefits world, there is a growing sense of dissatisfaction with how it works and what it produces in terms of economics and health. More and more self-funded plan sponsors see a growing risk in the traditional approaches and feel a strong call toward stewardship as it relates to member health and related costs. Many are changing their point of view toward healthcare and their place in the ecosystem serving members.

Shared Barriers – Tactical Solutions

Looking more closely, we begin to see that self-funded plan sponsors and members share the same barriers:

The barriers inform the strategy and stakeholders are beginning to realize that there are options. Where do you stand in this new world order? What is your responsibility? Are you seeing opportunities for better stewardship of your healthcare investment and the health of the members it is supposed to support?

A New Point of View

As self-funded plans evolve amid the changing healthcare landscape, the notion of health stewardship is becoming a watchword as it captures the essence of both financial and member health journey responsibility for the plan sponsor. Recognition of the growing barriers related to access, cost, and complexity are redefining the self-funded plan sponsors role in helping members navigate options responsibly and effectively.

What are the elements of this evolving health stewardship point of view?

Systemic healthcare problems of access, cost, and complexity cannot be “fixed” with a top-down approach. There is a growing understanding that regulatory and statutory intervention are exacerbating issues by adding complexity and limiting plan sponsor flexibility. Siloed fixes create new problems and generally serve the special interests sponsoring them.
The massive, fixed structures currently operating as the backbone of American healthcare cannot make the changes needed to remove the barriers. Self-funded plan sponsors are realizing that the financial and competitive incentives to keep things as they are, work against plan and member interests and needs for something different.
Existing systems and approaches to healthcare must be reimagined in new ways, centered on the needs of those paying for healthcare in the form of self-funded plans and their members, and incorporating fundamentally different models for access, experience, outcome, and payment. In this way, innovation will be led bottom-up by plan sponsors themselves and their demand for new options.
Self-funded plan sponsors need effective points of influence to help members steward financial resources and personal health. Strong primary care is a key part of the equation but must be paired with the right health solutions horizontally coordinated rather than vertically siloed. Data access coupled with meaningful insights become the backbone to direct stewardship in this new healthcare world order.
Plan sponsors and their members must be empowered in radically new ways to make better decisions and manage across less complexity for the overall production of better health. Digital technology is part of this but must be effectively integrated with the analog of high-touch healthcare and experience management.

Massive employers have already started much of the shift but they are still beholden in many ways to the fixed interests of the existing system. Less complex organizations have the advantage here as they can be nimble and iterate more quickly on ideas to find what works best. Scale brings some negotiating leverage but the most powerful assets for change are the point of view to see a better future, the courage to demand something different, and the will to pursue it aggressively.

What’s the power of a point of view? Everything. Shifting our mindsets to see a different future is the first step in creating it. If we keep telling ourselves that it’s too big, too much, too complex, too frustrating, too fixed, etc., we will continue to be on the receiving end of someone else’s priorities and quarterly earnings report. In this journey, we are all stewards of the resources, talents, and lives of those we serve and support. Our duty is to be good stewards. Anything else is unworthy of us and our capacity to make a difference.

Earlier this week, I was meeting with an employer client as we prepared for a joint presentation we’ll be delivering. Our presentation is centered on strategies and tactics employers can deploy to influence healthcare costs and outcomes for members of their health plans. A recurring theme in our conversation centered on how difficult it has become to trust the information, recommendations, and intentions in so many interactions across the health and benefits continuum.

The healthcare word is ablaze with calls for transparency. Transparency in pricing is chief among them. Purchasers of healthcare services want to know what they are paying for and how much it actually costs. Sounds reasonable to me. Wait a minute, that’s actually a problem? Yes it is.

Transparency in relationships is another call ringing across our health and benefit landscape. Purchasers of healthcare services want to know who is getting paid by whom to provide services. Once again, yes, we actually have to ask those who advise us who is paying them to influence our decisions.

Where else are we demanding transparency? In the data we receive. It seems that purchasers of healthcare want to know the results of the trillions invested in such services. It is surreal to think that such data is withheld, edited, and frequently manipulated to obfuscate reality. However, that is our world and the truth of many of our situations.

What is truth? What is the reality of our situation? So desperate have we become that we have started passing laws requiring “transparency” in healthcare pricing and the tangled web of relationships and incentives permeating it. Our reality is that we feel we need to pass laws to force suppliers of healthcare services and benefits to tell us the truth.

That’s really what transparency means. It is a cry for truth; for the reality of the situation. The truth of the contract, pricing, rebates, efficacy, quality, and myriad other factors that affect how we procure and consume the health services we need to live. Those of us who subsidize health benefits for our employees want to know the truth of our situation and what we can be doing about it.

Ultimately, the laws we pass demanding transparency are pointing to the fact that we don’t trust that what we’re being told is the truth. Our healthcare and benefits world is rife with obscuring words like discount, rebate, wholesale, average, and even transparency. Words highjacked to hide or obscure reality in the name of profit.

Ultimately, we cannot legislate trust. Sure, we can work to narrow definitions and behaviors to some degree but ours is a wily and resourceful lot. There is no way to define every situation or protect the unsuspecting from every behavior. The truth is that our $4 trillion healthcare economy has become bigger than our ability to control it or the people within it.

Trust is earned. Trust develops with time and experience. Trust is strengthened through difficult times and reinforced in good times. Trust is born through shared values, aligned cultures, and clarity of motivations. Trust happens when we see honesty, particularly when it is a difficult truth or seems to weaken the bearer’s position. Trust cannot be bought, contracted, legislated, or fabricated. Trust must be built and re-earned time and again.

Trust really isn’t a complicated process. Do what you say you’re going to do. Be honest, or at the very least, don’t lie. Work for the good of the other simply because that is the right thing to do. Seek win-win situations. Treat others as you want to be treated.

Not sure who to trust? Watch what they do over time. Watch what they do under duress. Watch what they do when they feel you are no longer worth something to them. What about organizations? Same thing. Some cultures are just better at fostering and following through on trust. Some cultures foster the behaviors that are short-sighted, obfuscating, and untrustworthy by rewarding their results.

The big unseen movement happening within our healthcare and benefits world is not really about transparency. It’s about trust. There is a massive shift underway in the fundamentals around what is acceptable and unacceptable in a space that has become comfortable with dishonesty, hidden deals, fuzzy rebates, and an attachment to the obfuscation of the truth through muddled words and misleading definitions.

I am very encouraged by various employer and union movements to deconstruct the structures that have created such massive gaps in trust. Calls for transparency, the criticism of hidden rebates, the demand for clarity on incentives, and increasing pressure for more accountability are all the result of the groundswell from our community of self-funded plan sponsors who have begun to recognize that they have options and a responsibility to demand more.

In a world short on “angels,” there are still opportunities to forge ties based on trust and mutual respect. There are still plenty of places to earn a living, price services responsibly, and be a force for good in the business of healthcare and benefits. Plenty. We don’t have to be perfect but we do need to be trustworthy. We don’t have to wait for angels, but we do need to expect more from those serving our organizations and our members. The truth is there and trust isn’t far behind.

“The people who are crazy enough to think they can change the world are the ones who do.”
Steve Jobs

Swim Lanes and Ecosystems

A friend recently shared the quotation above with me. The truly crazy thing is our $4 trillion dollar healthcare economy that seems to frustrate everyone, and our struggle to make meaningful improvements within it. Some complain. Some lobby. Some pound their fists. Some take action.

There is no guarantee that anything we do will ever “change the world.” However, we firmly believe that, given enough focus, we can change the lives of patients, one at a time. We also believe we can change the costs and results our employer and union clients are seeing, one patient, one disease state, one day, one location, at a time. We further believe we can change things for our healthcare provider partners one site at a time. That seems like a good place to start.

Last week, Northwind Pharmaceuticals announced our acquisition of QVI Risk Solutions, an Oregon based health benefits administrator. For those that know Northwind and our story, this move is probably not surprising. We’ve spent the last 15 years following the signs, and the value, around how our self-funded clients and healthcare partners want pharmaceuticals to work for them, their plan members, and their patients. We have relentlessly and unapologetically pursued new ideas to help wherever and whenever possible.

However, our acquisition does beg the question: why? Northwind has experienced tremendous growth in our home delivery pharmacy, our programmatic chronic disease-focused Clinical Blueprints^TM, and our pharmacy services administration offerings. Though we are growing rapidly and seeing amazing economic and health-related results for patients and their healthcare sponsors, there is still plenty of work to be done in our “swim lane.” Why would a “pharma” company take on the broader challenge of healthcare and self-funded health benefits?

Health industry contextualist, John Singer, writes that we need to think of healthcare innovation in terms of the “production of health” as novel combinations of old and new systems, ideas, and technologies. All of us are now in the business of healthcare in one form or another. Northwind is not leaving pharmaceuticals behind but evolving our own production of health to focus on the biggest problems and highest areas of value for our clients. We see ourselves within this broader ecosystem and will continue to pursue solutions to our clients’ and partners’ thorniest challenges.

The simple answer to “why” is: because it is needed. All of us are sitting within the perfect storm of a healthcare system that is in danger of being crushed under its own weight. The weight of rising costs, the weight of an aging population, the weight of incredibly high expectations, the weight of conflicted economic models, the weight of entrenched interests and misaligned incentives, the weight of a hugely burdensome regulatory & legal environment, and the weight of its own complexity. No one is immune, the implications for our future are dire, progress is slow, and our demographics will continue to put more pressure on it.

But we’ve heard all of that before. Stop, please. We already know. Agreed. But that is why, we’ve got to keep trying. All of us.

Health Industry Point of View

Our strategy and plan for execution becomes clearer when contextualized within our point of view:

Point of View #1: Most of the myriad issues with our healthcare system, how we pay for it, and the results it produces, can be bucketed into three categories: access, cost, and complexity. These are simple buckets with serious challenges and no simple answers.

Point of View #2: Our healthcare system will not be “fixed” from the top down. We will not solve the deficiencies through regulation or consolidation, but through innovation that happens bottom-up, through localized efforts in smaller, targeted populations.

Point of View #3: The “fix” must incorporate existing systems but they will need to be enhanced with innovation and reimagined in novel combinations – technology, process, and thinking. We need to think in terms of the “production of health” rather than simply reduced costs, regulation, or single-threaded technology solutions. No one player can do it all.

Point of View #4: The production of health is an act of stewardship – of ideas, of technology, of resources, of organizations, and of systems; all of which are necessary to create better overall outcomes in health, cost, and experience.

Point of View #5: Healthcare system innovation will be led by self-funded employers and unions leveraging existing pieces in novel ways while simplifying and unifying the healthcare experience with technology.

Already Happening

Self-funded plan sponsors have been working to address our healthcare system shortcomings for many years. Unbundling traditional health insurance and “self-insuring” was the first step and many organizations have moved, and more continue to move, in this direction. From there, point solutions have emerged and often have great impact for their adopters. Direct primary care, population health, direct contracting, chronic disease management, centers of excellence, care navigation, benefits navigation, and patient apps have proliferated among self-funded employers.

However, as the point solutions have matured, we’ve begun to realize that the access, cost, and complexity barriers to better results still remain even as we invest more in our efforts to address the issues. From a vendor perspective, this is the “what have you done for me lately?” conundrum. It also reflects the reality that we cannot solve the bigger problems in a vacuum. Focusing on solving single-threaded issues is appealing because they are easier to understand and seem to require less investment, but they do not fix the broader issues around cost and can actually increase complexity.

Lessons Learned

Over the last 15 years, Northwind has had the opportunity to partner with innovative direct primary care and advanced primary care providers to address access, cost, and complexity barriers through onsite and nearsite health centers. We have successfully paired our direct contract pharmacy services with our partners’ direct primary care offerings to provide robust clinic programs that reduce costs and improve health outcomes.

How? By taking money already being spent on prescriptions through a traditional PBM, shifting it to a direct contract, and redirecting it toward clinical programs delivered inside the health center, we’ve increased access, decreased cost, and removed complexity, resulting in better outcomes for the patient. We call this Strategic Rx Stewardship^TM and it has made a huge difference for thousands of employers and hundreds of thousands of patients.

Through our approach, we’ve discovered that we can help the employer influence and reduce overall drug spend while improving health for targeted populations and decreasing downstream healthcare costs. Today, drug spend makes up 25-30% of a self-funded employer’s overall healthcare costs. What about the other 70%?

Nexus of Care^TM

This brings us to the point of this post and the answer to the “why” question brought up earlier. In my book, Nexus of Care: Fulfilling the Promise of Employer-Sponsored Health Centers, I propose a strategy built on what we’ve done so far, what we’ve seen with our health center partners, and what we’ve heard from our self-funded clients. Those paying for healthcare for their employees & plan members want greater influence over healthcare costs and health outcomes. Many are having success with sponsored health centers but there is more to be done and not all self-funded plan sponsors have an onsite or nearsite health center.

Northwind acquired QVI to extend the success we’ve had with our self-funded clients and healthcare partners in pharmacy services into the broader realm of overall healthcare services. We see a world in which the self-funded employer or union leverages their own Nexus of Care^TM built upon a primary care point (or points) of influence to quarterback the overall health of their employees within the health center and beyond.

We see a health plan approach that is built from the self-funded plan sponsor outward. We see a non-disruptive (at least to the plan sponsor, the patient, and the provider) path to removing the access, cost, and complexity barriers that are plaguing our healthcare system today. In this world, the patient knows where to get care, does not ration it due to cost, receives care and counsel through their journey, and understands their decision points along the way. In this world, the self-funded plan sponsor has real-time visibility and understanding of their healthcare costs and opportunities, receives expert guidance on key decisions to be made along the way, and is able to track overall healthcare spend like any other investment to determine return and efficacy. In this world, the healthcare provider knows the patient and the health plan, is empowered to help with navigation, has visibility on what happens outside of direct care, and collaborates with the plan sponsor to manage overall population health.

Northwind, QVI, and the Road Ahead

Our plan to bring innovation to our clients and partners will center on the following approach: start from the bottom-up, go local first, be relentlessly patient and payer-centric, stay non-disruptive from an experience perspective, begin with targeted populations, and offer low-risk, progressive path to novel innovations.

Here is what our clients and partners can expect:

1) Northwind’s direct contract pharmacy and pharmacy benefit services remain available in all 50 states.
2) Northwind QVI’s benefit administration services remain available nationally.
3) We will launch our full health plan offering in Indiana, Ohio, and Kentucky for 2024.
4) Targeted population health versions of our plan, built on Northwind Clinical Blueprints^TM, will be available in all markets we serve, in coordination with our healthcare partners.
5) Northwind’s plan will be built upon relationships with our national health center manager partners, local direct primary care partners, and local health systems.
6) Northwind is expanding our clinical and support team in Indianapolis to support new demands from patients, clients, and healthcare providers.
7) Our RxSteward^TM platform will continue to support our pharmacy services and HealthSteward^TM will be made available to support new health plan offerings.

We will continue to post updates as we progress and welcome questions and conversations.

INDIANAPOLIS, April 28, 2023 – Northwind has announced the acquisition of QVI Risk Solutions, a health benefit administrator based in Bend, Oregon.

“The self-funded employers, unions, advisors, and healthcare providers, with whom we work, feel that the economic and experiential value of healthcare has become disordered,” said Phillip Berry, CEO. “They continue to ask us to help them create options that drive value back to those who pay for and access the healthcare system.”

“Northwind’s mission is to re-center healthcare around self-funded payer and employee plan members by leveraging points of health influence to remove cost, access, and complexity barriers,” continued Berry. “With our acquisition of QVI Risk Solutions, we add another piece to our Nexus of Care^TM vision by supplementing our direct contract pharmacy benefits services with the ability to administer a complete health plan for our clients. We are building a future that re-localizes and re-centers healthcare around the self-funded payer and the employee member.”

QVI Risk Solutions, Inc. (QVI) was founded in 2003, in Bend, Oregon, to provide Third Party Administrator (TPA) services to employers who choose to self-fund their employee benefit program and Business Process Outsourcing services to other TPAs and commercial health insurers. Led by Founder and CEO Carolyn Jarschke, QVI has grown to serve thousands of members and their sponsoring organizations across the country and will continue to operate out of Bend.

“For 20 years, QVI has shown-up for our clients and their members by being a good steward of their health and financial resources. Northwind’s values and vision for the future align ideally with our own,” said Carolyn Jarschke, Founder and CEO of QVI. “Quality, value, and innovation, have been hallmarks of our success and we are excited to enter this next chapter by joining our story to Northwind’s. I am thrilled to join Northwind’s leadership team in pursuit of the mission to remove cost, access, and complexity, barriers to healthcare for our clients and their members.”

Northwind offers a national pharmacy and health services platform that brings the logistics of drug distribution and home delivery pharmacy together with advanced analytics, pharmacy benefits, health benefits, chronic disease-focused Clinical Blueprints^TM, and RxSteward^TM software, to help self-funded plan sponsors create a Nexus of Care^TM to influence healthcare costs and outcomes for their plan members.

INDIANAPOLIS, March 16, 2023 – Northwind has announced the addition of John Singer to its strategic advisory board.

“Healthcare is at an inflection point,” said Phillip Berry, CEO. “Rising costs, barriers to access, struggles with quality, and a general sense of frustration, are driving self-funded employers to engage innovators like Northwind to help solve these problems.”

“John’s vision for innovation in a U.S. healthcare system stymied by ‘entrenched mediocrity’ aligns perfectly with our mission to empower employers and their employees by removing healthcare access, cost, and complexity barriers,” added Berry. “With over 25 years of strategy development work across diverse aspects of our massive healthcare ecosystem, John’s ideas on re-configuring markets and navigating change caught my attention years ago and I am delighted for the chance to collaborate with him.”

John Singer is the Executive Director of Blue Spoon Consulting, a global leader in strategy and innovation at a system level. Singer brings unique experience as a practitioner, business manager, and senior leader in big technology, digital health, marketing, strategic communications, innovation consulting, and industry thought leadership across all dimensions of the global health sector, including pharmaceutical, medical device, payer, and provider contexts. Singer’s insights on new business thinking and ecosystem-centered strategy have been published in influential media like MIT Sloan Management Review, the Wall Street Journal, the Journal of Business Strategy, and the Oxford Handbook of Innovation Management.

“One thing everyone knows about healthcare in the United States is that it tolerates stagnation and celebrates short-term gains,” said John G. Singer, Executive Director, Blue Spoon Consulting. “As the primary financiers of a $4 trillion health economy, it is the employers who sit at the nexus of care and hold the real power to break the structural stalemate sustaining the past. Northwind is well-positioned to break the mold of the status quo, and I couldn’t be more thrilled to advise them as they build out and implement innovative products and services for an economic system demanding a new vision of value.”

Northwind offers a national pharmacy services platform that brings the logistics of drug distribution and home delivery pharmacy together with analytics, pharmacy benefits, chronic disease programs, and software, to help self-funded employers create a Nexus of Care^TM to influence healthcare costs and outcomes for their plan members.

INDIANAPOLIS, February 22, 2023 – Northwind has announced the addition of Rod Reasen to its strategic advisory board.

“Rod is an incredibly smart and passionate guy who has had tremendous success leveraging his ability to solve complex customer problems into great businesses,” added Berry.” “With deep knowledge of the intersection of health benefits, data analytics, and technology, Rod brings a unique perspective on the problems we are working to solve in our industry, and the opportunities we see in our business. I’m excited to collaborate with him on Northwind’s future.”

Rod Reasen is a seasoned entrepreneur who sees problems as opportunities and has successfully used technology, scale, and data to drive results. Reasen has built and sold multiple businesses, including a high growth, venture-backed, tech company reaching nearly 5,000 customers. Serving as advisor to founders, CEOs, VC/PE funds, and boards of director, Reasen focuses on helping businesses and individuals see their “why” and works to help them aim for, and reach, their greatest potential.

“I’m excited to be part of an incredible story and to support Phil in his efforts to revolutionize the way employers leverage their investment in employee health and pharma benefits. Northwind has positioned itself as an industry leader and is uniquely equipped to bring much-needed change to the status quo. I’m looking forward to helping them deliver upon their incredible vision.”

INDIANAPOLIS, February 21, 2023 – Northwind has announced the addition of Jerry Ford to its strategic advisory board.

“Jerry’s extensive experience in leading one of the largest advanced primary care providers in the United States, his expertise in the challenges and opportunities facing our healthcare system, his heart for helping remove barriers to care, and his track record in scaling multiple high growth companies, are a perfect fit for our advisory board,” continued Berry. “I am delighted to have the chance to engage his heart and mind in our mission.”

Jerry Ford is currently a partner at Centerboard Advisors in Burlington, Vermont. Jerry served as CEO of Marathon Health from February 2008 through February 2021.  Prior to joining Marathon Health, Ford was CEO and president of an Accel-KKR owned company, Systems & Software. Ford also spent 15 years at IDX Systems Corporation where he served as vice president of operations responsible for more than 300 large and complex healthcare delivery system customers. 

“The Northwind core value of leaving it better than you found it is a value and a responsibility I believe we all have towards improving healthcare,” said Ford. “Having known Phil for a long time, I appreciate the focus he and all at Northwind place on ensuring this core value is lived in spirit and achieved in action.”

We are such a soundbite-driven society. Give us a quick nugget we can get our head around and then run with it ad-nauseam.

Case in point: look at all of the headlines associated with healthcare related costs. The noise level over costs has reached new heights even as the myriad solutions are raining upon us like a tidal wave. Regulation. Price transparency. Hidden incentives. Transparency. Cheaper drugs. Cheaper surgeries. Cheaper. Don’t get me wrong, costs are important. Very important. But cost isn’t really the problem, it’s only a symptom.

In our wildly flailing efforts to commoditize healthcare, we fixate on price as if it’s the Holy Grail – the end-all be-all to solve all that ails our massively complex and expensive healthcare system. If only we knew how much this procedure costed us. If only we knew how much we spent last year. If only we knew what someone else was paying. If only we knew how much those evil PBM’s earned on rebates. If only we knew.

But that’s what we do. We break things down into their smallest parts, parse them, quantify them, and then try to compare them. From there, it’s simple copy and paste. Why not? It works well with copper, oil, and pork bellies, right? Of course, the consumer in us wants to be able to compare so we know what we’re getting relative to available options. Fair enough.

Compared to What?

However, it is in our comparison process that things really start to break down. What is our reference point? How do we evaluate differing options? Where does quality, availability, support, and any of a myriad of alternative priorities fit in? What do we do with all of this information?

The easy answer is…the easy answer. Cost is an easy variable on which to base a decision. Thus, the massive wailing and gnashing of teeth over transparency. No argument here. When it comes to healthcare or anything else one plans to purchase, one should know what one is paying. But that is just the ante to the game. It is only a starting point and thrashing around in search of the price of something seems like a cry of impotence. Why isn’t it easier to know what something costs?

Ah…now we’re getting warm. Why indeed. One simple answer is complexity. Put another way: it depends. It depends on payer. It depends on market. It depends on provider. It depends on provider. It depends on risk, timing, and the particular orientation of the sun, moon, and constellations this month. Out system is built upon a universe of complexities and your particular constellation does in fact make a difference in what you pay.

Pitchforks and Complexity

Back to the headlines for a moment. You may have noticed headlines blaming hospitals for egregious acts of gouging in their pricing of life-saving procedures. Employers, get your pitchforks! It’s time to take down those hospital monsters who are crushing the souls of your employees and your P&L. Mr. or Mrs. Hospital, why do you charge so much?

Hospital exec, “Good question. Before I can answer, please let me know what network you are a part of.” Network? Whatever do you mean? We come to find out, the “network” holds the contract with the hospital. Who is the network? A better question is: who owns the network? It seems that there are a variety of networks, built over the years by big insurers (spelled BUCA) that provide patients with access to providers.

The argument is that the big insurers are able to negotiate better rates with providers due to their scale. It is arguably true. However, that doesn’t mean that those savings are passed through to the payer/plan sponsor. In fact, the opposite is true. It seems that scale makes a huge difference and those savings are converted to profits that then become the expectation of quarterly analyst calls. Shareholder exuberance must be maintained.

A Better Way

We love to focus on cost because it is easy and should be obvious. However, obfuscation on pricing schemes, misaligned incentives, navigation, quality, and a host of other comparatives make the system highly opaque. Tack on the sheer scale of our health system and the endless options, it is no wonder that we need an entire industry to help us navigate it, hold vendors accountable, make decisions, justify decisions, and pay for it. We all know that we need a better way.

The good news is that alternate approaches have emerged and the system of the future is being built on top of, around, and over our existing healthcare morass. Some things are getting refreshed and repurposed while new models, services, providers, and technology are also appearing.

In some ways, we are seeing a new ecosystem forming to respond to the complexity and the frustration it fosters. At its most basic level, it is a simplification to directly purchasing the services that comprise healthcare and the health benefits world that encompasses it. Employers and private plan sponsors are driving this new ecosystem as they take a keener interest in the inner workings of healthcare and realize that it is too strategic to leave to entrenched incumbents.

Pieces and Parts

The direct care movement has started by breaking the complexity up: primary care, surgery, emergent care, specialty care, musculoskeletal, occupational health, mental health, infusion, and pharmacy. Next, the mechanisms for funding and administering these pieces have been deconstructed and reformed into new plans/models. In between the old and the new lie myriad hybrid versions of all of the above that range between status quo and innovative. Cost savings can be found. Better ways are there. Great ideas rest hidden with. However, it is still wildly complex and expanding rapidly.

The Next Wave

On the horizon, beyond the pieces and parts of direct care, rests the potential for something different. An entirely new way of experiencing healthcare and health benefits. A new ecosystem built on direct relationships, localized health models, patient and payer centricity, innovative technology, real-time data, and simplicity of navigation and consumption. Sure, costs are still important but the future will be built on value in novel ways. Stewardship becomes the standard of measure and we all begin to look at all of it quite differently.

We begin by imagining. As patients, we understand the system and how to navigate it. We connect directly with care givers and get sound counsel on courses of action. We get timely care and never doubt its quality. We understand costs and our responsibilities. We get support when needed and always know where to turn. We have options when the worst happens and rest easier knowing we there is a way forward.

As employers, we understand the health and risks associated with our employee population. We have strategic and tactical support for overall population health – sound guidance on how best to support and manage it. We know the costs and implications of care; including influence at the point of care with providers able to guide patients when most needed. We have real-time data with meaningful insights as well as potential courses of action. We are still cognizant of costs and risk, but they now exist within a world that we can see clearly and we have mechanisms to help manage both. We are able to be good stewards of our resources and most effectively support the overall health of those working with us.

Not the Primary Issue

Pie in the sky? Not at all. Not if we are willing to dream boldly and make definite plans to make them a reality. We are spending massive energy on chasing costs when the real problem is the system and all of its complexity. The complexity hampers our ability to make decisions, see possibilities, get the results we want, mitigate the risks we face, and manage the escalating costs that are the ultimate result. We race to the squash cost but it is a race to the bottom as we fail to address the underlying issues.

Join us in the effort. Join us in the discussion. Join us as we walk with intention toward the horizon and its reimagined possibilities. The bridge to the future is being built and it promises to be an exciting journey.

The #healthcare system is not broken. I repeat: the health care system is not broken. The system as we know it is working pretty much as it was designed and built. Our healthcare system funnels trillions of dollars, handles billions of transactions, serves millions of consumers, facilitates millions of encounters, and pretty much gives all Americans a pathway to getting care.

The institutions built to deliver care are able to deliver care. The systems built to manage all of it are engineering marvels. The companies serving the entire ecosystem do an effective job at keeping it all going; some of them are fantastically profitable, employ hundreds of thousands of people, and give tons of money to charities and their communities. All of this is financed through an unbelievably sophisticated array of payment mechanisms, subsidies, and plan structures.

Yes, our healthcare system is working and by some measures, is working incredibly well.

And yet, despite the phenomenal industrial muscle and throughput of our healthcare system, about 70% of us believe our healthcare system is in crisis.

A recent article posted by Medifind summarized 8 major problems with the U.S. healthcare system today:

– Medical errors – now the third leading cause of death.
– Mortality rates – the U.S. consistently ranks lower than other industrialized nations.
– Lack of transparency – fraud, cover-ups, and hidden deals are rampant in our system.
– Difficulty finding a good doctor – anecdotal but a likely reality for many.
– High costs of care – we spent 10% of GDP in 2018 on healthcare and that percentage is expected to grow to 19.7% by 2028.
– Lack of health insurance coverage – no data shown here but medical debt levels are quite real; 100 million Americans with medical debt, 12% over $10,000.
– Nursing and physician shortage – by 2033, expected shortages of between 50,000 and 139,000 physicians.
– Inefficiencies – at least one study ranked us last in administrative efficiency.

That’s a serious list with some serious numbers. We can argue the details but the reality is that most of us, as consumers, acutely feel many of the issues, and those of us working within the system wrestle with the problems every day. Even those recognizing immense profits from it all recognize the need for improvement – preferably not at the expense of their shareholders.

The healthcare system is working, just not how most of us want it to work. We need new ideas. We need innovation. We need improvement. We need change. And, we need it all pretty much across the entire healthcare ecosystem.

We know we need #innovation but the reality is that “large scale” innovation scares most everyone touched along the way, and incumbents will always chase incrementalism as a means of protecting what’s in place, while passionately affirming their desire to innovate. There is a desire to change but there is an equal or greater resistance to it. And, naturally, we all have preferences for how and where those changes occur.

Our healthcare system is akin to the interstate #highways crisscrossing the U.S. The infrastructure is old, the routes are fixed, repairs must be incremental and done with the same old technology, and any meaningful change requires massive capital to tear-down and replace because it cannot be augmented with new #technology.

Meaningful change will have to be made one #community, or system, at a time and the bridge to it will need to be built over a long horizon. By the way, that bridge to change can’t melt the current state down while it’s being built. Few have the stomach for such long-range visioning, which will entail many setbacks, uncertainty, and resistance along the way. Not to mention the fact that some will have to give something up as things change.

Because the system is so massive and the problems so pervasive, it is easy to become overwhelmed by it all and retreat to the known, the easy, or the predictable, in the silos to which we all belong. The large, entrenched institutions double-down on what they know and what they can control. The innovators appear with single-threaded products, services, and technologies clamoring to solve our problems. When we do get a truly innovative idea, product, or technology, we get lost amid the money as we ask: who is going to pay for this great idea?

Right now, there are a lot of smart people trying to solve many of the problems facing our healthcare system. There are good ideas. There is a lot of #money. There are plenty of opportunities. Many, many options are appearing that offer innovation. New #health plans. Direct primary care models. New products, new #drugs, new procedures. Much of it is incremental. Much of it is focused on short time-horizons, small #niches, and race-to-the bottom me-too-ism, centered on cheaper. Always cheaper.

Where are the big ideas? Where are the #bold plans? Where is the moxie to chase something profoundly innovative? Where are the game-changers?

There is a better version of our current healthcare system waiting to be discovered. It is not going to be built on the same roads on which we are currently driving. Addressing even a few of the 8 major problems listed above is going to take more than one organization, one idea, one model, one drug, one service, or one small window of time. We need big thinking, big #goals, and more than a touch of boldness to push past the entrenchment holding us in place.

Yeah, that’s a lot. Time to close this post and go back to the issues of the day.

Still here? Then let me offer a few ideas on where to start.

Focus on the #experience – the existing structures and systems holding our healthcare system in place cannot be modified in any meaningful way. However, some of them can be repurposed and redeployed in a new version, or versions, of our healthcare superhighway. Start with the critical stakeholders: #patients, payers, and #providers. What would a better experience look like? Follow that thread to find the best place to start.
Follow the money to find the value – where are the buckets of dollars being consumed? What are the cost problem areas? Now, look beyond the single thread and beyond the concept of “cheaper.” A huge issue with healthcare #costs is that we get stuck on transactional costs and miss the forest for the trees. Getting my drugs cheaper is a silly solution until I know that what I’m getting is working. Putting barriers in health plans to avoid costs is foolish if they create bigger problems in productivity or cause downstream emergent events. Look at the money from a horizontal rather than a vertical perspective and follow it to value.
Don’t boil the ocean – we get overwhelmed when we try to tackle too many issues, too fast. Start small and reorient how you start. We don’t need more silo solutions – shiny object, point-solutions, may be part of the mix but they will only yield incremental results on the front-end. Think in terms of communities of individuals, geographic or organizational, and focus horizontally. Our obsession with using information technology to do everything, everywhere, all-at-once, sounds great in an investor pitch but healthcare system innovation must start in analog mode and center on the community of interest and their particular needs.
#Create in segments – a corollary to #3 above is that we need to recreate our system in segments. This makes sense because we’ve got assets and systems that can potentially be redeployed. By starting with our community and the redesigned experience, we center our healthcare focus on stakeholders rather than institutions. Connect to the old system where it makes sense and use it within the framework of the new.
#Build bridges – there is no shortage of ideas for ways we might improve or even redesign our healthcare system. Often, the most brilliant notions break down as we try to envision getting from here to there. Blowing up the current system would be frightening and irresponsible – resulting disruption would be worse than the disease. With this thinking, we get an either/or approach – those who want to blow it versus those who fight to protect entrenched interests. Workable ideas will include pathways to bridge from today to tomorrow, offering stakeholders a way to safely (relatively) get from here to there. The bridges should also help get some key pieces of our current system from here to there. There will be some pieces that must necessarily be left behind but the goal should center on bridging to the new experience as smoothly as possible.
Bring others along – the only way to reinvent the mass #industrial complex of U.S. healthcare is to create a new #ecosystem to support new measures and mechanisms of value. Like our current structure, it will need massive collection of innovators building it out but it will need to happen alongside what we’ve got and be built differently. All daring enough to undertake the venture will need friends…lots of them. Enemies will abound. Resistance will be fierce. Some can eventually be converted, many will stay behind. Most will fight. Find your co-conspirators and envision a future where many more can win.

In the coming weeks and months, I’ll share how we’re executing on the approach laid-out above as well as what we’re seeing others doing. We see the future being driven by a Nexus of Care model – a #primarycare-driven model for reworking the experience of each stakeholder on the path to better care for patients, lower costs for #payers, and, ultimately, greater value for all in the ecosystem.

Follow along, join-in, push-back, or sit on the sidelines. We all have a role to play.