Exploring Fee-For-Service 2.0 with Chuck Feerick, VP of Sales for Clarify Health Solutions

[00:00:02] Hey everybody, welcome back to the Outcomes Rocket. I'm so excited to have you here for another episode in the AHIP 2024 series, straight from Las Vegas. I have the outstanding Chuck Feerick with us today. He is the VP of Growth and Sales at Clarify. Chuck, thanks so much for being with us again.

[00:00:22] Chuck Feerick, VP of Growth and Sales for Clarify Health Solutions, Outcomes Rocket, Saul Marquez, and Outcomes Rocket.

[00:00:22] You're welcome. Thanks for having me again, Saul.

[00:00:24] It's always a treat to have you on. You're always thinking about the new and innovative ways that payers can benefit from the solutions that Clarify offers. Payers and providers, that is.

[00:00:35] And so here at the AHIP conference, I want to just start off by just kind of asking you, how's it going? What are you seeing?

[00:00:41] It's been great. This year has been awesome. It's been fun to be back in Vegas after a couple years away.

[00:00:47] We're hearing a lot of stuff about what's interesting to payers and providers. I think right out of the gates, calling it out because everyone's talking about it is AI, right?

[00:00:55] We've heard that from a lot of different panels, a lot of different people asking, really asking the panelists. I've heard from the audience, how are you thinking about AI? How is AI being used?

[00:01:04] And I think while it's a very hot topic, we are still figuring it out is pretty much the answer you're getting where it is a solution to a set of problems that are still yet to be defined.

[00:01:15] And there are enough challenges with it that are going to make it hard to implement confidently and successfully.

[00:01:22] The hallucination problem being a big one of those where I have to trust that the patient is going to get the right answer every time.

[00:01:29] And if I cannot guarantee that, that becomes hard. The other side of that equation that we're hearing is how do I ensure that I'm feeding the models the right data such that they don't run into the solutionation problems?

[00:01:41] And how do I give the right training data sets and other things that would go into a large language model to actually produce the outcomes that I want?

[00:01:48] So that's been one big topic that I think we've been hearing. And then the other has really been around the integration and partnership between payers and providers.

[00:01:58] I'm sure we can talk a little bit more about that later, but then the theme of value-based care is ever present, right?

[00:02:03] It's been ever present at every AHIP I've ever been to for the past 10 or 15 years.

[00:02:08] But we're hearing more evolution of what that looks like. It's not just about the contracting.

[00:02:12] It's how do you actually work between payer and providers to actually get the outcomes that we need, share data insights, and make sure everybody has a voice in that equation.

[00:02:22] Yeah, some great topics. And thank you so much for sharing it with those that couldn't attend the conference.

[00:02:28] I agree. A lot of the conversations are very real. They're candid. And AI is a big topic.

[00:02:33] And that relationship between providers and payers.

[00:02:36] One of the terms that I heard during these interviews, instead of calling it value-based care, calling it fee-for-service 2.0.

[00:02:42] Oh, interesting.

[00:02:43] What do you think about that idea?

[00:02:44] It rhymes. So I hadn't heard that, but it rhymes a lot with, I think, some of the things that we're doing at Clarify, which are, how do you get a provider to act as if they are in a value-based contract without necessarily requiring a value-based contract?

[00:02:58] How do you arm the provider with the incentives, the data, and the insights to do the right thing at the right time for the patient sitting in front of them,

[00:03:05] which is inevitably what every provider wants to do, without all the burdens and constraints of a value-based contract, tracking that, asking me to do something different for this set of patients and this set of patients when I just want to practice medicine.

[00:03:17] So let me do my service and then pay me based on the outcomes that I deliver.

[00:03:23] And we do a lot of that through our Clarify Engage or Clarify Advanced product, which is,

[00:03:28] I will give you the insights and the data and the rewards to do the right thing and give you that glide path to value-based care if you want it.

[00:03:35] But you can also just stay right where you are if you're delivering the outcomes that you need for your patients.

[00:03:39] So I think it's a great term. I'd like to see more of it.

[00:03:42] Cool. I love it. Yeah. And like you said, it does, I like how you said it rhyme with the things that you guys are doing. It fits well.

[00:03:49] So a lot of the things that really are being discussed here are making a difference for payers and the communities that they serve.

[00:03:56] What are your thoughts around any of those and which one of the insights that you heard has risen to the top for you?

[00:04:03] Oh, interesting question. You know, Terry did a panel today, Terry, our CEO, Terry Bach, on titled From Friction to Flow,

[00:04:11] the sort of the new model of payer-provider relationships.

[00:04:14] And I love that sense of flow because previously, and when I started my career, we heard from Abby Moy,

[00:04:20] who was on the panel today from Elevon.

[00:04:22] She had a similar experience where you give the providers the data and you think they can do everything that they need to do,

[00:04:28] and they're going to be successful in your models, and you just have to let them run.

[00:04:31] And you realize that it's much more of a back and forth.

[00:04:33] It's a dynamicism between the health plan and the providers.

[00:04:37] Now, that has to have trust at the core of that, right?

[00:04:40] You have to see me as a partner, not just the health plan that's denying claims or the provider that's doing way too much utilization, right?

[00:04:47] This has to be a partnership.

[00:04:49] And one of the individuals who's also on the panel today from Blue Cross Blue Shield, Rhode Island,

[00:04:54] made the great point that it's really a dance between the two.

[00:04:57] So they can give all the reports they want in the world to the providers, try to answer the questions for them, give them the data.

[00:05:04] But they also have sophisticated provider systems that are coming back to them saying,

[00:05:07] here's actually what I need.

[00:05:09] Here's what I need to be successful.

[00:05:10] Here's what I need to run my value-based programs.

[00:05:12] Here's what I need to do for care management.

[00:05:14] And then Rhode Island are turning around and saying, well, great.

[00:05:17] Now let us take these insights to our other providers who are newer in value-based care

[00:05:21] and show them how some of their successors, how some of the leaders in the industry are actually doing it in our local market

[00:05:28] so they can be set up for success as well.

[00:05:30] I thought that was a really interesting dynamic on how that interplay is continuing to evolve.

[00:05:35] And moving away from, I think, the conversations that we were having two or three years ago about we have to do value-based care.

[00:05:41] But now moving towards how does value-based care, how does it actually work in practice?

[00:05:45] It's not just about the design of a contract, right?

[00:05:47] It's how I interact with my providers.

[00:05:49] It's how I make sure they're successful.

[00:05:51] It's how I make them more partners than adversaries in this relationship.

[00:05:56] Totally.

[00:05:56] I love that.

[00:05:57] And that's a great approach to it.

[00:05:58] And to make them happen, you need the insights, right?

[00:06:01] So which one of the solutions that Clarify offers can enable that?

[00:06:06] Man, many of them.

[00:06:07] But I think the one that stands out to me, and I'll make this point for a specific reason,

[00:06:12] is our ability to assess provider performance agnostic of a value-based contract.

[00:06:17] Given the acuity of your panel of patients, their comorbidities, those social determinative factors,

[00:06:22] where the care was delivered, what would be the outcomes we would expect for a provider managing that panel of patients?

[00:06:28] And then we compare that to the outcomes that actually happened.

[00:06:31] How well did that provider actually perform?

[00:06:33] That's sort of core in a lot of the products that we have to offer, whether you're optimizing value-based contracts,

[00:06:38] you're assessing opportunity, or you're building networks for the first time.

[00:06:41] But the reason I bring that up is the other thing that I've heard in this conference,

[00:06:45] heard in two or three different settings now, is we need more standardization.

[00:06:50] Our providers are getting frustrated that they have one value-based care contract with this payer,

[00:06:55] another value-based contract with this payer, a third with CMS, and then another CMS program that exists.

[00:07:01] And they all kind of want the same things, but they all measure it in different ways.

[00:07:04] So I have no standardization across these different contracts.

[00:07:08] And while I'm not saying that we standardize contracts, we standardize the assessment of a provider

[00:07:14] against a known set of quality and performance metrics, so they can have a good sense of,

[00:07:19] here's where I'm performing, here are the actionable things that I need to do differently to perform better.

[00:07:24] That's cool.

[00:07:24] And I can track what my opportunity is against that if I were to perform these actions

[00:07:30] to get better care and better outcomes from my numbers.

[00:07:32] That's fascinating.

[00:07:33] So you kind of plug in the KPIs and then you automate it.

[00:07:38] Yeah.

[00:07:38] Yeah.

[00:07:38] It's fantastic.

[00:07:39] That's exactly right.

[00:07:40] And data is at the core of that, right?

[00:07:42] I'm sure I'm not surprising anyone by saying we need more data in healthcare,

[00:07:46] but given the assets that we've built on the Clarify side, layering in then the health plan data

[00:07:52] or the provider data that we're working with can create those very specific actionable,

[00:07:57] quantifiable opportunity assessments that then allow us to say,

[00:08:00] how do we go take action on that?

[00:08:02] And health plan, do you want to go take action on that?

[00:08:04] We'll tell you exactly where to go and what to do.

[00:08:07] And if not, we also have services and solutions that can help go engage the providers

[00:08:11] and go capture that opportunity, all coming back to that lens of how do we create more flow

[00:08:16] in the healthcare environment and less about the friction that exists today.

[00:08:20] That's outstanding.

[00:08:21] Thanks so much for sharing that.

[00:08:22] And really to close out here, Chuck, last question for you is now that you've been here,

[00:08:27] you've taken it all in, we've shared some insights with our viewers and listeners.

[00:08:31] What call to action would you leave them with?

[00:08:34] Be like me and don't bring your debit card so you can't lose all your money in Las Vegas

[00:08:38] and also forget your pin, which I did.

[00:08:40] So I'm still, I guess, in the black in terms of gambling.

[00:08:44] And the other thing that I would say is, I guess, think about how your value-based contracts

[00:08:48] are structured.

[00:08:48] And back to your point around, would you say fee for service 2.0?

[00:08:52] Yeah.

[00:08:52] Like, is a value-based contract the right answer?

[00:08:55] And there's a lot of different flavors of that.

[00:08:58] And Abby Moroy, again, from Elevance, who's on our panel, said it really well today.

[00:09:01] She said, I want to stop paying for process and I want to pay for outcomes.

[00:09:05] And maybe that doesn't need a super sophisticated value-based contract.

[00:09:09] It just means a better way of delivering care that gets the patients the outcomes that they

[00:09:13] need.

[00:09:14] So that's sort of what I think I'd leave the audience with.

[00:09:16] That's fantastic.

[00:09:16] No, Chuck, I love how you're closing this out with, it's a reframe, right?

[00:09:20] So for everybody listening, let's reframe our thoughts around this system and processes

[00:09:25] that we're engaged with and think about it in new ways, because that innovation is driven

[00:09:30] by all of us.

[00:09:31] And we're the ones that make it happen.

[00:09:33] Chuck, thanks so much for being with us today.

[00:09:35] Perfect.

[00:09:35] Thanks for having me again, Saul.

[00:09:36] I appreciate it.

[00:09:37] Take care.