NOVO Live: The Podcast

Episode 4: An Insider’s View

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About Dr. Tim Bartholow

Dr. Tim Bartholow is the VP and first Chief Medical Officer at NeuGen LLC. Before joining WEA Trust, Dr. Bartholow served as the Wisconsin Medical Society’s Chief Medical Officer for five years. In this role, he focused on physician and community engagement to promote change in the delivery and payment of health care. Prior to joining the Society staff in November 2008, Dr. Bartholow spent 16 years caring for patients at the Prairie Clinic in Sauk City, Wis., where he was one of 12 clinical owners and an EMR since 2003. In the late 1990s, he served as medical director for Community Physicians Network, an independent practice association with more than 400 primary care providers. Learn more:

The Transcript

Curt Kubiak: I want to welcome you again to our next edition of NOVO Live, where we’re bringing together thought leaders in the health care industry to discuss pertinent issues, and figure out how it is we can come together to solve these problems together. What we’ve recognized is that, you know, individually, none of us has all the answers, but collectively as a health care community, we’ve got a lot that we can offer. So with that, I’d like to introduce you to my guest this week. It is Dr. Tim Bartholow. Hello, Dr. Bartholow I want to welcome you to novo live glad to have you on the podcast today.

Dr. Tim Bartholow: Great to be here with you, Kurt.

Curt Kubiak: And you know, I think your biography, right is indeed is unique. And I want to make sure our listeners understand that. So could you just give me a little introduction, your history, and, you know, kind of how you’ve gotten to where you are today?

Dr. Tim Bartholow: Yeah, so I was 16 and a half years as an independent primary caregiver In Sauk City, Wisconsin. And during that time, there was an HMO in town, it was a rural HMO, that had started in about 1984. So I would come to Medical Direct at that time as an Independent Physicians Association, really the sort of the doctors contracting with insurance company in order to get the right work done. It was there, I became pretty aware of how decisions about where to spend money were being made, and, and you know, some alarming things to a primary caregiver, frankly. And so anyway, I did that until about 2008. And then I went to our State Medical Society. And I worked on an all-payer claims database there called WHIO where I watched physician variation, maybe 100% variation in the cost of care to get a knee or hip done, angioplasty, a variety of other specialties. And we worked hard on several cardiology opportunities. And then I joined the WEA Trust, which would later purchase an additional health care insurance company called Health Tradition. And about 2014, I joined them I’ve been there since, trying to make better care affordable.

Curt Kubiak: Excellent. Yeah, I appreciate you, even at the start of your career taking an interest in data, right. So every other industry, when they’re trying to solve problems relies on the data so that they can, you know, kind of fine-tune their next moves and make sure that they’re doing something that’s going to be impactful to their consumer. And so with health care, and WHIO, talk to me a little bit about this information, right? So this information has been available. But how has it been utilized, maybe underutilized? How can we think differently about that information that’s out there?

Dr. Tim Bartholow: So important question, right? We all have been interested in what claims data can tell us? Claims data, the doctors will say, don’t always describe every nuance of quality. And I agree with that. However, we can see where large blocks of investment are occurring. So for instance, in the course of building an angioplasty, how many dollars go into the institutional costs and how many dollars go into, for instance, the decision making in the skill of delivering the service. Turns out to be the physician pieces of that turned out to be pretty small. And, and understandably, institutional pieces are pretty expensive. We want really great care, right. But in our state, we have an all-payer claims database, all-payer claims database is actually $60 billion of charges. That amount of cash turns out to be against a $347 billion annual GDP for the state of Wisconsin. It turns out to be about one dollar in seven, Right? So the state has this opportunity, right to have an investigation into what does getting a hip or a knee or a angioplasty or taking care of the rheumatology patient or having a delivery look like at one institution versus another? One of the challenges we’ve had is trying to get our physicians the feedback about when I deliver a baby, how many resources does it take in order for me to do that, and how does that compare to my partner? And how does that compare to others across the state? Why should that matter? Well, if for instance, in delivering a baby and outcome is you know, healthy mom, healthy baby. In our state, we will have people do that for sort of 8,000 resource dollars, and other folks will do it for 14 (14,000 resource dollars) but the employers have to pay for that, right? Or, in the case of Medicaid or Medicare, then right in Medicaid, and specifically Medicaid is paying for that delivery. And we don’t you know, Medicaid is paid for by taxpayer dollars, we want the taxpayer right to have the best value for their, you know, their confidence and investment and choosing that doctor, right.

Curt Kubiak: Yeah. So let me just make sure that I’m following your comments here, because it’s very important for our listeners to be able to track. So the all-payers claim database effectively, these are insurance companies giving us their information about what they’ve paid different health care entities, or groups, in order to deliver care.  So this is claims paid, these are the actual dollars that have been spent by organizations for healthcare. So you can use that information to compare different geographies, different specialties, different positions within a specialty, that’s what I’m hearing you say.

Dr. Tim Bartholow: Yeah, even physicians within a practice, it’s interesting that if you take a large practice of cardiologists, there’ll be variation between them. And we haven’t done a good job honestly, of in sort of the general system of giving these physicians feedback about how many resources they’re using. And in fact, I think sometimes we haven’t known that it was important to achieve high quality but at the least resource use possible.

Curt Kubiak: So my manufacturing background, I like to talk about these types of things, because there’s more than one way to get to an end. But when you design the solution with cost as one of the elements, you start to think very differently, don’t you? Right? So it’s not just how do I get this mom and her baby, you know, a good outcome with regard to delivery. But what’s the shortest timeframe that I can have that happen? What is the least resource consumed possible in order to get to that healthy outcome? Right, because I don’t think we want anything more than that. But we certainly don’t want anything less than that. This isn’t this isn’t about cutting corners on quality, to reduce cost. But this is about removing variation, that wouldn’t be evaluated

Dr. Tim Bartholow: Clearly. I mean, you can get a high quality event with sort of, you know, one amount of resource use. But in the state, you can also get a high quality event, literally no difference in quality that we can perceive at double the resource use. Why would we? Why would we want that when we’re spending so much money on health care? It’s more so than that, actually. Right? It’s not just that we’re taking our community treasure, and we’re spending more on an individual outcome that, you know, maybe we wouldn’t have to. You tell me if we have a mom or a baby in the hospital, how much more radiology, radiation, right? How much more drug? How much more? How many more days in a hospital where there might be superbugs Do you really want that mom and that baby to be exposed to, right? In healthcare, we’re using sophisticated tools, right? And every time we use that sophisticated tool, it should help and and we know that there’s a small risk of, for instance, if you take an X-ray, little bit of radiation. So when somebody is using double the amount of resources, it’s not just the money, it may actually not even there may be a small amount of additional risk that we’re tolerating that we shouldn’t be doing. Right? So you’re paying more and having, frankly, a lower quality, overall quality outcome.

Curt Kubiak: Yeah, so health care acts a little bit differently than some people might think. Right? So typically, what I feel like I’m paying more for something, I’m getting a higher quality service or product. In healthcare, we could actually save dollars, not do the additional diagnostic test, not administer the additional narcotic and actually save the patient money and make them healthier.

Dr. Tim Bartholow: I think this is actually – we’ve had certain states have shown us some of your listeners may be familiar with Maryland Bartlett’s work in Montana: the state budget was running a little bit short, he public workers needed health care insurance, but there’s a several million-dollar shortfall. So Marilyn was brought in, she’s an accountant, but said, look, we’re witnessing sort of variation in the amounts that we’re paying our various institutions across Montana. And she also noticed that when some of the institutions were paid more quality actually was less Why? Well because folks when they’re operating in tighter margins, like your former life and like, where I’ve grown up professionally, if you don’t watch how many dollars you spend, you actually end up with, with a process, right? That isn’t as careful about the increments of choice that you make. So where we’re paying attention to cost, we frankly get a better result.

Curt Kubiak: The example that you’re giving with regard to the state of Montana, they’re a huge employer. So they’ve got large numbers of people that are working for the state, when they make changes, these things can have a huge financial impact. We’ve talked about ways that we can look at that data to understand whether we’ve got the right focus on the right things, right? So are we reducing variation? are we buying our health care from the most cost effective solutions? In every event, we’re talking about the employer having to take action. So if you’re an employer, and you’re not actively involved in requesting this data, or reviewing this data, getting involved with your insurer, or to ask about setting up a meeting with a group of primary care specialists that may have their best interest in mind, you’re missing out on the opportunity right here and now to try to take control of this huge spend, that you described very well sometimes exceeds the cost of raw materials for a manufacturer. Right? So how, how would you manage that if that was a steel supplier, you’d manage them very diligently. As employers, we’ve got to think differently about how we manage these suppliers of healthcare

Dr. Tim Bartholow: Completely agree, Curt.  A richness I had in my practice was when the folks from Milwaukee Valve came down the street and they said, we just want to know more about who our employees are going to and and are there ways that we, as an employer can help you and are there ways that, you know, we can help have the employee back at work productively properly, right, as soon as they’re able to? That was a vastly rich discussion. And I would encourage every employer, right, take the time Have they have the have the smart HR folks go down and meet, right, the primary care practice and just ask the question, well, how could we, together manage toward better quality, of course, but also a better cost experience?

Curt Kubiak: That’s excellent. So let’s flip the coin over. Because you are, again, you’re in a unique, unique position, because you speak from both the care delivery side as well as the consumer side. So how would you advise a primary care physician that has never met an employer that hasn’t had the opportunity to understand what it means to manage a group of employee’s health? And how to keep them on the job? What is it you’d say to them?

Dr. Tim Bartholow: Yeah, you know, the, so the doctors don’t have a lot of experience actually talking to employers, right? And to the to the young resident, I would ask, how is it that you’re going out and meeting the employer in your community? Right? How is it that you know, what it is they’re thinking? And look, they may not be able to their job as a, you know, a learning as of one of these learners, right, is to be a family practitioner, reading about all the fine points of being a primary caregiver. They can’t meet probably every employer, but but they should meet, they should meet several. And I hope that those, you know, residents – and we have a great training program in the Fox Valley, that, by the way, deserves accolades for the 210 graduates that have been that have literally been seeded into this area and Wisconsin – but I hope that those learners, right, being willing to be a little uncomfortable meeting an employer and such. And maybe some employers being willing to, to say why I’ve never talked to primary care practice and such. Perhaps a conversation there between several of them, right, would bring lots of opportunities for how can we do this a little bit better? How can we have a little quicker communication? How can we get disability forms completed, you can think of the, you know, some operational and tactical things that that could be smoother, but you could also develop a relationship where over the next five years say a goal might emerge, how can we together deliver better quality and better overall cost experience?

Curt Kubiak: This is the part that I find super engaging about you. Dr. Bartholow, you’ve always advocated for problem solving with as many resources as you can, right, that you’re not uniquely trying to solve problems but trying to get the right people around the table to solve the problem. And even in some cases where we’re talking about the consumer and the provider of healthcare, who have been historically at odds, if the if the provider is winning, somehow the employer is losing and vice versa. You know, what you’re suggesting, and I advocate, if we get on the same side of this problem and work this together a primary care physician-employer, we can actually come up with a better outcome for both of us.

Dr. Tim Bartholow: I think we’re silly not to do that. Right, Curt. Looking in the valley, there’s a certain amount of community treasure that we all are designating is going to go to healthcare. And part of the opportunity is to say, Well, how much of that needs to be in mental health, right? And how much of that should be in primary care and sort of the coordination of these elements? And yes, we’re going to have a few people that need transplants and some unfortunate, you know, cancers in various people with chronic illnesses, right. But the the proposition here is, it’s not like if the employer loses that doesn’t impact the number of people, for instance, they’re able to employ. Or if the health care system becomes too expensive, that it’s not decreasing the business’s ability, right to the aggregate to compete in a world marketplace. Look, to me, this is a this is a wagon. It’s got to be pulled by everybody. And the extent to which we, you know, sort of divide ourselves and aren’t thinking together I think is is mutual failure, honestly.

Curt Kubiak: Well, I appreciate you spending time with me today, Dr. Bartholow and explaining to me some of the intricacies from your perspective on the health care systems, how we consume, how we deliver, you’ve got vast knowledge, we could talk all morning about you know, these topics. But if folks want to learn a little bit more from you, and perhaps be consulted by you, is there a way that they could get in touch with you to have a conversation?

Dr. Tim Bartholow: Yeah, like so many I’m, I’m on LinkedIn. I’d be open to any conversations that folks would like to have. Obviously, a call to to WEA Trust or the Health Traditions folks could find me as well. But really grateful to be with you, Curt. I really appreciate what you NOVO Health is doing and trying to deliver that better care and, and cost affordability. I think if we don’t think more about this affordability problem, that we won’t be credible to our friends and neighbors that aren’t, you know, with big salary and such, right, we have lots of manufacturing jobs that are in that $30-$40,000 range, and we need to be more credible with them. So thank you for the work that you all do.

Curt Kubiak: I appreciate that. There’s things we can do to advocate for our communities. And there’s action that we can take that can make a difference. And that’s why I’m so encouraged to have you know, you among the people that advise me. And I think folks would be glad to have you on their advisory team so that we can look at this as a glass half-full opportunity here. Right We are there are things we can do we should do, to take action to save money, provide better health care and take care of our most valuable resource our people.

Dr. Tim Bartholow: Yeah, and if we have employers listening today, I hope many, don’t be afraid to ask to talk to your primary caregiver, right. And if we have some of those trainees that are listening today, please take the opportunity to come to know right, some of your major employers and understand what their pressures are because you’re trying to solve the same problem

Curt Kubiak: Thanks again for your time.

Dr. Tim Bartholow: Yeah, great talking with you. Excellent. Curt.

Curt Kubiak: I want to thank you all again for joining us for this episode of NOVO Live. I look forward to talking to you again in the near future and until then, let’s keep the conversation going.

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