Boulder Community Health and Optum

Matthew Stevens, Executive Partner & Managing Director, Advisory Board

- How does the relationship with Optum, the partnership, help keep care local for Boulder?

Rob Vissars, MD, President & CEO, Boulder Community Health

- There's no greater example than this past year. And we began having a conversation about this, I guess about half a year prior to the pandemic hitting, you know, really. And then all of a sudden everybody's world was turned upside down last February, March in particular. In fact, I was meeting with Optum partners at the time when I think we all remember it hitting, sort of March 12th or March 13th. I was like, "I gotta get home." Everybody scattered. And at that time, we had to decide, do we move forward with this partnership? I mean, we have a pandemic to deal with. We have a community to care for. And we felt like, if anything, this is an emphasis that we have to do this, and we have to do it now. So we managed to work through the deal last summer, and then we're coming up on our one year anniversary, but doing that at the same time. Having said that, putting things in place and having the support of whether it be the actuarials, or the prognosticators, or Advisory Board, our ability to navigate this past year was greatly enhanced just through this partnership. And it wasn't something that was part of the contractual obligation, but it was more of an example of the trust we built early on, the commitment that we're both going to see each other succeed, and our alignment in our cultures. And this is carried forward in a number of ways. Our leaders are integrated. And so it isn't an outsource model, even though we've rebadged employees. The Optum leaders are frankly mostly our prior employees that still remain boots on the ground in our facility, just wearing a badge that has two logos on it instead of one.

Matthew Stevens, Executive Partner & Managing Director, Advisory Board

- Talk to us about the relationship with the pillars, the structure, what is this partnership? What does it look like?

Rob Vissars, MD, President & CEO, Boulder Community Health

- Sure. I'll start off by saying that, we began by saying, "What are our goals? What are we trying to achieve?" And I laid out some of those earlier in the conversation, but the other intent was how do we take all the different components and opportunities for scale and expertise and create sort of, a sum of the parts where the sum is greater than the whole, where we utilize some synergy across a number of channels as opposed to just singular one-off vendor type relationship.

Matthew

- Yeah.

Rob

- And we identified three areas where we felt like we not only could benefit from the expertise and the technology and the strengths of Optum, but where there was overlap, and where together we could drive towards something greater. And then with the intent that this would grow. The foundation part of this was a rev cycle. And we recognize that this would also require some investment. So that, rev cycle innovation really gave us the financial opportunity to invest further in this partnership. And we're already starting to see that manifested a year in. However, there are other areas that we thought that we could absolutely benefit and one was around data-driven decision-making. And so we moved, and Optum joined forces with our analytics team, but that was an area we needed to invest. We built out EPMO. We built out a data analytics team that isn't just, what's based in Boulder, but I can access an actuarial scientist that might be based here in Minnesota, or some other data person in analytics in California or Nashville or whatever, depending on the project and the need, giving us scale and access that we never could have hoped to achieve on our own. And the third area was, what if we take this financial opportunity and investment and we combine it with solid decision-making and data to drive better decisions and drive better clinical operations performance. And so, finally, a partnership around and our operations. Now we of course, retained all our clinical operations, ourself and oversight and the personnel, but having the teams work with us closely to improve patient flow, to make sure we're optimizing ORs, et cetera. And so, not only are we're getting our patients out of the hospital, perhaps more quickly and safely and efficiently with better outcomes, but many other things like, there's a direct partnership around case management. And with that, we've seen a continued decrease in readmissions where we're in the top decile. That transition from the hospital to that post acute space making that seamless and all the technology that can also help with that. And then of course, that sets the foundation for population health and population health care. So again, the idea is these three areas, the sum is greater than the parts.

Matthew Stevens, Executive Partner & Managing Director, Advisory Board

- Rob, you mentioned transitioning 10% of your workforce, and the impetus behind it, and the reception that it's had thus far seems to be very good in terms of turnover and the like. Maybe I'd ask you to talk more about some of the workforce work that BCH and Optum are doing together in Boulder.

Rob Vissars, MD, President & CEO, Boulder Community Health

- Yes, I think it is important to mention that going into this, we had certain areas that had a great deal of concern for us on the board. And one was the wellbeing of our employees, and particularly the workforce that was most directly impacted. And that really has gone well. I think it's a reflection that this isn't the first time that this type of, at least, relationship or rebadging has occurred, particularly, in RCM space. And frankly, we were reassured going into it that it would go well, and it did go well. But since then, when we started looking at initiatives and things that we could do together, we recognized that we needed to re-look at our entire workforce, and certainly not around rebadging as a solution or outsourcing, but more importantly, optimizing. And while we are facing an acute struggle with the turnover and employment really in all areas, but in particular in nursing and some of these highly skilled professions, we recognize that certainly the solution isn't paying more. You know, and it feels like right now we're in a bit of an arms race with all the other health systems, and I don't think anyone's really benefiting. But how do we look at this over time? And so one of our first initiatives coming together is a workforce analysis, but not just, you know, how do you compare against benchmarks or standards, but using our clinical continuum and our analytics resources and our Advisory Board best practices to say, but where should we be going with our workforce? How can we restructure? How can we map out the processes of each unit, so that we look at our workforce in a way that it fits with the workflow? And so that, again, we hear this over and over again, but truly, our nurses are working at the top of license that they have, the more cost-effective, more available support staff, and we've got the right complement of people, at the end of the day, more cost-effectively, providing higher quality care and giving that great patience experience that we always have. So that's been at least certainly our focus. I talked a little bit about the challenges of COVID and the transition. And I think I mentioned earlier a bit about the turnover as well. We were very nervous about what this was going to do to our turnover. And I'll have to say that it has been better than actually the rest of our organization. But I'm not offering to rebadge all my employees. I don't think you want that.

Matthew

- Sorry, you're welcome?

Rob

- But we just recently looked at the data. And in fact, the turnover is probably about 25% less than the rest of our organization. It's similar to what it was beforehand. But what's been really heartening is to see employees who have left moved on to other roles within Optum. And it's a way of creating that advancement that we never could before as well.

Matthew

- Different aspect of scale.

Rob

- Absolutely.

Matthew Stevens, Executive Partner & Managing Director, Advisory Board

- Well, gentlemen, as our time today draws to a close, let me raise one sort of final question for your comments, and that's growth, right? A word that's not a minimal of a single definition, but Rob, I wanna get your take on where you see growth going for BCH and how this partnership helps fuel that.

Rob Vissars, MD, President & CEO, Boulder Community Health

- Well, one of the underlying requisites for us to achieve our goals, remain independent, have sustained financial stability is we're gonna have to grow, like every organization, every healthcare system. But historically, when we set out and looked at the year ahead, we would sit down and roll the dice. Maybe hopefully apply some principles and a lot of hope and we'd come up with something like, well, you know, ambulatory, maybe we'll grow 2% and inpatient side wIll grow 1% or 1 1/2 if and when we balance things out. What we lacked was the precision and the ability to, well, grow in a smart way. And while we recognized the need to do that, we just didn't have the capabilities. Now, with our partner, we not only have the data and the analytics, we have the resources of their marketing team. I listened to a presentation the end of last week and it was around precision marketing. And they had taken some of our data and they came back with answers to questions we didn't even know we had. How many individuals within our secondary service area are not even aware that they could benefit from, for example, our structural heart program. And so it's also around making sure that we reach the right people and grow in the right way. And of course, make sure we grow profitably. We still have to sustain our mission. We still have to have the resources to make sure that we have equitable access to everybody within our community, which means outside our community, we may have to be more strategic. And the tools and the capabilities that Optum brings to bear us significantly exceeds anything. Not only that, I think we had, but when I look at my local market, I think we actually have a competitive edge over systems much larger than us. So I'm really excited about how we grow in the next several years.