How Company Culture Can Change Healthcare

Here’s one example of how it made a difference.

If you have read my previous posts, you know that I believe our healthcare system is broken.

It is so complex and byzantine that all of us — no less the disadvantaged and elderly — are left trying to navigate an incomprehensible maze to obtain even basic services. Doctors are so disgusted with the red tape, bureaucracy, and paperwork that there is actually a physician “burn out” crisis. And the system is so rife with perverse financial incentives that many companies put their own financial gain ahead of the wellbeing of the people they purportedly serve.

How did we get here? How did the most personal of all transactions — obtaining the services we need to help our families get better and stay healthy — get so convoluted and costly?

These are big problems that have been decades in the making. And while there are many causes, in my experience, one, in particular is consistent across the industry: corporate cultures that do not inspire us to improve upon the status quo in meaningful ways. With some notable exceptions, too many companies in this space are slow-moving, risk-averse, and stultifying. And the level of dysfunction impacts all of us.

SYMPTOMS OF SOMETHING SERIOUS

Take one practice that has become increasingly common over the past several years: prior authorizations. This is a check that payers use to ensure that the care members receive is necessary, cost-effective, and safe. On the face of it, this makes sense. In practice, it often makes no sense at all. And it says everything about the culture of an industry that has allowed it to happen.

Before a physician can conduct a procedure or a pharmacist can fill a prescription for a defined list of products or services, he or she must often obtain approval from the health plan. This leads to a repetitive back and forth — often by phone or fax, if you can believe it — in which the provider must justify the need and expense. This can go on for several rounds. It is a highly manual process that can take hours, days, or sometimes weeks. Care is delayed and, in some cases, savings are realized when doctors and patients become too worn down to pursue the treatment.

This does not have the hallmarks of an industry with a culture of innovation or problem-solving. It certainly isn’t one that puts the customer first.

HEAL THY SELF

I strongly believe that the way we fix healthcare is to change the way companies in the sector inspire their people to think, act, and live. At Abarca, we identified six core values that we stand for above all else. These are not what you typically find on lobby walls across corporate America, and they aren’t appropriate for every company. Yet they are deeply woven into the fabric of Abarca. They guide our hiring decisions, the way treat each other, and how we approach problems. They are integral to our DNA as a company:

Humble competence. Deliver what is needed to execute, grounded in humility, driven by purpose.

Fire in the belly. Exude contagious passion, positive energy, and an unrelenting will to succeed.

Off road. Expand your comfort zone and explore bold new paths every day.

Like family. Care for each other’s success as deeply as if it were your own.

All In. Live profoundly committed to building a better way together.

Shake it off. Celebrate often, shrug off stumbles, laugh at ourselves, have fun.

These values took root not just because of what they say, but because of where they come from. Our values were not declared top down or developed outside the company by an HR consultant. They were developed from the bottom up from the people who live them every day.

We asked our team to identify those people among us who exemplified what we all wanted to be. And then they pinpointed the traits that were common between them.

What we found was that our team admired those who were bold thinkers, enthusiastic about what they do, deeply care about their coworkers, and so eager to find a better way that they forgave themselves and others for making well-intended mistakes along the way.

It became very personal and profound. People refer to the values daily whether in meetings, when considering candidates, while planning strategy, or when interacting with each other and people outside of the Abarca. I have been honored to hear that team members refer to our core values at the dinner table with their spouses or children.

It has allowed our company to have success and a trajectory that I know we wouldn’t otherwise achieve. And we know that our culture has created one of our greatest competitive advantages.

ACUTE AWARENESS

So let’s go back to prior authorizations. At Abarca, our team wasn’t satisfied with a process that imposed needless burdens on providers or members. And we were disappointed with the low adoption of the electronic prior authorization capabilities launched in the past few years. We just don’t have a culture that accepts the notion that because the rest of the industry is satisfied, we would be. So we set out to develop a better approach, one that empowers pharmacists dispensing specialty pharmaceuticals for conditions such as rheumatoid arthritis and multiple sclerosis to make decisions on the spot about whether a therapy is right for a patient in light of the cost, medical necessity, and alternatives. We provide the guidelines and the technology, and they use their clinical judgment. No multiple rounds of back and forth, no waiting, no fax machines. As highly trained specialty pharmacists become more familiar with the process, they get more leeway in decision making. It’s an easier process for everyone, and still provides the necessary visibility, accountability safeguards payers are looking for.

THE ROAD TO RECOVERY

We were able to do this because our culture is one that puts members first and encourages our team to be bold, “go off road,” and take chances in pursuit of a better way. This kind of atmosphere cultivates a team that is more engaged and enthusiastic — “all in.”

I am sharing our thinking around this because we are at a time of unprecedented change in healthcare, driven by giant companies consolidating and trying to fend off entry by tech powerhouses like Amazon. But that change won’t really happen until the companies think and act differently and cultivate cultures that enable our staff to put customers first. And that is in all of our interest.

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Jason Borschow is the President & CEO of Abarca Health, a company that has been challenging PBM industry thinking and conventions for more than a decade. Today, Abarca manages more than $2 billion in drug costs for millions of Americans, with among the highest levels of client satisfaction and retention in the industry.