Dan Ablett of Previon: 5 Things We Must Do To Improve the US Healthcare System
The United States is one of the only countries that doesn’t regulate new prescription drugs prices. Most other countries have established agencies to meet with pharmaceutical companies, review reams of data and evidence, evaluate their risks and benefits vs. existing drugs, and so forth. They then make informed decisions about whether it’s worth bringing the new drugs onto the market and at what prices.
As a part of my interview series with leaders in healthcare, I had the pleasure to interview Dan Ablett, President and Board Member, Previon.
Dan joined the company that has become Previon in 1982 and has continually pursued the application of information technology to production and business systems as well as client-facing solutions. Dan has a BS in Printing Management from CSULA and an MBA from the University of La Verne. His wife and two adult children are his enduring inspiration.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
My career has been focused on developing and deploying various enterprise communication systems using my experience in technology and production. Through convergence between my profession and my own personal health journey, I know that there remains a significant gap in how healthcare and insurance delivery systems communicate with their customers – their patients and members. Knowing the power of digital communication and the importance of engaging with healthcare service consumers, I have, over time, become focused on opportunities to help providers wrestling with improving their engagement of patients and members, and the outcomes deriving from those activities.
My career journey into the healthcare system began serving hospital systems with the design, production, and distribution of business forms and related services in the 80’s. At this time, healthcare used innumerable paper forms and information tracking formats in performing patient care and insurance services – lab forms, admitting forms, encounter coding forms, accession labels – and on and on.
As the healthcare industry and technology evolved, that career journey led to continually higher doses of applied information technology and into the domains of pharmacy benefit management organizations, payers, regulations (HIPAA, CMS), and population health management. Today, I focus on providing outsourced execution services and technologies for point-to-point communication systems that help healthcare companies and their partners address challenges and improve “last mile” member/patient outreach communications, including the deployment of at-home patient self-test kits at scale.
This is what gets me moving in the morning; integrating business strategy and technology in the pursuit of improvements in healthcare outcomes. I believe in a future focused on prevention, where education and personalized communications put healthcare management in the hands of individuals. Our work pursues a future that enables care systems to lead with preventive care and where healthcare cost savings allow us as a society to expand our services to underserved areas and upstream health determinants.
Can you share the most interesting story that happened to you since you began leading your company?
This really has to be overall story of how, working alongside our CEO and board, we moved the company through three discrete and complete business model transformations. None of those transformations were simple and each one taught me new leadership lessons.
The original company was formed in 1955 and I joined in 1982. As mentioned previously, the company focused on large-scale business forms printing and distribution. The first transformation was catalyzed by the encroaching effects of technology on our customers – think networking, digitization, and the emergence of electronic health records (EHRs). We achieved this transformation phase through diversification and by aggressively adopting and establishing leadership in digitally enabled products and services. The biggest take-away for me at this time was that moving quickly to address changing market needs is a prerequisite for business survival.
In 2006, we experienced a significant shift triggered by the opportunities revealed by the implementation of Medicare Part D. I took point on the development of a new “business within our business” aimed at developing and deploying solutions that would create value with this new ecosystem composed of Medicare payers, pharmacy benefit management (PBM) organizations, and other stakeholders. This transformation entailed establishing then-new Internet-accessible tools and complex data-dynamic communications to enable these systems work together in a manner that satisfied all of the requirements of the stakeholders and the Centers for Medicare and Medicaid Services (CMS) regulations. Throughout the process I learned that success requires having the right people, team structure, culture, vision, and communication. The lesson here was that fortune favors the prepared and that teams need to have capacity to thrive in a strategic pivot.
Our third transformation (circa 2015) was marked by a decision to put “all of our chips down” on the healthcare sector, and to phase out, separate out and/or divest of, those aspects of the business that pertained to lines of business other than for healthcare. That leads to where we are now.
Our current transformation has just seen the launch of a company that addresses two core market needs in healthcare: Preventive care and compliance communications. Our configuration enables health systems to hyperjump care gaps and enables government program managers to achieve compliance excellence with innovative SaaS tools, omni-channel communication services, patented test kit fulfillment and comprehensive program control dashboards. I am focused two things: First, on developing solutions that connect outputs to outcomes and provide evidence-based value to the health systems using our solutions, and second, on continually advancing our solutions so that they evolve with the needs of the industry.
I’ve adopted reinvention as both a personal and a core business practice. Large-scale changes were always in motion and are still so today – at an ever-accelerating pace. Evidence for this lies in the decreasing time intervals between our own transformation cycles. Now we systematically look for ways to ask, and plan for, the question “what happens next” routinely and early in any development cycle. Technological advancement, digitization of processes, regulatory drivers, value-based programs, economic business cycles all played a part in catalyzing this continual evolution. When I stand back and look at what all of that that took, it’s really breathtaking and inspirational to me.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Early in my career, I was visiting my brother, who was at that time, an MD at a major clinic in the Midwest. He was teasing me when I was talking about my work, saying, (I’m paraphrasing) “for a guy with a degree in printing and an MBA, you sure talk about healthcare a lot.” It was around Christmas, and his clinic was having their physicians’ party. He invited me to come along. We made a bet that I could pass myself off as a physician for at least 15 minutes. I lost.
What do you think makes your company stand out? Can you share a story?
Structurally, it’s the depth of our service offerings and the fact that it incorporates all aspects of our delivery: Healthcare and compliance domain knowledge, business acumen, marketing, SaaS, production platform, API connectivity with other system stakeholders, etc. It’s also our ability to adapt and our commitment to meet client needs. Case in point: We have a client who approached us with some challenges surrounding the fulfillment of an at-home patient test. We stepped up to the challenge to develop new operational approaches to increase their effectiveness in improving outcomes. We put on our “communication engineer” hats to address a variety of challenges from project design to postage cost optimization. We also had to implement our solutions alongside their existing systems and technical infrastructure. We developed and patented a way of delivering in-home test kits. This created immediate and substantial reductions in the postage costs for those test kits (a six-figure savings per year). Using many of the lessons learned in this, we introduced Preventive Care as a Service – Previon PCaaS™ – an innovative communication platform that includes patented at-home test fulfillment processes.
Today, the campaigns for this client generate response rates that are among the highest in the US and frequently more than double the outreach screening rates of which we hear in many systems across the nation. They’ve seen a decline in incidences of colorectal cancer and related deaths across a large, diverse population, and achieved repeated excellence in Star ratings. In one six-month sample period evaluated, the total estimated treatment costs-avoided, had those cases detected become catastrophic, totaled in the 8-figure range.
Qualitatively, we stand out because of our curiosity and innovation. We’re obsessed with addressing client challenges with implementing meaningful solutions that deliver outcomes. A recent example of this comes in a use case that is about to be deployed for an omni-channel communication SaaS tool, where we will direct it toward improving medication adherence alongside PBM and payer client partners. We’ve been developing this solution for a couple of years and we’re about to deploy it to tackle a persistent challenge for our customers – that’s very gratifying.
What advice would you give to other healthcare leaders to help their team to thrive?
Embrace a growth mindset and demonstrate this leadership characteristic with your teams so you avoid the potentially devastating pitfalls of taking the path of perceived lower risk and tuning out potential innovation because of a fixed mindset that “has all the answers.” Learning and effort, coupled with a mindset seeking continuing growth is the key to thriving teams and effectiveness in outcomes. When I look at our company history, our greatest successes (and those of our clients) have been preceded by many instances of experimentation, adaptation and agility.
Let’s jump to the main focus of our interview. According to a study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3-5 reasons why you think the US is ranked so poorly?
It is shocking. This is obviously a deeply complex topic – the Newsweek article mentioned was based on a study by the Commonwealth Fund comparing 72 metrics between the US, select European countries, Australia, New Zealand, and Canada.
From my view of the ecosystem, the biggest drivers of this poor ranking are these:
Rising drug costs. There are, of course a number of factors driving this: Decentralized purchasing, PBM market consolidation, and rebate handling to name a few. There is a good article on this very topic that sheds some light on the situation.
The United States is one of the only countries that doesn’t regulate new prescription drugs prices. Most other countries have established agencies to meet with pharmaceutical companies, review reams of data and evidence, evaluate their risks and benefits vs. existing drugs, and so forth. They then make informed decisions about whether it’s worth bringing the new drugs onto the market and at what prices. In the US, drugmakers set their own prices, copays are higher, and often people cannot afford life-saving medication – so the problem expands to touch the patient’s outcomes, care delivery, and insurance. All of this represents one side of the equation. On the other, the central challenge to a solution is that in the US system, lower drug prices translates to lower profits. And, lower profits dissuade investments, which in turn thwarts work toward new and innovative cures. The US system we have today creates a Catch-22.
Excessive administrative friction and costs. The US spends about 8% on administrative costs as opposed to 1- 3% in 10 other nations reviewed in a comparative study by the Journal of the American Medical Association. It points to the complexity of the US healthcare system and the “separate rules, funding, enrollment dates, and out-of-pocket costs for employer-based insurance, private insurance from healthcare.gov, Medicaid, and Medicare, in all its many pieces.” The system requires consumers to choose from several tiers of coverage in each of these sectors. These include, high deductible plans, managed care plans (HMOs and PPOs) and fee-for-service systems, which may or may not include pharmaceutical drug insurance which has its own tiers of coverage, deductibles, and copays or coinsurance. For providers, this means dealing with myriad regulations about usage, coding, and billing. And, in fact, these activities make up the largest share of administrative costs.
Insufficient focus on preventive practices. Although as an industry we’ve made huge strides in recent years in pursuit of higher quality and population health care practices, more work lies ahead. When I look at the National Colorectal Cancer Roundtable’s initiatives to increase screening in every community, I see the level of effort that will be required to narrow the gap between goal and current results. The US Centers for Disease Control reported in July of 2020 that seven out of 10 US deaths are caused by chronic disease, and that about half of US population has been diagnosed with a chronic illness, including heart disease, cancer, diabetes, AIDS, or other conditions classified by the medical community as preventable. These extraordinary statistics point to the need for a greater emphasis on preventive approaches to healthcare, like purposeful deployment of in-home tests in synchrony with enable primary care delivery systems. Routine tests and exams, particularly for middle-aged and elderly patients, help early identification and treatment for chronic diseases and infections such as cancer, diabetes, and heart disease. These health screenings along with primary care consultations have been found to significantly increase life expectancy.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Build and sustain provider/patient panels. In both our client relationships and in research, we repeatedly see that outcomes are significantly improved when patients have an ongoing relationship established with a provider over time.
In one study we see that quality indicators improved by an average of 9% and cycle time decreased by 12 minutes per patient allowing providers to see approximately four more patients and generate an additional $2212 per day.
Another study by Health Management Associates examined whether relationship-centered actually helped achieve lower costs, better health outcomes, and better experience of care. They used a defined framework for relationship-centered care that is founded upon four principles: (1) that relationships in health care ought to include the personhood of the participants, (2) that affect and emotion are important components of these relationships, (3) that all health care relationships occur in the context of reciprocal influence, and (4) that the formation and maintenance of genuine relationships in health care is morally valuable. This study asserts evidence demonstrating that the development of relationship-centered care cannot only improve patient satisfaction but also improve health outcomes and lower.
- Incentivize partnerships between Accountable Care Organizations and payers. ACOs need funding for preventive care programs delivering quality performance. Current incentive alignment needs adjustment to activate cooperation between ACOs and payers to better enable ACOs to fund preventive care practices. For example, the CDC reports that regular colorectal cancer screening beginning at age 50 is the most effective way to reduce a person’s risk of getting the disease. Despite this, only 25% of adults age 50 to 64 in the US, and fewer than 40% of adults age 65 and older in the US are up to date on colorectal cancer screening and other recommended clinical preventive services. Cooperation between payers and ACOs toward funding the programs that support delivering repeatable quality performance in the CRC HEDIS measure is in the best interest of both stakeholders – payers need quality performance, and health systems need support in delivering quality.
- Increase employers preventive care activities. With self-insured companies covering over 60% of the nation’s workforce, preventive care and continuing health education support deployed by these organizations will yield a healthier population and lower costs of care overall. The CDC Foundation reports that US employers on average lose $1,685 per employee each year due to absenteeism. The three conditions that cost employers the most—diabetes, heart attacks and high blood pressure—can often be prevented or caught early and treated successfully. Preventive care helps keep employees healthy (and lowers absenteeism) by avoiding some conditions and detecting others earlier making the easier to treat. In addition, employer support for preventive care – like paid time off for medical appointments – builds loyalty and attracts prospective employees. Both employers and employees have a huge stake in this. According to PeopleKeep.com the share of health insurance covered by employers across all employers (small and large) is 82% for single coverage and 67% of family coverage.
- Embrace the potential of interoperability. The rules issued by Office of the National Coordinator for Health Information Technology and Centers for Medicare & Medicaid Services in March 2020 regarding information blocking and patient access have started a process that is pushing the ecosystem toward an unprecedented level of empowerment and transparency for the consumer. The currency of the coming healthcare economy is data, and standards such as those from ANSI-accredited HL7®, including FHIR® (HL7’s Fast Healthcare Interoperability Resources), and USCDI (US Core Data for Interoperability) establish a technological platform of standard healthcare data formats and elements upon which technology providers can develop applications that bring meaningful reductions in transactional friction.
- Standardize subsystems. In interviewing systems on their methods for preventive care outreach, I frequently see patchwork implementations of testing methods even within health systems and discrete geographies and markets. Standardization in outreach programs yields cost containment through procurement consolidation and process leverage and enhances the repeatability of outcomes improvement. When we engage with a system that is using a combination of different CRC-FIT tests in their outreach and inreach systems, we inevitably see a reciprocal opportunity to enhance clinical outcomes and costs through standardization – the process simplification helps the caregivers too.
Ok, its very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
- We, as individuals, are the single most important factor in the outcomes equation. Preventive care practices, within whatever limits are defined by our geographic, socioeconomic and accessibility resources, have the potential to yield lifelong benefits for all of us as consumers in the healthcare system, as well as reducing the cost of the services deployed to heal us when we are ill. For this potential to take hold, we must first take ownership and accountability for our choices (where we have them), become involved and informed consumers and take actions to drive change. The participants in this ongoing journey are our families, coworkers, care providers, health and physical training coaches, civic, State and Federal leaders.
- If your organization has a purposeful, coherent and sustainable strategy for population health analysis toward risk stratification, meaningfully deployed alongside primary care and care coordination resources, it is on the right side of the curve. In order to achieve this, health systems require data, methodology, capability and team resources. As a strategic outsource service provider to healthcare systems, we touch all of these.
- Preventive care systems and purposeful incentive strategies are essential for employers. With more than 60% of the nations’ insured under their stewardship, employers represent a strategic resource and opportunity from the national perspective. While attending the National Colorectal Cancer Roundtable Conference in November of 2020, the NCCRT’s launch of the “80% in Every Community” campaign in pursuit of 80% screening levels in every community, one notable speaker (representing a major self-insured employer) asked the question – “where are the employers?”
- Healthcare and our society needs policies that are aligned with means and metrics that enable systems to engage primary care (and allied care systems) as a platform for delivering quality preventive care in manner that is sustainable over time. Incentives need to be developed or adjusted until they align with these goals. As an example, we run into instances where ACOs express an interest in the preventive care outreach programs we provide, but the cost of care avoidance and Federal quality performance rewards (Medicare/Medicaid) accrue to the Payers with whom they are engaged.
I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?
Addressing this as a lay person; I see the industry discussions of the impact of social determinants of health as walking in lockstep with an emerging view of treating “the whole person.” Integrated behavioral health only makes sense to me – our bodies, minds, interpersonal contacts and environments are absolutely interconnected.
Linking together information access and communication elements of the care coordination function with all of the organizational and information systems seems to be an essential pre-requisite to achieving success here.
How would you define an “excellent healthcare provider”?
An excellent healthcare provider uses the best evidence-based science, in a compassionate manner to empower and treat the whole person. I’m looking at this squarely from the perspective of a patient. As a healthcare consumer, I know that in my moments of greatest need, this is what I wanted and needed – and was blessed to have received.
Can you please give us your favorite "Life Lesson Quote"? Can you share how that was relevant to you in your life?
I’m an unabashed Lincoln groupie. I’ve always related to “Be sure you put your feet in the right place, then stand firm.” I believe in the power of faith and perseverance. When I look at the whole of my career and personal journeys, growth leads to happiness, and perseverance is a prerequisite for growth.
Are you working on any exciting new projects now? How do you think that will help people?
Yes, two projects in particular are very exciting to me now. One is looking into expanding the number of at-home physician-directed tests we support in our outreach solutions. This will offer provider systems and consumers a safe, effective way to support screening tests in their homes, and to avoid the incremental risks of COVID-19 exposure associated with accessing a point of care. The other involves the integration of risk stratification analytics upstream of our outreach engagement solution with a specific eye toward helping payers address coming interoperability requirements laid out by HHS / CMS. These offerings will meet new compliance requirements, assist in managing costs and leveraging quality outcomes.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
- Mindset; The New Psychology of Success (Carol Dweck) – Healthcare needs leadership and innovation. Leaders with a growth mindset are best equipped to deliver organizations that can execute.
- Fixing Healthcare (Podcast) (Robert Pearl MD and Jeremy Corr) – I love the conversational, provocative, direct delivery as well as the width and depth of the content.
- Traction; Get a Grip on Your Business (Gino Wickman) – As an organization that is navigating continual change, organizational synchrony is essential.
- Moneyball: The Art of Winning and Unfair Game (Michael Lewis) – Yeah, I’m a baseball geek (and brokenhearted for lack of in-person-attendance at games, at present). But look deeper – there is a profound message about institutionalized resistance to disruptive concepts and the cost it can carry with it.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be?
Personal care accountability. Having faced a personal healthcare crisis in my life, I have become passionate about personal health accountability and the integration of preventive care for my “whole person.” I appreciate my care delivery providers the most when they exhibit awareness of that, and incorporate this thinking into my care.
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