Dr Jeff Wells of Marathon Health: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

Shift from Volume to Value — the current healthcare system encourages volume — doctors and health systems get paid for each visit. This rewards more utilization regardless of outcome. We need to reward providers for the outcomes delivered. Quality of care is the goal and when healthcare providers don’t need to focus on volume, they can instead focus on patient health outcomes — working with patients to manage high blood pressure or diabetes, establish mental health services, etc. Value based provider groups can then be purpose built to drive health improvement and lower costs.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Dr. Jeff Wells.

Jeff Wells, MD, is the CEO and co-founder of Marathon Health, a modern health company that specializes in delivering advanced independent primary care for employers throughout its network of onsite, Network and virtual health centers. The company has delivered more than $1 billion in healthcare savings to date for its clients, which include the Cargill, Tyson Foods, the City of Indianapolis and OneAmerica.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

I’ve had a passion for healthcare for as long as I can remember. Growing up I was one of those kids who knew they wanted to be a doctor. But I also came from an entrepreneurial family and I liked the idea of breaking down and solving problems. So, I ended up getting a medical degree and MBA. I trained as a primary care physician in internal medicine — but it was the combination of my medical and business experience that led me into healthcare policy, where I became the first physician to lead the Indiana Medicaid program.

Through medical school and residency, I had the privilege of treating patients where I saw all the magic and the flaws of our healthcare system. But working as a policy maker allowed me to witness the economics and inefficiencies at a population level — especially among the most vulnerable. That part really drove me to become a change agent. I learned you have to change incentives to change behavior — and that we need better alignment between employers, employees and providers to drive better outcomes. In 2009, I co-founded OurHealth, a value-based primary care provider that served employers and their employees throughout the United States. Then, in early 2020, we merged that company with Marathon Health.

Today, I serve as the CEO of Marathon Health, where we have the privilege of delivering advanced primary care for nearly 1 million patients across 42 states. We do that through care teams located onsite at the employer, in Network locations around town and virtually. And my goal is still the same: to change incentives, change behavior and deliver better outcomes — for employers and employees. And that means changing the fee for service model we have today which rewards healthcare transactions, not outcomes. We want to know our patients, build relationships with them and help them prevent chronic illness as well as manage it — and we want to help employers save money while delivering true value-based care. We’ve been honing our model since 2005 and the data shows time and again that patients love it and we’ve saved employers more than $1 billion in healthcare costs. There’s no question that in five years, every employer will offer this type of benefit.

Can you share the most interesting story that happened to you since you began your career?

I don’t know if this is so much interesting as it is meaningful for me, but when we were starting out, our first real opportunity was with Interactive Intelligence, a fast-growing software company in Indianapolis led by Don Brown, a serial entrepreneur. Don had completed medical school and eventually left medicine to start his first of many software companies. We actually never had a chance to meet Don during the sales process becaue he’d empowered his leadership team to drive key decisions. But he knew implicitly how this solution would impact the culture and the wellbeing of his organization. Don’s view was that every business he’d ever started had a first customer, and he wanted to support local entrepreneurs and be our first customer. That first opportunity allowed us to get our next customer and we grew from there. I learned some powerful leadership lessons from that experience as well.

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?

Everyone who knows me knows that I’m awful at multi-tasking while driving. One day I was on the phone with my co-founder while driving to a client meeting, and after talking for about 30 minutes, he asked where I was going. I said, “Madison Indiana.” And at that moment I realized I was approaching Louisville, which is in Kentucky. Whoops! I was a bit late to the meeting, but thankfully they’re still a client 10 years later!

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Seek to understand.” At the end of the day, life’s about relationships. The memorable moments are with the people you love, and our most rewarding & fulfilling work is with people we care deeply about. One of the keys to foster deep, trusted, meaningful relationships is to listen more than we talk and make others feel heard. To be clear, this is an area I need to work extensively to improve, but I’ve found it to be so true.

Are you working on any exciting new projects now? How do you think that will help people?

To me what’s really exciting is we’re really seeing the normalization of this benefit with employers. Most employees don’t say “tell me about your free primary care benefit” during the interview or ask “where’s the health center?” on their first day. But in five years, every employee will be aware of and expect this type of benefit from their employer. And when we achieve that type of scale, that’s when we’re going to see the paradigm shift for healthcare delivery in this country.

How would you define an “excellent healthcare provider”?

Two things — the ability to listen and having the time to do so. Unfortunately, the traditional healthcare system isn’t built to support those two requirements, but ours is. At a traditional doctor’s office, you might get 10 minutes with the provider. We average 32 minutes. Better transactional care for sore throats or skinned knees won’t bend the curve on healthcare delivery in this country. To do that, we have to prevent and better manage chronic conditions which drive the lion’s share of the cost. And to do that, providers need time to truly get to know their patients — and you can’t truly get to know someone in 10 minutes.

Why does this patient have high blood pressure? Is there something going on in their life that is extra stressful? Are there barriers to eating a healthier diet or exercising more? Primary care providers that can take the time to get to know their patients and really listen to what is going on in the patient’s life are better able to help their patients work toward managing health in a positive way, personalized to meet the unique needs of each patient. This is what makes an excellent healthcare provider.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

One of the biggest struggles was around delivering basic care. People were afraid to go to a doctor’s office and many offices closed for in-person visits. And while many physicians were able to pivot to telehealth or virtual appointments, these can be barriers for a large segment of the population, the elderly for example. We know that primary care visits plummeted 60% at the start of the pandemic and ended the year about 30% lower than average. That means routine care was put off, monitoring for chronic issues like high blood pressure, diabetes, etc. were postponed. And mammograms and colonoscopies didn’t happen. These illnesses didn’t go away during the pandemic — they just weren’t identified or treated. And this deferment of care is not only going to cause issues for patients, it will also result in increased claims and costs for employers.

Moving forward, I think we’ll see high adoption of alternative ways to reach patients. But it’s not enough to leverage these channels for access alone; it’s critical we connect patients to trusted primary care teams focused on shared outcomes. And healthcare providers who are held accountable to those outcomes — especially those patients who are higher risk for chronic illness — will see better results.

Of course, the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

Absolutely. The selflessness and courage I saw from our providers and from those around the world was humbling to say the least. Basic care was a struggle for many, but we did see bright spots where providers pivoted quickly to deploy virtual and telehealth care, which helped. I can use my own company as an example here. In February and March of 2020, 90% of our care was happening in a clinic setting. But within 30 days, nearly 90% of our appointments were happening digitally.

We also used good old-fashioned telephone calls to follow-up with our most high-risk patients to make sure they had support and guidance. This is something we already do, but the pandemic accelerated our outreach. In Spring 2020, Marathon Health clinicians made more than 200,000 phone calls to connect with our patients, listen to them, and ensure that they received the care they needed — whether through a simple prescription refills or via a virtual appointment. In many cases, the simple question of “How are you doing?” meant so much. We talked to patients that hadn’t seen or spoken to anyone in weeks and that gesture went a long way not only for our patients but for the care teams making the calls. It was inspiring.

Here is the primary question of our discussion. As a healthcare leader 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

I think we can all agree the US healthcare system is in need of repair. The pandemic shone a spotlight on some big inadequacies and inefficiencies, and we have lots of folks stepping into the fray, trying to provide an alternative. While initiatives like Haven may have failed, I’m encouraged to see business and health leaders trying. But unless we address some core issues, we won’t get very far. These are some of the key changes that need to be made to improve our healthcare system:

• Shift from Volume to Value — the current healthcare system encourages volume — doctors and health systems get paid for each visit. This rewards more utilization regardless of outcome. We need to reward providers for the outcomes delivered. Quality of care is the goal and when healthcare providers don’t need to focus on volume, they can instead focus on patient health outcomes — working with patients to manage high blood pressure or diabetes, establish mental health services, etc. Value based provider groups can then be purpose built to drive health improvement and lower costs.
• Expand “Primary” Care — Over-investing in primary care is the single biggest lever we can pull to improve our healthcare system. We’re bracing for a “new wave” of issues brought on by deferred care and a shortage of providers needed to support patients. Taking time to manage the patient’s health issue before it becomes a crisis will lead to healthier patients and less strain on the healthcare system.
• Improve Multi-channel Access — Virtual care is here to stay but it’s not a silver bullet. The next focus will be on figuring out which types of visits are best served by which channel — in-person, virtual, phone, text — so we can increase our efficiency and our output. I’ve seen this work first-hand — resulting in a 50%+ engagement among high-risk patients.
• Increase transparency of cost & quality — Healthcare is way too opaque. Recent federal rules that require published prices for the most common healthcare services is a good start. We need additional effort to define and the increase the availability of quality outcomes delivered by different hospitals and provider groups. This will allow patients, and trusted navigation partners to guide patients to the highest value provider to meet one’s needs.
• Encourage Employer Leadership — 160 million Americans receive health insurance through their employer — and many of those employers are self-insured meaning they’re shouldering the financial burden of the US health system. There is a HUGE incentive for employers to take a more active role in shaping our healthcare system. Employer-sponsored health partners can be more targeted and focused on moving the needle on value-based care, which results in healthier patients. Healthier patients are more productive employees and they also cost less which will free up capital for businesses to reinvest in growth, wage equality, research & development, etc. Rich benefits like this also create competitive differentiation for employers competing in a tight talent market.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

I’ve talked a lot about incentives today, but I really believe how we incentivize physicians has a major impact on not only the care they provide but the satisfaction they derive from their job. By shifting to a value-based model, where doctors have more time to focus on their patients and deliver quality of care rather than quantity, we can not only produce better outcomes but also happier, more fulfilled doctors. This is key if we want to not only retain existing talent but attract new talent to the profession.

At a macro level, we do need critical policy changes to expand the supply of new primary care providers coming out of medical and nursing schools, and regulatory changes lowering barriers for the movement of labor to best meet the dynamic needs of patients. These changes could include increasing the number of funded training positions in residency programs for primary care specialties, alleviating the barriers of a patchwork of state-based licensing requirements, and limited the enforceability of non-competition agreements for clinical providers. At Marathon Health we have taken a leadership position on the last point and do not include non-compete barriers for our providers — we believe it’s our job to earn the right to retain our providers and don’t need to use handcuffs to do so.

How do you think we can address the issue of physician diversity?

We must talk about both diversity and inclusion. Over the last few decades the US has done a commendable job increasing gender diversity among providers coming out of medical & nursing schools, as well as numerous minority groups. That said, there is work to be done to increase representation among black Americans. The data is clear that patients often prefer providers that “look like them” and this objectively makes a difference in wellbeing and cost outcomes. As I’ve mentioned numerous times, personalizing the care plan for each unique patient is critical and one’s demographic and identify makeup are part of this. As providers, we must seek to understand our patients and their needs and respond accordingly if we hold ourselves accountable to those outcomes.

How do you think we can address the issue of physician burnout?

A shift from volume to value-based care is critical. Allowing providers the ability to slow down, spend more time with patients, and personalize care built upon deep trusted relationships makes the difference. Coupling a mission focused, service-oriented culture with this care model change will restore joy & meaning to work again for providers and clinical care teams.

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?

Begin with value based comprehensive primary care. As an individual, get a preventive care check-up annually with a primary care provider and seek to build a relationship over time. As a company, look at your benefit design and shift to value-based models built upon independent primary care. Community leaders can encourage individuals to seek primary care, lead by example, and address policy changes that make it easier to increase primary care providers, and limit regulatory constraints that inhibit value based primary care models or patients access to them.

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? You never know what your idea can trigger. :-)

Two thoughts come to mind. The first, and most simple yet least original, is to love thy neighbor. Regardless of one’s faith background and beliefs, we are a social species built upon community, and caring for one another remains the most important human movement we still need to aspire to. The second, as we are talking about wellbeing, is to continue to advance the concept of truly holistic integrated wellbeing, and breaking down the historic boundaries of physical and behavioral health. Human health necessarily includes one’s physical, emotional, psycho-social, and spiritual wellbeing.

How can our readers further follow your work online?

You can read more about my work at Marathon Health by visiting our website at www.marathon-health.com or by visiting my LinkedIn page.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.