Jami Doucette of Premise 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

We need to embrace a value-based reimbursement approach to care across the country, rather than accepting the fee-for-service payment system currently in place. The fee-for-payment model is solely based on the number of services performed, rather than the appropriateness of the services or quality of care provided, and completely overlooks the patient’s long-term health status and health outcomes. This model also leads to increasingly high levels of physician burnout, as it sets high expectations regarding the number of patients treated and procedures performed. By shifting to a value-based model, quality is the basis of payment, thereby encouraging healthcare providers to focus on improving overall health outcomes for patients.

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 Jami Doucette, MD, MBA, CSCS, President of Premise Health.

Current President at Premise Health. Premise Health is the largest direct healthcare provider in the world and one of the largest digital providers in the country, operating more than 800 wellness centers in 45 states and Guam for some of the largest commercial and municipal employers in the U.S.

Formerly Leader at Paladina Health. Prior to Paladina Health, was President and CEO of ModernMed, having started the Angel-funded company in 2007. Led all aspects of the organization and successfully negotiated and navigated first, its sale to DaVita in 2012, and second, its merger with Paladina in 2013.

Jami earned his MD and MBA in Health Management from Tufts University School of Medicine in a combined degree program. He also earned undergraduate degrees in Biology and Economics with honors from Duke University.

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 been President at Premise Health since 2017, when I joined the team to accelerate our direct healthcare model. Prior to this, I served as leader for Paladina Health (a DaVita subsidiary), and before that I was CEO and founder of ModernMed, a health services company providing concierge direct primary care through employer-based, onsite and near site health centers as well as 24/7 virtual access to members’ personal physicians.

My interest in disrupting the healthcare system began when I was in medical school. While I was considering which career path I would take, I worked with physicians who were transitioning their practices to direct primary care. The model addressed many of the concerns I was wrestling with about a career in medicine, leading me to commit to a career focused on innovating the way people access and experience healthcare, and improving the system as we know it.

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

When I started ModernMed, I had literally just picked up stakes, moved out West, raised some capital, and started a company from scratch not really having a clue what I was doing or if anything at all was going to work out. As part of my early first-hand market research, I personally joined a direct primary care practice to get that experience. The practice was a very well-known, established practice, and the physician took pity on me having just arrived into town. She offered to introduce me to another patient of hers that had been born and raised in town and could show me around. This was the sixth or seventh city in a row to which I had moved to not really knowing a soul, so I had the “yes, I would love that” routine down pat. Without violating HIPAA in any way, she connected me to one of her long-standing patients. I sent a note to this patient letting her know I was new to town, had gotten her contact information through our physician, and would be eternally grateful if she showed me around. Now my nickname, Jami, is gender-neutral, although it is much more commonly a female name, and she assumed as much. When the patient thanked the physician, she said, “She seems like a nice person, I’m happy to show her around.” To which the physician responded: “That’s great, you two have so much in common. PS — Jami’s a guy, enjoy your date.” The rest, they say, is history, and that same physician ended up marrying us several years later at a ghost town outside of Telluride, CO.

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?

When you start a company from scratch, a “whatever it takes” attitude and approach is often required, and starting ModernMed was no different. As a result, I found myself assembling all of the desks and chairs in our very first office well past midnight one night. This would normally not be an issue at all, as I have assembled more than my fair share of furniture and toys over the years. However, on this particular night I had just come back from a hectic, relatively sleep-deprived business trip. In my rush to get everything squared away so I could find my pillow, I took what I thought to be some perfectly acceptable shortcuts in the assembly process. However, when I got into the office the next morning, I came to realize that an unpainted panel was externally facing on every single desk. The same panel. On every desk. So much for efficiency and shortcuts. Which led me to spend that night disassembling and then reassembling every desk in the office. Lesson learned…to move faster with better results, it is sometimes prudent to measure twice, cut once…

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

I’m a huge fan of the quote: “Everything in moderation, including moderation.” To me this is about balance — but not balance all the time, rather balance over time. Sometimes you just have to push limits or get out of your comfort zone to really achieve longitudinal balance. Run a marathon. Jump out of an airplane. Spend all day reading a book on the beach. Don’t do moderation all the time, even if it is for just a little bit.

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

At the moment, we’re working on expanding our Digital Wellness Center, a cloud-based portal that gives members convenient access to digital health, ranging from at-home primary care visits, prescription delivery and pharmacist support, behavioral health counseling, and more.

In the wake of the pandemic, we are seeing that virtual visits are continuing to make up a significant proportion of care delivered, and we expect that to continue going forward. Importantly, virtual care provides increased access to a broad spectrum of healthcare solutions, and by introducing more digital offerings, we’ve been able to provide streamlined access to a wide-range of health services that patients may typically not seek out. This further demonstrates that when care can be delivered virtually it helps address barriers that prevent people from the healthcare they need and increases access in areas where adequate care isn’t available.

With our Digital Wellness Center, we ensure that our members are receiving quality care when and where they need it, all while lowering overall healthcare costs for employers. The high-quality virtual care we provide is a differentiating factor in the healthcare industry, and this very exciting and innovative new offering that we’re providing is redefining how Americans access and receive healthcare.

How would you define an “excellent healthcare provider”?

I would define an excellent healthcare provider as someone who prioritizes helping people get, stay, and be well over the long term, taking into account a person’s entire medical history and background. By taking an empathetic and holistic approach to care delivery, providers who spend time understanding the whole individual, including biological, psychological, and socio-economic factors that influence a person’s health, are more likely to improve patient outcomes. Additionally, an excellent provider is forward-looking, emphasizing preventative care for sustainable healthy living, rather than focusing exclusively on immediate conditions that can be resolved in the short term.

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?

The pandemic put a spotlight on the shortcomings of our healthcare system, exposing major health disparities and barriers to care that led to minority populations being impacted at a drastic rate. Unaddressed social determinants of health have become more apparent, highlighting how a person’s access to safe workplaces and living environments, clean water, healthy food, adequate healthcare, and more impacted their health.

Additionally, when the pandemic moved doctor appointments online via telehealth, many Americans postponed routine check-ins and delayed medical care. We watched as preventative care like colonoscopies, mammograms, vaccinations, cancer screenings and more dropped drastically as people put their care on hold and stayed at home. While delaying care is an understandable reaction during a pandemic, putting off care and leaving symptoms or conditions untreated can have long-term effects and was a major shortfall during the pandemic. As life returns to normal, we should expect to see a strain on our healthcare system from people seeking out the care they delayed and dealing with the effects of that, including rises in preventable diseases.

Another struggle we saw during the pandemic was the extreme spike in burnout among healthcare professionals. The US healthcare system was overwhelmed by the onset of COVID-19, with healthcare workers working tirelessly night and day to save lives. The urgency of the pandemic put an immense burden on healthcare workers, who were forced to face cutbacks, limited PPE equipment, pressure on their mental health, and more. We’re now in a place where we’re likely going to be living with COVID-19 long-term and we must manage physician burnout head-on or risk the ability to fight this disease.

As we move away from the initial stages of the pandemic, we can reflect on these issues to improve for the future. The US healthcare system needs to take a more equitable approach to supporting the public, including expanded access to high-quality, culturally-competent providers (as they often influence outcomes and equity) and focus on addressing specific social determinants of health. We also must also prioritize a more preventative approach to care, helping people stay well rather than simply focusing on helping people get well, and ultimately avoid health issues that may arise further down the line. Lastly, it’s essential to ensure that healthcare providers have enough support — both in regards to mental health resources and in the workplace — to reduce unrealistic workloads and burnout.

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.

Throughout the pandemic, healthcare providers truly demonstrated their ability and willingness to go above and beyond for patients and act as trusted sources through uncertain times. This group quickly adapted to the chaos of the pandemic, implementing the difficult learnings that the first few months COVID-19 taught us in order to eventually bring down the death rate and save lives. Throughout the past year and a half, healthcare professionals have worked persistently to provide quality care in the face of physician shortages, limited beds, ventilators, PPE, and more, demonstrating empathy and grit during a time where they were stretched beyond belief.

As an example of this care and support providers gave throughout the pandemic, the Premise Health team implemented a care navigation program intended to support COVID patients. In the context of COVID-19, the team’s focus was on symptom management and isolation strategies, assisting quarantined members with a suspected or confirmed diagnosis navigate their COVID-19 symptoms. Being alone during a time of self or required isolation can be challenging and scary, so the care support team helped individuals stay connected to the care they needed by proactively reaching out to these members to check in, verify their symptom status, and assess their overall wellbeing, while providing support and answering questions. As the COVID-19 outbreak evolved, our teams played a critical role in providing continued support and access to high-quality healthcare. Importantly, this was an entirely new program we created at Premise Health in response to COVID-19 and that we implemented and rolled-out in a matter of weeks.

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.

The first change that should be made to improve the US healthcare system is expanding access. Improving access and opportunities to receive healthcare, specifically the availability of resources that address various social determinants of health, can build up the overall health and wellbeing of entire populations. An equitable approach that prioritizes wellness, prevention, and culturally competent care, while intentionally expanding access and removing barriers to preventive services and wellness programs, is the best way to support populations the system traditionally neglects.

Second, a digital-first approach to the healthcare system can streamline the care navigation process and eliminate inefficiencies. By focusing on digital, providers can aggregate a patient’s medical data in one place, making it easier for providers to access important information and share it across outside organizations. On the patient side, people can access care whenever and wherever they may need, in addition to having various virtual resources centralized in one location. With more access points for patients, there will be a broader reach for the healthcare system, further engaging patients.

Third, better integration of health resources when it comes to care delivery is critical. In doing so, the healthcare system will be better equipped to address patients’ multiple health concerns in one place and provide the best care plan. Much like Premise Health’s Digital Wellness Center, patients should be able to access healthcare resources in one centralized place whenever they may need it. Through a simplified approach to care navigation, members have convenient access to digital health resources, ranging from at-home primary care visits, prescription delivery and pharmacist support, behavioral health counseling, and more, eliminating the overwhelming burden of having to seek care elsewhere.

Fourth is ensuring primary care can and does identify and mitigate serious health issues early. By making primary care more accessible and encouraging providers to take a preventative approach, it increases the likelihood of catching health problems earlier, providing treatment sooner, and limiting the amount of care needed overall. This is extremely important for those with chronic conditions, especially as early intervention and routine monitoring can prevent the risk of serious illness.

Fifth and finally we need to embrace a value-based reimbursement approach to care across the country, rather than accepting the fee-for-service payment system currently in place. The fee-for-payment model is solely based on the number of services performed, rather than the appropriateness of the services or quality of care provided, and completely overlooks the patient’s long-term health status and health outcomes. This model also leads to increasingly high levels of physician burnout, as it sets high expectations regarding the number of patients treated and procedures performed. By shifting to a value-based model, quality is the basis of payment, thereby encouraging healthcare providers to focus on improving overall health outcomes for patients.

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

The reality of the situation is that there is not a physician shortage in this country. What we have instead is a shortage of primary care physicians, and an abundance of specialists. The challenge is misallocation of resources, historically and presently driven by discrepancies in physician compensation across specialties. In round numbers, we have approximately 900,000 physicians in this country, more than 650,000 of whom are specialists. If that ratio were reversed and we had 600,000 primary care physicians, like in much of Western Europe and developed Asia, the average panel size would be 550 people per primary care physician and everyone in the US would be able to have a primary care physician. So, in my opinion, the more appropriate question would be: how do we change the decision matrix for medical students and residents so that we reverse the current ratio? The answer to that is change the cost/benefit equation.

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

There are a couple things we can do as a society to influence and impact physician diversity. To start, greater exposure and access to the sciences in early education in the underserved populations would open doors to careers in medicine. If there is exposure in early childhood, grade school, and high school, it sparks interest in healthcare for those deciding whether they will want to take that career path in the future. Next, we need to value diversity and work to attract students from diverse backgrounds to the medical field through steps like targeted recruitment and summer enrichment programs. Finally, we need to figure out a solution to medical school debt. Many talented, diverse students look at the cost-benefit equation to becoming a primary care physician, and they can see that the math doesn’t work. We need a solution to ensure those who dedicate their lives to primary care can afford the schooling it requires without going deeply into debt.

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

In order to address physician burnout, we need to lean more on digital healthcare resources. The latest technology and digital tools should be integrated into patient care, limiting time consuming administrative tasks that often slow physicians down. Additionally, physicians should adapt electronic health records (EHRs) to fit into their practice, allowing for real-time, patient-centered records to be easily accessible whenever a healthcare provider may need them. EHRs can also be used in tandem with evidence-based tools that can make decisions about a patient’s care, streamlining provider workflow, and they can also be shared with providers across more than one health organization, making it easier for physicians to view and share a patient’s complete medical journey.

To take this an additional step further, the healthcare system must move away from the fee-for-service reimbursement model. By following a model designed to reimburse healthcare practitioners based on the number of services they provide or procedures conducted, there is apparent pressure to treat and see more patients than necessary. This approach prioritizes quantity of patients rather than quality of care, creating high levels of physician burnout and inadequate care. In order to address this issue, the healthcare system must prioritize a value-based approach, reimbursing healthcare practitioners based on the quality of care provided.

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?

It’s clear that the issues facing the wider healthcare system and physicians must be addressed on the institutional level, requiring the participation of people across the country. Ultimately, the healthcare system is in need of innovation and transformation in order to support those that care for our country.

On the individual level, people can change the healthcare system by being aware of their healthcare choices. When they are in a position to research and choose their own providers, individuals should take the time to find high-value options. It’s better for them, and their families, and can help drive change in the system by empowering value-based care.

A big player that can make an impact here is business leaders. Many businesses are self-funded, granting them the power to choose which healthcare provider to partner with and impact the system by choosing better solutions — namely, working with high quality, value-based, and cost-effective providers that prioritize long-term population health. For many Americans, their healthcare starts with their employer, and business leaders need to understand the important role they have to play in ensuring their employees are receiving the care they need. This should also go beyond just primary care and extend to behavioral health, workplace wellness, and more. By understanding their role in the healthcare system, and what they can do to improve it, business leaders can help to overcome barriers and challenges many Americans face.

Additionally, communities and community leaders have an important role to play when it comes to overcoming challenges. Many people rely on their communities as a lifeline for managing their everyday lives, including as a resource for information. It’s important that leaders within communities know that they have the opportunity to help push individuals to access and seek out the care they need and provide them with information about important topics, like COVID-19.

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?

If I could inspire a movement that would benefit the most people, it would be the expansion of direct healthcare. I truly believe in the power of utilizing direct healthcare to address the shortcomings of our country’s healthcare infrastructure, so much so that I founded a company centered around its abilities and now work at the world’s leading direct healthcare provider. COVID-19 exposed gaping inequalities ingrained within the US healthcare system, spotlighting the various barriers to care and difficulties navigating the complex system. Direct healthcare tackles these issues head-on, making healthcare easier to navigate than ever before through convenient access to everyday healthcare resources, readily available virtual care, chronic condition management, and more, with a financial benefit that millions need.

Additionally, the direct healthcare model encourages constant innovation and change, which we’ve been able to use to our advantage at Premise Health through the expansion of our digital offerings. We know our healthcare system needs to change, and we know direct healthcare is a solution for it, so over the past year and a half, we’ve partnered with our clients to address challenges, innovate in the face of uncertainty, and reimagine what healthcare can and should be in a post-pandemic world. Looking forward, I hope that more people come to adopt this model in similar ways.

How can our readers further follow your work online?

To follow the work we do at Premise, readers can check out our blog: https://www.premisehealth.com/blog/ or, follow me on LinkedIn: https://www.linkedin.com/in/jamidoucette/

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