Best Practices: Harry Saag
The co-founder and CEO of Roster Health on addressing social determinants of health and redefining healthcare delivery with more equitable, localized solutions.
As the former Medical Director for Ambulatory Quality and Network Integration at NYU Langone Health and a practicing hospitalist, Dr. Harry Saag has a deep understanding of the unique challenges facing healthcare organizations today — particularly when it comes to care and payment models.
Two years ago, Dr. Saag co-founded Roster Health to redefine healthcare delivery beyond the traditional four walls of clinics and hospitals. Read on to learn more about his passion for leveraging social determinants of health to deliver actionable health insights and developing equitable, value-based payment models.
How did you get started in medicine and how did you choose your specialty?
I was first exposed to medicine through my father, who was an HIV doctor in Birmingham, Alabama during the height of the epidemic. Thanks to his work and that of his colleagues, I had a unique lens through which I observed the arc of HIV. I saw how it started as a death sentence for many, and continued to evolve up to the point where it became what it is now: A manageable and treatable chronic disease. Although no one referred to it as ‘social determinants of health’ back then, I also saw how important addressing the non-medical barriers his patients faced could impact their ability to lead healthy, happy lives. He and his colleagues at the HIV clinic in Birmingham called the 1917 Clinic were ahead of their time in providing whole-person care and that has always stuck with me.
Even still, when I started college, I didn’t know what I wanted to do. I was very interested in economics, and decided to major in it while taking science classes on the side. By the time I applied and entered medical school, my economics background sparked a genuine interest in learning more about how we pay for healthcare in the United States.
Over time, I gravitated towards this question and spent a lot of my non-clinical work with hospital administrators and mentors who helped me understand how we finance healthcare in this country. It was an important and formative experience that opened my eyes to the complexity of financing in the US healthcare system.
When it came time for my residency, I knew that I wanted to become an internist, but I also wanted to go to an institution that would provide a diverse patient experience and enable me to see multiple hospital systems at work. I was fortunate to match at NYU, a residency program that comprises three independent hospitals: NYU, an academic medical center, Bellevue Hospital, one of the largest publicly funded hospital systems in the country, and the VA, which is a single-payer federally funded system. As someone who was interested in investigating the ways in which we pay for health care, it was a fascinating place to train.
What inspired you to co-found Roster Health?
During residency, I gravitated toward alternative payment models, which include any form of reimbursing or financing healthcare that isn’t a fee-for-service model — the predominant way that healthcare is currently funded in this country.
After I completed my residency, NYU offered me the position of Medical Director of their Value-Based Contracts Division, which we called the Division of Network Integration. I soon had a front-row seat to see how these alternative payment models worked in action.
By participating in value-based contracts, doctors and hospitals assume some amount of financial risk, instead of offering a simple fee-for-service model. In this alternative payment model, we at NYU had to work around quality and cost benchmarks in order to effectively manage a population and keep them healthy and happy at home. Working with these value-based models also demonstrated how the system, doctors, and administrators were aligned as one group around a central mission: treating people in the right place, at the right time, and with the right resources.
What I saw come up time and time again, was that it wasn’t a lack of clinical care that was the biggest obstacle in achieving this goal, but helping patients address their non-clinical barriers to good health. In other words, it wasn’t that we as practitioners didn’t know how to treat diabetes, or heart failure, or COPD, or even the 30-minute office visits that were affecting outcomes. Instead, it was the 30 days in between appointments when what now we all refer to as the social determinants of health can significantly impact a good or bad outcome for patients — and for our larger healthcare systems, too.
There were three pain points or blind spots I was seeing in the social determinant space: One was the lack of social determinant data that organizations had to understand their population from the lens of whole-person care. The second was what interventions or solutions can be deployed to address these social determinants, and the third was how to finance these efforts sustainably. Seeing these unmet needs was the genesis of my decision to step out of academia and start Roster Health.
Your work is rooted in addressing social determinants of health. Can you tell us more about this work?
At Roster Health, we help health systems, clinics, and health plans uncover the hidden layer of information that isn’t available in traditional claims and clinical data. By leveraging this data, we help them understand how to meet their patients where they are in order to drive the best outcomes possible.
We feel strongly that this is an unprecedented opportunity to help uncover what’s really going on in a patient’s life besides their disease states, diagnosis codes, or past utilization data.
On a concrete level, we help them to understand the social determinants that are impacting their patients’ or members’ health. Factors like does your patient live alone, own a car, or have social connections in the community? Do they have access to broadband and digitally connected devices?
We weave all of that data and information into actionable insights that community health workers, care managers, or social workers can use to do their job more effectively and ultimately help the patient have the best outcome at the lowest cost.
How has Covid informed this data?
The global pandemic has shone a brighter light on social determinants of health and how important they are in dictating health outcomes.
The pandemic has made it very clear that if we’re serious about finding ways to deliver better outcomes at lower costs, we’re going to have to start doing things very differently. And one of the biggest things that we have to learn how to do is to treat the whole person. I think the pandemic has accelerated the recognition that we’re going to have to change the way that we think about data, engaging patients, and providing meaningful and successful care.
We’ve heard from many practitioners about how telemedicine has improved access to care. Can you tell us more about how you’ve experienced it exacerbating health inequity?
I think it’s clear that the digital health revolution and the general concept of care moving outside the clinic and into people’s homes and communities is only going to grow once the pandemic ends. This is a good thing, but it’s also highlighted an existing disparity when it comes to digital literacy and digital access.
As a system, we need to be cognizant of not unintentionally worsening health care disparities. When it comes to telehealth, this means making sure that everyone has access to broadband and digital devices, but it also means making sure everyone has the digital literacy to leverage these tools.
The other key success factor is who can provide the whole-person care experience. It may start with a basic two-way audiovisual feed, but building and delivering effective telehealth programs is also about managing follow-up care, especially for someone who has chronic diseases. Ensuring key care elements like obtaining vital signs, performing medical reconciliation, virtual physical exam tools, and helping patients execute the ‘after visit plan’ will separate the successful models from the unsuccessful ones. The concept of whole-person care will be even more critical in a digitally-enabled world.
How can we ensure that no one gets left behind as we explore new models of care delivery?
Partnerships, scalability, and financing models will be key to ensuring no one gets left behind. Taking scalable technology and crafting local solutions is essential. It’s about fostering partnerships between payers, physicians, health systems, and community groups to co-create solutions with tight goal congruence across stakeholders.
Even if we create a great piece of technology, or have all of the right data, when you get down to the actionable solution, it has to be tailored to the community. And its champions have to be the local members of the community because that’s who patients trust most. And trust is the ultimate currency in healthcare.
So, how do you help local communities grant accessibility to tools and technology in health? Let them be a part of the solution in partnership with established payers, health systems, and physician groups.
I’m more optimistic than ever that we have finally reached a boiling point where a system as complex as our healthcare system is ready for transformational change. There is so much energy and enthusiasm right now about new payment, delivery, and data models — I think we’ll start to see this collective experience, as well as the catalyst of the pandemic, lead to meaningful positive change in the industry.
Vital Signs
Where’s your favorite place to go for a walk in New York? Battery Park, I love looking at the Statue of Liberty.
How do you de-stress? I take my English bulldog, Lumpkin, out for walks.
Do you have a favorite book, TV show, or podcast of late? Team of Teams, by Stanley McChrystal.
What’s one healthful habit you’d love to see patients adopt? Find a coach. It can be a friend, mentor in your field, or even an acquaintance — anyone that you have some trust with that can be an objective sounding board. This is something that I found incredibly helpful, both personally and professionally.
You can learn more about Dr. Harry Saag here.
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