Julian Harris, Deerfield & ConcertoCare, on innovating elder care
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Julian Harris, M.D., is a Partner on the Healthcare Services team at Deerfield and Chairman & CEO at ConcertoCare. Launched in 1994, Deerfield Management Company is an investment firm dedicated to advancing healthcare through information, investment and philanthropy — all toward the end goal of cures for disease, improved quality of life and reduced cost of care. ConcertoCare was formed recently by a combination of the assets of ConcertoHealth and Perfect Health. ConcertoCare is one of the nation’s leading risk-based health care companies focused on providing integrated care for seniors where they are best served: in their homes.
Before Deerfield, Dr. Harris was the founding President of CareAllies, Cigna’s family of multi-payer provider services and home-based care businesses. Previously, he led US Strategic Operations for Cigna and managed a $500M internal investment portfolio focused on technology and innovation. Dr. Harris was also an Adviser to Google Ventures (GV) focused on tech-enabled health care services. Before GV, he led the health care team in the White House Office of Management and Budget (OMB). As the federal government’s chief health care finance official, he oversaw a $1 trillion budget and provided management and policy oversight for a range of programs, including Medicare, Medicaid, FDA, NIH and CDC. He also served as the chief executive of the $11 billion Massachusetts Medicaid program.
Dr. Harris trained in internal medicine and primary care at Harvard Medical School’s Brigham & Women’s Hospital and practiced as a hospitalist at Cambridge Health Alliance and as a clinical consultant for BestDoctors. He graduated summa cum laude with a B.A. in Health Policy & Medical Ethics from Duke University and holds an M.Sc. from Oxford University, where he studied as a Rhodes Scholar. He is also a graduate of The Wharton School of Business and the University of Pennsylvania’s School of Medicine, where he currently serves as an Adjunct Professor. Dr. Harris is a trustee of the New York Academy of Medicine and a member of the advisory boards for the Leonard Davis Institute for Health Economics at Penn and the NYU Department of Population Health.
In this episode, we discussed:
● Julian’s background as a healthcare leader across state and federal government, payers, growth-focused investment funds, and digital health companies
● The lack of gender and racial diversity across healthcare organizations, and the need for every company to take a role in better representation and company focus on equitable care delivery
● Julian’s dual role as both CEO & Chairman of ConcertoCare, and Investment Partner on the Healthcare Services team at Deerfield
● Where the landscape of Medicare innovation stands, and ConcertoCare’s focus on primary care for seniors, including PACE programs and care delivery for MA/D-SNP beneficiaries
Start— 4:30: Julian’s background
● Journey to healthcare: Julian is a primary care physician by training, but has leveraged his business school training to do a significant amount of consulting. He had the opportunity to consult for the state of Massachusetts, helping them think about building Medicaid ACOs. That evolved into Julian coming into state government and leading MassHealth, Massachusetts’ Medicaid agency. During his tenure there, they not only implemented Medicaid ACOs, but also led the country’s first capitated Medicare-Medicaid Duals demonstration focused on addressing medical, behavioral, and long-term services and supports (LTSS) with an intensive focus on the SDoH. After his time in Massachusetts, he joined The Obama Administration, leading the health care team in the Office of Management and Budget (OMB). In leading their healthcare team, he oversaw finances, policy and regulation at CMS, NIH, CDC, FDA, SAMSA, HRSA, AHRQ, and other federal health care agencies. He spent a significant amount of time working with CMMI on Medicaid 1115 waivers-fueled innovation, changes to the Medicare FFS payment rules, and approaches to working with MA plans. He then advised Google’s venture firm on healthcare strategy. Thereafter, he led Cigna’s strategic operations across US businesses, then aggregated and ran a family of healthcare services companies called CareAllies, focused on population health and management services, Medicare ACOs, and MA risk arrangements and home-based primary care.
● Dual investor and operator: More recently, he joined Deerfield — the largest healthcare focused investment firm in the country. Deerfield invests across healthcare, from therapeutics to diagnostics and devices to healthcare services, health technology, digital health and data analytics, etc. At the beginning of 2021, in addition to being a Partner at Deerfield he stepped in as Chairman and CEO of ConcertoCare, which Julian has been working for the past couple of years.
4:30–12:00: Health equity
“It is not infrequent for us to see pitch decks where there are no women in positions of leadership, or where there are no people of color in positions of leadership. We need to get to a place where leadership of organizations at all levels reflect the incredibly rich diversity of this country. Heaven forbid, that means that I’d like for us to be at a place where half the people in positions of leadership are women.”
● On equity across healthcare companies: Julian and others with platforms have increasingly fought to make it clear that incidents that you see on television or hear on the news are not isolated incidents. We will only make progress by addressing just how pervasive they are, in ways that are systematic. Over the last year, Julian has been struck with the widespread recognition that there is a need for comprehensive solutions that cut across sectors. Within healthcare, Julian has seen a greater focus on looking at both at how companies pick their areas of focus, and also how they pick their teams. Representation actually matters. It changes not only business performance, but also the ways in which teams engage in work to solve problems.
Editor’s note: Just after this episode was recorded, Deerfield released a report entitled “Gender Disparity Among Venture-backed Healthcare Companies and Their Investor Base”. The authors found that 48.5% of companies had no female board members, women make up about 10% of board director roles in venture-backed healthcare companies, only about 20% of investment professionals are female across the most active investment firms in the healthcare space, and of the six organizations analyzed that have 50% or more female board membership, all but one are helmed by female CEOs. Deerfield, alongside Oxeon Partners, runs Break Into the Boardroom, a training program to empower senior women healthcare executives to take on their first Board role across public, private, and non-profit organizations.
● On equity in company focus: COVID-19 has made clear that addressing disparities in access to care and outcomes has to be a major focus for every company and organization that works in healthcare. We’ve seen the disproportionate impact on morbidity and mortality across communities of color, informed by the relative prevalence of chronic conditions that are risk factors for COVID-19, and that Black and Brown folks are often in roles that are considered essential, putting them at disproportionate risk.
● Vaccination rollout: Now we’re in a place where there is vaccine hesitancy in the African-American community and other communities of color as well. These concerns are informed by a long history of mistreatment in the healthcare system and in biomedical research. As an example, in the African-American community, people grew up hearing about the Tuskegee syphilis experiments, in which a group of lower-income Black men with syphilis were allowed to be observed untreated for decades in an observational study sponsored by the U.S. government, years after penicillin was known to be an effective treatment for syphilis. That story is new for many people, but almost never new for someone in the African-American community.
● Other similar stories have created long standing areas of distrust. Beyond vaccine hesitancy, there have been real challenges in equitable vaccine access and distribution. The challenge is, we know that we know that we will not get to herd immunity unless we figure out a way to ensure that all communities feel like the vaccines are safe. But that challenge of speed cannot be used as an excuse to not ensure there are focused efforts to prioritize equitable access and distribution at the local, state, and federal level. This has been a major area of focus for the Biden administration.
Editor’s note: The Kaiser Family Foundation (KFF) is monitoring vaccination data by race and ethnicity nationwide. Unfortunately, states variably mandate whether race/ethnicity data are collected at the time of vaccination. As of June 23, 2021, the CDC only knows the race/ethnicity of just over ½ of all people in the U.S. that have received at least one dose. Among this known group, “60% were White (vs 60% of the U.S. population), 15% were Hispanic (vs. 17% of the U.S. population), 9% were Black (vs. 12% of the U.S. population), 6% were Asian, 1% were American Indian or Alaska Native, and <1% were Native Hawaiian or Other Pacific Islander, while 8% reported multiple or other race” (source: Kaiser Family Foundation).
12:00 — End: ConcertoCare
“Without further investments in innovation, [Medicare] will be challenging to sustain over time but is one of the treasures of our federal system. I think that’s why there really is bipartisan consensus that we have to think about ways to drive innovation in the Medicare program. Private sector engagement has accelerated substantially since the passage of the Affordable Care Act, the creation of the Innovation Center, innovation pressure from MA plans, and increased focus on social isolation, among other drivers. We also have real opportunities to think about food security, housing and transportation, whose impact on outcomes is often underestimated. But in all honesty, this is not a new challenge.”
● The role of CMMI with Medicare innovation: Julian sees the major opportunities in Medicare as evolving from just being a reimbursement program, to being a force for improving quality of care while being mindful of budget challenges. He also believes people might underestimate that the Innovation Center was always designed to have an ethos of test-and-learn. Every model that has been developed at the Innovation Center has leveraged lessons learned from prior models, including data and operational implementation requirements. We are going to see iterative, not overnight, progress in terms of how these innovation models are designed. Julian encourages folks that are skeptical of the pace of CMMI’s innovation to remember that there was very little exposure to meaningful upside-only structures when the Innovation Center first launched, so providers’ willingness and sense of their own readiness to take on downside risk was very different just a decade ago. But, he believes that there needs to be an acceleration of mandatory models and greater exposure to risk going forward.
“I think there was some reticence to move too quickly towards downside risk because of concerns that the prior wave of provider-driven health maintenance organizations (HMOs) involving downside risk, in certain cases, yielded adoption challenges. Many providers struggled significantly from taking more risks than they were ready for. Now, I think there will be more willingness and appetite for models with more risk over time as providers feel like they have more supportive infrastructure.”
● What ConcertoCare does: ConcertoCare has three care model pillars. Deploying Interdisciplinary care teams — “orchestras” that wrap around a patient, addressing unmet social needs, and providing caregiver support are priorities for ConcertoCare across all three components of their model. While there are companies that do each of these things, Julian sees a lot of opportunity with how these models can reinforce each other and serve as laboratories of innovation:
A. In their first model, they partner with MA and Duals plans, and work with their existing provider network and PCPs to deliver a range of intensive services that enable ConcertoCare to help seniors lead healthier lives, maintain their independence, while experiencing better outcomes. These wraparound services include an intensive focus on geriatric services, geriatric psychiatry, social work, and behavioral health. ConcertoCare is not the PCP of record in this business.
B. In their second model, ConcertoCare can serve as the PCP of record, similar to the above first model. These are both home-based, in-person, and virtual models, but ConcertoCare doesn’t build brick-and-mortar clinics as their way of engaging with this population.
C. Their third model focuses on the Program for All-Inclusive Care of the Elderly (PACE). Julian describes the PACE program as a hidden jewel within the context of how patients with Medicare and Medicaid can receive access to services and care. While PACE involves physical centers, the magic of PACE really happens in the home. One thing that excites Julian about the PACE model is that there is a significant opportunity to think about how we enable seniors to stay in their home, which is a large driver of cost and outcomes. To qualify for PACE, a patient or beneficiary needs to be nursing-home eligible. These are patients who, with the right kinds of support (medical, behavioral, social, respite, caregiver), can have full lives, in their own homes. ConcertoCare’s PACE approach is likely more intensive, in that it expands on the center-based approach to deliver excellent home-based care.
Editor’s note: After this recording, ConcertoCare announced its PACE expansion strategy alongside being a Direct Contracting entity (DCE). It will launch its first PACE center in Virginia later this year. Additionally, as a DCE on the “global track”, ConcertoCare will be eligible to take on 100% risk for their patients, initially focused in Massachusetts, Ohio, New York, and Washington, with more states to join its network in the years to come.
● Metrics of interest: There are many metrics tracked across MA and duals lines based on program reporting requirements and often states. There are typical “culprits” like hospital readmissions, hospital length of stay, discharge to the home vs SNFs, length of SNF stays, and complex chronic condition biomarkers. Concerto takes risk on these kinds of measures in the Care Partners and Geriatric Primary Care models. Through its PACE programs, ConcertoCare is both the provider and the health plan, so they have many ways to optimize clinical operations and strategy since they are both delivering and financing care.
● Expansion foci: Much of the company’s internal roadmap involves product evolution across all three of the above business lines. Ultimately, ConcertoCare’s partner organizations are looking to innovate with ConcertoCare, whether that be ConcertoCare being a value-based provider organization to support existing provider networks with a more intensive, home-based model, or providing holistic care as the provider of record.
“People often ask about what we think about competitors. I know how few Medicare beneficiaries today have access to the kinds of models that we and some of the other innovators in our space make available. It will take quite some time for us to collectively provide access to these kinds of services to seniors who would benefit from them. We’re in the early innings as an industry in terms of the folks who are focused on this population and providing the kinds of comprehensive services that we make available.”
