Lauren Lisher, Mount Sinai Health Partners, on innovating care delivery in NYC

Large health systems are realizing the importance of innovative models of care. Mount Sinai Health Partners (MSHP) has demonstrated significant success in working directly with purchasers and investing in population health to improve costs while maintaining quality and increasing access. Lauren Lisher (WG ’09) has been part of the team since 2017 and now serves as its Chief Product Officer. In this episode, we explore Lauren’s path to Mount Sinai, her experience working in an entrepreneurial division of a large traditional employer, and the forces shaping healthcare in New York City’s hyper-competitive market.

Lauren’s career path to Mount Sinai (Start–3:45):

• Our guest today is Lauren Lisher — Chief Product Officer at Mount Sinai Health Partners
• Coming out of undergrad, Lauren was interested in consulting and got connected with the Advisory Board, where she became interested in healthcare (and specifically growth-stage companies)
• After working at a small consulting company focused on mutual funds, re-centered her interest in healthcare, which led to her applying to Wharton (where she majored in Healthcare Management)
• While at Wharton, interned at McKesson; a significant tailwind for healthcare IT around the time of graduation was the passage of the ACA, and this led her to return to McKesson where she started an inter-system data-sharing alliance
• Returned to NYC to work with Oxeon Ventures and co-founded a company called Empiric Health (tech-enabled service model to reduce surgical costs)
• Joined MSHP in 2017 to build out a new venture focused on purchasers (employers, unions, and D2C) in commercial populations

The New York City Hospital Landscape (4:05–7:30)

• The competitive landscape in NYC is unique, beyond its large size
• There are multiple (four) nationally-ranked academic medical centers within miles of one another, creating hyper-competition
• NYC also has a significant cultural bias towards self-referral (particularly to specialists), which makes population health management particularly challenging

Editor’s note #1: As a practicing physician in Manhattan, this is something I’ve experienced first-hand. I’ve had many patients who directly called specialists (including cardiologists, gastroenterologists, and surgeons) for consultations, without referrals from their primary care doctors. Oftentimes this leads to the patient seeing specialists affiliated with three or four different systems, effectively creating their own PPO network and making it incredibly for the treating clinicians difficult to coordinate care and execute on a population health strategy.

• Many of the systems in NYC have not been as innovative on the delivery side compared to other markets; growth tends to occur via mergers and acquisitions in a FFS model
• Mount Sinai has taken a different approach by tearing down a large inpatient hospital and building an ambulatory care center instead, focusing on population health
• The current ‘If our beds have filled, it means we’ve failed’ marketing campaign demonstrates Mount Sinai’s commitment to this way of thinking

How do you define population health in the traditional lens of Medicare and Medicaid? (7:40–9:30)

• Both nationally and in NYC, most of the investment in population health has been within the Medicare and Medicaid patient bases and primarily led by payers (most notably, CMS)
• These patient populations are among the sickest and most complex, and payers see significant opportunity to utilize population health strategies to improve the quality of their health and bring costs down

Brief Overview of Mount Sinai Health Partners (9:35–13:00):

• This is the third start-up/start-up-like environment Lauren has worked in; it continues a pattern of working on start-up teams within larger organizations
• Much of MSHP’s success is tied to its deep connections to a large academic health system (Mount Sinai is on average 10–15% cheaper than its peer NYC institutions)
• The Product team at MSHP is looking at what customer needs are, thinking through build/buy/partner strategies, and then executing on the chosen strategy

How are employers thinking through gaining value in on-site health centers (13:00–20:00):

• MSHP has two models — a traditional model (on-site dedicated health centers) such as the partnership between MSHP and Credit Suisse, and membership-based models (near-site health centers shared across employers) such as the partnership with Hudson Yards
• Companies see high-quality on-site healthcare as an amenity to offer to their employees, a way to improve productivity and employee health, and a way to reduce overall healthcare cost
• The specialty services employers are most interested in bringing on-site include behavioral health (most commonly asked for) and physical therapy (musculoskeletal costs account for ~10–15% of total employer healthcare spend)
• The biggest lever employers have pulled to combat rising healthcare costs is shifting costs to employees; there is now increasing recognition that employers must find new ways to tamp down their quickly rising costs

How does this model compare to One Medical’s (20:30–23:00):

• One Medical is currently a partner of MSHP, and MSHP uses their services as a benchmark for high-service quality with a tech-enabled component
• Mount Sinai can go beyond what One Medical provides given the breadth and depth of secondary and tertiary referral services it can provide (which standalone primary care organizations cannot)

Editor’s note #2: One Medical (NASDAQ: ONEM) became the first large healthcare public offering of 2020. While a sign of the growing popularity of direct primary care, it will be interesting to see how One Medical uses the capital to grow, particular as it relates to the large hospital systems One Medical currently partners with (including Mount Sinai Health Systems).

How can MSHP’s work in the New York City area impact care delivery across the nation? (23:30–25:00):

• Mount Sinai has been conscious of the limitations it faces primarily participating in one geographic area
• The system sees value in proving the model in NYC, and then thinking about how to partner with health systems in other geographies

How Does MSHP Approach Data? (25:00–30:00):

• MSHP has followed a hybrid approach by both buying some data analytics services and also building products in-house
• Even though a huge amount of data is collected, a challenge is deciding what data is salient and high-quality enough to put through analysis
• One challenge across the health system is a distraction of IT resources towards EPIC and ensuring all users have migrated to the platform
• There are also challenges in tracking the efficacy of population health strategies, including patients going in and out of payer networks and uncertainty around which outcomes should be tracked

Hiring MBAs (30:45 –34:15):

• The size and scale of impact one can see working in a large healthcare system is compelling; even a 2% improvement on the hundreds of thousands of lives MSHP covers is meaningful
• MSHP continues to hire MBAs for the product team (just-in-time timeline), and across the health system there is a need for MBAs who can work on strategy and then execute on the vision through operations
• Contact Lauren at Lauren.Lisher@mountsinai.org for more on opportunities

MD/MBAs And Practicing in Population Health Practices (34:30–37:00):

• There is a shift in appreciating how to make population health feasible for clinicians; the burden that practicing in a population health model creates for physicians has been underappreciated
• MSHP is experimenting with non-traditional physician compensation models that more closely mimic its population health goals (e.g. salary + bonus, in place of RVUs) in order to better align incentives

Advice for MBAs (37:30–40:15):

• Stay true to what you want to do, versus following what your peers are doing
• Do your best to understand what different jobs and career paths actually involve (what will you be doing when you start, versus what is the partner in the group doing?)
• Think about where you want to go and how do you play for the best option value to get there; doing something that builds a strong skill set will never hurt your career