Complexity is the defining business and leadership challenge of our time. But it has never felt more urgent than this moment, with the coronavirus upending life and business as we know it. For the next few weeks, we’ll be talking to leaders about what it takes to lead through the most complex and confounding problems, and about Brody Moments (from Jaws’ Police Chief Brody and his famous line “you’re going to need a bigger boat”) related to the coronavirus.
Today we talk with Dr. Michael Cropp, President, and CEO of Independent Health, one of the highest-ranked health plans in the United States. A family physician by training, he has always focused on helping physicians meet patients’ needs in more efficient and effective ways. Cropp started an eight-person practice in Southeastern Massachusetts, and later relocated to Buffalo to apply his experience to a large existing group practice. Since then, he has moved into health insurance, intent on using payment and incentive models to help further catalyze patient-centered care. Cropp serves on the boards of America’s Health Insurance Plans (AHIP) and the Alliance of Community Health Plans (ACHP).
David and David: Do you have a Brody Moment to share with us from your past?
Dr. Cropp: When I joined Independent Health, we used a classic model for health plans – we offloaded risk to physicians by withholding a percentage of their fees until the end of the year when we would determine whether the health plan was in a position to return all fees to the doctors. As a physician by training, I thought the model was insane. I said to my colleagues “ let’s create a budget with premiums that pay physicians their fees and also incentivize them to provide results that are aligned with patients’ interests.” It didn’t take a whole lot to sell that concept, because it aligned with our desire for more patient-centered results. People who had previously dug their heels in suddenly came to me and said “we’re not moving fast enough. You know, this model gives us a framework for the future.” We started that back in 1998, it took two years to implement it, and everything we’ve done since then has built upon that Brody Moment.
David and David: And did you have a Brody Moment regarding Covid-19?
Dr. Cropp: Well, I had two connected Brody Moments. One was pre-COVID-19. A snowstorm in 2019 caught us off guard, and we realized we didn’t have the technology to support people from home for two or three days. We resolved to never let that happen again. And so, when it became clear in March that we needed to have everybody working from home, it was just a matter of flipping the switch on the technologies that we had invested in for the past year.
Our second Brody Moment happened when we realized that all the good work we had done for primary care physicians to build a new payment model was coming apart. Part of it pays them for face-to-face services – which we encourage – and those had quickly evaporated. The beauty of this Brody Moment was that my team immediately said we must do something different to help physicians. So, we looked back at what we paid them in the prior year for all their face-to-face activity and converted it into a prepayment so that they are cash flow neutral from where they were pre-COVID 19. And that was huge because primary care physicians saw their patient volume and revenue drop precipitously. Our financial support enabled them to retain staff and maintain vital services to their patients through the worst of the pandemic. It also reinforced that we were in this together with them.
David and David: What have you and your colleagues learned over the last few months?
Dr. Cropp: One of the lessons is that our Associates, our Provider Partners, and our Members have varying levels of risk tolerance. Given that variability, we’ve decided that we’re not going back to the office until after the new year. 60% of our Associates have school-aged children. We don’t want them worrying about how to manage their job plus kids. So, we took that worry off the table.
We’ve recognized that many of our Members, particularly those who have chronic and co-morbid conditions, might not want to go to the doctor’s office. So we’ve invested in state-of-the-art remote monitoring capabilities to help their doctors have a better handle on their vital signs.
We’ve also put a lot of energy into helping Associates’ mental states. Early-on, we replaced the phrase ‘social distancing’ with ‘distance socializing,’ and made significant investments in not just technology, but techniques. Our wellness team put things out there to help people stay connected, not only colleagues but also family members and loved ones.
Like everybody else, we’ve thought deeply about diversity and equality. The events that have taken place across the country have forced us to take a step back and recognize that while we thought we were good, we’re falling far short, and so we’re taking steps and making investments to do much better.
Overall, I think the biggest learning has been to take a more active and aggressive role in aligning parts of the healthcare delivery system to be poised to transform more quickly. I’ve spent a lot of time thinking about the healthcare delivery system of the future, and which critical assets must be in place, and how to be more tightly aligned with them from an ownership model to contractual status. We’re taking a very, very hard look at that.
David and David: When you think about the future, the “new normal,” do you have a sense of the new trajectory that leaders need to move their organizations to?
Dr. Cropp: Speed. If you’re not moving at a considerable pace, you’re going to get passed by. There’s no question about it. Leaders must empower and educate the people closest to the front lines and closer to the decision making, to help them see the need to be able to move more quickly. So, it’s much more about organizational decentralization for decision-making that I think is key. That’s easily said, not so easily done.