In his fourth year attending the World Economic Forum, an annual convening of world leaders in Davos, Switzerland (the Forum is also known as “Davos”), Pat Geraghty can draw a direct line from this global meeting to his role as president and CEO at GuideWell. Each year, the agenda at Davos reflects the most pressing forces that can disrupt and shape society, the global economy and international security. It is no wonder, then, that the opioid epidemic and the drivers evolving the health industry were focal points. As a health industry executive experienced in both issues, we are honored Pat was invited to share his perspective with this global audience.
You can also find the interview available as a podcast on iTunes.
Our interview highlights include:
- Pat explaining how the United States is ahead of the curve in piloting and scaling effective solutions to curb deaths from opioid use disorder;
- Why stigma against addiction is hard to justify when, as Pat states, “addiction is not a criminal act” but a disease that’s overdue for a compassionate response.
- Why moving from fee-for-service to value-based care is “in the best interest of the patient.”
- Big Pharma’s inability to reconcile the disconnect between the United States being the “most medicated nation on earth,” yet suffers from one of the lowest health quality rates.
- What health industry incumbents must do to compete – and win – against Amazon, Apple and the other tech giants.
On that final point, Pat declares “I'm bullish about our future, our ability to be successful, and our ability to take on all challengers.”
At GuideWell, we will continue to be inspired by Pat’s ability to translate issues as challenging as the opioid crisis into action, and his vision to direct our nearly $19 billion enterprise on delivering on our mission: to help people and communities achieve better health.
The complete interview transcript is included below for your convenience.
- Hi everyone, this is Kate Warnock coming to you from the Enterprise Communications team of GuideWell. Delighted to have a chance to talk with our CEO Pat Geraghty, about his experience at the 2019 World Economic Forum, better known as Davos. So Pat, happy to have your time here today.
- Kate, always a pleasure to be with you.
- Alright well let's open up Pat. You were actually invited to participate on a panel on the opioid crisis and I think it's really fascinating the fact that the opioid crisis is now an agenda item on something like the World Economic Forum really does prove that this is now a global epidemic and really requires a global response. Can you share with us what you learned from the panel, maybe who else the participants were?
- Yes, so I was the person representing the United States on this panel. There was an addiction expert from Brazil on the panel, and there was a finance minister from India, and the panel was being coordinated by the Editor-in-Chief of Politico. So it was a very interesting give and take, and it was really fascinating for me to look at the way this issue, opioids, is being addressed around the globe.
- Right, so I understand there's a lot of curiosity. I think as far as the epidemic itself, the opioid crisis, a little bit farther along unfortunately in the United States with that experience, so there is a lot of curiosity about what the United States and you as a payer executive is doing to address that. What did you share?
- Well I think we got a lot of credit actually in this forum and actually led the discussion, if you will, around some of the things we've done here at Florida Blue. For instance, we took OxyContin off of our formulary. The most addictive of the opioids. Now, when you do that you have to replace and you have to have other options, which we do. So there are less addictive options that are covered under our formulary. So that's an important change that we made. We also were one of the loudest voices in Tallahassee, lobbying for a restriction on the length of a prescription that would be given. It had become standard in the marketplace for a thirty day supply to be given out, now it's three to five days depending upon the condition. That's really important because many people can get addicted after just the five day supply, so we wanted to make sure we kept it to five days or less, because of that risk. So that was an important piece. I think the other things we talked about were removing the stigma around opioid addiction. This is something we have to deal with as a society. It is a medical condition. It is not a criminal condition. So we need to be taking care of this, in the right place, and in order to do that, you have to take the stigma down around opioids and what's happening here. We have many cases in our state where young athletes were injured in their playing field and ended up with a 30 day supply of opioids and that prescription that they followed the rules on, got them to be an addict. So that's really a very different circumstance, and something that we obviously need to be sensitive to. We also need to be in tune with medication assisted therapy. So moving from the highly addictive opioid, people cannot cold turkey stop that in very many cases. In most cases, they need to be moved to a different medication and actually worked off of the opioid. So we've been supportive of those kinds of transitions as well. One of the sensitivities in all of this, is there will always be some people who need very serious pain relief medications, and in those cases there are opportunities for some exceptions, there's opportunities working very closely with a medical provider to get those patients what they need, but they're more the exception than the rule and we have to make sure that what we're doing stems the tide of this opioid epidemic that has taken so many young people from us over the last few years.
- I know in a previous conversation you had mentioned that the addiction expert, I believe she was from Brazil, was talking about how it's really proving that one of the most effective ways to help someone work out of an addiction is to have a peer counselor. Someone who has been through the same sort of addiction themselves and has managed to come through to a state where they have a more normal life. Tell me, at Florida Blue, how are we helping put more people like that out in the community?
- Yeah, well she was exactly right, and we supported each other in that particular development, if you will, because when we were talking with law enforcement and we obviously convened a forum here in Lake Nona last year, when we were talking to law enforcement about what they were seeing, often they would see the same person three times in a day where they were stabilizing them, but then they would go out and actually be in this overdose condition again in the same day. So it was clear something else needed to happen. So, many of the programs that we're sponsoring, and our foundation has supported with grants a couple million dollars, as a matter of fact, in grants, are with Lutheran Family Services where they're meeting the patients at the emergency room with a peer counselor. So we're trying to be holistic in how we look at this issue and really take the stigma down, encourage the medication assisted therapy, but bring a counselor into the equation to help people truly navigate back into life.
- So Pat, before we explore what else happened at Davos, I know as soon as you came back from the World Economic Forum you had an opportunity with this global perspective that you were just participating in to really have a local response, so can you tell us more about Project Opioid?
- So Project Opioid was an effort that we were putting together in Orlando with the mayor, with the Sheriff, and really trying to make sure that we brought both the perspective of the legal system, the healthcare providers, everybody together along with business, because everyone in business has been impacted and we actually put this program up, it sold out in six hours. So all the seats were taken, bang, in six hours. So highly interested population, and we had a very good forum, and as it turns out the attorney general recently elected, Ashley Moody, is taking this issue on, on a state-wide basis. So we were very clear that our program is supportive of what the attorney general is going to do in the state, and we want to be part of the solution. So, she sent her representative, Sheriff Lemma, who is going to run this state-wide effort on curbing the opioid epidemic, and he spoke to the group and he attended the entire forum, and we created a tremendous relationship because he knows we're bringing the right stakeholders together, and it was really rewarding for those of us from Florida Blue in the room. Every single person that addressed the group whether they were a clinician, a hospital executive, a sheriff, an elected official, every one of them said "Thank you Florida Blue for bringing "all the stakeholders together." People had been operating in their own silos around trying to do something, we need to bring people together to work on this issue, and we need to do more than what has been done so far, and collectively, that's where you have the opportunity to make a significant impact, so I'm excited about what we launched in Orlando, and I'm also looking forward to launches around the state and other locations.
- Alright, well we'll stay tuned and certainly check back in and hear what kind of progress we're making there so that's great. So thanks for summarizing that. Let's turn back then to another opportunity that you had while you were at Davos. You were invited to participate on a panel, which was really interesting. The topic was around healthcare at the crossroads, and you were asked to kind of have the particular, share out your opinion on one of the drivers of change. What do you think is the most important driver of change in the health industry, and then maybe tell us a little bit about the panel itself.
- Yeah, so they asked me to comment on value health, and reimbursements that are value based, and obviously we're doing a lot in that space. I think the movement from fee-for-service to value is one of the most, if not the most important driver that will change the healthcare system. It's really about aligning people's incentives. Making sure that the hospital, doctor, patient, we're all aligned towards keeping people well in the first place, using the right level of service in the right location when service is necessary and by paying on a value basis, that really gets emphasized, because it's in the best interest of patients. So, that's what we were talking about. I also happened to have pharma to my right, and pharma to my left. The pharma folks were talking about genomics and future therapies and specialty drugs and the promise of the future. We had a little bit of fun because we were really trying to challenge pharma, not just on what can be developed, but on how do we pay for it. So there was a very lively discussion around making sure that we can pay for the things that we're rolling out, and part of that was around making sure that people take the drugs that are prescribed today. We have a lot of gaps in people following through and having their prescription completed when they need to. We have many prescriptions that get ordered but not picked up. So there's a compliance issue in the pharmacy space today, before you even move to new medications and new therapies. One of the issues and challenges that I made to my pharma friends on this panel was, the United States is the most medicated nation on earth, and yet our results, our quality in our system are about the low thirties. So, how do we square other nations not using pharmaceutical drugs had anywhere near our rate, having much higher quality of care. So, they struggled with that question, and I think some of it is based around incentives and certainly if you look at opioids, you can see that we provide more opioid drugs than any place else on earth, and now we're dealing with the fallout of addiction and death as a result of how widespread that became in our culture. So, that looking for just the magic pill is something that we've got to deal with on a philosophical basis in our society and really get to places where we're looking at alternative therapies, we're looking at wellness in the first place, we're looking at nutrition, we're looking at the whole being, and I think that was part of the dialogue, is thinking more comprehensively about how to keep people well in the first place and where to treat them when they are ill.
- You know Pat, I know that you're really passionate about having that; let's move farther upstream, let's keep people healthy, so that they don't need that magic pill. But to your point, we might consider waste or bloat in the system, someone else's income. What's your response to that? How do we work through a stakeholder who's going to dig in and not want to evolve, because it might mean their livelihood is at stake.
- That is the biggest challenge to changing the healthcare system. There's always somebody who sees it as their piece of the pie, and that's why data, clinical analysis, facts, need to drive us to the right conclusions, and we also need to be open to the idea that the system must change and must emphasize wellness in the first place and thinking about the whole being. If we can align incentives, lots of other things will change.
- Okay. Well let's pick up a little bit on that thread you mentioned around data and analytics, and how proof is in the pudding, right? So, so much conversation is happening around the tech giants, the Amazons, the Apples, the Microsofts of the world really making a play for the healthcare space, and a lot of those folks that they've got this tremendous advantage because these are data driven companies. How is it that you feel legacy players can really respond to that sort of thing, and might we have an advantage that's not getting talked about quite as much?
- Well, first of all I think we definitely have an advantage. One of the most encouraging discussions I had in Davos with a gentleman named Scott Schneider who spent his whole career in Silicon Valley. He's written a book and we're also talking to him about a coaching model that he has, because he believes deeply that all executives need to learn about the digital space. That it isn't about having a digital officer who you turf that to, but that everybody needs to be educated and smart on the transition to digital. It is a tool. The digital natives, the folks that you mentioned, all think that they can come into healthcare, and because of their digital advantage, take it over. What they don't know, is the detail of the clinical side of healthcare, and what they aren't familiar with is the communities that we serve. We are deep and close to the communities that we serve. We understand the nuance in each part of our marketplace. We understand healthcare, we understand actuarial risk. There's lots of things that we understand. They're bringing forward a tool. If we're smart, we bring their tool into our equation, and we continue to be the go-to player, the player that can integrate the answer for our community. So, shame on us if we're disintermediated by a digital native. We think we can win the day, by bringing those tools into our environment and using them smartly. I'm encouraged by that, and I think the continuous learning that we've embraced as an organization will add some of that digital learning to our equation, and we'll move forward. So I'm bullish about our future, our ability to be successful, and our ability to take on all challengers.
- Okay. Well, really exciting and motivating for everybody that hears that. One of the most practical and best uses then of that technology is, again, reaching out to that individual, keeping them healthy and helping give them the tools that they need, to stay their healthiest selves. How at GuideWell are we working to deliver that sort of experience Pat, can you speak to that?
- So we've made lots of commitments in the health and wellness space. We do it with our Better You from Blue. We do it with our outreach to our customers. Many of the large customers have very progressive programs that we work with them on. We do it through all of our emphasis on wellness and wellbeing, and I'm very encouraged about the future.
- What has you most energized, looking at the year ahead?
- I'm also excited about what we're doing in the Medicare space. We've been revitalizing our Medicare product. 1/1/20, we're going to be in the marketplace with a new and revitalized Medicare product that will build on the stars results that we had. Five, 4 1/2, and four stars in our latest review. We'll build on that. We'll look at the new team that we've got in the Medicare space ready to go, making great progress towards the 1/1/20 date. So I'm excited about that, I'm excited about what we're doing in our commercial space. I think under Chuck's leadership, many of the things that we've taken for granted are being reviewed again. So there's lots of good stuff going on there. We reorganized the company, with Chuck and Sarah leading their respective groups, the commercial and government programs group. I think those new structures are going to add focus and real discipline around how we enter the marketplace. I'm excited about the team of people I get the privilege to work with every day. I think we are at this critical crossroads in our country around where healthcare is going to go, and I believe that continuing to push our mission forward, continuing to drive on, wellness in the first place, treating people in the right place when they need to be treated, will absolutely lead us to the right set of answers that can be a role model for the rest of the country. So I'm excited about all of it.
- You have reason to be. Alright, well Pat, thank you so much for sharing your insights with us about the World Economic Forum and the year ahead, and look forward to more to come. All right, this is Kate Warnock. Thanks so much for watching.