New Frontiers of Health: An Interview Series with CAPG President, Don Crane
PART ONE: “Our health care spend is twice what is experienced in other developed Western countries, while the quality on population based measures...is about half as good.”
Don Crane, President and CEO of CAPG, is to be honored at the 17th Annual Vision & Excellence in Health Care Leadership Tribute Dinner, presented by Partners in Care Foundation. He sat down with Partners in Care CEO, June Simmons, for a frank and wide-ranging interview to be published in four parts in the lead up to the Tribute Dinner at the Beverly Hilton, on May 9, 2016.
In this, Part One, he explains why he believes integrated care paid for through capitation is critical to the future of healthcare, and why rising rates of chronic disease should worry us all.
For a man on a mission to revolutionize the US health care system, Don Crane does not have the air of your stereotypical table thumper. Affable, with a boyish grin and a mop of sandy-colored hair, he exudes an easy-going charm that belies his quick intelligence and encyclopaedic knowledge of the machinations of health care reform. For the past 15 years in his role as President and CEO of CAPG, the leading U.S. trade association for accountable physician organizations, Crane has been in the trenches of health care reform through arguably its most tumultuous period; fighting tooth and nail for a move away from what he and CAPG’s members view as wasteful and ineffective fee-for-service models, towards clinically integrated, comprehensive, and coordinated healthcare.
“Healthcare is interesting to me for many reasons,” says Crane, scanning the burgeoning skyline from his office at CAPG’s Downtown Los Angeles headquarters. “For one thing, it’s immensely complex. Physician groups and hospitals are the most complex business organizations in American business. They each have a multiple stakeholders, and multiplicity of contracts with a multiplicity of health plans.. Then add to that, the fact that at its core healthcare is essentially a moral activity. We’re in the business of trying to deliver good care to people so that they’re healthier and happier and have more productive lives. I mean this is not just sport; it’s life at its most essential.”
Crane began his career in healthcare as a young lawyer, writing contracts for Northridge Hospital Medical Center, a client of the San Fernando Valley law firm where he’d landed after graduating from Loyola Law School. It was while working for Northridge Hospital, initially as outside counsel and then as in-house lawyer, that he first experienced the corporatization of healthcare that characterized the late 1970s and 80s.
“I sat on the community board of Northridge Hospital when it was led by Paul Teslow, who was a visionary thinker. Under his leadership, it morphed into HealthWest and then into UniHealth. What was initially a single hospital turned into a system of ten or more hospitals, including some outside of California, and then ten to twelve multi-specialty medical groups, and a wholly-owned health plan called Care America, along with a a majority interest in PacificCare. It embraced all three legs of the health care stool – health plan, hospital and physician group – so it was genuinely one of the pioneers of clinically integrated care.”
That early experience laid the foundation for Crane’s strongly held views on healthcare reform, capitation, and his leadership role at CAPG. “I think the reason CAPG’s membership has grown so much (CAPG represents more than 200 multi-specialty medical groups encompassing 80,000 plus doctors) is because of the natural superiority of the model that my members represent, which is clinically integrated care paid for through capitation. That model is better than any other alternative we see across California and the US, most specifically, the fee-for-service model. And that reality has now been recognized by the policymakers and legislature, nationally. With the Affordable Care Act, they’ve effectively adopted the model of care that CAPG and our members represent.”
Crane is quick to acknowledge that there’s also been an element of ‘right time, right place’ to CAPG’s increasing profile and membership. “I consider myself the lucky steward of this particular trade organization that represents this particular model of care, which has, to my good fortune, been adopted for proliferation across the country. It’s luck to a large extent, but we have done good work and our members have been awesome in their innovation. I work with lots of very good, very smart people – my staff, my board of directors, a succession of really great chairs of the Board – you take that whole gestalt together and you have a genuine tour de force.”
But while Crane is happy to see the wider scale adoption of integrated care and the capitated payment model, he’s not ready to retire to the golf course quite yet. “We have this huge opportunity to make our healthcare system better by achieving the Triple Aim – better service, at higher quality and lower cost, But in very rough terms, our health care spending is twice what is experienced in other developed Western countries, while the quality, expressed in population health statistics, is about half as good. We have an enormous opportunity to improve upon that picture.”
Beneath the spirit of optimism, Crane acknowledges that there are many mountains to climb. “Look, if we were to have the kind of spend that other countries do with equal or better levels of quality, we would effectively have a surplus of money to drive into education and infrastructure and other things that are so important to the country. And then there’s the quality issue – while we have some of the best research and education, and certainly some of the best specialty care in the world, when it comes to population health statistics we don’t look so good. Infant mortality is often held up as an example, and there are many areas where our macro stats are not good. And we’re really struggling with chronic disease.”
The escalating rates of chronic disease in the US are indeed shocking. According to the most recent statistics from the Centers for Disease Control and Prevention, diabetes, the seventh biggest killer in the US, now affects 29.1 million people, with a further 86 million in a pre-diabetic state. The annual cost of diagnosed diabetes alone is estimated to be close to $250 billion in medical expenses and lost productivity.
“It’s clear that our current system isn’t well built to cope with this level of chronic illness,” acknowledges Crane. “We have to modernize the delivery model and move away from the rescue-based model of past centuries. That’s not what we need now. What we have now is chronic disease, fueled by several major causes. These diseases are less amenable to in-patient care, and are better suited to ambulatory care or in-home treatment. These are the new frontiers in the delivery of care.”
Part two of this four part series will be published on January 21, 2016.
For information on sponsorship opportunities and tickets to the 17th Annual Vision & Excellence in Health Care Leadership Tribute Dinner, please go to picf.org/tributedinnersponsorship, or contact Stephanie Wilson, VP, Development at Partners in Care Foundation, at email@example.com 818.837.3775 x121