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Accreditation: You’ve Heard The Term But What Does It Really Mean?


Guest: Shawn Griffin, MD

Narrator (00:00):
Welcome to 360 degrees of healthcare with Dr. Stan an in depth. Look at our industry from our very own chief medical officer who will talk with other medical and industry professionals on the changing and evolving landscape of the healthcare system from the inside.

Stan (00:21):
Thanks for joining us. My name is Stan Schwartz. I’m an infectious diseases physician with decades of experience in healthcare. As a student, a teacher, a fellow, a researcher, a practicing physician in both solo and group practices, a health system executive, and now a healthcare entrepreneur. And as I get all older as a patient, I want to share my 360 degree view of healthcare with you. My thanks to zero studios for support of this podcast. My guest is Sean Griffin. He’s a medical doctor who is the president and CEO of URAC and accrediting organization. Dr. Griffin has an interesting story to tell today and a remarkable journey to get where he is today. Sean, tell us about URAC and what employer purchasers need to know about accreditation and how to use accreditation to make purchasing decisions, because there seem to be a lot of accrediting organizations like URAC joint commission and so forth.

Shawn (01:22):
Absolutely Stan, and thank, thank you for the invite for being on here today. So, um, accrediting and and accreditation really is, uh, focused on, uh, quality evaluation and making sure that an organization has a resilient quality infrastructure. Um, and the way that I, I talk about this is when, when people come into medicine world, when people come into to medical environments, most people, when they come into that environment, don’t really know what’s going on. You know, they, they may have a little bit of exposure, but, but we really don’t know what’s going on. We come into medicine and to have a group that has experience, uh, working in medical areas and knows what quality looks like as a trusted sort of scale on which to measure people’s performance and organization’s background. That’s really what accreditation does. Uh, we’re pretty familiar with the idea of board certification for physicians.

Shawn (02:14):
Board certification is when you’ve gone through all of the training and then you go through generally some additional training, some additional qualifications, you take a test and you can be board certifi. When I was practicing as a doc, I was board certified in family medicine. And that meant that I did more than just simply get licensed. I was training in the state of Iowa. You could get your permanent medical license after training for one year. If you wanted to be board certified, you had to complete the residency. And then you had to take the test and you had to keep up with quality improvement activities to stay board certified. But like accreditation is the focus on an entire program. So a physician may be certified board certified for what they do, but accreditation is for a whole organization. So we think about the joint commission or DNV, which does accreditation for hospitals.

Shawn (02:58):
And if you want to be a hospital who participates in Medicare and Medicaid, you need to be accredited by those organizations. Well, URAC actually started about 30 years ago and the place where we started was utilization review. If you think back into the eighties and into the nineties, there were were HMOs and there still are some of those, but when HMOs formed, one of the big concerns was, is that, uh, they were designed to save money and there was concern that they would save money by cutting quality. And so utilization review was instituted that time to be sort of the, the hospital says, sorry, the, like the, the payer, the insurance company is concerned about spending on care because if they save money, they get to keep, well, the patient’s concerned that the insurance company’s going to turn down needed care so that they can make money and the patient won’t get the care that they need while in this environment was sort of this idea that we need somebody who’s outside of those organizations to make the rules as to what’s good care and what’s bad care, and to make those decisions.

Shawn (03:55):
And so your act was founded back then in, in 1990 was the utilization review accreditation commission. And they brought together payers and providers and patients and regulators, and they said, let’s set up the ground rules for what this is gonna look like, how we can have independent decision making about what’s best for the patient. So URAC, as we said now has over 30 years of being that independent what’s best for the patient third party independent organization. And we do a lot of work in, in health plans. We do it in pharmacies, uh, mail order pharmacies, specialty pharmacies, where you’re dealing with certain medications. We do accountable care. We do telemedicine, we do mental health care. So we have over 40 different programs where we have gotten together, the experts. We have written standards. We have a team of employed reviewers who will come in and evaluate an organization and generally put our trusted stamp seal of approval that this organization is doing it right.

Shawn (04:50):
And because we’re an independent organization, we can react faster to changes in what’s the best quality measures. What’s the best way of doing something faster than regulator can. So we often say that that regulation sets the bar for safety and accreditation sets the bar for quality. And also in accreditation, we’re looking for chances to highlight excellence, which is even better than, than any of the other things. So it’s, it’s more than just the, the bare minimum to be legally safe. We’re gonna say that if you see the URAC gold star, it’s like getting a gold star on your paper as a kid in elementary school, it means you did a pretty good job.

Stan (05:27):
So for employers who purchase healthcare, are there particular areas where they should be very tuned into whether an organization is accredited and other areas where accreditation really doesn’t matter so much?

Shawn (05:41):
Sure. So when it comes to accreditation, most of it has to do is it’s not on the employer side, it’s more on the payer side or on the network side. So when it comes to, um, like your, your health plan, generally, you’re going to have an accredited health plan. And, and uric is very fortunate because we have been, uh, named a government deemed accreditor for health plans across the United States. So, um, generally if you’re looking at your network, now, the names you recognize, you know, Aetna, Cigna, and, you know, name, your plan, almost all of them are accredited, but you wanna make sure that your health plan is accredited. Um, often you’ll see accreditation follow where money is being spent. If no one is spending money on much, most people don’t get accredited, but if you’re gonna spend a bunch of money on it, and that’s sort of where pharmacy started, um, in, in the old days, pharmacies were, I count 30 pills.

Shawn (06:31):
I give 30 pills out. That’s sort of what pharmacy was. It was dispensing medications, but as pharmacy products and pharmaceuticals have gotten more expensive and required, closer monitoring all these biologics, all of these, you know, genomics and those sort of things, then you couldn’t just be a pill counter anymore. You had to make sure that it was the right medicine for the patient, and then it was being delivered consistently, and that they were taking and all these sort of safety things come in. So any place where you’re spending money as an lawyer, which very often these days is pharmaceuticals and, and pharmacy spend, you wanna make sure that you have an accredited network of providers. Um, so all up and down the chain, your plan, your PBM, your pharmacy benefit manager, your specialty pharmacies, your mail order, pharmacies, all of those, you want to have accredited your physician network.

Shawn (07:18):
Some people do accreditation for an accountable care organization or a clinically integrated network. Um, we’re also seeing it in telehealth with the pandemic and the huge increase in spend that we’re seeing in telemedicine. Um, I, I say that telemedicine during the pandemic went through the, the government through the doors wide open and anybody who could deliver telemedicine, got to deliver telemedicine. And now the we’re coming down towards the end of the pandemic. You’re seeing more controls going back on. And, and everybody who pays for telemedicine is saying, how do I know that I’m getting good telemedicine and not just convenient telemedicine. So more and more we’re having organizations come to us because we’re the leading telemedicine, accreditor and telehealth accreditor, uh, both in the United States and across the world. And we go in check the program. And when we check the program, the, the thing is, is that with telemedicine, you can look pretty good on camera, but still be an idiot. And so, so you wanna make sure that just because you had a convenient connection with somebody who says, they’re a doctor, are they really a doctor? So we, we check credentials, we check evidence based medicine guidelines. We check, you know, safety protocols, all of those sort of things to make sure that it’s a good program and not just a good camera.

Stan (08:24):
So two questions then should an employer who uses a blue cross or a Aetna or a United healthcare, as you know, to process their claims, even though the employer pays the claims eventually, should they assume that everybody that’s network is accredited? And what’s the difference between providers that are accredited versus providers that are credentialed?

Shawn (08:50):
Okay. So credentialing generally looks at the academic background of a, a provider. So, um, when, when I was getting credentialed for the medical staff in, in Missouri all those years ago, when I, when I went into practice, you know, I had to take in my diploma, I had to take in my test scores, I had to show my training to show that what they were going to credential me for was stuff I had been trained in. And, and the same goes with licensure license takes a look at primary source verification and those sort of things, and there’s requirements that we have within our standards along those things. So, so you can be your credentials refers to sort of your, uh, your, your training and the things that you have gone through, uh, is, is credentialing. When we talk about accreditation or certification certification is generally additional sort of training steps that you go through beyond simple licensure, beyond the simple regulatory minimums, when it comes to us.

Shawn (09:41):
And we look at a program like for, for example, when we talk about our telemedicine, we take a look at the credentials of the providers. We take a look at their training that they do particular for telemedicine. We take a look at their evidence-based medicine, their quality oversight, their technical, uh, director for their program who monitors the technical things. So there’s much more, it it’s sort of like me saying, um, when, if you’re gonna have heart surgery, it’s really important. Who’s doing your heart surgery, who the surgeon is, but a great surgeon in a bad hospital, or with bad recovery or bad rehab, doesn’t end up with a good outcome. So, so credentialing and certification look at the individual provider. Accreditation looks at the entire program to make sure that all of the pieces that are, that are contributing to your care are good. And we have standards specific to almost all of those things.

Shawn (10:29):
I mean, whether it be, you know, audio telemedicine, people talk about telemedicine and, and, and, and what’s a phone call worth. I mean, I come from a part of the country where they don’t have cell service. So to expect everybody to have a broadband connection with a, a, a 10 ADP camera is probably not realistic, but what, what are you gonna do when you don’t have the best things that you can have in all the cities? And, and that’s one of the things that I bring to my, my role as the first physician to lead URAC is I’m a physician who’s practiced in little towns where I was the only doctor in the county, and I’ve been in Houston, Texas, and I’ve been in Washington DC and all those things. And so we really write our standards so that, um, people, smaller organizations can qualify for our accreditation and not just the big ones who are in the 50 largest Metro areas.

Stan (11:16):
So let’s go to accrediting talk about accrediting telehealth.

Shawn (11:21):

Stan (11:21):
Does the accreditation process look at whether or not telehealth doctors actually got things right, or that they have a system that’s likely to get things right.

Shawn (11:32):
Well, there’s, there’s parts of both. And, and let me just talk about that during the accreditation process, we talk about what is your quality oversight for your providers and general, that’s a quality review committee. You’re expecting them to look at things like, are they following evidence based medicine? What are the guidelines that they have? What are the escalation protocols, those sort of things. So that’s all sort of upfront setting up the program so that things should be done right, as part of a quality, uh, improvement program, which we require to be part of the organization. We also take a look at case reviews, you know, our, our, our well qualified providers reviewing the cases and making sure that the doctors doing what they said they were gonna do. And, and that’s one of the things that we do in our accreditation process is we, we go through, what’s called a desktop review.

Shawn (12:14):
The desktop review is making sure you have all of the policies and you, you have everything covered for your plans. And then the validation review is where we go in. And we say, you had great plans now, did you follow ’em? And, and, and that’s the steps of accreditation is desktop review getting all your policies straight, all of your committee straight. And then the validation review is let’s look at your committee minutes. When you said you reviewed the quality outcomes. Let’s take a look at your prescribing patterns. Let’s take a look at your credentialing and all that sort of stuff. And we make sure that that for individual cases, for individual providers, you’re doing things the way that you said that you would, the other part of accreditation is there’s, there’s something called a grievance. If somebody goes to an organization that is URAC accredited and have some bad outcome where they say they weren’t following their processes, or, or those sort of things, they can actually reach out to URAC and file a grievance.

Shawn (13:02):
They can say, I saw Dr. Smith and he is accredited by URAC. And on June 4th, you know, uh, he did these, these things wrong and they can send that to us. And if, if the, the come plane has to do something with something that we accredit them for, then we will investigate it. We, we can do, what’s called a four cause review. And if we go in and we find somebody who’s doing something that isn’t right, or isn’t safe, we can pull their accreditation. And that’s very different than like licensure and those sort of things. If, if you were trying to pull somebody’s license, you know, that’s a long drawn out process that can take months and years and all this sort of stuff, but it, with accreditation, if we find somebody’s doing something that actually is causing harm to patients, I can, I can, you know, write a note and say, we’re pulling your accreditation.

Shawn (13:46):
We’re doing a four cause review, and you will not be accredited until we get to the bottom of this. So accreditation has different mechanisms that we can do. And, and when you go through accreditation process, accreditation is a voluntary process. Nobody can come to uric and buy accreditation. They can come to uric and they can pay to go through the accreditation process. But we have people who fail accreditation, and you can fail accreditation because you’re not doing the right things. Or because you, you think this should just be a rubber stamp and you don’t work with us the right way. So accreditation is, is really much more than, than people sometimes suspect. I, I kind of say, I, I hate to use analogies. It’s, it’s sort of the, the good housekeeping seal. You know, I, I, I joke we’re like Angie’s list for medicine. You know, it’s, it’s people who who’ve been checked out and you can trust as you go through the process.

Stan (14:33):
What happens to an organization that has their accreditation pulled

Shawn (14:38):
Well, it’s interesting in, in certain accreditations to be accredited is required to be part of networks. There are some specialty pharmacies that have to be accredited to be in a network with a, with a provider organization. And so we have had organizations that when they lost their accreditation, they lost their ability to do business. They just, they were dropped from all of their networks because they were no longer accredited. Now accreditation is required in some areas, but in other areas it’s optional. And very often like with telemedicine right now, there’s nobody in the United States who requires that you be accredited in tele to participate in a network. But we’re hearing the questions being asked you, you asked about employers. And, and I would say that employers are starting to ask, how do I know that I’m getting good quality telemedicine when I pay for a visit?

Shawn (15:22):
And so I’m expecting that that will move that way over time. But most organizations that do telemedicine these days, the big names that you would recognize the national players, most of them went through the accreditation process. And they say that they want to use accreditation to show that they are practicing good quality telemedicine or telehealth. And, and that’s part of their argument for why they should be covered. Um, but that’s, that’s not been written into law or written into regulations for all the networks at this point, but we’re hoping that people will see the I of accreditation and that consumers will recognize it. And payers will recognize it. One of the reasons why we’re located here in Washington DC, is because, you know, we, we talk to the people over in the government who are looking at, at expenses in Medicare and, and those sort of things, and, and, and having those discussions with them.

Shawn (16:07):
And because we’ve been been here for 30 years, and because we have multiple government deem programs, they know that we sort of check things out the right way, that we’re a fair set of scales. And, and so they, they come to us and they ask us what we’re seeing going on in telemedicine and what we’re seeing when it comes to quality, cuz there’s a lot of concern in telemedicine about, you know, fraud, waste and abuse, but there’s also the benefits of, of improved quality and improved access. And trying to strike the right be is, is gonna go a long ways for deciding how it’s paid for and what it’s worth, uh, to healthcare payers.

Stan (16:40):
So from my friends who are primary care doctors who don’t do telehealth, the two things I hear are number one, the telehealth doctors prescribe way too many antibiotics, cuz that’s all they can do when you have a cold or a sinus per problem, even if you don’t need them. And the second is they often don’t know what they shouldn’t treat over the, over the phone or over the video. Can you comment?

Shawn (17:04):
Sure, absolutely. Uh, I would say that when I was practicing, um, I had partners who I felt prescribed too many antibiotics and they were sitting in the room with you. Um, I, I, I think that were one of the things that, that we bring to the table in our experience is our experience. And, and when you look at hundreds of programs, hundreds of providers who are doing this, you see things that are being done wrong. You see things where providers, um, are, are being judged only on patient satisfaction for a telehealth visit. And that makes me no sense what whatsoever. You’re basically paying them to be a vending machine because they’re supposed to be applying their, their medical experience and their medical knowledge to the encounter, just like they would be if they were in front of a patient and they were talking to a patient.

Shawn (17:48):
Um, I remember the conversations where you’re trying to talk to inexperienced parents and they want an antibiotic for their child with a cold and you have to educate them. And, and that’s one of the reasons why I talked earlier about evidence based medicine, if you’re practicing good evidence based medicine, not everything is treated with an antibiotic. And so we expect you to have those policies and those procedures. And then we expect you to follow them in this and have quality oversight and, and, you know, have a, have a well trained supervising provider. Who’s taking a look at, you know, if, if every time you see somebody in a telemedicine visit and you’re prescribing them an antibiotic, you’re not practicing good medicine. And every time you see somebody in a clinic, if you’re prescribing them an antibiotic for a cold, you’re not practicing good medicine. So, so I, I I’ve heard those arguments.

Shawn (18:29):
I’ve heard those concerns. I’ve seen places that I think tilt a little too far one way, and I’ve seen some that tilt too far the other way. I think that’s why you need to have guidelines and, and escalation plans and what is an appropriate visit for telemedicine. And what’s not, um, you know, we, we often, as, as doctors, we’re trained to be exception based thinkers. When you go through your training, you’re always taught to think about the zebra, not the horse. If you hear the galloping hooves, well, sometimes it’s a horse. Um, but because we always think about the exceptions we go, you know, I understand you’re concerned about overprescribing antibiotics for viral infections, but let’s talk about behavioral health counseling. Is there anything in behavioral health counseling that has to be done face to face? Um, some studies coming out now that say that behavioral health during the pandemic actually had, uh, some increased uptake because people didn’t have the stigma of having to walk through the front door of a psychiatrist’s office and maybe see somebody they know in the waiting room.

Shawn (19:23):
And so they were actually more willing to receive care that way. Um, children who’ve had surgeries who just need a follow up check on their wound. Um, parents not having to travel 200 miles to go back to the hospital two weeks after their surgery to, to check a wound where they could just look at it with a camera that that was an incredible convenience. And, and I, I think that we’re still trying to work out where beha, where, where telemedicine works well and where it doesn’t work well. And, and, and we were doing that before or when urgent care clinics came in and when emergency rooms came in and when offices came in and when house calls went away or when they came back. So I, I think that when you think about telemedicine, there are places where it does seem to work with chronic diseases. Uh, you know, we’re seeing a lot of uptake in, in telestroke. We’re seeing it in, in rural areas and underserved areas. Um, when I was training, we said, I would say, we tend to see it in rural areas. Now I tend to say underserved because I recognize that underserved can be right next to the freeway in a large city. And they still may not have access. It’s not just rural and urban, but there are places that are underserved in both locations.

Stan (20:27):
Going back to what you said about, um, looking at antibiotic prescribing habits, for example, does the accrediting organization actually look at patient records or do you look to see that they have a quality improvement committee or some other structure that looks at patient records

Shawn (20:49):
In general? What we’re going to do is we’re gonna say, what is your process for evaluating the quality of the care that’s being delivered? And very often that will be a quality committee. Now we don’t say it has to be 47 people on a quality committee, or we don’t because we have flexibility and little organizations, the quality committee. Now we talk about a medical director, somebody who, who is taking on responsibility, so a medical director and a quality committee. And what is your process? And, and as your process, is it chart reviews? Is it committee reviews? How do you handle that within your organization? And that’s what we look at. We don’t go down and go, you know, Mr. Johnson on Friday should not have gotten an antibiotic on June 12th or anything like that. We say, what is your process in your has to follow what follow generally recognized quality improvement, you know, sort of structures and processes.

Shawn (21:32):
And that’s what we look at as adherence to your processes or your processes is your design. Good. Do you follow the design process and what do you do when, when something falls out? So we’ll say, you know, talk to us about the positive findings from a quality committee review. Talk to us about the negative for a quality committee review. And what did you do with those providers? What is your ongoing education? What are your, how do you update your evidence based guidelines, all those sort of things. And, and so we don’t tend to get down into a particular chart unless we have some sort of grievance or a fore cause review where looking at a particular chart is what’s necessary to, to get into the details.

Stan (22:09):
I’d like to turn a question now to patient-centered medical home and advanced primary care, which was a great interest of mine. I was involved in bringing patient-centered medical home in the federal comprehensive primary care initiative here to Northeastern Oklahoma. I’m interested in the work you’ve done with patient centered medical and particularly the, of what you call measurement based care.

Shawn (22:31):
Absolutely. So the patient center, medical home concept from probably a couple decades now was taking what I mean to, to oversimplify it. There is the concept of as a primary care physician, I had an idea as to what would be good quality care for a community. And, and when you think about a patient center, medical home, you think about access, you think about, um, you know, um, uh, support services. You think about chronic disease management, acute disease management, there’s, there’s all these concepts, which wrap up into a, a patient center medical home and, and a couple decades ago came this concept, the qualifications of a patient center, medical home, and, and Ric created a program, NC Q a created a program. There were a couple other programs that were created and recognized by the federal governments being patient center, medical homes. And the idea was, was that when, when I look across a network of providers, there are some providers who offer more in their offices than others.

Shawn (23:29):
And a patient center, medical home was sort of this deluxe sort of office for, for primary care. And so the advantage that this had was that payers recognized it, but whether it be the federal government or whether it be some of the private payers, and they said, you know what, if you go through all the trouble of becoming a patient centered medical home, we’re gonna pay you a little bit more. And oddly enough, if you pay physicians a little bit more to do something, they very often will do it. Uh, if it’s a good thing and, and, and it fits in with what they’re planning on doing now, at the time I was helping to build a clinically integrated network in an ACO in Houston, Texas. And we had a lot of, as physicians, we had about 2000 physicians, 90% of whom were independent. And some of them were involved in being patient center, medical homes.

Shawn (24:11):
And the payers were saying we wanna have more of these. And we said, okay. And so we actually launched an initiative to take a lot of practice over a hundred different docs and put them through becoming a patient center, medical home. And whenever you, you have something like a list or qualifications, what you’ll find is that the idea with a patient centered medical home wasn’t that you checked all the boxes, it was that you changed your practice to be more patient-centric patient-centered medical home. And you also checked the boxes. And in leading our team, as we went through this, I found some docs who absolutely embraced the idea of being patient centered medical homes. And they, they updated how they were scheduling and they had how they did their intake and all those sort of things. And they, they became real patient centered medical homes.

Shawn (24:54):
But I also unfortunately saw some doctor’s offices who got really good at sort of checking the boxes to say they checked the boxes and not really changing their care. And so it’s, it’s sort of like, um, it’s, it’s dancing with the love of your life versus dancing with the girl you don’t know at your junior high dance. They both technically are dances, but one looks very different than the other. And, and, and so when I came into accreditation, I said, you know, we wanna make sure that we’re advancing quality with everything that we do. And, and that’s really important to us and on all the people who work here you’re at, because we are a healthcare organization, we don’t deliver the care, but we help others deliver the care. And when I came here to Eck, one of the things is I went to a meeting of the Mid-Atlantic business group on health, and they were talking about some of their initiatives to improve care.

Shawn (25:40):
And one of the initiatives that they had was the idea of measurement-based care for behavioral health and mental health treatment and measurement based care essentially, is to say that what you’re going to do is you’re going to treat behavioral issues or mental health issues. Like you do diabetes or blood pressure control. You’re going to have standard, uh, analysis. You’re going to take a look at that analysis. You’re going to use the results of that screening tool to guide your care. And you’re going to do treatment. Then you’re going to circle back, repeat the test and make sure that you’re improving the numbers to the numbers that you wanna get to. And so measurement-based care has been practiced by a lot of groups in different areas. Generally they have a little bit different flavor to it, but this concept of measurement-based care came along. And I, I would into this business group and I said, you know, what, how do you know if somebody’s doing measure based care?

Shawn (26:32):
And they said, well, they tell us that they are. And I said, well, how do you know it’s any good? And they go, they tell us it is. And I said, well, there’s a gap there because at some point you can’t just say, you’re the best you have to prove you’re the best. And so I, I came back to Eck and I said, we’re gonna create a program for measurement based care. And we did what we usually do. We go out and we get some experts in the area. And we say, what is measurement based care? And they gave us basically the description that I said to you, it’s, it’s standardized screening tools that have been verified through research. You, oh, apply them to patients. You, you begin a treatment. You recheck to see how they’re doing used in the same. So measurement based care as part of behavioral and mental health care within an office.

Shawn (27:12):
And, and when we started doing this, one of the challenges that we faced is, is there were so many flavors of measurement based care. There was measurement based care around depression. There was around, uh, attention deficit or anxiety or those, or, or depression or, or those sort of things. And so we had to say, all right, we’re not gonna tell you what tool you have to pick, but you have to pick a, a vetted tool. You have to apply it to the population. You have to take the findings to guide individual treatment. You have to repeat the evaluation as appropriate for the tool that you’re using and continue that cycle. And you need to analyze what you’re doing as a practice, as a whole. If you, if you’re applying the tool to everybody and nobody gets better, you’re doing something wrong. And so really there was sort of this virtuous cycle that we were trying to establish.

Shawn (27:53):
And so we established this measurement based care, and I went to the business group and I said, here it is. You said you wanted somebody who would do this. And here it is. And, and they said, that’s great. That’s fantastic. And they started writing measurement based care accreditation or designation within their programs. If we’re, if we’re going to pay for somebody to be doing measurement based care, then we want you to go through uric and, and, and prove that you’re actually doing it in a standardized way. And, and I was all gungho for this. I’m like, look at this, we built this because one of the problems that you have with accredit is people don’t go through accreditation. If no one pays for it. And nobody pays for it. If no one’s gone through it. So there’s this sort of negative cycle of, well, they don’t have it, so I’m not gonna do it.

Shawn (28:34):
Well, I’m not gonna do it cuz they don’t pay for it. And nobody advanced it. And I said, you know what? I can do it. So I created measurement based care with the team, my great team. And they rolled it out and almost nobody has into it because nobody’s paying any different for it right now. So this is one of those things where the employers say, we’d like to have something and I’m like, okay, well here I built it. And they’re like, well, we don’t really want to require it yet. And they’re like, could you just ask if people are doing it, we just want, could you drive some business to at least take a look at what we’re doing? And, and that’s one of the challenges and things is that, that you move a market by, by having people begin to use it and begin to do it.

Shawn (29:09):
And it just takes a while to sort of build that momentum specialty pharmacy. You know, we created 10, 15 years ago and nobody was paying anything different from the specialty pharmacy we created. Cause we said, there are these drugs coming out, which require closer surveil surveillance or closer care monitoring. And we, we think that this is worth somebody going through to be tested, to show that they can do it. And that’s actually where those, those cold chain standards, uh, were first sort of written about that eventually became the, the standards for taking care of the early COVID vaccine to keep it at ultra low temperatures. Those are direct descendants of the care standards that we wrote 15 years ago when it came to specialty pharmacy.

Stan (29:50):
Do you have a good sense that accreditation matches up to better outcomes, especially in, in primary care.

Shawn (30:01):
So anytime you get into outcomes in primary care, I, I, I can tell you that, that, you know, we have, we have good research, which shows that what we have done in pharmacy over the past decade has improved pharmaceutical care delivery and patient safety. We have, we have good, good science, which shows that at when it comes to primary care and patient center, medical homes, it is really tough to create any sort of a, to B than to C because none of this occurs within a vacuum. The principles of patient center medical homes have been shown to improve outcomes, have been shown to improve, um, you know, uh, diabetes management, hypertension, those sort of things, improve patient access, all of those sort of things. But, but they’re, they’re more sort of midpoint outcomes as opposed to ultimate outcomes because of all the other things that have been going on, um, in telehealth, um, there’s, there are outcome studies being done right now that have to look at telemedicine and principles of good telemedicine and telehealth care.

Shawn (31:01):
And the pandemic was a tremendous, um, advance in that. But there’s, there’s no one that I know of that can can say this. This is how it works out. And this is exactly a to B then to C uh, accreditation. You know, um, the thing I would say is if I’m gonna go get a doctor, I’m gonna go to a board certified physician. If I were to challenge you and say, we have direct evidence that board certification saves lives, you might say, well, yes, you might say, well not, I mean, depends how you limit the question. I think that that further training and further capabilities intuitively make sense. Um, and I don’t always wait for final outcomes if I can’t isolate the final outcomes medicine, it, you know, books are, books are clean and people are messy and, and whenever you start dealing with people and, and the things that affect their care, um, it’s, it gets more complicated to do that kind of analysis. So I’m not gonna stand here and claim that I have, I have direct evidence that accreditation saves thousands of lives every year. I can tell you that based upon the standards, as I know them, any program, any organization’s gone through, one of our accreditation programs is the kind of organization I would want my family to receive care from.

Stan (32:12):
Um, talking about the mail order pharmacy, you know, there’s, you know, a brand new one. Now they mark Cuban’s cost plus drugs. And you mentioned coal chain verification. If I mail order a drug and it sits out in my mailbox, for example, for four hours in 110 degree weather, or here in Oklahoma, or up in the Plains of Iowa, do we have to worry about things like that? Do you look at that?

Shawn (32:41):
Uh, yes. You have to worry about it. Yes, we look at it. And the funny thing is, is, is cold chain was the first area that got our attention, cuz there were drugs that need to be kept extra cold. Um, we actually, now don’t just do cold chain monitoring. We do temperature monitoring because, uh, I, a medicine that’s meant to be kept warm that freezes in your mailbox is just as dangerous as a frozen medicine. That thaw is in your mailbox. So we actually require as part of the accreditation that we have for, for mail order pharmacies is that they do seasonal checks and, and, and those seasonal checks have to do with temperature monitoring in the packages, standard packages that are AED and, and those sort of things. Now, now, if you have a, anybody who’s ordered anything online, if you’re supposed to get something in two days and it doesn’t come for two weeks, it’s probably tough to sort of maintain that for that time period.

Shawn (33:31):
I mean, you sort of have an expected time period that something’s supposed to be in transit, but we, we check not just that your cold medicine stays cold, but that your warm and doesn’t get cold. And we, we check it throughout the season. So that’s one thing that URAC added just a couple years ago to our, our, our mail order pharmacy standards, uh, to make sure that things are delivered as safely as can be expected. Now you mentioned the, the mark Cuban drug, uh, drug, uh, cost plus, uh, that that actually is a PBM. So there are a pharmacy benefit manager and they work with one with a URAC accredited mail service pharmacy to deliver those medications. So, so I am familiar with, with the organization and, and with the work that they’re doing,

Stan (34:11):
You mentioned to me earlier that you’re the first doc to lead URAC. And I know a lot of organizations, quality organizations don’t have physicians at the helm docs, the right people to lead quality organizations.

Shawn (34:24):
I think docs can be the right people. And I, I don’t wanna say that docs must be the right people cause that’s incredibly self-serving and, and, and physicians should never be the center of any known universe, but, but physicians do bring a unique perspective and, and unique experience. I mean, uh, my I, my career is this is this strange winding road that, that has led me to this place. And, and when, when I came to uric, one of the, one of the stories that, that sort of highlights why I did this is, um, if I go back to when I was in private practice, I was a family practice doctor, full-time staff, family medicine, that sort of stuff. If I was as busy as I could be, I could influence the care for maybe thousand people in a year. That’s about as many as I could touch directly and deliver care to was 6,000.

Shawn (35:07):
And when I became an administrative physician, I, my clinical time decreased and my administrative time increased, but the number of people whose care I was influencing significantly increased. So when, when I think about what I’m doing now, um, I have of line of sight on influencing quality care for millions of people in the United States. And now even across the world, we actually accredit internationally in telehealth and telemedicine. And there’s some incredible stories that have happened overseas about, you know, stroke care in Egypt to think that a, a doctor who trained in rural family medicine in Iowa would get to help write standards and oversee quality care for stroke care in chiro. Egypt is just remarkable and, and, and, and thrilling, but, but the, a physician does not make you a fantastic leader. And, and, and there, I’ve worked with some incredible people through healthcare who are not physicians, I’ve worked with fantastic nurse leaders, fantastic pharmacy leaders, fantastic, uh, social work leaders and all, all these different people who bring great leadership experience to what they’re doing.

Shawn (36:09):
Now, physician a, a clinician, um, is, is a very useful thing to have in your organization, in the leader structure. Now, whether they’re the CEO, the CMO, the CEO, those sort of things depends upon their background and sort of what their training has been. You know, I, I may have been a tremendous family practice physician, which is what I will claim to be. I would’ve been a terrible heart surgeon cuz I wasn’t trained for it just because I’m a doc doesn’t mean I can do everything well. And, and I think that that me coming into Eck, I did bring a certain mixture of experiences including being a physician to my leadership principles and my, my expectations on healthcare. And I’m, I’m just as comfortable going into rural Oklahoma and talking about quality as I am going into New York city and talking about healthcare quality. And I think that the people in both those locations need appropriate care, tailored to their environment. And that’s one of the, one of the passions that I bring into this role.

Stan (37:05):
So talking about rural Oklahoma and Washington, you know, I can honestly say I had entirely uninspiring elementary school teachers, but you had Mrs. Hire who took you from a little boy in, in a, a tiny village in Iowa to the president of a large organization in Washington, DC. How did she change your life?

Shawn (37:30):
Uh, Mrs. Hire is one of my favorite stories and I, I thank you so much for letting me talk about this. Um, so I mean I grew up in small town, Iowa. I mean I grew up in, in a, a town, um, a little town in Northeast Iowa, you know, about a thousand people, uh, in, in this little town. And I was, I was in a class of 16 people was my class in elementary school. And I was just sort of going along like a kid in small town, you know, riding my bike to school and, and that sort of stuff. Um, but when I was in about fifth grade, my parents divorced and, and anybody who’s been through divorce as a child will tell you, that’s a very traumatic experience. And, and I’m in fifth grade with Mrs. Hire. And honestly I was acting up, okay.

Shawn (38:10):
I was, the world felt crazy and all this sort of stuff. And I was acting up a little bit. Now my father heard me talk about this once. And he’s like, you know, what kind of acting up were you doing? I said, dad, I didn’t join in a gang or anything like that. I mean this, I mean, I, I was just sort of causing a little bit of trouble in class and Mrs higher saw me causing a little bit of trouble in class and, and as opposed to, uh, and she knew a little bit about my family situation and she, she chose in that moment to engage me as opposed to punish me and, and the story there is that, um, she saw me acting up a little bit and I, I was really bored. Okay. Uh, I have a very quick mind that sort of thing.

Shawn (38:48):
And, and I was very bored, so I was causing trouble. And what she said is she said, Sean, when you get done with your work in class, if you want to, you can help the other kids in the class who are having more trouble than you are. And so she turned me into this little sort of teacher’s aid thing. And, and, and so when I’d be, be done with my work, which would tend to be pretty quick, I could go help the other kids in class. And this was really nice for me. This was very kind of her to do this for me. And so I found that I could help people and I wasn’t getting into trouble. So it helped her with class also. Um, but also it made me think about, you know, how, how you serve others. And, and I did this for a while and eventually, uh, around that time we started talent and gifted program in our school, which gave me another outlet for, for using my creativity and those sort of things.

Shawn (39:35):
And I just loved Mrs. Hired death. She was like a grandmother to me at, at that time during my, during my childhood and towards the end of my, my fifth grade year, she came to me and she said, Sean, um, you have, you have been given gifts, your, your mind works differently. Some of the other kids, you’re very quick learner, that sort of thing you, you like to help people and those sort of things, she said, one of the most important things you need to decide the rest of your life is are you going to use your gifts to help others or to serve yourself? And I mean, that’s a very profound question to ask a fifth grade boy, I mean, you know, fifth grade, boy’s trying to figure out, you know, when’s his face gonna clear up and when’s he gonna get taller and this sort of stuff.

Shawn (40:15):
And she she’s asking me a about, about worth and value in life. And, and around that time, um, I, I was watching the TV show mash and mash had a character named Hawkeye Pierce. And, and if you’re a fifth grade boy, Hawkeye Pierce was, was almost an ideal. And it was cuz he was funny. He liked people. He helped people and he got all the, all the women. And, and I hate to say that that was one of my motivators, uh, for a career choice, but I thought, you know what, I’m gonna be a doctor and I’m gonna be able to help people. And I’m gonna, I’m gonna be able to, to make a difference and care for people and use my brain and, and, and, and make a difference. And so I decided in the fifth grade to be a doctor now there’s no doctors in my family.

Shawn (40:55):
I come from a, a line of teachers. And so to be, be a doctor, I might, as well said, I’m gonna be an astronaut. I mean, you really just didn’t stand a chance for doing that. Um, but I said, I wanted to be a doctor in the fifth grade. And so I went to undergrad as pre-med biology and I graduated from that and I went to medical school and I became a doctor and I trained in rural family medicine in a town about two hours from where I grew up. And, and my, my plan was to be what I call a county seat doctor. I planned to be, you know, one of the five doctors in a little town that was a county seat in Iowa. And I figured I’d be along the sidelines on the football games on Friday night and probably stitching people up on the kitchen table on Saturday morning and making house calls.

Shawn (41:33):
And that’s what I thought my career would be. And that’s what I became. I went to St. Joseph, Missouri, and I joined a practice and I had a great bunch of partners and we did all those sort of things. And then administrative work came calling and my background with technology and computers and organizational management and, and those things sort of took me out of the, out of the room and, and, and put me at the desk. And when, when I was making that transition, you know, Mrs. Hire, you know, took a kid who was getting into trouble and gave them some purpose and asked them some hard questions that, that he hadn’t considered before. And a TV show influenced me in my career decision. And also knowing that the, the little doctor in our hometown, every, every winter, he took his family to Hawaii for vacation. And I, there there must be some money to be made in medicine if he could afford to take his kids on vacation to Hawaii. And, uh, and so that, that’s what I did.

Stan (42:25):
Wow. What a story, how a single individual can totally change the vector of somebody’s life.

Shawn (42:31):
Yeah. And, and it’s funny because, um, and actually in my office here in Washington, DC, I, I sit about eight blocks Northeast of the white house, um, is a plate on my wall and it is the young medics, and it was a graduation gift, uh, from Mrs. Hire to me. And it’s one of the things on my wall that I can see just as I sit here at my desk today.

Stan (42:50):
That is great. Sean, thank you so much for being our guest today. We really appreciate your time.

Shawn (42:56):
Uh, I, I’ve had a great time and, uh, happy to speak with you today and come back anytime. Uh, we wanna have another talk,

Stan (43:02):
Thanks for listening. And a special, thanks to zero studios for sponsoring this podcast. Zero health worked with midsized self-insured employers to help them save up to 50% on their healthcare by connecting employers and healthcare providers in healthcare marketplace. And at the same time, providing a great benefit to employees, learn more on the web at zero.health, or send an email to info@zero.health.

Narrator (43:29):
We hope you’ve enjoyed the time with our very own doctor Stan for 306 degrees of healthcare with Dr. Stan Schwartz, a part of zero studios tune in subscribe and review our podcast to keep current with the ins and outs of the medical and healthcare industry from the inside out.

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