Mavericks of health care #2: Doug Hetherington

I have talked with many mavericks over the last few months.  In a series of four vignettes, I am happy to share some key insights and a look into the philosophies and paradigms that make someone a maverick of health care.

Common values exemplified by health care mavericks

• Caring and competence
• Innovation partnership
• Appropriateness and stewardship
• Trust and advocacy

Be sure to read the part one, featuring Nancy Giacolone, president and owner of Olympic Crest Insurance.

Vignette #2 in a four-part series:

Doug Hetherington: CEO & Program Architect at HealtH2Business

Maverick Values:  innovation and partnerships

“Get out of the rut – health CARE is the solution”

Doug has done what many of us have said was impossible.  He has created a collaborative approach to providing group health benefits that brings together employers, employees, and health care providers.

Q:  What was the spark, or series of sparks that led you and your team to think outside the box?  What are some of the elements that you have found helpful in developing partnerships and the collaborative relationships between players to create a common objective and the solutions to achieve those objectives?  What barriers have you encountered?

Doug shares how as a broker, he saw a misalignment of incentives that was resulting from sociopolitical events that he noticed were shaping thoughts and behaviors of the stakeholders in the system; namely the employers, providers, and insurance companies.  As he remained curious and observant, he realized with anger that really what was happening was that stakeholders were being “pitted against each other.”  He and others like him recognized hopelessness and dissatisfaction with the status quo in our health care system – something had to change.

He found that clinicians faced restrictions as they were dictated how to practice care in an often irrelevant manner by insurance companies.  Revenue cycles were off or slow, and the result was a degradation of the care continuum.

His light bulb moment came in his interaction with clinicians, which sparked a belief that the providers would be the solution. He embarked on creating partnerships with a basis of mutual respect – taking into consideration the impacts on the employers, clinicians, and especially for the patient.  If the provider was the solution, “how can we get out of their way?”

Doug is best known for leading with his conscience and his insatiable desire to do and say the right thing.  He leads with a strong desire to ensure communities have access to excellent and affordable care as he focuses on building care models directly between providers and patients with employers.

His model is taking off.  When asked if he was surprised by how his model is growing, he stated that he had a burning hope for success – he hoped that it would be 10% to 15% better than the traditional insurance model.  He married that hope to his confidence that it could work.

Today, he and his concept HealtH2Business have four to five years of data and dozens of employers and providers who are finding:

• 30% lower costs than in the market
• Medical trend in line with regular inflation
• 100% persistency with increased sustainability and predictability in the health systems

Tapping into the brilliance of the clinicians in our health systems and the robust resources of these systems is the key to finding problems, inefficiency, waste, and the solutions for those problems.

He’ll be the first to admit that despite the amazing success of his model, it may not be the best for all communities.  He and his team look at many factors in the market: the provider community, the health systems in play, payor communities, employer types, competition in the market – all these factors drive the feasibility or lack of feasibility of a community to embrace a concept like this.    But where will, desire and need are coupled with community members and players who are ready, there is no limit to the success of a model like this.