When Saint Thomas Health Services announced its plans for a regional accountable care organization in mid-2011, it tapped Jason Dinger to lead what officials called a holistic approach to delivering health care. Dinger, who formerly ran Saint Thomas Health Services Ventures, recently talked to Post Editor Geert De Lombaerde about the approach he and his team have taken and the progress they’ve made.
What were your initial thoughts when the Ascension folks called on you to launch MissionPoint?
First, that it’s a privilege to do this. It’s rare that you get the opportunity to make a difference for so many people. Even during the orientation phase when we bring in new people, they quickly realize the impact we can make.
The second thought was, “Where do we start?” And the third was, “And once we’ve started, how can we make change sustainable?”
What was your first big step?
We conducted more than 150 interviews with patients, physicians, insurers and administrators to find out what they wanted us to do, where their greatest needs were. Great innovation starts with great listening. Many people think they have the next big idea. We wanted to listen for the next big idea.
Listening like that reduces your risk. You’re no longer creating a market.
What’s the most important thing you learned from those interviews?
That we’re not in the ACO business. We’re in the healing business and the collaboration business. For us, it wasn’t about saying, “We’re going to be this kind of organization.” Too often, people get put into a box that way.
Part of a being a leader in innovation is remembering the business you’re in, not being the business others want you to be.
Did your experience with Weberize in the early 2000s influence your approach in building MissionPoint?
The thing I learned most from the Weberize experience was the importance of culture. Great change starts with the committed few. So you need to support your employees and innovate around their needs. I learned that in spades coming out of a technology setup.
The second thing I took away from Weberize is the experience of working with great companies and how we leveraged that. I’ve always seen technology as a tool for leverage and we’ve been apply that idea here.
Regarding supporting your employees, you’re a big proponent of giving people the freedom to do what they need to do when they don’t know what to do. Talk about that a bit.
If we really believe that, in this business, everybody is unique and worth healing, then each will present differently. No amount of training will prepare you for that so you have to fall back on principles.
In many ways, we’re like musicians. We carry our instruments and we’re trying to connect with people. But I think you lose a lot when everybody is playing the same sheet of music every day.
So how does that play into daily operations?
We’ve built checklists, not policies. We’re responding to unique needs and we have to be flexible around nonclinical needs. That means things such as helping with transportation, helping people with the social aspect of getting their first shots and helping them identify their asthma triggers.
It’s not very sexy; it’s all pick and shovel. We talk about that approach all the time. Innovation gets you in the game, but execution wins the game.
On that note, you had to make some big changes early on to your contracts with doctors.
We look at physicians as our trusted partners in making this work and we want their candid feedback. They let us know early on where things weren’t working well and their concerns were right. We iterated contracts with them several times in those first few weeks.
It has helped us go from having a network of about 400 to 1,500. A year later, we’ve cut costs by 12 percent and we’re cutting checks to doctors for their participation and role in our first year’s accomplishments.
That’s why it’s so important to be a good listener. When people know you listen, they will engage with you.
And it lets you live one of MissionPoint’s 10 principles: ‘Fail quickly and often.’
We like to celebrate course corrections. It brings us back to the culture of listening and it reinforces what produced the change.
One example of that was our first set of business cards. The font size was way too small. Now we could have said that we weren’t going to change them, that it wasn’t that big a big deal. But we celebrated changing the cards to make it easier on our members and partners. And we went further by asking ourselves and others, “What else is too small?” We ended up revising several of our marketing and information pieces and reframing how we talk about our services, collaboration, and other areas where we help and support our members.
What has surprised you about MissionPoint’s development so far?
Some of our outcomes have been great — all the literature showed that the clinical interventions we were rolling out would bring change. But life issues turn out to be as important or more important as anything clinical. For people who struggle with transportation, the highest predictor of health care cost is the stress they experience from trying to get to the doctor.
What are the next big steps?
We’ve built a network here in the area. Now we’re looking at doing that elsewhere. A big part of that is managing our concept risk and figuring out why what we’ve done so far has worked. We’ve narrowed down to 15 the list of things that appear to work. Now we need to pick the seven that will let us build on a big scale. But we don’t yet know for sure which ones those are.
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