Focus on the patient experience.The best care happens when doctors and patients are brought closer together without the health plan and system administration interfering, but the typical doctor spends more time documenting for the regulator or the payor than they do communicating with patients and collaborating with other providers. Financial incentives encourage frequent, short visits and more procedures, discouraging thoughtful patient-doctor dialogue and collaboration. Health plans and integrated delivery systems should focus on educating consumers and creating pathways to coordinated care that allow doctors and patients to form meaningful, long-term relationships, facilitating greater trust on the part of the patient and enhanced clinical data on the part of providers. Integrated delivery systems (IDS) have the power to restore the kind of direct and sensible relationship between doctor and patient (as well as doctor and doctor) that is sorely missing today.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Simeon Schindelman, Founder of Create®. Prior to founding Create, Simeon was Chairman and CEO of Bloom Health from 2012–2015. During his tenure as CEO, Bloom’s revenue increased by eight times and its consumer base grew by four times. Contributing to this growth, Simeon led the efforts to secure two Blue Health Plan RFPs, which resulted in the establishment of six new health plan partnerships for Bloom across 21 states. Before his time at Bloom Health, Simeon served as Senior Vice President, Commercial Markets at Medica Health Plans from 2009–2012, where he successfully developed My Plan and delivered it to the Minnesota market. Similar to Create,My Plan focused on developing two-way relationships between patients and a single health care provider. Following the launch of My Plan, participating employers have seen their health care costs decline year over year, an almost unheard-of occurrence. He also has held roles as a Senior Vice President at UnitedHealth Group from 2008–2009 and has held a variety of executive roles at UnitedHealthcare from 1993–2009. Simeon received his BA in Mathematics from Dartmouth College.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
When my wife and I had our first child, he had some serious health problems that we started to notice when he was about three weeks old. We knew we needed to get help for our son, but we felt lost when trying to navigate the health care system. Our experience will sound familiar to many — every time we saw a new doctor we had to fill out the same forms and answer the same questions about our son’s symptoms. When we received our first referral for a specialist from our son’s pediatrician, he simply wrote down the names of three doctors on a piece of paper and told us to call one of them. We didn’t get any support from our doctors or our health plan to help coordinate our son’s treatment — we had to do the work of tracking down specialists, explaining the situation again and again, and trying to decipher industry knowledge. It almost became like a second job — we would go to the library after work, sift through medical textbooks, and try to figure out what was going on with our baby. I was already working in health plan management at that time, but this was an entirely new experience for me as a vulnerable new parent. That was when I decided I wanted to use my position as an industry insider to shift the culture of health care and help families connect with their providers for effective, long-term care.
Can you share the most interesting story that happened to you since you began leading your company?
When we started building Create® more than three years ago, it was difficult to find that first health system that was willing to try a new model for health care delivery. It took a tremendous amount of effort to show that Create could actually benefit the highest value providers, enhance patient-provider relationships, and encourage patient loyalty. These were things that health systems wanted, but couldn’t figure out how to achieve.
It took us about a year to sign on our first two health systems. Today we receive in-bound calls from major health care systems who are excited about what Createis doing and are eager to participate. What that means is that the Create model is helping shift how health care providers are delivering care, and prompting them to think about how they can provide more unique services and demonstrate more value to consumers.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I’ve spent three decades aligning the interests of employers, individuals, health plans, and health systems. I have a deep commitment to transforming the health care industry to make the system work better for all involved. Previously, at Medica Health Plans in Minnesota, I led the rollout of My Plan by Medica, a groundbreaking health care model that generated stunning results: Patients reported 16 percent fewer admissions, 11 percent fewer readmissions, and 14 percent fewer ER admissions. Now I’m bringing my learnings to the most challenging health care market in the country — the New York tri-state area — with the Create platform, which is an alternative medical delivery network combined with state-of-the art consumer technology and a full-service health plan. Createis a bold solution to the competing priorities and spiraling costs that plague American health care today.
What makes your company stand out? Can you share a story?
Traditional health plans attempt to address the symptoms of America’s health care woes — high costs and diminishing quality of care. Create is unique in that it is the only health plan to address the root causes of these symptoms: fragmentation of care, misaligned incentives, and disruption of market forces. What’s more, it empowers everyone — providers, plan sponsors and patients — in the process.
One telling anecdote is when I first launched our model in the Midwest, we started working with a trucking company with nearly 600 drivers. There was concern from the company’s leadership, who were used to doing onsite open enrollment, that their drivers would not use the technology platform that supports our model because they were always on the road. What we found instead, however, was that these drivers were the highest users of technologies like tele-health in their company, and that they were actually early adopters of digital tools because of their convenience. They loved our platform and model and the fact that they could enroll online and receive advice on what doctor to see from anywhere in the country, at any time. The combined power of closer provider relationships and technology completely changed the nature of health care for this company and its employees. That demonstrated to us two things — 1. The transformative power of a forward-looking product that allows members to have better partnerships with their doctors and health systems, and 2. Don’t underestimate your consumer!
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
In health care today, employers, patients and their families, health plans, and providers and health systems all have competing incentives that prevent doctors and patients from developing meaningful, long-term relationships. As a result, patients feel frustrated and overwhelmed — just like my wife and I did — and doctors aren’t able to provide the standard of care for which they strive.
What Create does is construct a win-win situation for all parties. We ask families to enroll with a single integrated health care delivery system from which they receive all their care. By leveraging local system mergers and acquisitions, we’re able to offer significantly lower costs since members aren’t paying for access to an expansive network of health care providers across the country — the vast majority of which they will never visit. And when families consolidate their care within one health system, their doctors and specialists are able to collaborate and become more familiar with their patients’ medical history and needs — leading to better health outcomes and greater satisfaction from all parties.
Are you working on any exciting new projects now? How do you think that will help people?
Right now we’re exploring collaborations that will allow us to bring Createto more employers in the New York tri-state area and beyond. We’re working to bring more of our region’s top-ranked integrated health delivery systems to the Createplatform. We believe in partnering closely with care providers because that is where the cost and quality improvements are driven. Createis also helping our current health system partners grow their market shares by improving the overall consumer experience for their patients.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
1. Health care providers want to change the health care system — they just need the right partner. Create’s expansion throughout the New York tri-state area is a testament to its reputation for being the right partner. By aligning with integrated health systems and their doctors in the tri-state for a common purpose — to lower health care costs and elevate the quality of care — Createis driving desperately needed change in today’s health care industry. Our team has placed the transformative potential of the Createmodel front and center when establishing the brand, and it’s resonating with these health systems. We’re seeing increased call volume from major health care systems looking to partner with us. More importantly, we’re working directly with medical providers, finance staff, customer service teams, and other health system personnel across a wide range of functions, so we have the potential to impact cost, quality, and consumer experience for Createmembers.
2. Employers have the power to change the health care system but they are risk-averse.In the past year, we met with the CHRO of a Fortune 100 company in the greater New York metro area who told us that he was tired of how traditional health insurance offerings have stayed more or less constant. But despite the interest he expressed in starting a wave of change in the industry, the company ultimately chose a health plan that fit the status quo — missing out on an opportunity to energize and motivate their employees with an innovative offering.
3. There are plenty of people who want to change the world.When we launched Create, one big question was whether we could recruit the highly talented and motivated team we would need to deliver on such an ambitious undertaking. It turned out that our passion, our commitment, and our mission to change health care in America resonated powerfully with all kinds of people. We built a fantastic team full of skilled, committed team players with remarkably diverse backgrounds. The team is our biggest asset and it’s why I know the future is bright for the Createnetwork.
4. In business we often hear about “role clarity.” But what’s most important is “goal clarity.” We’re building something totally new at Create — something that we know can be great. Along that path we’ve had to work with people who have vastly different backgrounds, priorities and stakes. Being crystal clear about what we are doing to improve health care in America, why we are doing it, and that we are doing it as partners — not adversaries — has been crucial every day.
5. Know your audience. We work with all kinds of people in spreading the Createmission. Some immediately embrace our goals and want to be a part of transforming health care. Others want to see spreadsheets and micro-economic analysis. Many are a combination. We need to meet people where they are, which requires us to check our assumptions at the door, and learn about our partners and potential partners to ensure we meet their unique needs. That focus on our partners, rather than ourselves, has been key to our early success.
Let’s jump to the main focus of our interview. According to this studycited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Although the US ranks lower for life expectancy, that measure isn’t an accurate reflection of the quality of health care in the US because it is skewed by the number of violent or accidental deaths, which other countries don’t deal with at nearly the same level as the US. Our accidental or violent death numbers, of course, point to another very serious problem vexing our country; however, if you remove that category of deaths, you’ll find the US actually has the highest life expectancy related to poor health and disease. What does that mean? It means that there is actually very good health care in the US.
Another reason that the US ranks so poorly is that health care is terribly expensive. The high cost causes major impediments to accessing comprehensive health benefit plans, especially for those with lower incomes. Medicare, Medicaid, Commercial, and Affordable Care Act plans all offer different rates to providers, meaning they are not valued equally, and they don’t provide equal access to care.
The third fact is that financial incentives within the health care system are extremely important to care providers in the US and have significant effects on care quality. Nowhere in the world are doctors, hospitals, and drug and device manufacturers paid so much. This incentivizes doctors to behave in ways where they will be paid more, which has resulted in higher rates of C-sections and the use of emergency departments, and a severe lack of accountability.
You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
1) Leverage health system consolidation.System mergers and acquisitions are the new normal in health care today, and they’re driving up the cost of care. But, by having consumers consolidate their care within one system each enrollment period, we can reintroduce market competition, rewarding the best health systems with patient loyalty and forcing them to drive down costs. In Salt Lake City there is Intermountain Healthcare, and in Pennsylvania you have Geisinger, and in my backyard of New York we have several that we count as our partners which are all popular examples of vertical integration and how a consolidated health system produces improved clinical quality and efficient health care delivery.
2) Measure provider and health plan performance.Every day, consumers use information, data, reviews, and reports to make their choices. However, measurements to quantify and qualify provider and health plan performance don’t exist in a way that is designed for public consumption. This inherently inhibits competition, encouraging higher costs for lower quality care, and prevents consumers from making informed choices about a health plan that is the best fit for their needs.
3) Take advantage of integrated care models and EHR/EMRs.Electronic health records and electronic medical records on their ownwon’t solve health care’s problems because there’s no interoperability between systems. Since doctors and care providers in different health systems don’t have access to patients’ data outside of their network, they are forced to rely on patients to provide an accurate overview of their medical history at each visit. With integrated care models, providers in a health system can coordinate directly using the same EMR and get a more holistic view of the health of their patients and to reduce redundant testing — allowing doctors to provide more personalized, quality care.
4) Focus on the patient experience.The best care happens when doctors and patients are brought closer together without the health plan and system administration interfering, but the typical doctor spends more time documenting for the regulator or the payor than they do communicating with patients and collaborating with other providers. Financial incentives encourage frequent, short visits and more procedures, discouraging thoughtful patient-doctor dialogue and collaboration. Health plans and integrated delivery systems should focus on educating consumers and creating pathways to coordinated care that allow doctors and patients to form meaningful, long-term relationships, facilitating greater trust on the part of the patient and enhanced clinical data on the part of providers. Integrated delivery systems (IDS) have the power to restore the kind of direct and sensible relationship between doctor and patient (as well as doctor and doctor) that is sorely missing today.
5) Think locally.The very breadth of the traditional PPO medical network model is its weakness. Health care is consumed locally–not nationally. Providers can refer patients in and out of a maze of unaffiliated practices, hospitals, and medical groups — making health care navigation tedious, stressful, and costly for the consumer, and coordination of care for doctors nearly impossible. Health plans should instead act as the strategic liaison between patients, their health benefits sponsors, and top-rated integrated health delivery systems where the patients live.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
We can start by creating meaningful choice for employees and health care consumers. Offering a plan like Createalongside a traditional open-access plan and allowing individuals to decide the best fit for themselves and their families is one way to empower consumer choice.When members have the choice to consolidate their care with one health system, their doctors become more familiar with their medical histories and are better able to coordinate with one another. This continuity of quality care leads to not only healthier outcomes, but lowers spending too. Collaboration among providers is essential to expanding health systems’ care capabilities without further enabling the surge in health care costs; and, health plans can play a key role in fostering these relationships immediately by using existing platforms.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I enjoy learning about people who have had to lead through change and by challenging convention. A few people who inspire me are Andy Grove, Abraham Lincoln, and Teddy Roosevelt. There are also three podcasts I listen to that I find helpful in understanding the world around me:
1. The first is “Stuff You Missed in History Class”, which I love because you learn about particularly difficult and unusual events that not many people know about, where people overcame the odds to disrupt the status quo.
2. Another podcast I find interesting is “Odd Lots” by Bloomberg which is similar to “Stuff You Missed in History Class” but specifically about what you don’t see every day in business. When I learn about history and business in these ways, I learn new ways of thinking and new ways of attacking problems that may not be the way I had done it previously. That I find to be really interesting.
3. I am a big Formula 1 fan, and what I love about the sport is that it’s very visible but people win and lose because of the very small, important decisions they make. They have to pay attention to every detail, and I love learning about how they attack this when the differences are so small. The podcast “Beyond the Grid” interviews key players in Formula 1 — from drivers to mechanics to team owners — who share these kinds of stories, and I really enjoy learning from them.
How can our readers follow you on social media?
You can keep up with me on my LinkedInpage.
Thank you so much for these insights! This was so inspiring!