Today we hear an important conversation about the role of local government in population health and wellness. Scott LaVigne, Public Health Director of the Franklin County Health Department in North Carolina, talks with CHESS vice president, Josh Vire, about the broad scope of work his team is responsible for and how they are successfully tackling numerous initiatives, including managed Medicaid, to be a safety net provider for community health needs.

Scott LaVigne, welcome to the Move to Value podcast.

Oh, it's great to be here.

We're we're really excited and looking forward to the conversation. Scott, as a public health director, you're responsible for all aspects of the Franklin County Health department from the clinical to environmental services and you balance state mandated services. So for the audience that things like vaccines, basic health screenings, environmental services, and with the expectations of Franklin County government, all while dealing with the critical workforce shortages. Health departments are considered safety net providers in most of North Carolina's counties. Can you share how your team is addressing the specific healthcare needs of the Medicaid population in the county?

Sure. Well, after hearing all that, I'm, I'm getting tired. Yeah. That that is a we have a lot on our plate here at the health department and a lot of they're, they're not very often competing interests. But you know, I think what we look at when we talk about healthcare services in general and the overall health of the county, we don't break it up into per SE Medicaid population, although we do focus on that as part of the work that we do. But we, we have 2 broad missions and one is obviously population health and that it cuts across all payers and everyone in the community. And then the other role, which you correctly identified as we're a safety net provider. So in addition to putting out a lot of population health initiatives, we're also a provider and we're involved in a lot of the initiatives that all the providers in the community are involved in. So, you know, that gives us a unique position and we get to tailor some of our initiatives as a healthcare provider based on what we know the community health needs are. So it's, it's, I'm going to be honest, it's not very easy to do all of that. I would say we, as I said, we don't just focus on the Medicaid population, but we do have a lot of initiatives that cut across all of that.

Great. What are the specific issues that that I think you have a lot of experience in close to 30 years of behavioral health experience with much of that coming in New York. Can you describe the changes in public health that you see in your career and maybe also for the audience contrast the differences between the public health in New York and North Carolina. What are the differences you've seen?

Sure. Well, when I was in New York, I was a a mental hygiene director for a county and, and when I came to North Carolina, I became a public health director. But we were actually in the same building in New York with our public health programs and we had a very close relationship with that program. But there are some significant differences, but a lot of similarities. You know, the some of the big differences though relate to some of what we're talking about. Medicaid managed care being a big one in New York. Medicaid managed care started first with medical care and then they brought behavioral health and IDD into the picture. In North Carolina, they did it the exact opposite. And so that that was a, a big difference. When I came down here, we had a mental hygiene system that had already made the conversion and was and, and medical care, which is what I was now in, we had to make that shift. So, I would say that was a, a big difference. But in New York, most of the public health agencies had gotten out of...

In this episode, we hear the second half of the conversation between Kris Shepard, Senior Vice President at Advocate Health, and CHESS President Dr. Yates Lennon, as they discuss how physician networks and primary care services are the backbone of the value movement in healthcare.

So Chris, welcome back to the Chess Move to Value podcast. Look, look forward to continuing our earlier conversation.

Awesome. Well, had a good time so far and I'm expecting nothing less for the second, second-half.

OK, great. Well, let's start out the second-half here. Just let's talk a little bit about some of some business development goals, both from the lens of the MSOVSO and from Advocate perhaps as well as if I'm an independent physician in the market, whether that's the Carolinas, Georgia, Wisconsin, Illinois, what should I be thinking about? So come at it from both sides.

It's a great, great question. The, the starting point for me is really an acknowledgement that the healthcare industry is changing. And you know, we've, we've talked about change and transformation in healthcare for a long time. So this is I think part of that broad continuum in the future, I expect that there will be increasing, it would be increasingly important for the ambulatory enterprise to take on more of the care delivery then perhaps we have historically it's more and more expensive to build hospitals. I think you, you know, you see a lot of commentators talking about hospitals becoming more focused on kind of higher acuity, higher complexity things. And so you know, they're always going to be here. And we're, you know, we are building broadly in facilities across the advocate enterprise and investing in, in improvements in the facilities. And at the same time, it's going to be increasingly important for the ambulatory enterprise to take to take on more and more. Some of that is is is has a regulatory dimension to it. So for example, CON laws being loosened or removed in in South Carolina, North Carolina, perhaps other places. I think those those kinds of regulatory changes, reimbursement changes that that encourage certain certain types of procedures and certain care to move out of facilities into the ambulatory setting. All those I think point us toward a future where to for a health system we are going to need to be successful in that ambulatory space as well as as as with our facilities. So what does that mean from a physician you know, or a clinical enterprise development lens, a physician partnership lens? I think those relationships become even more important and and in some ways more challenging because there there are a lot of organizations, whether they're payer backed organizations or private equity backed organizations or public companies like an Amazon who are moving into that ambulatory space. There's almost nobody going into the facility areas, you know, not a lot of new money or new entrants, if you will, into in building hospitals, but they're definitely a lot of new entrants rolling up ambulatory practices. So, you know, from a strategic lens advocate can either, you know, choose to focus on, on the facilities or, you know, alternatively, what we've done is, is really geared toward building a significant ambulatory presence. And you know, we, we already have thousands of physicians employed, you know, hundreds and hundreds of clinic sites. We, we have a significant ambulatory presence already. But it's going to it's going to be increasingly important going forward to do that. And I think, you know, some of the some of the discussion we've already had about what's the right relationship within it with a given group and a given specialty is those, those questions become more significant when you think about how the industry is, is trending.

Yeah, Yeah. Let's let's head toward, I mean MSOs/VSOs are networks in and of themselves. But let's talk a little bit about physician...

Today hear from Kris Shepard, Senior Vice President of Clinical Enterprise Development and Core Market Growth and Physician Partnerships at Advocate Health. In a conversation with CHESS President, Dr. Yates Lennon, Kris talks of how Management Services Organizations benefit patients and creates opportunities for practice growth and professional development for providers.

OK, Well, good morning, Chris. Glad to have you on the chess Move to Value podcast. Look forward to our conversation today.

Good morning. Yeah, great to be here.

Good. So Chris, I'm looking at your title clinic, SVP, clinical enterprise development and core market growth physician partnerships. Tell us what you do.

I do a few different things. And as that title probably implies, sometimes I'm working on your plain vanilla physician practice acquisitions. Sometimes I'm working on acquisitions that are not so plain vanilla in a more complicated in a larger scenarios, something particularly unique. And then I work on a range of other physician partnership transactions, professional services arrangements, as well as working on management services opportunities that we see with groups. And we really view that clinical enterprise development as, you know, broadly designed to look at our physician networks across the Advocate enterprise and and pursue what we think will work in a given market, a given specialty. And so that's why it's a fun job to have. I get to be creative and yeah, engage with people in a very different settings and try to put together things that that are appropriate in the right context.

Yeah, never a moment of boredom, I would imagine with that much variety. Well, you, you, you touched on managed services. You know, there's a lot going on today with various managed services organizations as well as what you might call value services organizations. Talk to me a little bit about sort of at a high level, what do you think the opportunity is in the MSO slash VSO either or both market today?

Yeah. I think I'll, I'll come at it from the perspective of physician groups that we talked to pretty regularly And you know, different groups have different needs. But one of the realities that seems to be hitting a lot of, you know, physician owned practices is that they don't necessarily have the scale to keep up with whether it's, you know, physician practice infrastructure needs or, or it's and, or the value-based care capabilities that they need to be successful. And so, it's, you know, two different buckets that are that can be addressed through management services and value services arrangements. But that's the reality. I think practices used to be able to kind of, you know may do just fine on their own. I think there are a variety of factors playing in to the challenges on independent practices now, payer relationships and kind of reimbursement challenges that exist, the cost pressures that are hitting every everybody, especially in the healthcare industry, kind of inflationary factors. And then there are things like, you know, EMRs are expensive. It's expensive to fend off cyber-attacks, to have the right cyber security frameworks in place, to make sure that you can you can continue in operations, to have the best revenue cycle, the best supply chain options. All those are things that are I think increasingly challenging even for the larger physician practices out there. So there's a, there's a scale factor there, same kind of themes with respect to value services. I think it, it takes a lot. There's analytics platforms, there's teams of people to support, to support a practice in, in delivering care the right way and then being able to record that and have that be a parent in quality metrics that get reported and cost metrics and, and everything else. So I just think, I think it's this moment. And from a, you know, I work for Advocate health for the health...