The Race to Value Podcast
Ep 184 – The Activation of an Ecosystem: Overcoming “The Cost Conundrum” Through Equity-Based Co-opetition, with Edwin Estevez
Fourteen years ago, surgeon, writer, and public health researcher, Atul Gawande wrote his landmark article, The Cost Conundrum, about the healthcare challenges of the Rio Grande Valley (RGV) of South Texas. Gawande showcased the challenges that health systems confront when dealing with public and private insurers and the paradox between high-cost treatment options and low-quality outcomes. His careful assessment of McAllen, Texas, a small city on the border, found that it had the most expensive healthcare system in the nation. This “cost conundrum” in the Rio Grande Valley inspired President Obama to pass the Affordable Care Act and begin a national movement to value-based care. Now that ACOs have reached a critical mass in the Rio Grande Valley we must now ask ourselves “to what degree can value-based care accelerate health equity?”
Value-based care is the seed from which health equity transformation can bloom, nurturing a system that values every life, cultivates well-being, and harvests a future where health disparities are but a distant memory. Health equity transformation in underserved regions (like the RGV) is not just a matter of providing medical care; it’s a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity. Equity transformation is currently underway in the Rio Grande Valley, one of the most underserved regions in the entire United States. The RGV – a 50-mile stretch of towns that span the border of Texas and Mexico – is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country. Issues like poverty and lack of access to healthcare burden the Valley. These factors are the leading cause of health problems like diabetes, obesity, and cervical cancer.
Our guest this week is Dr. Edwin Estevez, a nationally-recognized value-based care leader and champion for health equity in the RGV. His vision is to activate the local health ecosystem to expand access and promote inclusivity through the power of co-opetition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem.
If you want to be a part of the health equity transformation in the Rio Grande Valley, register today for Accelerator2023 on October 17th! (Attendees can attend in-person in Mission, Texas or virtually). More information at www.equity-accelerator.org
01:20 The landmark article, “The Cost Conundrum” about the healthcare cost crisis and how it inspired a national movement to value-based care.
02:30 The underserved region of the Rio Grande Valley (RGV) as a focal point to create a replicable convening model of equity-based co-opetition.
04:30 Advancing health equity through a community-based ecosystem – Eric and Edwin discuss their upcoming collaboration in the RGV.
05:45 “Value-based care is a platform to shape policy, redirect programs, and understand services better through the lens of health equity.”
06:00 Edwin’s prior VBC success with RGV ACO, one of the earliest (and most successful) physician-led MSSP ACOs in the country.
06:30 Edwin discusses AltaCair, a new population health enablement company borne out of the desire to optimize efficiencies and maximize care management.
08:45 The RGV is a bilingual, border region is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country.
09:00 According to the RGV Health Connect Organization, the region’s median household income is $46,016, compared to $71,347 median household income state-wide in Texas.
09:30 The RGV has 24.7% of families living below poverty level, nearly triple the percentage for the nation. The Rio Grande Regional Hospital states that an estimated 76,000 people in the region have diabetes.
10:00 Edwin provides his perspective on the economic development and demographic growth in the RGV (and how it has not contributed to a rising tide for underserved communities).
11:00 The opportunity for whole-person care and community collaboration to address social determinants of health.
11:45 Despite value-based interventions to reduce avoidable ED visits in the RGV, SDOH challenges still contribute to overutilization of healthcare services.
12:00 The opportunity for Community Benefit Organizations (CBOs) to create a “collective impact model.”
13:30 Dr. Gawande’s careful assessment of McAllen, Texas, a small city on the border, that found that it had the most expensive healthcare system in the nation.
14:00 According to the U.S. Census Bureau, 9.8% of people under the age of 65 do not have health insurance nationwide, but the percentages in the RGV are much higher at around 30%!
15:30 How a broken system of big business fee-for-service healthcare emphasizes profiteering at the expense of community health outcomes.
16:30 “The economics of value-based care galvanized our healthcare community in the RGV following the wake of Gawande’s The Cost Conundrum.”
17:00 The continued challenges of accessing primary care in the RGV (wait times may be up to 2 hours).
17:30 Various community ACOs (e.g. RGV ACO, RGV Health Alliance, South Texas Clinical Partners ACO) have triggered an elevation of consciousness to drive accountability.
18:30 “A mindfulness of engagement to see the whole-person” (focusing on prevention and AWVs)
18:45 RGV-based hospital systems are now focusing on value-based care (e.g. direct admissions)
19:30 Finding opportunities to disrupt the local ecosystem to improve equity (whole-person care responsiveness and focus on social influencers that drive health).
20:00 The critical shortage of PCPs, nurses, and other healthcare professionals and the opportunity to create equity in the access and attainment of education for underserved learners.
21:00 A recent survey of healthcare CEOs by ACHE shows the #1 challenge is workforce — eclipsing even financial challenges which held the top spot for 16 years in a row up until last year!
22:00 Edwin discusses the Higher Education landscape of the RGV (WGU Texas, UT RGV, STC) that are actively engaged to address staffing shortages and workforce development needs.
23:00 How the pandemic created a perfect storm to transform the educational landscape in the RGV for health professions.
23:30 The presence of educational institutions change the relationship of labor to community-based health challenges in a given region.
24:00 “Access to care is at the pinnacle of problems related to equity and opportunity for people of the Rio Grande Valley.”
24:30 “It is astronomically crazy that folks in our market can find it easier to access basis care in the ER than see a primary care physician!”
25:00 A renewed focus on the development of additional primary care access points in the RGV.
25:30 “We must think of access to primary care and labor shortages as a matter of equity. Collaboration can better coalesce around the opportunities to better meet these needs.”
26:30 A Vision of Pioneering Co-opetition for Health Equity — a partnership between theInstitute for Advancing Health Value at the Leavitt School of Health and AltaCair.
26:45 “Co-opetition is a transformation strategy that combines elements of both cooperation and competition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem.”
27:30 Accelerator2023, will be held in Mission, Texas on October 17th, bringing together competing health system and ACO leaders, CBOs, Higher Education, entrepreneurs, civic and other community leaders.
29:30 “We want to advance equity through community-based focused conversations. Transformation in health equity in the RGV will result from co-opetition.”
31:00 Edwin discusses how a researched-backed convening event can foster impactful strategies that drive high-level tactical execution in the advancement of equity.
32:00 To what degree has health value accelerated health equity?
33:00 The activation of an ecosystem for better health.
34:00 Creating replicable models for health equity co-opetition across the country.
34:30 “Health equity transformation in underserved regions is not just a matter of providing medical care; it’s a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity.”
35:00 “It is impossible to continue on a trendline where your zip code is a better determinant of health than your genetic code.”
36:00 Activating entrepreneurship for social justice and health equity through community collaboration.
37:00 Parting thoughts from Edwin on our upcoming event to transform health equity in the Rio Grande Valley.
38:30 Register for in-person or virtual attendance to Accelerator2023!