Primary care provider Astrana Care of Nevada is making its mark in Las Vegas with clinics that offer extended hours seven days a week.
Dr. Upinder Singh, the chief medical officer for Astrana Care of Nevada, outlined the strategies of the health care provider.
“A lot of health care companies are focusing on Medicare Advantage plans,” Singh said. “Astrana’s focus is on the whole family, and the whole body. We are as focused on commercial patients as on Medicare Advantage patients. There are a lot of younger people, too, and they need medical care, too. We want to be a solution for the community, and the whole family and body.”
Singh said Astrana trains the entire team of employees from front office to back office on customer satisfaction.
“The first impression can sometimes be the last impression,” Singh said. “If the person answering the phone is not courteous, not knowledgeable and not accommodating, that will leave a bad taste in that person’s mouth even if it may be the best doctor. We believe in a total team approach. We take pride in training the front desk, the back office and medical assistant because just having good doctors is not enough.”
Q: How do you improve total cost of care without compromising quality outcomes?
A: That is really important. The first thing we need to understand is quality care can’t be compromised. Anybody can deliver a low cost of care without delivering a good quality care. The best model is, if you can deliver the best care in the most cost-effective manner. That’s what Astrana’s focus is. We make sure we provide (the patients) access to (our expert health care) in the office. Traditional clinics are 9 a.m. to 5 p.m. or 8 a.m. to 5 p.m. Astrana’s focus is extended hours seven days a week. We have clinics starting at 7 a.m. going all the way to 7 p.m. seven days a week. You have no idea when you are going to get sick. What happens if you call the doctor at 4 p.m., and they can’t see you. You are going to end up going to the ER or urgent care. You have to wait there for four hours. You go there with one problem and catch three other problems and come home. And it’s very costly. If we have extended hours, that helps patients not having to take time off from their office time. You can finish your work and get your work done. Secondly, you don’t have to take the kids away from school. Everybody doesn’t have a car and someone may not be able to take you until after five o’clock. That was our big focus.”
Q: How do you define clinical excellence in a value-based care environment?
A: Value-based care we have seen in the last 10 to 15 years is different from the old model in which you see more patients and you get more money from insurance companies. It was volume-based. Over the time, payers including Medicare, Medicaid and commercial payers have understood that is not the right way of delivering care. The right way of delivering care is if I can keep you healthy. That is a big paradigm shift. Clinical excellence is if I can get good patient satisfaction by delivering that care.
Q: What is the CMO’s role in driving the transition from fee-for-service to value-based care?
A: We are not new in this town. The parent company started in California, and they have delivered care for more than 30 years. We are here to stay. So many of the old-school providers are still going by (the model of, ) if I see more patients, the more (revenue) it (will) bring to the organization. My job is to understand that this is the old model, and the new model is delivering excellent care and keeping them out of the hospital and keeping them healthy. I have to help them understand how to improve access because if I can improve access then more likely you will come to the doctor’s office and not go to urgent care or the emergency room for the same care.
Q: How do you align medical strategy with financial performance in risk-based contracts?
A: What is happening these days is most of the payers have risk-based contracts. If you do a good job they will give you a bonus on top of what you were supposed to get. If you don’t do a good job, they will take something away from you. I think that is very fair. It tells people to perform and deliver the best possible care. People are not going to be ignoring delivering good quality care.
Q: How do you drive physician engagement and accountability in a risk model?
A: This is what I try to get the doctors to understand. We have doctors and wonderful nurse practitioners and physician assistants on the team.
I always tell them to treat this as your practice. When you believe it is my practice you want to deliver the best customer service and make sure the patients are engaged. If you consider yourself an employed person, you want to do the minimum. That is our philosophy. I’ve tried to emphasize to them that they are ambassadors of Astrana Health.
Q: How do you address resistance from providers who are hesitant about value-based care?
A: I think once they understand what value-based care is and that it means good quality care, I have not met a single provider who does not want to provide good quality care. There’s no hesitancy once we are asking them what we want to achieve.
Q: What is the connection between patient satisfaction and clinical outcomes?
A: That is very important. If you are satisfied by the care your family doctor delivers to you, that will make you keep coming back. You will follow the care plan, and that way you will be taking your medications that will keep you healthy and out of the hospital. That results in good care all across.
Q: What operational factors most influence patient satisfaction?
A: The biggest patient satisfaction is access to care. If I am sick today, I want to be seen today or tomorrow. If we can have good access – good hours and weekends – that is the best thing to have.
Q: How do you reduce provider burn-out while maintaining high patient experience scores?
A: Providers burn out when they have to see more and more patients, and in value-based care it’s not based on volume. The providers are less burned-out in a value-based model because they have to see fewer people and deliver good care.
Q: How do you address disparities in outcomes across different populations?
A: That all depends on health literacy. That’s how aware you are of your problems. If you don’t know what your medical problem is and how to manage it you will handle it differently compared to someone who understands the disease. In value-based care, our focus is for you to understand your own disease like if you have heart disease and what makes it worse and fixes it. We don’t only tell you about medications but your non-pharmacological ways to handle that like diet and exercise. Pills are not the solution to all there is.
Q: How would your physicians describe your leadership style?
A: We call it servant leadership. They can reach out to me any second of the day if they have a question. My biggest thing is I don’t judge. If you have a problem, I will try to solve it. I try to put myself in your shoes to understand your problem and find a solution that works for you and the company. We don’t call it the corporate headquarters. We call it the support center. We are here to support our clinics who are the ones delivering the care.
Q: How do you balance cost control, quality performance and patient experience when they conflict?
A: It is very simple. The patient is in the center. Patient care comes first and everything else will fall into place
Q: How do you partner with network and market leadership to drive both growth and performance?
A: I think if you deliver good results, people will know you are there and can’t ignore you. That is how we have grown. We have grown from three clinics to 12 clinics in town.
Q: What is the biggest mistake people make in deciding their health care options?
A: There are a couple of things. If the office staff is good, there’s a good chance the doctor is also good. It’s a culture. Look at the culture of the office. If the culture is not good, you are not going to get good care.
Q: How do you rate health care in Las Vegas?
A: We have come a long way in the last 10 years. We have opened three medical schools. There are 20-plus residencies in this town. A lot of things have changed where we are getting good specialists who are home grown who can provide the best possible care in town. There is no need to go to the airport, California or some other place for care.
Q: What makes Astrana special?
A: We want to be considered part of the community, and it can’t be somebody working from somewhere else. We want to be the local provider for the community. The CEO of Astrana moved from California and made Las Vegas his home. That is how much Astrana is serious about delivering good health care.
