Rescuing primary care: the role of health administrators [PODCAST]

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We welcome Sara Pastoor, a family physician, and delve into the pressing issue of the primary care crisis in the U.S. health care system. With projections showing growth in the market for health administrators, we discuss how these professionals can help rescue primary care and contribute to the greater good. By leveraging their unique business acumen and competencies, health administrators can bring fresh perspectives and insights into the complexities of the health care industry, resulting in a more collaborative and strategic approach to solving issues across the primary care landscape. Join us as we explore the potential for health administrators to make a positive impact in the U.S. health care system.

Sara Pastoor is a family physician.

She shares her story and discusses her KevinMD article, “The powerful role of administrative leaders in high-value primary care.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today we welcome back to the show Sara Pastoor. She’s a family physician. Her KevinMD article is titled “The powerful role of administrative leaders in high-value primary care.” Sara, welcome back to the show.

Sara Pastoor: Hi, Kevin. Thanks for having me back.

Kevin Pho: So Sara’s been on multiple times. Just go to KevinMD.com/podcast. In the upper right-hand corner, there’s a search bar. Search for Sara’s name to see her previous episodes. But today I want to jump right into the article that you wrote last fall, “The powerful role of administrative leaders in high-value primary care.” So tell me, how did this article come together?

Sara Pastoor: Well, I have a master’s in health care administration myself and have been on the business side of medicine for most of my career. I have had the opportunity, in multiple roles, to work collaboratively with nonclinical or administrative leaders in health care who were big primary care champions and so helpful in assisting with primary care transformation, moving away from a volume-based system to a value-based system that focuses on quality and outcomes and patient experience and all of that.

When I started in my role at Elation Health as the director of primary care advancement, we had recently started partnering with Johns Hopkins Bloomberg School of Public Health and their master’s of health care administration program to precept their students. They do the first year of their MHA program in the classroom, in didactic training, and then their second year is embedded in a health care organization. Historically, these students have almost always been placed in hospitals and health systems, and more recently in consultant types of organizations. I thought it was really important for us to start training these students in other arenas of health care.

I work for a technology, or EMR, company that’s very focused on primary care, and my background and experience working with those types of leaders in the primary care setting had been so positive, even though historically we have thought of these administrative leaders as being sort of the evil administrators, somebody who’s making clinicians’ lives miserable because they don’t understand what it’s like to actually touch patients and deliver compassionate care.

So Elation decided to start precepting these students, and we took our very first student. She was very passionate about primary care and about the kind of work that I was doing, and we enjoyed that program so much that we decided to continue it and take another student the next year. We actually hired the first student to come and work for us full time, and it really has been a terrific experience.

We feel very passionately, and I feel very passionately, about adding this type of role to the army of people who are fighting for primary care in this country. They can do so many things in terms of helping us analyze data, develop business cases, look at sort of the operational side of things, and help with budgets and finances and all those things. As we move toward sort of a value-based paradigm in health care, we need people who understand those models and who can help primary care be successful. So maybe a small independent practice can’t benefit from one of these, but in innovative primary care organizations like Oak Street Health, ChenMed, and Crossover Health, organizations like that, I’ve seen folks like this be super successful and contribute a ton to the mission.

Kevin Pho: So you alluded to this earlier, that administrators in primary care, and throughout our health care system, often get a bad rap. You’ve walked on both sides. You’re a family physician yourself, and you’ve been on the administrative side. So tell us, and you alluded to this earlier, some misperceptions, misconceptions, that clinicians have about administrators in health care that you would like to clear up.

Sara Pastoor: Yeah, well, I’m not sure that it’s all misperceptions. I think that has been born of some genuinely bad experiences. I don’t want to invalidate that at all, and I’ve had those bad experiences myself. But what I want to say is that that’s not because they’re bad people. On the whole, what I have seen is that they are caught up in a bad system. So when you recruit these folks into the primary care setting and put them on the primary care team, they have incredible skills and talents that can help move the primary care agenda forward.

So again, I think anybody who’s worked in a hospital or health system has had those bad experiences, for good reasons. But it’s not because they’re bad people in general. It’s just because the system is set up in such a way that it positions them to be in opposition to what clinicians are trying to do to take better care of patients.

Kevin Pho: So you mentioned that a lot of administrators specific to the primary care setting are going to take a more macroeconomic view in terms of population health, and they have the skills to really help with that. Now, speaking as an individual primary care physician, tell us a story, case study, or example of how a primary care administrator can positively impact the patients on my panel.

Sara Pastoor: Gosh, there are so many examples of this. I was working in the academic setting, and we were really trying to transform our operations to something that was more patient-centered, a team-based type of model, and focused more on outcomes. The administrator that I hired to work at my side was so helpful in collecting the data that we needed to understand sort of the status of our population, and in setting up reports so that at an individual panel level we could see which patients were due for certain services, so that we could monitor and manage our performance against certain outcomes over time. Her ability to aggregate data, organize it, and then present it in such a way that it was actionable was super helpful for us. I can’t say enough good things about how she contributed to the mission.

So that was on the clinical side. Then, on the business side, we were pursuing PCMH recognition through NCQA, and she managed that entire program. She really helped us understand what the areas were that we needed to improve on and what we were trying to achieve. She helped us communicate that message to our teams and helped us work on a bunch of process improvements. So there are so many opportunities, now that you think about it that way, so many opportunities for somebody like that to really contribute to the mission.

Kevin Pho: As I said earlier, because of the health care system, health care administrators are often placed in opposition to clinicians. Now, if they were to work better together, and I’m going to ask you this in two ways, what are some things that administrators can do to improve the collaboration with clinicians, and what are some things that clinicians can do to improve the collaboration with administrators?

Sara Pastoor: Well, again, I’ll start with the second question. Again, if they are in a position or in a role on behalf of the organization that just puts them in a difficult position where they really can’t collaborate with clinicians, that’s not their fault, and they are not, I think, going to have an opportunity to be particularly successful. But I think it really does help for those folks to get into the clinical workflow and to observe what the pain points are, to see how hard these people are working. Instead of being layers removed and just saying, “Well, this is inefficient, and you’re not achieving whatever metrics,” getting in there and really understanding, taking a look under the hood, I think is a great way for those folks to understand better.

Then, on the clinician side, open yourself up to that partnership, identify what you need, and ask for what you need. Again, if they’re not in a position to support you, just because of their role in the organization, that’s going to be problematic no matter what. But I think that there are opportunities for clinicians, particularly the clinical leaders, to bring those folks closer into the fold and say, “Hey, why don’t you come down here to the clinic and take a look at what’s going on, and let’s talk about why you’re not seeing the kind of results that you’re expecting from us.”

Kevin Pho: Now, from your personal experience with health care administrators, do you find that the majority of them have that interest in going into the day-to-day operations of primary care and interacting with the clinical side?

Sara Pastoor: Again, it boils down to what their goals are on behalf of the organization. I think if they know that looking under the hood and asking those questions is not going to support them in getting their job done, then they’re less likely to want to partner more closely. But if they really want to understand the clinical experience, if they really are invested in patients and what patients need, then they will step up and do that, and I’ve known many who do that. But I tend to work more closely with the ones that are primary care champions and pro-primary care, and I have certainly had my share of bad experiences with those who feel like they’re pitted against me, just systemically.

Kevin Pho: Now, when it comes to reforming our health care system, there’s a whole school of thought, from both clinicians and nonclinicians, that we just have all too many administrators in general. So what’s your response to that school of thought, for people who simply want to eliminate more administrators and remove that middle person from the doctor-patient relationship? How do you respond to someone who wants to reform the health care system that way?

Sara Pastoor: I think that we have an administrative tail to the way our health system is designed that is bloated and out of control, and I think that we have a lot of administrative inefficiencies that are primarily driven by the transactional fee-for-service payment system, and that area of health care does need to shrink. So how many health care administrators do we really need in a transformed health care system? I don’t know the answer to that. But I do think that there are important jobs to be done on the administrative side of medicine and the business side of medicine in a value-based paradigm that they could really make a lot of contributions to.

What we don’t want to keep doing is supporting that unhealthy, sort of dysfunctional system that we have been used to historically. And we do have a lot of administrative bloat there, for sure, especially when you compare us to peer nations who are performing much better on health outcomes and total cost of care.

Kevin Pho: Now, if you were in charge of primary care in our country, tell us your ideal scenario and the immediate next steps to get us to your ideal scenario.

Sara Pastoor: If I were the primary care czar of America: We hear a lot of talk about universal health care and Medicare for All and health care for all, and I think those are probably a bridge too far in this country. What I’ve been thinking about more recently is primary care for all. I think if we could just get that far, if we could get a primary care physician for every American, we could influence so much of the rest of the system, and also influence the health of every American, and the health of society by extension.

So if we could come up with a way to make primary care affordable and accessible for every American, we’ll figure out the wraparound stuff. The DPC, and we’ve talked about DPC before, the DPC community is already doing that for people who are uninsured or underinsured. They’re figuring it out. And so, yeah, I think my dream step one is a primary care for all type of scenario.

Kevin Pho: And my final question, Sara: What is the take-home message that you want to leave with the KevinMD audience?

Sara Pastoor: I think we really need to start focusing on the value of primary care in this country, and we need everyone on board to help, and that includes our health care administrators. They have a lot of value to bring and also can communicate the value of primary care to sort of their team, their squad, the people that are in their tribe, in ways that maybe might not be as well received by clinicians. So having all of us working together on this and pulling together is the way that we’re going to get there. It can’t be just doctors. It’s got to be doctors and nurses and administrators and all the people in health care who really see and understand the value of primary care pulling together if we’re going to see change.

Kevin Pho: Sara, thank you so much for coming back on the show and sharing your time and insight.

Sara Pastoor: Thank you so much.

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