Expert Spotlight: Lightning Interview with David Contorno October 2019

October 18, 2019: Billy Nicolich (Executive Director of the Health Care Nudge Coalition) was able to meet informally with industry expert David Contorno. On behalf of the Health Care Nudge Coalition, many thanks to David for spending a little bit of time with us, and fielding our lightning interview. We hope that students and innovators in health care will become more familiar with David's work and his perspective.

Billy: In your interview with Dr. Zeev Neuwirth on his “Creating a New Healthcare” podcast, you mention how you have been out there creating better value-based employer health plans, which is fantastic. In what ways have you been scaling this out?

David: I've been scaling out in two ways. One, I do a lot of writing and speaking. All that I apply to health plans is common sense. If you just get people to think and act a little differently, they can often do it on their own. But, some are scared. So, we work with them and help them directly. My speaking, writing and social media (LinkedIn, etc.) is one way to scale it.

The other channel is that I mentor and co-consult with consultants and brokers around the country. So, they do a lot of the heavy lifting and I do a lot of the building, strategy and execution which allows me to reach a lot more clients a lot more deeply than I would otherwise be able to do.

Billy: What opposition have you faced from the status quo and what suggestions would you share with students and innovators that may also challenge the status quo?

David: Well, in general, people hate change. But in health care, it's even worse. I think the reason is, people think of "health care" and "health insurance" as though they are one and the same. The presumption is, if you are changing my health insurance to a cheaper version, that must be a worse version than what I had and therefore I must get worse care. By that analogy, that would be like switching one's car insurance from GEICO to a lower budget company advertised on TV, thinking that your car will somehow be of lower quality. It's not true. Thinking about health care and health insurance, the quality of the two don't directly relate to each other. If anything, the lower the health care quality, the lower the insurance quality (value of the insurance to you).

So, the status quo is really strong. Everyone calls health care broken. It's not broken. It's working really well, just not for employers who foot the bill, doctors who give the care or patients who receive the care. But it's working really well for a lot of people and those people are going to dig in tightly. It starts with the ground up. It starts with the 30-life employer, 50-life employer, 100-life employer, 500-life employer who know their employees, who care about their employees, who are willing to take a stand and make a difference. That's how it's going to change. Period. It's not coming from D.C. or some big ivory tower in your downtown area. It's coming from you. And we can do this.

Billy: Your approach has included working with direct primary care physicians and favoring primary care and preventative medicine. What merits and trends do you see here that students and innovators should be aware of?

David: Think about the average primary care doctor. They work for a large health care system. They have to see 30-40 patients a day, which means they get an average of 7-10 minutes with each patient. When you come in with back pain, the most likely outcome of that is going to be two-fold: 1. Get pain medicine. 2. You get sent to an Orthopaedic Surgeon. Well, what's the most likely outcome of going to the surgeon? It's orthopedic surgery. So, we eliminate unnecessary care. We minimize invasive things. We give more empowerment and control to primary care to do what they went to school for. We pay them in the right way. It dramatically reduces specialty care, outpatient, inpatient. Chronic conditions get under control so much better. So, that's why we believe so strongly in direct primary care.

More about David Contorno:
Twitter: dcontorno

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