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Optum’s Dr. Wyatt Decker on building a patient-centric, physician-led health care system

Optum | November 3, 2021

Wyatt Decker, MD, MBA, joined OptumHealth as CEO in 2019 after serving as Chief Medical Information Officer for Mayo Clinic and CEO of Mayo Clinic in Arizona, and teaching as a Professor of Emergency Medicine at Mayo’s College of Medicine.

At Optum, he leads a range of platforms spanning care and ambulatory delivery, behavioral health, complex care, population health and consumer offerings — placing him in a unique position to help shape the future of health care.

Health Evolution interviewed Decker about Optum’s plans for the near future, how the enterprise is positioning itself for the next generation of health care, supporting physicians and patients alike, the need for health care to transform itself and more.

What should health care consumers and prospective clients expect of Optum in the next 18 months? And beyond that, the next two to three years?
In a nutshell, we’re reimagining and asking what would a consumer want that next generation health system to look like? We’re creating what is hopefully an informed vision of what people want. In my career, I spent 22 years as a practicing emergency physician so I’ve taken care of literally thousands of people who were in emergency departments because they couldn’t get care after their prescriptions ran out and they didn’t know how to refill them or how to get them paid for. Other people came to the ER because they did not know where else to go for medical care or how to navigate the system. I’ve seen firsthand the impact of what I would say is the 1.0 version of America’s fee-for-service, fragmented, inefficient health care system. Our aim is to reinvent that system around what people want and what most people want is to stay healthy and to have a health care system that supports them with a doctor and a team that wants the best outcomes, a team that actually reaches out to them, maybe when it’s time for appropriate screenings to help prevent cancer or other serious diseases, cardiovascular disease, or to diagnose it early and intervene early. That’s the system we’re building at Optum, and I’m very excited, but also humbled, to be able to play a small part in that.

Building on that future, how is Optum positioning itself to deliver on the promise of improving the health care system for everyone to achieve the vision you just outlined?
We have a few tenets around this notion of building a modern, high performing health care system. One is bringing technology and people together in new and differentiated ways. We place the patient at the center of everything we do. They do not want to take an entire day off from work when they just have a half-hour appointment. How do we leverage virtual care in a way that is actually convenient for patients and providers? Virtual care has a couple of Achilles heels. One is if I’m using virtual care, I want to see my trusted provider, not just any provider that I don’t know and they don’t know me. Connecting people virtually with their own provider is critical. Another element of virtual care is that it not infrequently butts up against the limits of what you can do medically on a video camera. There’s a lot you can’t do, including a physical examination, drawing blood, x-rays and on down the list. We are blurring the boundaries of virtual and physical. The third piece is behavioral health, so that those can all come together. Imagine if someone is in a virtual appointment with their doctor or a member of her team, and then they need to have something done and we can bring that patient in or refer the person to an urgent care center that can draw blood if that’s convenient. We can ask if the patient would like an appointment in two hours to get blood drawn? Our vision is to make health care much more personal, much more consumer friendly and much more focused on in-home and lower cost environments. We’re going to emphasize that experience, and when we do it, that experience is going to be less in the hospital and more in alternative sites of care, urgent care centers, primary care offices, and your own home.

While we make the experience better, we can improve outcomes and we can lower the total cost of care. It's hard to do, but it isn't that hard if we relentlessly drive value and think about how we can connect those dots around what people really want.

Wyatt Decker, MD, OptumHealth CEO

Now, what about the physician and the provider side of this? How is Optum supporting physicians and providers so they can do what they love?
This is super critical and something I’m deeply passionate about. To set the stage with one more layer, we have a situation in the United States where 40 percent to 50 percent of the physician workforce is burned out — early retirement, physician suicide is two times higher than average the general population — it’s devastating on the physician workforce. But it’s also a loss to the U S public because we lose doctors to other professions and activities. They stop practicing. What we’re bringing to life will change what it’s like to be a primary care doctor in the United States. We’re going to do that by creating an environment where the doctor, primary care and specialists, have the support around them, both with sophisticated technology and analytics, that actually makes their work easier instead of harder.  

Between the technology, analytics and the support team, our aim is to take a significant portion of the clinical and administrative burden off the backs of the doctors and help them start practicing at the top of their license, which makes doctors happy. They don’t like being reduced to data entry clerks. Let’s stop having our highly educated, deeply compassionate, committed health care workforce functioning as data entry clerks. Let’s elevate them to the top of their license.

Let me give you an example of how that comes to life through value-based care. A busy fee-for-service family doctor might be seeing 25 patients a day in 20-minute visits, with a lot of documentation in between each visit. Instead, under a robust value-based model, we have that doctor seeing 14 patients a day and those 14 patients aren’t people who randomly called the doctor’s office to get an appointment because they’re nervous about something. Those are patients that our team knows because we’ve sent nurses to their home, to do house calls, to get to know them. We are following their health. We know who has Type 2 diabetes and early-stage heart failure and who will really benefit from a visit to their doctor. We know who might just need a prescription refill that we could do with the house call or even a virtual visit with an advanced practitioner. That creates an environment where the doctor is practicing at the top of their license and when we take a fair amount, not all to be frank, but a fair amount of clinical burden off, the fee-for-service paradigm falls away. I’ve personally met dozens of our doctors who are in this environment and love what they’re doing. Some were even on the verge of quitting or retirement before we switched to value-based care.

The phrase we hear frequently is “bringing the joy back to medicine” …
Wonderful aspiration. It turns out it’s harder to do but needs to be done. We have to let doctors do the work they love. That’s the joy, the joy is patient interactions, making a difference and not spending 45 minutes getting some simple clinical task done.

Throughout the course of your career, you’ve been credited with pioneering innovations such as AI and telemedicine. What are some of the most exciting advancements you’ve seen and what are some of the things that haven’t really advanced enough?
As I reflect on it, we’ve seen incredible advances in therapeutics, minimally invasive surgery. Let me just come back to thinking of the U.S. health care system as a sick care system and our ability as a health care community to care for the sick has gotten better. Early-stage cancer diagnoses and survival rates have improved fairly dramatically as have cardiovascular death rates over the past 10 to 15 years. We’ve seen progress.

What we haven’t seen is the health care system as an entity transform itself. It’s too hard to break the chains. Let’s think about other industries, particularly consumer-focused industries, whether it’s retail or banking. Banking is an interesting example because we went from having to go in and conduct the interaction inside a bank during banker’s hours, which is super hard, to ATM’s, which I liken to the health kiosks that are making their way into health care. But now most of us do all of our retail banking via an app on our phone. Health care is 15 to 20 years behind the adoption of banks versus ATM’s. We haven’t seen the health care experience follow suit. By and large, there are more than 150,000 health care apps, but most of them don’t actually help people digest and execute the health care they need.

Why is that? One reason is that health care is complicated. It’s life and death. It’s not hailing a ride or buying a t-shirt. There’s a lot more at stake and a lot more regulation around it. There are some valid reasons why our health care has been slow to work this out and adapt to it. But that’s the opportunity in front of us and it’s something we are embracing at Optum right now.

You have said that there’s a significant opportunity to reinvent health care from the perspective of access, affordability and consumer preferences, as well as social determinants. So, what shape will that take?
The shape will be a patient-centered, largely physician-led, health care system that leverages technology in a way that helps people access the care they need in new and innovative ways virtually at home or in the hospital or clinics when that’s appropriate. While we make the experience better, we can improve outcomes and we can lower the total cost of care. That is recognizable as The Quadruple Aim of better provider and patient experiences and better outcomes at lower costs. It’s hard to do, but it isn’t that hard if we relentlessly drive value and think about how we can connect those dots around what people really want. We’re very passionate about this time and I would add that there have been policy papers, health care economists, political scientists and health care experts for decades who have opined on the challenges of the U.S. health care system. What we’re excited about is to actually be building a sustainable, scalable solution that creates better health care at a lower cost for people. We’re providing care or services to over 99 million individuals today across Optum. We’re excited with our opportunity to continue to grow that and offer solutions more and more broadly across the health care system.

About the Author

Optum, Author

Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 190,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group (NYSE: UNH). For more information, visit www.Optum.com.