ECG’s Scott Cullen, MD, is focused on facilitating transformation. He has helped numerous healthcare systems navigate the challenges of emerging payment and delivery models to manage populations successfully while maintaining viability. We recently sat down with Dr. Cullen to hear more about his transition from primary care practice to consulting as well as his views on the challenges facing the healthcare industry today.
Q: How did you get into healthcare management consulting?
A: I was in private medical practice for about 10 years, but during that time I developed electronic health records technology. When I sold that technology, I decided I was more interested in the systems issues than in continuing with day-to-day clinical practice. Through networking, I was offered a position at Capgemini Health, which quickly became part of Accenture after an acquisition. My intent was not necessarily to be a consultant for the rest of my life, but to do it for just a while and get a feel for what areas of the industry I might be most interested in pursuing. Of course, here I am 15 years later, still doing it.
Q: How did you get into managed care services?
A: I’ve done quite a bit of work with children’s hospitals because Valence Health, where I was the president of Advisory Services, was focused on helping organizations take on full risk for the cost of care. For a variety of reasons, most children’s hospitals were making the transition to risk-based prospective payments all at once, as adult facilities had already been doing for 20 years. DRGs and value-based models were new to children’s hospitals, but we were well positioned to assist organizations. My experience in strategy for risk contracting was a big part of why I ended up in ECG’s Managed Care Services Division. However, I work across the firm on a variety of engagements, mostly in facilitating care model transformation, which is essential to being successful in value-based models.
Q: What’s the biggest challenge in managed care services and pediatrics-facing healthcare organizations today?
A: I would say having the organizational, strategic, and management bandwidth to transform in the ways that are necessary to be successful in a risk-based environment. I think bandwidth and skill are really a challenge for a lot of organizations because for a long time they have lived in either a cost-plus or a purely volume-driven, fee-for-service environment. Now suddenly they find themselves plunged into the world of managed care. Most children’s hospitals are at least 50% exposed to Medicaid, and until somewhat recently, Medicaid operated on a cost-plus or per-diem basis in many states. Because of regulatory changes and state Medicaid decisions, these hospitals suddenly had to find a completely new way of doing business almost overnight.
Q: What’s the most interesting challenge you’ve faced as a consultant so far?
A: I think the most interesting challenge has been trying to help motivate organizations to make change proactively. Most of healthcare management has been reactive for a long, long time. To tell someone that a tsunami is coming down the pike and about to wash up on their beach, you know, they’re not necessarily used to trying to manage something that isn’t right in front of them yet. I would say this is a significant issue for some organizations.
Q: Why do you think that is?
A: I think it’s just the conservative nature of healthcare provider organizations in general. Margins are already tight for many, and transformative change is risky, as the necessary changes are going to be significant. The entire business model is going to change. If you have leaders who’ve been in their positions for 20-plus years, and you’re telling them you’re going to turn their business model on its head, that’s not an easy sell.
Q: What is a particularly rewarding project you’ve worked on?
A: There have actually been a good number of them, but one recent project stands out. I worked with a health system in Louisiana, helping them build not only a clinically integrated network but also a new care model for population health because they’re taking on risk for the cost of care for a large chunk of their population. One thing that was so rewarding about that project was that the system’s executive team is extremely talented and very motivated, and they know how to lead change. They also know how to work with consultants, which not all systems are adept at. It was a great partnership that involved a lot of teamwork, and we got to get into the weeds with the client and could really see the process all the way to its conclusion, from strategic conception right through to execution and implementation. That makes it really rewarding, when you can be involved from beginning to end.
Q: What is the best part of your work day?
A: I would say the best part of my work day is when I’m working in a team with other folks and we’re all sharing ideas and our experiences and creativity. It’s really the thing that’s kept me in consulting so much longer than I expected, that opportunity to be creative with other people. That’s the best part of my job.
Q: How has ECG differed from other consulting firms you’ve worked at?
A: What distinguishes ECG is the breadth of talent and capability at a consistently excellent level. ECG is able to be a transformation partner for most health systems to a greater extent than any other place I’ve ever worked. We can really help all the way from strategy right through to execution and even optimization. Most firms this size just don’t have that level of capability.
Q: And what publications do you read to keep up to date on healthcare issues?
That is a good question. Right now I’m generally reading primary and secondary research articles for answers to focused questions on what’s successful in care model transformation and change management. Health Affairs and the Journal of Health Economics are very helpful sources right now. I also utilize databases like Medline.
Q: What do you do outside the office?
A: I like to cook and entertain with my wife. I’m a big skier; we have a house in Vermont where we do a lot of entertaining. I also make Shaker-style furniture. My recipe for lamb stew is a huge hit during ski season.