Q&A: Steve Wigginton, CEO of Sutter Health | Aetna

Steve Wigginton is the Chief Executive Officer of Sutter Health | Aetna, a jointly-owned health care company serving members in Northern California. Wigginton joined us for a Q&A to discuss the joint venture’s major accomplishments in its first year, key lessons learned, and the partnership’s overarching goals related to utilizing data and analytics. 

Emily Boerger: It’s been about a year since the partnership between Sutter Health and Aetna began, what are some of the big accomplishments of the first year that you are excited about? 

Steve Wigginton: “It’s been really interesting and exciting. I think a couple things. If you think back on the past year, not in any particular order, we’re really excited to have added Stanford Health Care as a network partner. I think we announced that in April of this year, so a few months in. We added, arguably another marquee health system — obviously an academic health system — with a narrower geographic focus, but certainly in the Peninsula and the Bay Area [it] is an important presence. It also showed, I think, a broader spirit of regional cooperation amongst health systems that are looking to move further up the food chain, if you will, in terms of controlling total quality and cost. 

The second thing that’s really exciting to us is that we added our first cadre of commercial health plan sponsors – employers who offer our insurance product to their employees. We actually brought our first members live in January and have had really great feedback from our quote/unquote “first customers.” That’s always a big deal.

Another one, sort of down the same vector in terms of new customers, growth, and validating the demand and the market, is a specific relationship that we announced with California’s Valued Trust (CVT),  which represents about 165,000 school teachers and administrators across the state of California… That’s one that we’re really excited about. We’ve been doing some innovative things with CVT. The school teacher universe has not had giant increases in the contributions to their health benefits. And so, being able to provide an innovative and more affordable set of solutions has been really fun. 

The other thing I’d say is we’re also in the process of inking contracts with, I’ll just say three other innovative health care technology and service providers to expand the convenience and ease of access to core health care needs for all of our members beyond the traditional physician’s office, emergency room, hospital settings that are typically associated with health care.

We, as you know, live in arguably one of the hotbeds of innovation — certainly around tech and analytics, but also specifically around health care. So, we’ve been able to go to some of these really innovative firms and strike partnership deals to offer new features that are maybe unique to our proximity.

But it’s obviously been a great start.”

EB: Are there any lessons learned during the first year? Or maybe surprises from the partnership?

SW: “Boy, too many lessons to list. You know, this is a very unique offering in terms of the value point that we are serving, the quality of our network, and the unique competitiveness in Northern California for labor talent. And so, there have been, honestly for me personally as the CEO, but I think for our team, many lessons learned. 

Two big things that jump out at me. One, there is a huge appetite amongst commercial plan sponsors — which is a little bit of an inside baseball word, but employers who are buying benefits on behalf of their employees– for innovation that lowers the barriers and makes it easier for employees and their families and dependents to access care. A big appetite for it. And I think as much as we thought we were moving quickly, we find that the market is willing to entertain an even faster pace of innovation. We’re well-positioned to serve that. I wouldn’t say it’s been a surprise, but it’s been a learning that we’ve really tried to feed, if you will. 

The second one, which is a little more nuanced, is that Sutter Health | Aetna, focuses on the commercial market. So, we do not offer a Medicare product, we don’t offer a Medi-Cal product today. And yet, what I’ve learned and what I think our team sees everyday is that the commercial market is actually several submarkets. That a small, 300-400 employee, highly localized firm with maybe a focus on cost and trying to continue to offer benefits in an increasingly challenging economic environment, is very different from Apple or Google or some of the companies that are truly in a war for the most innovative talent in this market. 

If you think about just those two examples, we’re being pushed on affordability and delivering high quality at a cost that is beating the market trend for health care inflation on the one hand. And on the other hand, we’re being asked to deliver the latest and greatest for mental health access, for texting and video visits, and other modalities that for these large employers add a ton of value beyond just coverage when you get really sick… Just looking at our geography, there’s a great deal of diversity; there’s several sub-segments in that commercial market.  So, our challenge is to figure out how to take the innovations we’re deploying, and the analytics, and the data integration, and bring that to bear both on the cost/quality spectrum, but also on the innovation and access front.” 

EB: Can you tell me about the overarching goals for how Sutter Health | Aetna wants to utilize data and analytics? What are some of the guiding principles, or the North Star of where you want to be on that? 

SW: “Well, I think all of us as consumers, if you’ve ever had a health episode that has resulted in claims to your insurer, bills from your provider, trying to schedule appointments, trying to coordinate between primary care and specialty or different sites of care, or getting a lab and an imaging and getting all of that to your primary care appointment on time, there are a ton of really basic disconnects that would not be tolerated in other industries that I think many of us just expect because the payers and the providers are on opposite ends of the supply chain. 

And that has been the traditional way of health care. Insurers and the providers or deliverers of care are in negotiation with one another over rates, over utilization management policy — there are all these nuances to their relationship. And they have served to separate information that if you brought it together, you’d actually advance the value proposition on behalf of the end customer. 

I was on a panel the other day and someone asked, ‘what kind of technology are you using to bring all this data together?’ And I said, ‘Jeez, the most important technology we used was Microsoft word,’ because Microsoft Word was the software program that we used to write the contract between Sutter Health and Aetna to own, 50/50, a health plan together. And obviously I was being a little glib, but… the best thing that can happen is we share everything we know, because we own, together, this entity. If we can deliver higher quality at a lower cost over a persistent period of time, we will capture share. Which is good for both of us. 

And so, I think our North Star is to eliminate what were previously structural divides between information pools. And once you’ve done that, you know, taking claims data, putting it into a database, taking EHR or clinical data, combining it in that database, and then generating insights, is relatively straightforward. The big hurdle has been, historically, governance and business structures. So, long story short, our North Star is to break down those barriers.”

EB: Can you talk to me about the recent Docent Health announcement and what value that adds or offers for the member experience?

SW: “First off, Docent brings some unique cultural, technological, and builder capabilities that we identified as being really accretive to our broader strategy of simplifying the experience and making the experience of accessing and paying for health care feel much more like a high touch, empathetic, loyalty-inspiring experience — as opposed to running the gauntlet with your hands over your head just hoping that you make it out the other side. What we recognized between Sutter Health and Aetna is, you’re talking Sutter Health is $14 billion in revenue, 20-something hospitals, 55,000 plus employees. Aetna, arguably the leader in technology innovation in the insurance space, now a part of CVS health, is connected to in total over 300,000 professionals across the country. You know, these are large organizations with a huge amount of innovation, technology, scale, capital to invest, and yet, when you try to innovate between those two companies, a firm like Docent can be really helpful in moving faster, and also deploying a set of tools that allow us to integrate all the goodness that we’re providing.

So, the down and dirty of it is we saw an opportunity with Docent to build the capability within our health plan that approximates the level of service you would expect if you walked up to the concierge desk at a nice hotel. ‘We’d like to have dinner, we’d like to check out a show, tomorrow morning we need a taxi to the airport, and if possible, it’s our anniversary it would be great when we got back from dinner if there was champagne and roses in our room.’ And you don’t have to fill out forms, you don’t have to talk to six different people. That ‘concierge function,’ or navigation function if you want to use a different term, sort of takes over. 

The goal long-term is to leverage machine learning and AI. The idea here is, if you think about it, we are at the junction point between a large, highly integrated, highly sophisticated health system with thousands of ways in which you can enter into that health system – online, video, walk-in, urgent care, emergency room, doctor visits, specialist visits, hospitals, you name it. But, we just clearly recognize that you don’t want to have to figure all that out. You want to have the service, the capability that streamlines that for you. And so that’s really the goal with Docent — to build that service, leverage their tech, their empathetic, cultural approach which feels much more like hospitality than health care, and use that as an integration engine to bring together all of the things that we’ve assembled on behalf of our membership.

The long-term objective is: you’ve got your phone in your hand, you have everything you need to access and navigate your Sutter Health |Aetna plan. And over time, there will be less and less in the background that’s kind of running up and down the halls and figuring out how to make it actually come true, and more and more of the automation that you would expect to see from, again, an AI-fueled platform.”

EB: Are there any other areas of innovation that you’re working on to improve member experience? 

SW: “The biggest area we are focused on is being, as we say, ‘always there,’ and innovative forms of access, particularly for your front-line health care experiences. There are a number of innovative firms, a few of whom we’ve partnered with and as I said we’ll be announcing shortly, that are very focused on that issue. That particularly in the commercial, kind of, employed population, you have an ever-increasing cohort of individuals who expect to be able to leverage their phone for almost anything. Our challenge is to connect these new, innovative access features to a core, clinical infrastructure which Sutter Health and Stanford and our other providers provide. So that they’re not all disconnected and it’s not dependent on you as the individual to stitch together what the text conversation with your physician was, to the specialist visit he or she encourages you to make and have, to the lab results that were generated in your primary care visit a month and a half ago. So, opening up these new modalities, these new ways to access, particularly the front-lines of health care.

But then, when those interactions occur, regardless of who the vendor is or who the partner is, on the back end bringing all of that data together, so that you’re managing the whole patient. That’s how you really drive the cost and quality, which drives, we believe, retention and growth. So that’s the biggest area I’d say our focus is on. 

And the underlying integration infrastructure is in place. The care management, population health management that Sutter Health, Stanford, and our other providers are so well-equipped to provide is in place. And so as we bring these new access features live, and connect them to what you might think of as a traditional provider infrastructure, we can offer, I hate to say the best of both worlds because they can’t be separate worlds. They really do need, I think for sustainability and impact, they’ve got to be connected.”

This interview has been edited for clarity and length.