FAIR Health Board Access Interview with Grace Wong
September 21, 2023
Having recently joined the FAIR Health Board of Directors, Grace Wong brings a unique viewpoint as a widely respected healthcare executive. Prior to launching her own consulting firm, GYW Consulting, Inc.—which provides healthcare consulting services to hospital systems, digital health start-ups, accountable care organizations and others—Ms. Wong was the Chief Operating Officer and Chief Network Officer of OneCity Health, the largest Performing Provider System in New York State, which is wholly owned by NYC Health + Hospitals. Her notable list of executive leadership positions also includes Vice President and Chief Financial Officer of Medicaid Strategies and Network Services at Northwell Health, Head of Managed Care and Clinical Business at State University of New York (SUNY) Downstate, and Head of Managed Care at NewYork-Presbyterian Healthcare System and Chief Financial Officer of its NYH Community Health Plan. An award recipient from the American Society for Public Administration, she has shared her healthcare expertise with students as an Assistant Professor at SUNY Downstate School of Public Health and with various organizations whose boards she has served on, including Healthfirst and the New York Urban Coalition. Ms. Wong spoke with FAIR Health Access about the evolving healthcare environment, the challenges and opportunities facing hospitals and health systems, and the role of transparency in the healthcare sector.
FAIR Health (FH): What led you to pursue a career in the healthcare sector? What, if anything, has surprised you most about healthcare over the course of your career?
Grace Wong (GW): I will say this: I like to help people. Moving from Hong Kong to the United States after graduating high school, I planned to attend medical school to become a doctor. Being an immigrant, however, I needed to get a job. Within a few months, I started working as the right hand of a Chinese-American internist in his private practice and enrolled in a biochemistry course. I went to school full-time and worked 30 hours a week as a jack-of-all-trades in the doctor’s office. I did medical billing, in-house lab tests and even patient intake since 60 percent of patients coming in spoke only Chinese. After working there for three years, I decided I wanted to continue working in healthcare but not as a doctor. I applied to a joint MPH/MBA program in business and healthcare administration, and although the doctor I worked for told me, “Look, Grace—you are a small, Asian-American woman and you speak with an accent; you could be like a sandwich to an administrator,” I went through with it. I have always been passionate about healthcare. Since then, I have realized that the entire system is fragmented and hard to navigate, but there is a lot of innovation—new specialties, a boom in patient-centered care, telehealth services, primary care services in retail centers. It is wonderful.
FH: In light of your tenure at OneCity Health and Northwell Health, what do you find are some of the most significant opportunities and challenges facing hospitals and health systems in the current healthcare environment?
GW: One of the major challenges right now is finances. That is why so many hospital CEOs have a financial background—they have to figure out how to best answer the question, “How do we finance all of the demands of a hospital?” This would include construction, new technology, medical supplies and more, and CEOs have to balance those demands with rising costs. But there is a lot of unnecessary waste in the system, which increases healthcare dollars.
Another major challenge is the shortage of medical professionals, especially for primary care. There are fewer doctors wanting to go into primary care and instead pursuing more lucrative specialties like ophthalmology, dermatology and neurology. I have also seen a lot of burnout and quitting, with providers moving into other fields. They go into population health, information technology, administration, pharmaceuticals or genetics. It does not seem like patient care is the biggest priority.
I think an opportunity right now is furthering the practice of value-based care and integrated care, which can help save money in the healthcare system. We know that 5 percent of people in the United States use 50 percent of medical resources, and 10 percent of medical costs for Medicare are associated with end-of-life care. By pushing value-based and integrated care—which includes figuring out best practices, implementing care coordination, doing community engagement and pursuing other forms of collaboration—we can reduce the rates of episodic care, which costs a lot more money than continuous care. There is a statistic that value-based and integrated care reduce preventable admissions to hospitals by 26 percent and readmissions by 16 percent. That is huge, and we can use the money that we save by reducing episodic care to expand needed resources like Medicaid and Medicare coverage. There are a lot of innovations driving value-based and integrated care, such as telehealth and artificial intelligence (AI), which aid remote patient monitoring, patient compliance and continuous care. With these innovations, we can address the provider shortage and expand provider capacity because they reduce wait time and downtime—you do not have to wait for the patients to change into hospital gowns. Doctors can then see a lot more patients.
FH: In March 2020, with the need to limit in-person contact during the COVID-19 pandemic, telehealth utilization among the privately insured began to increase significantly, a trend that has been reflected in FAIR Health’s Monthly Telehealth Regional Tracker. How has the growth of telehealth services impacted the healthcare landscape, including healthcare spending? What role, if any, can telehealth service delivery play in value-based care?
GW: We know from the FAIR Health Telehealth Tracker that commercial payors have seen a rise in the volume of telehealth services, but there have also been increases in public programs; Medicaid has had a 10-fold increase and Medicare has had a 15-fold increase. Telehealth is not going away, both because of its convenience and because of the medical professional shortage. As I mentioned, it is important to expand providers’ patient capacity and reduce wait time. That is why you see private equity companies investing in telehealth companies—how we use it, and how much we use it, is just going to grow. Now that critical access facilities are struggling due to high healthcare costs, telehealth can go into rural and underserved areas and provide care, even for specialized services. Its use also goes beyond video calls and phone calls—for example, patient monitoring with smart watches. It is like a hospital without walls, allowing chronic care and even acute care to be provided at home.
I do not think innovations in telehealth are a driver of value-based care, but instead a tool of value-based care. I recently read an article about a program in Australia that provides pregnant patients and their clinicians with 24/7 access to senior neonatologist support—this both streamlines services and gives patients access to proper care. Also, telehealth is a part of value-based care because it helps reduce physician burnout and, as a result, improves patient outcomes. I think that’s why AI has become really important, too. If AI can do patient intake and produce documentation, it can help prevent additional headaches for providers. I am hopeful technologies like telehealth and AI can squeeze out waste in the system, such as administrative costs and unnecessary medical care visits.
FH: Providers are increasingly documenting—and public health professionals are increasingly studying—information regarding social determinants of health. How do you think the healthcare system can benefit from the expanding window into social determinants of health? How do you think it can contribute to the healthcare delivery system writ large?
GW: I think there are still many steps that need to be taken to address social determinants of health. We need more leadership and money to put it in motion—not just for Medicaid and Medicare patients, but the commercially insured too. Now that social determinants of health are being documented more, we have to put more resources into centralized planning. This will include linking healthcare, community-based organizations and social service programs and spending more time going into underserved communities.
Telehealth can play a crucial role in identifying social determinants of health. For example, when I worked at OneCity Health, we saw a lot of inpatient admissions among kids with asthma, but asthma patients should not have to be admitted to the hospital or end up in the emergency department (ED). To address this issue, we developed an asthma program that included individual patient action plans and integrated care teams for those participating. One of the key parts of this program was referring patients to community healthcare workers, who would do home assessments. The community healthcare worker would let the care team know about the conditions of the home and whether it needed environmental treatment (e.g., pest management services). The results of the program were stunning: Hospital admissions decreased by 95 percent, ED visits went down by 44 percent and outpatient visits dropped by 36 percent. With telehealth, a provider can see patients and their surroundings on a video call and may be able to quickly identify whether their environment is affecting their health. Telehealth makes it easier to flag these social determinants of health.
By joining healthcare and social services, there are so many other ways we can help underserved communities. Let me give you an example. When people from underserved areas are incarcerated, they may go into the system with chronic conditions or develop them while in jail. After they are released, they are likely to still be dealing with these health issues, but there is no program in place to connect them with a provider. A lot of these patients may end up in the ED as a result. To avoid this, we need to join social service organizations with the healthcare system and connect with the community to make sure they get the right care. It takes a village to care for patients, and we need a redistribution of labor between hospitals and social service workers to better address social determinants of health.
FH: FAIR Health strives to lead as a source of independent and objective price and utilization information. How do you see FAIR Health’s role in the healthcare sector and the value of claims data in addressing the system’s current challenges? Looking to the future, what do you predict the next few years will hold for FAIR Health?
GW: Healthcare pricing is almost like a trade secret, and the bigger you are, the more leverage you have to increase revenue. That is why FAIR Health data are so important for price transparency—to bring light to the costs for all stakeholders. FAIR Health is also valuable, and will continue to be valuable, in identifying market variations and assisting in central planning. With the claims data, you can determine best practices and eliminate certain processes that are causing unnecessary waste in the healthcare system, which will help push the system toward value-based care. I see FAIR Health making a significant impact in this arena.
I can also see FAIR Health playing a role in the global market for medical tourism. Say I am from Dubai and am seeking a medical service outside of the United Arab Emirates but do not know what it costs elsewhere. If I am interested in getting the service in the United States, I can use FAIR Health data to find out how much it will cost me. There is an increasing amount of international medical traveling, and FAIR Health can help medical tourists identify why they might want to come to the United States for their care.
It is surprising—before I was called to serve on the Board, I did not know about FAIR Health, and you have a gold mine of data. If I had known, I would have contacted FAIR Health a long time ago. But you all are doing a great job getting the word out, and I know you will continue to do so.
*FAIR Health interviews reflect the views of the interviewee in his or her individual capacity and not necessarily those of FAIR Health or other organizations with which the interviewee is affiliated.