SCA's plans for 2020: CEO Caitlin Zulla on key investments, partnerships and more

Caitlin Zulla became CEO of Surgical Care Affiliates in December after spending nearly five years as the company's CFO and chief administrative officer.

She is a respected leader within the company and champion of SCA’s diversity, inclusion and belonging program including teammate resource groups. She also has a strong background in revenue cycle management and risk-based contracting, with a track record of launching successful bundled payment initiatives as well as leading through acquisitions. As CEO, she is responsible for the company's more than 230 surgical facilities, 9,000 teammates and 8,000 physicians that perform around 1 million procedures each year.

Here, Ms. Zulla discusses her new role and where she sees SCA investing in the future.

Question: What is your vision for the future of Surgical Care Affiliates?

Caitlin Zulla: First and foremost, it's all about achieving the quadruple aim of delivering high quality, low cost solutions for patients, and supporting physician and specialist partners. It's an exciting moment with healthcare being so present in the upcoming presidential election as candidates discuss how to fix a broken healthcare system. We need to make sure everyone has access to high quality care, but the costs have to be adjusted. What we do in the ASC space is such a meaningful part of the solution to address this challenge.

The second thing I'm thinking about is how to partner with specialists in ways that are additive to the traditional ASC. We want to find ways to diversify offerings beyond the ASC, which includes SCA’s specialty practice division, called Optum Specialty Practice (OSP), which is all about providing practice management support, value-based care solutions and network participation. Through partnering with SCA’s OSP division, physicians have access to capital, which can help them expand and recruit physicians early in their career to join their practice.

On the specialty diversification side, we are also investing in cardiovascular specialty centers including office based labs and thinking through overall ancillary and anesthesia needs.

Q: In your former role as CFO of Surgical Care Affiliates, you were a big advocate for culture and employee resource groups. Now as CEO, what will you do to support company culture?

CZ: The reason I joined SCA was our incredible culture. We are focused on supporting that culture, and I'm incredibly passionate about diversity, inclusion and belonging. When we are diverse, we are stronger. We just added our sixth Team Resource Group (TRG), which is focused on creating a stigma free environment in our support of mental well-being of our teammates and their family members. We want SCA and this TRG to be a safe place where they can talk about their struggles and anxieties. Our focus in 2020 is around mental health companywide.

Q: That is fantastic. Shifting gears here slightly, I know SCA has entered into some value base contracts. Will that continue in 2020? How do you view value-based care?

CZ: We are incredibly strong advocates for value-based care, now more than 64 percent of our facilities are in some form of value-based arrangement, and we expect that number to increase quickly. On Jan. 1, we launched a statewide total knee bundle with a major payer, which is that payer's first prospective bundle, for 14 of our facilities. We see value-based care as an incredible way to align high quality, low cost care.

For patients, value-based care means simpler billing. Providers have accountability for the episode of care, and for payers it creates savings because they are paying for quality. And for our teammates and partners, these contracts fuel growth, which means we can continue to recruit surgeons and invest there. We are firm believers in value-based care and we are seeing those structures grow across the board. We are also doing shared savings agreements where we commit to lowering the cost of care for affiliated physicians.

Q: When it comes to physician recruiting, what trends are you seeing? Are you seeing any uptick in specialists interested in the private practice or ASC model?

CZ: We actually have an SCA physician development institute (SPDI), which is a training program that prepares early career physicians to participate in today's Medicare environment and outside of hospitals. We recognize that physicians are trained in medicine, not the intricacies of private practice and managed care. Physicians are also training in hospitals instead of ASCs, so they are more familiar with that setting. So through the institute, we engage with physicians that are just completing their residencies and educate them about private practice. We have done more than 30 workshops and educated more than 700 residents, some of whom now work within OptumCare or other ASCs.

Q: What do you want to do more of in 2020 and what do you plan to change?

CZ: We need to do more within clinical quality. We are definitely upping investments of our clinical services team. We are doing that really in three primary areas. The first is establishing a medical executive board, which is a national body of clinical thought leaders from across the SCA network, including physicians from all specialties. The group is focused on providing expert advice and supporting patient safety initiatives.

That was a huge effort in 2019 and it will amplify in 2020. We have patient quality teams and regional quality leaders that promote and execute best practices for quality on a daily basis. The third and final way we augment our investment in clinical quality is putting on a clinical leadership session to focus on nurturing the culture of patient safety and investing in clinical leaders so we can continue progress on our vision to make SCA the safest place for surgery.

Q: What challenges do you see?

CZ: The biggest challenge has been, as we start to diversify our business beyond ASCs, what will that take from our team and business, and how can we communicate that to our surgeons and proceduralists. We closed two significant investments at the end of last year, including a group of specialists that don't yet work with SCA ASCs . One is a cardiovascular group and the other focuses on orthopedics.

Q: Do you foresee cardiovascular procedures becoming more common in ASCs?

CZ: It requires hard work and is not a slam dunk, but we do see cardiovascular as a huge opportunity in the surgery center world. Medicare recently added more codes for payment at the ASC, and we think based on our conversations with physicians and cardiovascular interventionalists, there is interest in moving out of hospital employment where most of them have been. The service line is challenging and expensive, and there are regulations in many states that should be considered before launching the line.

Q: What types of partnerships, with surgery centers or other organizations, do you anticipate over the next few years?

CZ: Partnerships are incredibly important for the future. I'm focused on deepening our partnerships with Optum, which also includes primary care. Some of their contracts are full risk and some are fee for service, but they are all looking for meaningful solutions to reduce the total cost of care and improve quality for patients. We are thinking through how to align and become a high value ecosystem. SCA is a huge part of that.

We are also actively looking and seeking to partner with health systems and payers across the U.S. where it makes sense to align because we have the same mission and values for healthcare delivery. We recently partnered with Allina to develop ASCs, and I expect to see future partnership like this in diverse geographies. We are also still very focused on acquisition as a high growth organization. We go through our portfolio to exit centers where it makes sense while still acquiring. We did a large amount of acquisitions last year and expect more this year. But the acquisition has to make sense for the specialists at the center and allow us to provide value to patients. There is a large opportunity to find specialists that want to partner with us and we are making sure that's the right partnership.

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