Atlantic Health's Brian Gragnolati Preaches the Gospel of Value-based Care

Atlantic Health System President and CEO Brian Gragnolati says he believes healthcare that is delivered as a 'team sport' works best when the focus is on access, insurance, affordability, and proactive, preventive care.

This article appears in the July/August 2019 edition of HealthLeaders magazine. 

"From day one," Brian Gragnolati, president and CEO of Morristown, New Jersey–based Atlantic Health System, says without hesitation, when the veteran healthcare executive is asked when he became a true believer in the gospel of value-based care.

A long-held belief in healthcare delivered as a "team sport" that works best when the focus is on access, insurance, affordability, and proactive, preventive care started when Gragnolati was an undergraduate at the University of Connecticut in the late 1970s.

At UConn, Gragnolati got an introduction to the clinical side of healthcare by working as an emergency medical technician to help pay his tuition.

"It was that experience of taking care of patients that convinced me that healthcare would be a great way to continue the work that I was doing as an EMT," Gragnolati recalls. "But I also recognize that I did not necessarily have what was needed to be a physician."

Fortunately for Gragnolati, UConn offered a healthcare systems engineering program and that's where he found his niche.

"In retrospect, that program was way ahead of its time," Gragnolati recalls. "It was interdisciplinary, so I took classes in the School of Public Health, the School of Allied Health, the School of Business, and the School of Engineering."

"We had interdisciplinary projects that we worked on and, lo and behold, that set up the work that I do here, even today, trying to bring different groups together to work on complex problems," he says.

"That's really what started my career. I came to realize that healthcare is a team sport, and how you finance healthcare is also a team sport, and we've got to do a better job playing like teammates on that."

The other big influence in Gragnolati's life was his father, who served as a Connecticut state legislator, and who taught his son the importance of cooperation, building consensus, being practical, and believing in the process.

"Getting involved on the advocacy and policy side was another way that I could approach healthcare and use a skill set that I understood," says Gragnolati, who is also the 2019 chairman of the board of trustees at the American Hospital Association.

"Consequently, I've always been pragmatic about how is healthcare going to continue to be funded, and I have always had an eye on affordability and how we make sure that whatever we're doing is going to be able to be continued," he says. "Throughout my career, I realized that unless you had access to insurance, you were going to struggle to get healthcare. As I continued my work in various capacities, I kept seeing that becoming a roadblock."

In mid-2015 Gragnolati took the CEO job at Atlantic Health System after serving for several years as a senior vice president at Johns Hopkins Medicine.

Following are highlights from a recent conversation between Gragnolati and HealthLeaders.

"What I saw here when I was looking at this role was an organization that was of sufficient size that could make the kinds of investments needed to be made in data systems, in the talent that we were able to bring in, in the technology."

"Specifically, I really liked what was being done here with the accountable care organizations and how they were developed, and I liked that they were beginning to move the commercial payment systems and data into an ACO infrastructure."

"[Atlantic Health System in mid-2018 began a partnership with urgent care provider MedExpress, owed by Optum, a subsidiary of UnitedHealth Group, co-operating 11 joint clinics in northern New Jersey] and is another example of how you partner with somebody differently. Historically, they haven't done these types of relationships where we actually own part of that organization."

"The reason we did it is because there are a lot of urgent care centers in this region. The easy thing for us to do would be to just put another one up and put our brand on it, but then all four corners of an intersection would have an urgent care center on it and continue to confuse the heck out of the patient-consumers about where they were going to receive high-quality accessible care."

"We found a great partner in MedExpress, and we've been able to co-brand to take advantage of how the community feels about the care that they receive at Atlantic Health."

"One thing that I've learned through this process is, in addition to being available and convenient and affordable, through the myriad of choices that patients have, they're also looking for urgent care centers that they can have confidence in. Our participation did bring that. When you talk to the folks on the ground, the leadership in each of the centers, they would agree with that."

"Probably the most important thing that I've learned is that continuity of care is very important. What's critically important is that we can get reliable information moved across from MedExpress and to MedExpress for our patients in a way that reduces unnecessary testing and makes sure that the providers have access to information that can help the patient when they're there."

"That's a really important piece because we have a system in this country of fragmented care. Our example of our relationship with MedExpress moves that in another direction."