Pioneering change

Former equities analyst Dan Collins talks to Christopher Niesche about how a personal experience spurred him to create a new healthcare model, GenesisCare.

Dan Collins could be considered an unlikely driver of change in the Australian healthcare system. A former equities analyst, he had no experience in healthcare when he founded GenesisCare a decade ago.

Yet GenesisCare is pioneering a healthcare model where it partners with government providers and health insurers and is paid not by the procedure, but on outcomes.

It is a model that is likely to become more prevalent in Australia and overseas as governments try to rein in their growing healthcare expenditures and seek demonstrable benefits from care providers.

With more than 1,400 employees, GenesisCare provides cardiac and cancer care services across more than 125 sites and clinics ranging from the major capital cities to regional and rural centres. The model is based on the provision of fully integrated healthcare to patients, where different providers work together and co-ordinate their treatment, rather than confining their focus to their own silo.

Genesis CancerCare is the largest provider of radiotherapy in Australia and Genesis HeartCare comprises the country’s largest group of privately practising cardiologists. Collins, 40, was driven to start the company after seeing his father suffer and eventually die from amyloidosis, a disease which deposits insoluble proteins into the body’s organs and tissue, inhibiting their function. His father’s treatment regime gave him an insight into what was wrong with the healthcare system.

“Care wasn’t coordinated. There was a lot of duplication and waste. There was limited connectivity between almost every component of the healthcare value chain,” he says. “Each person or team was only interested in what their responsibility was, or what they thought their responsibility was, and they didn’t take ownership of the fact that what they did had an impact on other parts of the value chain. There were not good linkages between different specialists or different types of providers that would help the patient move through the system well.”

Instigating change
So in his mid-20s, Collins set out to change the system. He spent two-and-a-half years investigating the problem by engaging all stakeholders in Australian and international healthcare to try to dissect the common threads of what was working and what was not working.

Collins – a former analyst of media and financial stocks at Wilson HTM Investment Group – got a mixed reaction. “The question was: what could a 25 or 26-year-old media stock analyst possibly contribute to trying to design, let alone change, the healthcare system so it was better for patients and more efficient?”

He got around the scepticism by sponsoring discussions between health professionals and had a breakthrough in 2004 when Dr Geoff Holt, a cardiologist at Brisbane’s Heart Care Partners agreed to let his practice of seven cardiologists be the foundation practice of GenesisCare. Holt shared Collins’ vision about how team-based care could improve patient outcomes and recognised that he had to partner with people or organisations outside of his own practice to achieve what was possible.

From the outset, Collins put a lot of thought into the new business’s governance structure. Along with a corporate board at head office, each practice in GenesisCare also has its own clinical management committee, which has a large amount of autonomy to make decisions regarding how the practice is run on a day-to-day basis. The committees operate much like a board and are comprised of doctors, technical people and managers who together set the direction of the practice.

“The philosophy underpinning our view on governance was that the critical decision-makers in our organisation, or in healthcare, are the decision-makers closest to the patient, and the people closest to the patient needed to be empowered,” Collins says. “And to support them in making those decisions, they needed a structure that was consistent through the organisation and that devolved decision-making authority and maximised responsiveness.”

When the business was founded, Collins and the doctors drew up a governance deed which uniquely, is embedded in the company’s constitution. It sets out the purpose and roles of the different parts of the organisation, and how resolutions are brought about at all levels of the organisation. Only the doctors can change the governance deed.

“We created clarity about ownership and responsibility of decision-making before the business even started, so not only would people contribute and buy into a strategy and a corporate plan, they were connecting to a governance structure that created shape and support, and protected people and helped drive the business,” Collins says. “We have a rally point around which to make decisions quickly and how to do that uniformly across the business of scale.”

Each practice makes all of its day-to-day operating and strategic decisions, including which technology it adopts, in what sequence, and how local services are developed. Each practice is also responsible for capital expenditure to a certain level and their local profit and loss.

While the practices have a lot of autonomy in decision-making, Collins says it was important to have the same strategic plan and governance structure across the company’s practices so the business could develop network capabilities from which the practices could reap the benefits. “Part of our point of difference was we wanted to achieve more together than we could apart.”

By way of example, Collins explains what network benefits can mean for cardiac practices and their patients. GenesisCare tracks and measures patient outcomes and pools all the data from the local practices. The data is then shared back with the doctors who use it to drive better outcomes in their practices and share this with patients and often, referrers.

But there is another great advantage from being part of a network, and one that has the potential to revolutionise healthcare in Australia and even globally: “We are contracting with health funds and governments who will pay us to deliver a patient outcome rather than a specific service provided, and that is a profound change in healthcare,” says Collins. “So, we are delivering an outcome that the patient needs and wants, and getting paid for that rather than paying for a specific procedural item, and we do that by harnessing the group benefits of common governance structure and culture, and measuring and tracking data relevant to both quality and efficiency.”

Collaboration is crucial
One of the strengths of the GenesisCare model is that it relies on collaboration to drive national programs, which Collins says gets better buy-in and traction from the practices and connectivity to purpose. But it also presents a challenge. “In the beginning of any initiative, it takes more time because you cannot send directives,” he says. “We have to say: ‘Look, here is our common vision and plans. We are seeing this new data or here is an idea, we would like to have a crack at this. Do you agree and how should we do it?’”

Collins puts great store in board diversity, of experience and of skills, to foster a “nourishing debate” around the boardroom table. “If the board finds itself agreeing too much with each other, the board probably doesn’t have the right setup,” he says.

The GenesisCare board contains a mixture of specialist doctors, independent directors, and directors representing private equity giant KKR, which bought just under half the business in 2012, leaving the doctors holding 40 per cent and management with a 15 per cent share. David Vaux FAICD, former managing director of listed healthcare company DCA Group, is chairman and Dr Brian McNamee AO, long-time CEO of biotechnology company CSL, has recently joined as a board adviser.

Board culture and “softer factors” are crucial to the success of an organisation, says Collins. “There needs to be a very keen focus on culture and transparency and ownership of challenges in the organisation because you can have all the procedures, policies and systems you want, but if there isn’t a supportive culture around performance, outcomes, improvement, change and risk, then that organisation will have challenges and the board has to set that tone,” he says.

This considered approach to governance has helped the business as it has expanded around the country and will likely stand it in good stead for Collins’ ultimate ambition. “We would like to be the tip of the spear – not just in Australia but more broadly — to lead with outcomes-based healthcare service delivery. That’s what we want to do. That’s how we want to influence healthcare and make it better for everyone, especially the patients we care for,” he says.