Dr. Julian Harris of ConcertoCare

    We Spoke to Dr. Julian Harris of ConcertoCare About How to Build a Successful Service Business

    As part of my series about the “5 Things You Need To Know To Create a Successful Service Business,” I had the pleasure of interviewing Dr. Julian Harris.

    Dr. Julian Harris, MD, is Chairman and CEO of ConcertoCare, a tech-enabled, value-based care company that provides integrated, in-home care for adults with complex health and social needs. He has also been a Partner on the Healthcare Services & Technology team at Deerfield since 2019. Before Deerfield, Dr. Harris was the founding President of CareAllies, Cigna’s family of multipayer provider services and home-based care businesses. Previously, he led US Strategic Operations for Cigna and managed a $500 million internal investment portfolio focused on technology and innovation.

    During his tenure as Chief Executive of the $11 billion Massachusetts Medicaid program, the agency deepened its partnerships with the state’s Program of All-Inclusive Care for the Elderly (PACE) and developed a unique, capitation-based Medicaid accountable care organization (ACO) program. He and his team also built an integrated approach to addressing medical, behavioral and unmet social needs into the country’s first Medicare-Medicaid duals demonstration, authorized by the Affordable Care Act.

    Dr. Harris was also an adviser to Google Ventures (GV), focused on health care services and technology. Before GV, he led the health care team in the White House Office of Management and Budget (OMB). As the federal government’s chief health care finance official, he oversaw a $1 trillion budget and provided management and policy oversight for a range of programs, including Medicare, Medicaid, the Food and Drug Administration, the National Institutes of Health, and the Centers for Disease Control and Prevention. During Harris’ time at OMB, the Centers for Medicare & Medicaid Services and the CMS Innovation Center greatly accelerated the development and implementation of value-based care programs focused on improving quality and reducing costs.

    Dr. Harris trained in internal medicine and primary care at Harvard Medical School’s Brigham & Women’s Hospital and practiced as a hospitalist at Cambridge Health Alliance and as a clinical consultant for Best Doctors. He graduated summa cum laude with a Bachelor of Arts in Health Policy and Medical Ethics from Duke University and holds a Master of Science from Oxford University, where he studied as a Rhodes Scholar. He is also a graduate of the Wharton School of Business and the University of Pennsylvania’s School of Medicine, where he currently serves as an Adjunct Professor of Health Policy & Medical Ethics. Dr. Harris is a trustee of the New York Academy of Medicine and a member of the advisory boards for the Leonard Davis Institute for Health Economics at Penn and the NYU Department of Population Health.

    In his free time, he likes to find new places to hike and kayak with his family. He also enjoys teaching himself how to play the piano. While still several years away from being able to attempt a concerto, he loves to listen to them and dream.

    Thank you so much for joining us! Our readers would love to “get to know you” a bit better. Can you tell us a bit about your “backstory” and how you got started?

    My work at ConcertoCare is inspired by my personal experiences with my grandparents. Ensuring that seniors and adults with complex health conditions have a path to receive multidisciplinary intensive care and services in their home is deeply important for me. I watched my grandfather take care of my grandmother, who had complex health care conditions, in the home. For over a decade, she benefited from having access to personal care services that undergirded the range of services that members of our family were able to provide or other parts of the care ecosystem were able to contribute.

    Watching my grandfather in the role of the caregiver was life-changing. My grandfather felt personally responsible for ensuring that he prepared all of my grandmother’s meals and cut up her pills. In fact, he spent the better part of his 80s being the primary caregiver for his wife, my grandmother, who had Alzheimer’s disease with Parkinsonian features. This experience brought into clear focus for me the kinds of services and supports that are necessary to enable patients to maintain their independence and remain in the home.

    My grandmother grew up as an African American in a small town in Georgia in the 1930s. As a child, while helping her mother, who worked as a housekeeper, she declared that she was going to college, and she did just that. She went on to become a schoolteacher, community leader, and mother and grandmother extraordinaire who taught herself how to paint in her 60s and loved watching wrestling on the WWF. She was also one of my closest friends and confidants. Throughout her life, my grandmother had made it known that she hoped to spend her later years surrounded by family. She played a key role in helping my great-grandmother, my grandfather’s mom, spend some of her final years and months in their home. Taken together, seeing my grandmother support and enable that for her mother-in-law, and having watched my grandfather beautifully care for his wife, supported at the end by wonderful hospice providers, really focused me on optimizing in-home care options for seniors. I’ll never forget my last visit with her, holding her hand as I sang her favorite songs, and thinking how grateful I was to have those last moments with her at home in her favorite chair.

    All that to say, like many members of our team, it is my lived experience with my family that brought me to this work at ConcertoCare. Since then, I’ve had the opportunity to care for seniors and adults with complex conditions as a physician and to help design innovative payment and delivery models as a policy maker, health care executive, investor, and entrepreneur.

    Composer Chris Bowers has called a concerto “a conversation between a soloist and an orchestra.” Much like my grandmother, each ConcertoCare patient is the soloist in their own concerto, and our team of physicians, nurses, pharmacists and social workers is their orchestra.

    At ConcertoCare, we are delivering integrated care to adults with complex health and social needs, orchestrated where they are often best served: in their homes.

    Grounded in health equity, we are reshaping health care delivery to reduce the cost of health care and improve quality of life with our unique human-first, tech-enabled approach.

    What was the “Aha Moment” that led you to think of the idea for your current company? Can you share that story with us?

    I’ve shared my personal inspiration for doing this work, beginning with my grandparents’ experience as caregiver and patient. From a career perspective, I’ve had the opportunity to practice clinically in community health centers and in safety net hospital settings where I’ve seen patients who face a range of challenges: complex medical conditions, unmet behavioral health needs and challenges that we describe as unmet social needs. In many cases, these patients could have been cared for more effectively in their homes.

    I have worked as a policymaker on the state level running the Massachusetts’ Medicaid program and on a federal level overseeing Medicare and Medicaid and other federal programs from the Office of Management and Budget in the Obama-Biden administration. I have also worked in the private sector with Cigna at the helm of its CareAllies affiliate, where we delivered home-based primary care and built a palliative care model. More recently, I’ve worked as an investor in tech-enabled services businesses at Deerfield. I have been fortunate to see the health care system from many different angles and those experiences taught me that while the healthcare system too often fails patients who have complex health care needs, there are opportunities to address these challenges through innovative care delivery models. So we set out to create ConcertoCare, leveraging fantastic assets that we acquired as a foundation for the all-inclusive in-home care needed to improve patient outcomes.

    My personal and professional experiences have informed my passion for creating better models of care delivery and financing for patients who have Medicare and/or Medicaid, driving greater coordination across primary care, behavioral health, and long-term services and supports while addressing unmet social needs.

    Health care for adults with complex needs is often fragmented with little coordination between primary care, specialists, behavioral health and social services. This leaves many patients and family members frustrated and disheartened.

    At ConcertoCare, we’ve orchestrated a human-first, tech-enabled approach to meet the care needs of geriatric and high-risk adult patients through comprehensive in-home care that leverages our proprietary technology platform, Patient3D, and a combination of intensive virtual and in-person supports. Our expert care teams address the multidisciplinary needs of our patients with personalized treatment plans including clinical care, behavioral health and social services. This includes everything from intensive health services to helping to coordinate patients’ meals and transportation, as well as counseling visits.

    And, because we are a direct care provider with the ability to serve as the primary care physician of record for our patients or to partner in support of their existing primary care providers, we offer a full range of in-home care capabilities that allows us to keep patients out of the hospital and in the comfort of their own homes.

    So, ultimately, there wasn’t one “Aha Moment,” but a decades-long personal and professional journey of discovery that inspired me to pursue this work focused on seniors and adults with complex care needs.

    Can you share a story about the funniest mistake you made when you were first starting in your career? Can you tell us what lessons or ‘take aways’ you learned from that?

    When I first took over running the Medicaid program in Massachusetts, I was hired in part because I had previously worked to help the state develop an accountable care organization (ACO) strategy for the Medicaid program. ACOs are organizations focused on helping providers take financial responsibility for both the cost and quality of patient care outcomes. I showed up on day one, week one and said, “I’m ready to go. Let’s build out this new generation model of care.” And the feedback that I got from internal and external stakeholders was, “That sounds great. But first, we need to address call wait time for our health plan members and Medicaid patients who were managed by the state-run health plan. We need to figure out how to reduce the turnaround times for claim payment. We need to expand the range of ways that we respond to feedback from both provider groups and patient advocacy groups.”

    So, the long and short of it was, while I had my mission and charge to drive an innovation agenda, I had to very quickly re-center on both building the support internally and externally needed to drive an innovation agenda, but also to strengthen the core operational infrastructure and processes upon which to deliver an innovation agenda. There was a lot of just “blocking and tackle” work that we needed to do to strengthen the foundation of the organization from an operational perspective while also accelerating new payment and delivery models for patients with Medicaid only and with Medicare and Medicaid.

    Thank you for that. Let’s now pivot to the main focus of our interview. Extensive research suggests that “purpose driven businesses” are more successful in many areas. When you started your company what was your vision, your purpose?

    At ConcertoCare, our entire organization is purpose-driven — and everyone who works in the company has a “why story” like mine. We are focused on transforming the care of seniors and adults with complex health needs in ways that enable them to maintain their independence in the home.

    This leads to improved health outcomes and quality of life. And we’re privileged to play a part in improving our patients’ lives through coordinated care delivered by our orchestra — an interdisciplinary team focused on addressing patients’ medical, behavioral, and unmet social needs comprehensively.

    The work we do matters, and that’s what motivates us at ConcertoCare — our commitment to putting patients’ health, well-being and happiness first.

    What do you do to articulate or demonstrate your company’s values to your employees and to your customers?

    At ConcertoCare we spend a great deal of time talking about our values. We have town halls and small group sessions where we reflect on our mission and vision. In a recent town hall, we were talking about respect and what it means to respect our patients, our partners and our colleagues. It truly is a privilege to be invited into a patient’s home and to have a window into their lives in ways that help us to deliver better care, but also in ways that are deeply personal for them. So, we work to ensure that when our care teams cross that threshold, they enter our patients’ homes with respect and recognition of the privileged position that we are in to have the patient’s trust and to enter their homes. But respect is also a value we live by on a corporate level. Our teams treat each other with respect, and we have an understanding and appreciation for each other in our various roles. That matters.

    One of the things we spend a lot of time talking about and leaning into at ConcertoCare is this idea that all of the members of the care team are part of our orchestra that is wrapping around a patient.

    In our context, a concerto is really a conversation between a patient and their care team, just like you have a soloist engaged in a conversation with an orchestra in a musical context. And so, as a team, we respect each other’s roles, whether you’re the nurse, or the coder or the accountant; we’re all engaged in the business of providing care.

    Do you have a “number one principle” that guides you through the ups and downs of running a business?

    It’s really simple. Put the patients first. I have been very fortunate in my career to have been in clinical roles where I had the opportunity to take care of patients, to be in finance roles where I had to think about how we ensure that the resources are available to continue to deliver service, and operational roles, where we had to execute against service and care delivery. But fundamentally, I believe that if we are doing the right thing to take care of patients, everything else will take care of itself.

    Can you tell us a story about the hard times that you faced when you first started your journey? Did you ever consider giving up? Where did you get the drive to continue even though things were so hard?

    I will share that during my grandmother’s illness, at one point, she stopped talking, and we couldn’t quite figure out why. I was a medical student at the time and had recently learned that patients who suffer from dementia can also suffer from depression. We decided to have her screened for and ultimately treated for depression, and once we did, she started talking again. To think that we lost my grandmother’s voice for two years was such a painful thing. But it really illustrated to me, personally, the importance of recognizing all of the physical and behavioral aspects of care that are needed to enable patients to stay in their homes. It’s not solely physical health that needs to be addressed in comprehensive care, but rather all aspects of health, including the mental, emotional and unmet social needs of patients. And that’s a big part of what we do at ConcertoCare.

    I have two principles related to the idea of failure. One is, to whom much is given, much will be expected, and I feel like I’ve been extraordinarily blessed in my life in so many ways, including with having the privilege to be involved directly in patient care, but also in thinking about the structures in which care is delivered. The other is knowing that what feels like a hard day for me, or a hard day for our teams, pales in comparison to the challenges that many of our patients face on a daily basis and that their caregivers face in seeking to support them. I hearken back to those experiences and insights on hard days and they power me to keep going.

    So, how are things going today? How did your values lead to your eventual success?

    Things at ConcertoCare are going incredibly well. We have the best team in the industry, bar none. We have really thoughtful and incredible partners who understand our value propositions and are looking for ways to expand the kinds of ways we work together. And the best parts are that we’re having a demonstrable impact on the quality and the cost of care for the patients that we serve, and that we are increasingly viewed as an industry leader and a partner in broader conversations around how this market needs to evolve. As a country, we need to continue to innovate in the delivery of care for seniors and adults with complex health conditions. And we’re doing that at ConcertoCare.

    Our personalized, in-home approach makes a meaningful difference in the health and quality of life of our patients and provides peace of mind for their loved ones.

    Our Integrated Care Team has succeeded in:

    • Reducing emergency department visits
    • Reducing inpatient hospital admissions
    • Reducing readmissions
    • Increasing annual wellness visits

    And all of the work we do, and the impact we’re able to achieve, is powered and enabled by our proprietary health data and technology platform, Patient3D®, which helps clinicians identify and monitor patient needs in near-real time. This allows for seamless orchestration amongst the care team and quicker response to patients’ health care needs.

    I have this very, very deep belief and passion around the idea that in healthcare, it’s not just the nurses or doctors or care team members who are going into the home or into a facility and touching patients who are caregivers or who are providers.

    Everyone in the organization is truly a part of the care team — the orchestra. That includes the person who is helping to answer the phone or to clean the patient’s room or hospital room. My other grandmother worked in environmental services at a hospital in Georgia and helped to keep patients’ rooms clean. While it wasn’t in her job description, she also worked as an unpaid lactation consultant and taught new mothers how to breastfeed their babies and assisted the nurses with various tasks. She always saw herself as a part of the care team, and that was important to her and to me. In our company, maybe it’s the person who works in IT in the organization and is ensuring the electronic medical records (EMR) work properly. Or the person who works in accounting and finance who is ensuring that the organization has the financial ability to continue to be able to deliver services.

    That belief about the integral roles that all of our team members play and our values, like respecting patients, partners and colleagues, has led to our success in helping ConcertoCare transform health care delivery, reduce costs and improve quality of life with a human-first, tech-enabled approach. I am grateful and moved to be able to do this work.

    Based on your experience and success, what are the five most important things a founder or CEO should know in order to create a very successful service-based business? Please share a story or an example for each.

    1. A strategic vision and strong purpose-driven foundation are key to success in both the public and private sectors, no matter the size of the organization. I think that people have an exaggerated sense of the differences between large complex government organizations and large complex companies, even tech-focused ones like Amazon, Facebook or Google, or large health services companies or systems. One thing I’ve learned, not just from my time at Cigna, but having interacted with a number of large health services and technology companies, and having friends who work at a number of the large and big branded technology companies, is that size and scale bring complexity. Strategic vision and focus, and a results- and purpose-driven foundation, are the building blocks to creating a successful organization and tackling the complexities that come with organizations of all shapes and sizes. A purpose-driven foundation, backed up by a laser focus on operational excellence, will center you on the right path as your company grows.
    2. Hire incredible people who believe in your organization’s mission and are passionate about the work you do. One of the biggest challenges for organizations as they grow in scale is how to put in place systems and processes and ways of working that reflect the needed focus on a range of things, from compliance to long-term people strategy, to long-term technology strategy and infrastructure, in a very different way from a smaller organization or an earlier-stage organization. That’s why building and hiring a phenomenal team that can scale with the business is such an important part of the growth of a company. It’s also key to ensure that the team is 100% committed to seeing the organization through the challenges that growth brings — and addressing them. ConcertoCare is made up of some of the nation’s leading clinicians, experts and operators in home-based geriatric medicine, palliative care, value-based care, digital health and data analytics. Our forward-thinking team is committed to delivering the highest level of care to the most vulnerable patient populations. And this is, in large part, why we are so successful.
    3. Even large organizations must continue to be nimble and responsive to be successful. I’ve seen the challenges and the potential challenges in government and in the private sector, and not just places that I worked, but in places where I’ve had friends work, and these are universal challenges. I think people can go back to a cliche. “Oh, well, government must be slow, clunky and bureaucratic, and the private sector must be nimble, innovative and disruptive.” I’ve actually seen and lived government being nimble, innovative and disruptive, and I’ve seen a number of public and private companies do things that are also nimble and innovative and disruptive, but then also have the challenges that come with size and scale. They’ve had to figure out where and how processes that might be called “bureaucracy” are important and an enabler, and when those processes need to be disrupted and refined. Agility and adaptability are crucial.
    4. Strive to strike the right balance between innovation and tackling foundational challenges. Driving towards the brave and bold innovation agenda is important, but not at the sacrifice of the foundation and building blocks of the organization. You must be blocking and tackling while pushing the boundaries of innovation. That is a challenge for a lot of organizations, and especially for many investor-backed companies.
    5. All of your personal and professional experiences will inform your work. Learn from it, build on it and use those varying perspectives to deepen your understanding of the industry you’re in. It’s been a journey thinking about my personal experiences, my clinical experiences, and my policymaking and business experiences across both the public and private sectors. The lessons learned from each of those chapters of my life have been transformative. My work leverages all of those experiences and impacts how I tackle the challenge of delivering the best possible care for patients.

    None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story?

    As I mentioned earlier, I credit my grandparents for showing me how important and special in-home healthcare can be, but also for giving me the opportunity to see firsthand where it has historically fallen short. Through their experiences, I have looked for ways to improve and provide a more holistic in-home healthcare system that can benefit the patient and their caregiver. That is truly my life’s work.

    You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

    In healthcare, if we succeed at putting patients first at all times and think about them holistically across their medical, behavioral, long-term social services and supports, and unmet social needs, we would radically transform the experience and outcomes of care for patients who need it the most. We would impact communities that have been historically underserved and have a meaningful impact on health equity. And we would take a human-first, tech-enabled approach to delivering care.

    If that sounds a lot like ConcertoCare, that’s because we are leading a movement today with a very simple goal: to make health care work for the patients who need it the most and in the place where they are often best served: in their homes.

    How can our readers follow you on social media?