Dr. Groves is the Chief Medical officer of Banner Aetna, an independently licensed insurance company with a 50/50 ownership split between Banner and Aetna. "We have taken two elite athletes, put them together and said 'who is best at what, and let's leverage their respective strengths going forward.'"

Banner Aetna has tried to be strategic about what services that are currently handled by the care delivery system or insurer should reside with the other. By pushing care management (among other things) to the delivery system, they have been able to eliminate confusion for patients and duplication of efforts.

We also spoke about prior authorization. In the eyes of Dr. Groves, prior authorization is a way to check, "Is this really necessary based on medical literature?" now that the speed at which medical information doubles has gone from 50 years in the 1950's to weeks or months today. At Banner Aetna, half of all prior authorizations are now being done by Banner, which means that Banner doctors are speaking to their peers within the health system when discussing authorizations, and that those peers have access to the patient's record in real time, and can check for missing information.

When it comes to attribution, Dr. Groves rejects the concept of "owning patients", and notes that Banner Aetna patients are often treated by physicians in the Banner Network that are aligned but not owned by Banner. Dr. Groves sees Banner Aetna's role as financing the services that a trusted physician feels his or her patients need, and helping to support the trusted relationship between a doctor and patient wherever it is occurring.

As we moved to a conversation about innovation in healthcare, Dr. Groves noted that technology should always be in service of the relationship between a clinician and patient. Trust, he noted, is what has suffered as technology has created a wall between patients and physicians. Dr. Groves is interested in technology that can streamline back office functions, make it easier for patients to find the right doctor, and assist patients in following through on commitments they have made to their physician to improve their health.

We also touched on physician incentives. It has been Dr. Groves' experience over 30 years of managing physicians that whenever you attach reward and punishment to a metric, it immediately starts being distorted. "Intrinsic motivation is dampened by external rewards."

Dr. Groves cited research by Brent James, which indicates that the ease of accomplishing a task is what drives most physician behavior. Physicians are inherently competitive, and thus sharing data with physicians so they can see where they stand in relation to their colleagues is also important. Financial reward is a distant number 3 on the list of what influences physicians. Putting excessive weight on specific metrics results in an overemphasis on a limited set of metrics instead of the relationship and an evaluation of the whole patient.