Welcome to the ninth annual value-based care report

Hello. My name is Kate Goodrich and I am the chief medical officer for Humana. I am just really excited to be here today to moderate this panel on value-based care as we release our annual value-based care report here at Humana. And I'm here with three colleagues who work very closely with Humana. Dr. Satish from Sally Prehistory and Michael Self, and I'll have them introduce themselves in just a moment.

In the last two and a half to three years have been hard on everybody, and they certainly have been hard on clinicians and physicians and their practices. They've had to worry about so many different things. They've had to worry about the health of their patients. They've had to worry about their own health and their family’s health. They've had to worry about revenue loss, identifying new capabilities to help them care for their patients like telehealth.

Supply chain problems, staffing shortages. And frankly, burnout, which has been a problem for a long time. This is required resilience on the part of clinicians and physicians in particular on so many levels, personal level, supporting their patients, supporting their staff. It's really been a challenging two and a half years. What we've learned here at Humana is that physicians and other clinicians who participate in value-based care arrangements may have actually been more prepared and therefore more resilient when the pandemic started.

For example, we learned that physicians who were in value-based care arrangements, particularly if they took on downside or full risk, were more likely to be able to stand up telehealth capabilities much faster and much more seamlessly. Whereas physicians who were primarily in fee for service had a had struggled a bit more to be able to stand up and use those capabilities.

So we do think that that's just one example of how resilience during the pandemic has played out a bit differentially, depending upon the type of arrangements. Of course, physicians who are in value-based arrangements focus regularly and always have on quality and efficiency. And of course, that's what all physicians go into the practice of medicine for. But certainly, one of the features of value-based arrangements is that it facilitates the ability, makes it a bit easier for physicians to really be able to focus more holistically on quality and efficiency and cost.

And they do this every single day before the pandemic and during the pandemic. And it certainly does get to the core of why we all went into medicine and what sustains us as physicians having the tools and the time to be able to provide the highest quality care for our patients. So as part of our annual based, our annual value-based care report that looks at physician progress within the value-based space, we wanted to expand upon this quality driven approach with a trio of physicians from around the country who experience this world every single day, but in a somewhat different way.

So let me have each of you introduce yourselves, maybe starting now with Dr. Bhansali.

Thank you so much, Kate. So good morning, team. My name is Management Sally, and I'm a primary care doctor by training. I serve as a senior VP and medical director of Medicare Advantage for Julie Health and Care, formerly known as the Patient Medical Group where I oversee the care model design and care delivery, total cost of care management, appropriate documentation, heat to stars and quality have been here for about a year before, which I was at Oak Street for three years, which is where I learned the foundations of Medicare Advantage.

Dr. Feldman, good morning.

Thanks for having me on this program. I'm a full-time nephrologist in active clinical practice and wear many hats, and one of them is the chief quality officer for our organization. We've made tremendous gains since partnering with Summit Health out of New Jersey. We've partnered strongly with Epic and have leveraged the Epic platform to really its maximum potential, gaining ten stars.

And that's really been instrumental in our move towards successful value-based care and population health management.

Dr. Suresh.

Hey, morning. Thanks for having me on. I am here for Chief Medical Officer for a large IPA here based in Houston, Texas, Venezuelan physician organization. And I also am the regional medical executive hematologist, which is I. I'm also and think more closely with IPA primary care physicians and specialists. And I'm an internist by training and it's a very cool thing was a number of physicians and specialists and a moment of silence from volunteer value.

Thank you.

So let me just start just to open a little bit to hear a little bit from you all about your practices. You know, there's there's no particular roadmap for getting started in value-based care. Every practice and organization is different, but there are so foundational capabilities that I think are needed. Everybody has to sort of look at their own operation and organization to determine what they need for success, whether it be hiring, particular types of staff, organizational restructuring, any particular financial investments, ensuring they have the right culture and how they use data.

So I'd like to hear from each of you a little bit more about your organization, what particular areas you all had to focus on as you began in the value based care space, some of the challenges that you faced and how you work to overcome them or may still be working to overcome them. As we know, this is not a quick or easy process.

It could take several years to really get up and running in the value-based world. So maybe let me start with you, Dr. Suresh. You wouldn't mind talking a little bit about your practice?

Absolutely. Thank you very much. And like I mentioned in my introduction, I work very close in our organization, and I work very closely with multiple physicians who are all independent, maybe independent single practice physicians are they are in small group practices, but they all stay independent, different EMR. They use their own software as an EMR. And our slogan has always been movement of physician ideas and practices from volume to value.

And we truly see that the patients are the physicians are inclined to switch to a value-based care when they hear that is momentum from the IPA when there is financial realization, also outcome realization. So when the idea physicians meet regularly, which we do frequently, they share their best practices as well as their challenges and how they overcame them.

So this is one of our biggest areas of focus where we have physicians meet in a common ground and meet together frequently so they can share not only their best practices, but what they have achieved by moving to a value based care model. So the challenges typically that we have seen is when individual physician practices are used to a specific fee for service model and they really see the value based care as a restrictive model, right?

They don't see the benefits as they are used to a fee for service structure. So what I have and we have seen is peer physician coaching, IPA leadership coaching as well as shared experiences between the peers is the greatest strength of our IPA engagement. Like I said, we need frequently, mostly monthly, but more frequently than that if some of the physicians are asking for additional help.

We also have in our organization, we bind these physicians together by our population health platform, which is actually linked to their EMR as the main EMR. And so that is easy exchange of data. And this is one of the biggest challenges as well as ask from our primary care physician, how quickly and how reliant are the data that we are sharing with them.

So that's one of the biggest challenges, but also opportunities for our allies and our IPAs to by to bond together through this stop population health platform. And I hear this. This actually kills me when I hear from the IPA leadership. It doesn't matter what kind of patient you see, it's the same the fact is, if a diabetes hits the same exact goals, it's the same exact objectives.

So it actually is exhilarating me to hear that from IPA leaders. It's of agnostic and they look at how can I provide the best value to our patients? And we've seen that in outcomes, in metrics, in, in CMS time metrics, we see that increase in the part fee and part D outcomes year over year.

Great. Thank you, Dr. Patel. Now about you.

So I can share a little bit about Julie's structure, excuse me, and formerly known as to patient medical. So I'm sure Julie has been taking risk on patients for a while, almost a decade, either for risk or partial risk, both in Medicare and on the commercial side. But the big pivot that happened was in 2022. So I joined in 21 and in 22 we quadrupled the number of lives that we were at full risk for in Medicare Advantage.

And so that was a pretty large shift culturally. Organizationally, etc.. As far as the organization goes, it's a unique structure. So we're a multi-specialty group where primary care docs, specialists pretty much everyone that you can imagine outside of transplant surgeon, so whatnot. We have our own hospitalists, but we don't own any hospitals. We have ACS, we have urgent care centers and we don't own any snips, but we have manifests.

So what this creates is essentially our clinicians being able to provide care essentially pretty much throughout the entire care, continue from primary care to pre acute care to acute care to post-acute care. The other big thing is that because we don't own any hospitals or stents, that there are at least some aligned incentives in reducing party costs or essentially a decrease acute utilization.

One is inappropriate and the third thing is that we have vertical integration of our not only all our care providers, but also our EMR. So it's a singular EMR which is accessible to everyone and we have a concentration of patients. So this puts us in a very unique position to be able to take more and more risk because and the part of the risk that we can help improve or part of patient outcomes that we can help improve are sort of the lowest hanging fruit, which is hospitalizations, keeping people out of the hospital happy, healthy, that our structure is primed to be able to do that.

So we're a little bit more about trying to avoid unnecessary hospitalizations a little bit later. Dr. Feldman, what would you say.

Though, similarly to documents, Sally, we have a similar conceptualization of cost containment, and I would break it down into three large buckets. So the first is a culture, and the culture is that of bending the cost curve. And that's a process over time to change the entire organization from the registration technicians to the back-end billers across the entire organization.

Everybody is focused on cost containment and outcome. That is some specifics on that. The next is appropriate workflow. And by that I mean it's critical to provide mineable data to demonstrate to payers and regulators that you're providing the quality care that you actually provide. So it doesn't matter how many times you counsel an obese patient about the merits of an ideal body mass index to the payer, it's important that you document it in a way that you can demonstrate it.

And so it's critical to utilize the EMR to its fullest. And this is really, I wouldn't say revolution, but the final evolution of the EMR, where we need to move from the construct of a computerized paper chart to really one of a population health tool that has many uses and a primary uses to demonstrate to payers the quality care that you're providing.

Another component of the workflow includes appropriate access for patients to timely care, and that's a huge focus of our organization. Coupled with that is what I call access to in between care and this is linked directly to reducing unnecessary E.R. visits and hospital days. So having a group of care navigators or care coordinators who are available to patients, particularly in the higher risk categories for high site of care utilization, allows us to bend that cost curve significantly.

And lastly, site of care for all components of health care is critical. We've leveraged relationships throughout our community to move almost everything that can possibly be done outside of high-cost centers into low cost centers. So we've partnered with our interventional radiology colleagues, for example, to move 95% of their procedures to an outpatient lab, which foregoes the very high facility fees.

We've moved vast majority of spine work to ambulatory surgery centers. We've moved most total joints to ambulatory surgery centers on and on and on. And then additionally, as Dr. Bhansali described, we have an integrated hospitalists team. Embedded with that team is a Phase II trust who ensures that patients in the rehab centers are progressing. As we look to not only shorten the length of stay in acute care hospitalization, but also post-acute care stays, which is sort of the second high-cost center.

So it's really a continuum across culture, workflow side of care, vertical integration that has allowed us to really succeed in the ABC market.

But I feel like I've heard so many different aspects of what's required for success. But an overarching theme is really being able to understand where the patient giving the patient the right place in the right, in the right system at the right time across their entire care journey and having visibility into that and making that easier.