Advancing Value-Based Care IRL: Highlights from HLTH Day 2

Hey, everybody. It's David with Jeffrey Roche. We, we have our own podcast today. We're coming to you live from HLTH. Las Vegas. We thought we'd share with you a little bit about what we've learned since being here. Give you an inside view on on the event, some of the sessions that we've participated in. And if you haven't had a chance to be here, maybe we can educate you, engage you, even inspire you on some of the conversations that are going on in in Las Vegas this week. I host the Highway Health podcast on Market Scale. You wanna plug for yours? Sure. Yeah. I I cohost the holistic leadership, future of work, and education, and healthcare, podcast on market scale. I wasn't here on day one, but, you were. And I think some of the main takeaways that I have today, tie in. To some of your experiences yesterday, you know, some of the conversations that I've had most recently, whether it's on a podcast or just on a conversation is around value based care, which isn't a new topic. I've been in health care last twelve talked about it every year that I've been here. But there's been some nuances and some some further education and some progress for lack of a better word that's being attributed to some of the new innovations that we've seen in health care and honestly some of the more collaborative partnerships that we're seeing. You know, today, I said in a session where it was executives from Divita, Biogen, Maven, and Geisinger. These are the leaders in value based care. Not self proclaimed, but the consensus is. And I was pretty shocked. It's not the right word because health care, it takes it takes a while to see true adoption or absorption of of new models and new technologies, but I was surprised to hear the number of patients, the number of dollars attributed to value based care models across these organizations. And I'll just start with one. I'd like to get your feedback. So, David, large company. Maven, large company, seventeen million lives. Hundred and forty five countries. Only ten percent of the lives that Maven touches are a part of a value based care model. Divita only a third of those thirty three percent of DaVita. It's a hundred percent full risk model, which I thought was interesting. So we'll talk through some of these things. Geisinger, leader in the industry. You know the history there. About fifty fifty p for service. Value based care models, which to me, a little lower than expected. You have some history here. You've you've got some background. There's some challenges that go to this. Whatever well, well reasoned. Legitimate challenges. This ties into a lot of the things that you talked about yesterday and and learned yesterday. Speak a little bit about your experience yesterday in day one. So, you know, yesterday, I had the privilege to attend the care quest Institute for oral health event, that was entirely on, you know, really addressing systemic innovation. And then the idea was really about how do you integrate oral health within our primary care setting and really get at value based and if you think about it, oral health is such an important aspect of the whole person and the whole person care. Yet in the United States, we still don't treat it as that. I mean, it's really interesting. And if you look at the statistics, so many diseases could be detected through really, really good oral care. And if you think about it from a value based care, m, so much of our healthcare system could be a more equitable system, could be portive system, really could be a more human centered system if we integrated oral health. And I wanna, you know, obviously applaud Maria, Philip and her team there for really not just raising attention to this, but doing so with a real attention to bringing payers. They have payers there. They have positions there that that also represented, you know, the multiple sides. And I think, you know, that payer piece critical. I mean, because to your point Geisinger, which obviously, you know, is a fifty fifty with value based guarantee for service. I mean, if you look at why that is, you know, they have their own health And they've had their own health insurance plan for quite some time. And so health care systems that have their own health insurance plan are in a stronger or in a stronger position to really leverage or move more towards value based care. But I think as we move towards value based care, and I honestly find it interesting that we haven't already, other than the fact that we're so risk averse in health care, and and we have a lot of people who kinda don't row in the same direction, we have to remember oral health. And that was a central message, certainly that Marie and her team share, but the other piece of it too that was shared was we've got invest more in oral health. We've got phenomenal startups. They showcased some of their startups yesterday. Truly trailblazing work. I was I was inspired by some of them. You know, I mean, they there was a startup there that actually had a technology that they built you can put into your tooth, and that tooth can measure the acidity of things you're eating or drinking. And they have scientific evidence behind it to show you the impact that that could have to diabetes impact it could have to heart disease. So, I mean, really, really innovative work, but if you have less than one percent of the investment dollars going to oral health, we're not gonna be able to really drive the needle there. And I think, Care Quest has certainly on an important mission, a mission that should be recognized and a mission that should be joined in. We're gonna really move towards, you know, not just value based care, but a better healthcare system for all. Yeah. And I would imagine, you know, I wasn't a part of that session, but I would imagine a large percentage of that one percent is made up of cosmetic or aesthetic investment. Yep. You know, I think of a line and other direct to consumer technologies that have become available in the world space. My dad, twenty eight years in military, a dentist in the military for that long. And he would completely agree. He oftentimes was the first one to know of a health condition from a patient, including dietary disorders, like bulimia and others. The signs are obvious to the educated and to the one to that dentist. I've heard about it for a long time through his voice, and I could imagine there's a lot to be learned from the world health of our our patients. And that kinda goes back to that builds on the conversation that I had that was titled, what are we willing to risk to be well with these executives talking about value based care? Is it went down to the act, you know, they they talked about the challenges of attribution where in value based care, you have more players responsible for the overall health of the patient. But who's the primary and who where how do the how do the payments get split up and there's risk there when Davida Maven, these, you know, the the dentist, the oral health care, all have a hand on the patient when that bundled payment of that value based care reimbursement model gets delivered. Where how does the pie get split up? There's science to that. There's areas of greater that. And I think adds to the risk that these providers, these payer, these patients, everybody involved are hesitant to adopt your point. I think it's it's that it is truly that issue. I mean, right? Like, I mean, as a, you know, when I was a hospital administrator, we were working and obviously, you know, this was this was two thousand nine through twenty or actually two thousand eight through twenty team. And if you think about it, you know, during some of those years, we were doing some shared services type programs through CMS. In fact, they were doing through CMI, the centers of Medicare, and and Medicaid, innovation. They were doing some projects just like leading to a value based care model. And part of the challenge with them was getting providers on the full ecosystem to accept what they would get out of it. But ultimately, when you really think about it, the system has to move. Fee for service is not sustained see that. We've got healthcare systems crumbling every day. We have hospitals closing every day. We have really significant shortages in all aspects of our healthcare system. We have doctors that are leaving. We've got partitioners that are leaving. And so we've gotta move more quickly to value based care because value based care is gonna also help, and many ways can help address some of these issues too. You know, I think to your point on who owns the patient. I mean, end of the day, the physician, the attending physician or attending provider, if it's a nurse, nurse practitioner or a physician assistant, I mean, obviously depending on the state, there's some other regulations we have to consider there. But ultimately, that provider, clinician does still own the kind of responsibility for and with that patient. I think it's time for the full ecosystem to realize. I mean, if you're a devita a geisinger, if you're another provider in the ecosystem, there's there's gotta be some way of us of us assigning appropriate percentage of what we should earn in the process. And government's gonna do it if if they can't figure it out at some point. I think, you know, government has made more moves, more steps towards this, and I think we're gonna continue to see that happen. When you say government, what do you mean? I mean, I think at the CMS level, I mean, at least for the Medicare Medicaid Services portion. Obviously, the commercial side still remains, you know, a little bit of a piece. But, I mean, let's be honest. Right? I mean, if you think about it, in most communities, Medicare is could be fifty percent market share, Medicaid could be a thirty percent market share, and then the rest is commercial. And so Medicare and Medicaid still make up the bulk of these things in most communities. And so I think for commercial, you know, I think way past time for our providers and our payers to just figure this out. We've been talking about value based care now since at least that I can remember two thousand eight, two thousand nine. We're sitting in twenty twenty three. And frankly, in my opinion, we've seen little progress a little bit, but every little bit seems like we go back. We don't really take steps forward. For me and for our listeners, if I'm putting onions on the spot, I I apologize. What is the difference between value based care compared to bundled payments and compared to what used to be termed, you know, an ACO. The best way to view that is bundled payments and accountable care organizations would would be kind of a piece of the puzzle within value based Right? It's really that idea that I I I think even under a value based care full full system, I don't, in my opinion, based on what I understand, you wouldn't necessarily get away with even ACOs. You start gonna have shared savings per because ultimately, but in value based care, you're gonna have, you know, different pilots or different innovation type projects related to orthopedics, for example, you know, for example, which oftentimes has been one that a lot of familiar with, because if we can if we can do a really good job to take care of a patient, do a surgery, get them home, get them into rehab, keep them home, not have them readmitted, then we're getting to shared services, but our shared savings, but we're also getting to value based care, in that model. Right? So in many ways, it's it's all combined, and I would also add population health, certainly an important piece to that. ACOs play an important role in population I would also add, you know, really advancing health equity. You know, I I would never want anyone to look at and say like an ACO or shared savings as not part of value based care. They are really a part of the full spectrum a value based care. When I think of what value based care could mean or what it could be long term in its ideal form, if I'm a physician and it gets to that ideal state, you could argue would empower me to provide the kind of care that I got into health care to provide, you know, this holistic vision, providing the best level of care to the patient community, which is intriguing. It's inspiring. But we've already talked about the risks. And what might be holding some of them, you know, some of us back. Let's talk about the the impact of the patient too. If we're working in a value based care world, it makes it even more important for the patient to know, which providers are performing at a higher level. Because it takes a lot of takes a lot of work on that provider, a lot of collaboration to provide that value based care, that type of care we're all hoping for. There's gotta be some innovation there. There's gotta be some improvements there to get the patient educated enough to make the right decisions on where they go and and how they go about care journey. That goes into the consumerism topic. What have you seen in that space that might, you know, might inspire you that, you know, this is possible. And we can't empower the patients to be really engaged in informed and educated on the kind of services that are available. Well, I mean, we've definitely seen a push. Right? I mean, you look at, you know, and, obviously, there's a big debate. There's a lot of frustration in the health care world on you know, the the work of health grades, the work of leapfrog, the work of of all these different consumer based ways of measuring care, measuring performance is an important step towards. And and again, there's there's always gonna be debate on rankings. But when you really think about it, in our society, at least in the United States, we have more access to research understand all the aspects of purchasing a car as a consumer than we do a provider or a hospital or health system, and we don't make it easy. And so I think as a whole, CMS and others have made some really, really important strides for this. I mean, hospital compare certainly is an important step to understand readmissions and understand quality, you know, and then you have health care agent. You got leap frog and, you know, kind of third party approaches to this. Ultimately, we've got to improve in these areas, and we've gotta be more transparent. In our system of health care, today, there's this idea in many cases that the bigger health system is the more superior the care will be. But the irony is that if you actually compare it, that's not always the case. Sometimes our smaller hospitals, our smaller healthcare systems, who are really making value and impact more of a priority have higher have a higher quality. In fact, you know, I had I had the privilege of of running into a chief medical executive that I worked with today, here at health that I worked with for a decade, and we were reminiscent about the fact that our little regional community healthcare system had higher quality, had higher patient and staff engagement scores, then the system that acquired us still to this day. And unfortunately, our system scores have plummeted under this And, you know, we were just reminiscing on that, and and I asked him, I said, you know, as we were talking, I said, what's the difference? What, what changed? And he said, the focus is not there in the same way that we had it. And so, you know, when I think about it for the patient, a patient today expects that things are gonna be managed. The whole person care is going to be And this is why, we're seeing disruptors. This is why we're seeing startups, and this is why we're gonna continue to see it because the current traditional model of health care is not managing a whole person care. And we're not managing it with our patient's needs in mind. And we're really managing it still with our provider's needs in mind. And I'm not speaking about our docs and and our nurse practitioners. We're I'm really talking about the system. And so I don't know how how far we have to go until we really realize this from a systemic level, but it's it's time we've gotta change. And I think the disruptors are gonna force Yeah. And I think the disruptors are are starting to focus a lot more on, you know, you talked about health equity. A version of that is health literacy because you can go to them with the you can go to the with the information. But this isn't buying a car or buying a plane ticket. It's highly clinical information and data. And there's different levels of literacy when it comes to understanding that that kind of information. What I've seen recently and through some of the conversations that, you know, we we're having is the understanding that we've gotta bridge the gap and get not only our patients access to care, but we have to help them understand what some of this means because the literacy is at all different ends of the spectrum. And to your point on that, right? You know, I attended a session today. Two two different sessions. One that was actually, I mean, you were there too with YouTube. Right? And I also attended another one with LinkedIn, which was all about, you know, how can you use your voice and your expertise to impact the audience? The reality of it is is if you look at medicine, if you look at healthcare, there's a lot of work occurring in that space. I mean, if you think about just just the sheer fact of physicians, so many physicians are turning to a YouTube or turning to other sources to share information and irony about that is that even even physicians using TikTok, I mean, Doctor. Austin Chang shared an example, where, you know, he shared you know, an elect a new elective procedure in endoscopy and a TikTok video that ultimately then patients from that video went and actually sought out doctors have that elective procedure done in those doctors and called him and said, oh, Doctor. Chang, they said you refer us. And so, you know, things have changed. Yep. I think, you know, from from that perspective alone, not something we would have ever thought would be the case. Right. So, you know, I think we just have to be prepared for it. Yeah. I think, you know, influencers like the ones you mentioned that are creating, delivering this education through new forms of media, powerful. Just in my own experience, AI is gonna be a big part of this too because what do I I used to I used to Google everything didn't understand. Now I chat GPT, everything I don't understand. And I've got a, you know, a prompt that I just copy and paste. Explain this to me. Like, I'm a fifth grader in West Texas. It does a pretty good job. And I'm starting I'm starting to reverse engineer some of these new innovations, new technologies, but also new types of treatment and and all different types of therapies because AI is bridging that gap for me and improving my health literacy even though I've been in this industry for twelve years. And it and it that's it. That opportunity is there for everybody now. And I think to your point, which critical as you gotta harness it. Right? Yeah. If you think about what Chat GPT and artificial intelligence can represent. It can it can be a great way for to, help with efficiencies. It can also be a great way to help our staff take away tasks that take away the time that they need to be with patients. There's so much encouraging signs from those end This is not about replacing positions, but this is really about how do we how do we create more technology or or more technological solutions that ultimately can help our and help our providers and our clinicians. And so I was at another session earlier where they talked about that. And and I think from a workforce perspective, which is a number one issue at every healthcare system today. Work Hey, man. Probably a number one issue at a debit, probably a number one issue at every aligned provider, maybe other than maybe a virtual care type of offering. You've got to be thinking we do to augment challenging, you know, aspects within the workplace that make it harder for our team to do their job. That's what our focus has to be. That's day two in a nutshell. I can't wait for day three. Yeah. Me too. It's exciting. Don't party too hard tonight because you got a long day tomorrow. Yeah. I don't party. I'm an angel. There's no party in at health. Right? That's right. That's right. Not even in Vegas. Thanks, Jeffrey. Thank you. Appreciate it.