September 4, 2024 • 31 mins
In this revisited episode, we are joined by Sean Cavanaugh, CCO / CPO Aledade. Previously he served as Deputy Administrator and Director of the Center for Medicare @ CMS. You’ll hear his viewpoint related to today’s independent primary care physician, the impact of Value Based Care (VBC), and how Aledade supports their practices for success in their ACO.
Sean can be found:
LinkedIn
Twitter @dc_cavanaugh
Learn more about Aledade:
Website
Twitter @AledadeACO
The transcript of our conversation can be found on our website.
Credits
Production Assistance & Editing: Nyla Wiebe
Scripting by: Aaron C Higgins
Show Notes & Transcription: Aaron C Higgins
Social Media Management: Jeremy Miller & Nyla Wiebe
News Co-Hosts: Aaron C Higgins & Jason Crosby
Interview co-hosts: Mike Scribner & John Crew
Show Producers: Mike Scribner & John Crew
Visit our website
Like us on Facebook
Tweet @ us on Twitter
Follow on Linkedin
Send an email contact@shpllc.com
Production © Strategic Healthcare Partners, LLC.
All rights reserved.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Aaron Higgins (00:03):
As we gear up for the exciting Season 5 of Beyond
the Stethoscope VitalConversations with SHP, we're
taking a moment to revisit someof our most impactful episodes.
This one from Season 1.
In this replay, we dive deepinto the world of value-based
care with Sean Cavanaugh, theChief Policy and Chief
Commercial Officer for Adelaideand Chief Commercial Officer for
(00:25):
Adelaide.
John Crew and Mike Scribner satdown and they shared valuable
insights with Sean from his timeat CMS and discussed how
Adelaide is empoweringindependent physicians to thrive
in the evolving healthcarelandscape.
So, whether you're curiousabout the future of primary care
, the role of data and improvingpatient outcomes, or the
transition to value-based care,this conversation is as relevant
(00:47):
today as it was when we firstaired it.
Don't miss this chance to catchup on a critical discussion that
sets the stage for what's tocome in healthcare.
Tune in and get ready for morevital conversations when we
return with season five.
Oh, and before we go, don'tforget to rate and like the show
in your favorite podcast app.
It really helps us reach morelisteners.
(01:08):
Let's listen to this vitalconversation.
Jason Crosby (01:18):
Hey everyone, Welcome to Beyond the
Stethoscope Vital Conversationswith SHP.
I'm Jason Crosby of StrategicHealthcare Partners, alongside
our principals Mike Scrinder andJohn Crew, your hosts for
today's episode.
Today, our guest is SeanCavanaugh, Chief Policy Officer
and Chief Commercial Officer forAllidade, who, for the last
several years, have provided thetechnology and services to
(01:40):
independent physicians as partof their successful ACO ventures
.
Previously, he served as theDeputy Administrator and
Director of the Center forMedicare at CMS.
Sean, thanks for joining ustoday and welcome to the podcast
.
Sean Cavanaugh (01:54):
Thanks for having me, guys.
Jason Crosby (01:55):
So with that we'll jump right into the
conversation.
We'll start off with John first.
John Crew (01:59):
Thanks.
This is John, sean.
We appreciate you being with ustoday.
The question I have first isand I think, as Georgia
experienced, as well asnationally, we're seeing primary
care diminished, independentprimary care physicians
diminished.
We're seeing more and more ofthe young residents coming out
or preferring the employmentmodel.
When you look long-term atvalue-based care models, do you
(02:23):
see a direct line where youwould be working eventually with
employed physicians in thesemodels?
Sean Cavanaugh (02:30):
Yeah, I think anybody who's committed to
improving health care, whichmeans doing what's right for the
patient, working within abusiness model where you get
rewarded for preventinghospitalization rather than
doing a hospitalization, I thinkwe'd be willing to work with
them and I think anybody shouldbe willing to work with them.
As you correctly point out, youknow, in my current position
(02:53):
with Allidade, we've very muchfocused on the independent
primary care doc and that'sbecause of alignment.
We think they're already therein their mindset.
They're fully aligned withvalue-based care and doing the
right thing by the patient.
I think and you've probablyexperienced this for hospitals I
have a lot of sympathy forhospitals.
They're in a difficult positionas the world transitions to
(03:15):
value-based care.
If we're really going to reducehospitalizations, how do they
change their business model?
It's not as simple as it is forindependent physicians, but in
the long run I think they'regoing to get there and I think
we'll be happy to work with themand not just us.
We're not the only value-basedcompany out there.
Some already work withhospitals with some success.
(03:36):
If this movement to value-basedcare is going to work, it's
going to have to includeeverybody.
Mike Scribner (03:49):
Allidade's starting with the independent
primary care position, becausewe think there's where you get
the best alignment.
Initially, sean, when you thinkabout the independent primary
care that most interestsAllidade, what are the
characteristics of them thatkind of lead you to believe that
they're going to be mostsuccessful with VBC in the first
place?
Sean Cavanaugh (04:01):
Mike, thanks for that question.
We get that question often frominsurers as well.
Like are you guys, you know,going in and finding the elite
high-performing primary carepractices and forming like a
specialized, high-value network?
And we're?
No, you know, we're not takingjust the high performers.
One thing we look for is somebasics.
People need to be on anelectronic health record, which
(04:24):
most people are, but noteverybody.
They need to have a pretty goodtrack record as far as program
integrity.
You know, not prescribing tonsof opioids, but those are fairly
low bars, hopefully.
Beyond that, what we're lookingfor is, you know, practices
that are tied to their community, that know their patients tied
(04:45):
to their community, that knowtheir patients, that are looking
for a better way to delivercare and are willing to consider
the use.
You know our tools.
You know, as you know, weprovide some data and analytics
and some workflow tools to thepractices.
What we find is, if they givethe tools a chance, they love
them and then it doesn't takeany coaching to get them to use
them.
But that's what we're lookingfor someone who's willing to try
something a little bitdifferent and, you know, do the
(05:07):
right work for their patients.
And what we find is typicallywith independent practices.
They feel like they're doingthat already, and so we're
enhancing their ability to do it.
Mike Scribner (05:17):
Can you talk a little bit more about the kind
of tools that y'all do provideand the things that enhance the
practice's ability to besuccessful?
Sean Cavanaugh (05:27):
Sure, what I usually say is it boils down to
two buckets.
One is who's not in yourpractice.
That should be in your practicetoday, right, rather than
sitting and waiting for someoneto come in.
We're going to give you dataabout your whole population, but
not just dump a bunch of dataon you.
We're going to show you veryabout your whole population, but
not just dump a bunch of dataon you.
We're going to show you veryspecifically who just got
(05:48):
discharged from the hospital.
Yesterday that you should bereaching out to today.
There's all sorts of evidencethat patients that get
discharged from the hospital ifthey see their primary care
physician within a couple ofdays much lower readmission
rates, better for the patient,better for Medicare, better for
the practice.
Better for the patient, betterfor Medicare, better for the
practice, in fact.
(06:10):
I'll tell you a little story, atrue story.
From you heard at the outsetthat I used to work at CMS.
When I was at CMS, there werestudies coming out showing just
that transitional care works.
Patient gets discharged fromhospital.
Some see their PCP they dobetter than those who don't.
So we created a new billingcode in Medicare called
transitional care managementthat specifically pays for
practices to see those patientsand pays pretty well, I think,
(06:32):
compared to some other visits.
And we waited two years and welooked at the data and no one
was using the code.
So you know, the greatest planscoming to failure.
So I went around to thephysician groups and I asked
them why isn't anybody using thecode?
The first thing I heard fromyou know, the family physicians,
the internist was we don't knowwhen our patient's been
(06:54):
discharged from the hospital.
How are we supposed to do that?
So sometimes it's as simple asthat tapping into the local he
to hie, tapping into directly tothe hospitals and not just, you
know, creating a very simpleway for the practice to come in
and turn on their computer inthe morning, get a list of
patients who left the hospitalyesterday, their phone numbers
and a work list, call thesepeople, bring them in.
(07:16):
So, like I said, the first thingis giving you an understanding
of what's happening to thepatients who aren't in the
practice.
A lot of data analytics to showyou which ones really could use
some help if you reached out tothem.
The second bucket is we knowwho's coming into your practice
today and who's in a value-basedcontract.
What's the most important thingfor you to know about these
(07:36):
patients.
What are the quality gaps theyhaven't had filled?
What hospitalizations have theyhad recently?
What specialists are theyseeing?
How many times that the PCPknew you were seeing three
cardiologists?
He or she couldn't do somethingabout that.
So we give this 360-degree viewto PCPs.
We let them do what they dobest, which is provide great
(07:57):
primary care.
We don't, you know, interferewith how they practice medicine.
They know what's best, butwe're making sure they're seeing
the right patients at the righttime.
John Crew (08:07):
John, to that effect, data to be actionable, data
needs to be as current as it can.
Can you share a little bitabout how you receive data and
then how you disseminate thatback to practices as real-time
as possible?
Sean Cavanaugh (08:23):
Yeah, john, you're exactly right.
You know, the ability to taketimely action is only as good as
the datatime as possible.
Yeah, john, you're exactlyright, the ability to take
timely action is only as good asthe data you've got.
First of all, the tool we givepractices and we literally give
it to them, called the Allidateapp.
It ingests data from numeroussources.
So, first of all, we get claimsdata from the payers we have
(08:43):
partnerships with, and sometimesthat's Medicare, sometimes it's
, you know, a commercial insurer.
We get notifications, as I said, of admissions and discharges
and transfers from the local HIEor directly from hospitals.
We get lab results from themajor lab companies, just
massive, you know, script part Dresults on drug utilization.
(09:06):
Massive amounts of data.
But, as you said, what we'reconstantly fighting is the
battle to get it faster and moreaccurate, because finding
something out you know claimsdata can be two months lagged.
Ironically, one of the thingswe found and I'm a little bit
proud of this, having come outof CMS is the data we get the
(09:27):
fastest from a payer on a claimsdata tends to come from
Medicare itself.
And we've been talking to thebig insurers United, aetna and
those guys and saying come on,guys, you got to be able to beat
the government right, and thething is they have these huge
legacy systems that they're allworking to upgrade.
(09:48):
But what we try to convincethem is it's in your interest
too.
The sooner these doctors knowwhat's going on with the
patients, the better the careyour members will get.
But we do have at times, youknow, we can only be as fast as
the payer partners.
Mike Scribner (10:05):
You know we can only be as fast as the payer
partners, but we try to get astimely data as possible.
Sean, as the ACOs you know havematured that you guys operate,
has it been more difficult towhen you get past the
low-hanging fruit?
Is it a little bit tougher toplow the ground to continue to
have success, or does it catch aflow that just continues to
(10:26):
improve?
Sean Cavanaugh (10:29):
Yeah, that's a very fair question.
If we're only gettinglow-hanging fruit.
There's more low-hanging fruitthan I thought because we're
still improving Even ourearliest ACOs, which started in
2015,.
They're still gettingincremental improvements.
They're getting—I think part ofwhat you see is it takes time
Like anybody who's thinking thatyou know this will turn around
(10:51):
and a dime is wrong when we look.
We did a study and we've updatedit several times.
We looked at five differentACOs.
We started in five verydifferent states across the
country back in 2016.
And we followed them every yearsince then.
And this is a study.
This is not using CMS data.
Then, and this is a study, thisis not using CMS data.
(11:13):
This is us using all Medicareclaims data, matching those
people against similarbeneficiaries in their community
, and we see consistently everyyear the same result and
continuing to grow, which ispeople in an Allidate ACO get
more primary care.
So I think we're up to in thefifth year.
Fourth year, it's 35% more thansimilar beneficiaries in the
(11:34):
community 35% more primary care,and what that leads to is about
14% fewer ED visits, about 15%fewer inpatient visits.
We haven't plateaued yet.
It is plausible, but that's whyone of the things we're thinking
about is like what's the secondengine?
Like, how do we expand theability of these practices to do
(11:56):
more?
You know, physicians and theirstaff only have so much time in
the day.
Are there services we canaugment to help them?
So until today, allidade hasalways focused our services on
the practice.
What can we do for the practice?
We've now created a subsidiarycalled Allidade Care Solutions,
which will be patient-focused.
What can we do directly for thepatient?
(12:20):
But this is where there's animportant distinction between us
and Optum and some others.
We're going to do it inpartnership with the practice.
The practice will get to decidewhen the Allidade services are
used, who they're used for, andany data we collect about
patients by servicing themdirectly will go directly back
to the PCP, because we thinkthat's key Keep the PCP in the
(12:40):
driver's seat.
So, to go back to your question, mike, yeah, there's probably
low-hanging fruit out there, butthere's a lot of it.
We're still working on that andas we do, the problem with the
phrase low-hanging fruit youforget.
These are patients.
They're getting better care.
They're going to the hospitalless.
So that's important.
But we think, with adding someservices and helping the
(13:02):
practices directly with patients, we'll be able to move beyond
that too.
John Crew (13:08):
Sean, when you have markets that aren't as
sophisticated as other in termsof the growth of value-based
care and you come into it,there's this perception right,
wrong or indifferent byproviders that this is going to
change my workflows within mypractice.
It's going to be more timeconsuming, I'm going to have to
hire more people, and so I mayor may not see a return.
(13:29):
I'm sure you've been exposed tothat.
How do you deal with that asyou first come in and work with
providers to introduce them tothe value-based model?
Sean Cavanaugh (13:39):
First of all, we tell them we have no interest
in blowing up your practice andmaking your life miserable.
We're going to take youstepwise through this.
We're going to take you throughdifferent steps you can do
incrementally.
We're not going to throw thewhole playbook at you on day one
.
So things will change because,let's be honest, rather than
churning patients through thepractice, like when you need to
(14:01):
make more money right now, yourincentive is to see more
patients for a shorter period oftime, to see the less difficult
patients.
Over time, not on day one yourbusiness model is going to
change, where you're going towant to focus on the harder
patients, you're going to wantto refer out less when you're
capable of treating them.
But that'll happen graduallyover time.
(14:23):
The other thing we tell them isthere's some things that help
you along the way.
Our practice is when we havethem doing more transitional
care visits, more annualwellness visits, they see their
Medicare fee-for-service revenuegoing up day one.
So what we call goodfee-for-service Like if you're
doing these good preventiveservices, you can see practice
revenue going up 10%, 15% beforeyou get a shared savings check.
(14:47):
So there is a transition herethat we can work with practices.
I know you guys have done thesame.
It's not turning things on adime and it's not like seeing a
drop in revenue while you waitfor a shared savings check.
There's a pretty good pathwayhere role of the specialist in
(15:13):
that.
Mike Scribner (15:13):
I get that it's very primary care based and very
cornerstone in that world.
But what is an effectiverelationship with various
specialists look like?
Sean Cavanaugh (15:20):
Yeah, that's a great question.
One of the things I want to sayis I think the whole country's
grappling with that question Iknow CMS is.
Cms has been struggling to comeup with a specialist strategy
and you know they're continuingto talk to people.
What we found that works bestis, you know, especially in
smaller communities wherethere's not just a professional
(15:42):
but often a personalrelationship between the PCP and
a specialist, is to sit downand have communication about
expectations.
So you know in some of ourcommunities that literally we
invite the specialists in and weexplain we're doing an ACO,
here's why we're doing it,here's what our goals are, you
know, and the goals of the ACOare really good for the patient
(16:04):
and so when the specialists seethat they understand like they
want what's good for thepatients too.
But what we find is PCPs oftengo into this conversation
thinking they're going tolecture specialists.
But if you're a neutral partyin these conversations, you hear
the specialists having verygood demands of the PCPs too.
When you send me a patient, bevery specific about what you
(16:26):
want.
How many specialists get apatient walking in who said Dr
So-and-so sent me why, I don'tknow.
He just told me to come see you.
So improving the communicationsand understanding what the
expectations are.
I'm sending you to thespecialist for this very
specific purpose.
I want to hear back what theresults are.
I want the you know, anunderstanding of who's going to
(16:48):
manage that patient.
If this is cardi, you know.
If you're referring to acardiologist is.
Am I turning over management ofthis problem to the
cardiologist or do I just need asecond opinion on something?
When we've seen these two-waycommunication, we've seen some
bonds form that are reallyfantastic, where the specialist
now becomes a preferredspecialist because they're seen
(17:10):
as a partner and their businessdoes better.
But I'm going to be frank withyou.
This is not true everywhere.
I think sometimes there's adistrust is too strong a word,
but misunderstanding what thepurpose of the ACO is.
The other thing is and this iswhere we're all trying to get
better is it's really hard toknow who's a true high-value
(17:33):
specialist.
So the other thing is beingtransparent about the data.
Here's what you know, allidadewe provide our doctors data on
specialists.
You know outcomes, cost, but weencourage them to have a
discussion with the specialistabout it, and the typical PCP
doesn't want to change theirspecialist like meaning switch.
They want their specialist tobe the most efficient and the
(17:56):
highest quality.
So I guess if I used one wordinstead of rambling on, I would
have said communication, likethe communication between the
specialist and the PCP, is socritical, and it's hard because
everybody's so busy taking astep back and talking about what
are we trying to accomplishhere together.
It's hard.
Mike Scribner (18:14):
Where do you see the specialists being involved?
Like where two part question.
Where do you see CMS going interms of coming up with value
based incentives for them?
And then what?
Where is Allidade placed?
Is there any sort of financialmodel around that within y'all's
ACOs?
Sean Cavanaugh (18:34):
Yeah, so I'll answer Allidade first, then CMS.
At Allidade we're experimenting.
We have such a broad networknow, you know, in 40 some states
.
Before we roll anything out toall of our practices, we test it
in some markets.
So we're testing a coupledifferent specialist approaches.
One is you know there are somecompanies that have started up
(18:55):
that will give you real-timeconsults, you know, by phone or
technology.
That's one pathway.
Another pathway is literallytrying to create, trying to
profile specialists in yourcommunity and create a preferred
list of those who are signingcompacts to work with the ACO,
who are shown as high value.
(19:15):
But it's hard work and so wedon't have one single product.
We're rolling out across thecountry, we're collaborating
with doctors locally trying tosee what works, and I think
we're a small part of what CMSis going through.
So I'll tell you, when I was atCMS we got requests from all
different specialty societieswho all wanted a value-based
(19:37):
model for themselves.
So the orthopedists had someideas, and the cardiologists and
the nephrologists, and I thinkwhat CMS quickly learned is it
doesn't have the capacity tocreate new models for every
specialty.
It doesn't have the capacity tocreate new models for every
specialty.
It has had its bundled paymentfor care improvement, which are
(20:01):
certain hospitalization andpost-acute care bundles that are
typically specialist-oriented.
But that's been a mixed bag.
I have seen them out in thecommunity.
This is CMS folks talking tothe specialists, talking to the
ACOs, trying to find a pathforward.
I do think they're looking forsome model where you could embed
a bundled specialist modelwithin an ACO.
What gets really hard there ispricing it accurately.
(20:25):
A number of specialist modelsthat CMS has tried have had
either overly generous prices orthe price has been too low, and
so you've seen results all overthe map.
But I think that's what you'regoing to see is them trying to
embed some sort of specialistbundles as an option or maybe
(20:45):
mandatory, within ACOs.
I don't know, but that seems tobe where they're headed.
John Crew (20:53):
Sean, in your response I caught something that
I want to ask you about.
In your pilot programs youmentioned or at least I thought
that you mentioned a model thatmaybe you're looking at
telemedicine as part of thatdownstream, in terms of
specialists consults, things ofthat nature.
Did I understand that correctly, or is that something that?
Do you see telemedicine playinga role in your models?
Sean Cavanaugh (21:19):
Yes, I think certainly telemedicine has a
role, whether it's extendingprimary care or improving
communication between primaryand specialty care.
The specific test that I wasreferring to is this group that
is willing to.
So if you're a PCP and you havea question about a patient's
cardiac condition, you can get aspecialist consult like within
(21:44):
10 minutes, and what the resultswe've seen from that are
two-thirds of the time what thespecialist is telling the PCP is
what you were planning to domakes sense.
So it's just reaffirming theinstincts of the PCP, but giving
them some comfort.
And then there's a subset wherethey steer them a different way
, like escalating the care orsaying this person does not have
(22:06):
you know, you don't need torefer them to a specialist.
Obviously, that's one level ofsupport you can give to PCPs.
It's not a solution to how do weintegrate specialty care and
primary care better, but itcould be an interesting piece of
it.
And what we found in this testjust because you asked is there
are multiple versions of this.
The one our PCPs liked the mostwas the one where they got
(22:28):
immediate feedback, meaning theydidn't send the patient home
and wait 36 hours to get somefeedback from a specialist.
And that's hard to do, but itseems to be essential to get
that feedback while thepatient's still there and they
can change what they're going todo while the patient's still in
the office.
But we have a lot more to learnhere.
I don't want to suggest wesolve this puzzle here.
Mike Scribner (22:54):
I don't want to suggest we solve this puzzle,
shown as as y'all have, you knowsuch the breath that you do.
Obviously we deal withpractices that are both urban
and rural based.
What differences have y'allseen in the operations of your
ACOs, rule versus urban, andwhat?
What allowances have you had tomake for that?
Sean Cavanaugh (23:10):
Yeah, well, as I said, so one of the differences
is the options for specialists,options for facility partners.
You know, in a rural communityyou know the options can be less
.
The upside is there may be apersonal relationship there, so
you might be easier tocommunicate with the specialist
(23:30):
and have that sit down in thetalk with the specialist.
And have that sit down in thetalk.
We love the rural communitiesand we tend to operate more in
rural communities than a lot ofACOs, and that's because we work
with independent practices andwhen you get into the major
metropolitan areas what you seeis heavy consolidation where the
practices have been bought upby the big health systems.
(23:51):
So that's one of thedifferences we see.
For us, in the near term, theopportunity to work in some of
the major metro areas is limited.
Going back to your firstquestion, though, I don't think
that's a permanent condition.
I think everybody's going to bepivoting to value at some point
and we will be working withpeople you know, employed
(24:11):
physicians, health systems inthe larger urban areas.
Mike Scribner (24:21):
I hope that answers your question.
It does.
It does kind of bring me fullcircle back to a question John
asked way back at the beginning.
Do you see value-based care andthe financial incentives of
that being so great as to shiftthat move toward employment in
the first place to whereindependence is so much more
financially attractive in thefuture that it just shifts that
(24:41):
tide in general?
Sean Cavanaugh (24:42):
Yes, I do see that We've seen small aspects of
it.
So think of the world threeways.
You've got truly independentPCPs, you've got independent
PCPs who've joined a hospitalCIN and you've got people who've
sold their practice to thehospital.
Those people face threedifferent landscapes.
(25:03):
We work with the first two.
Quite a few of the physicianswe've recruited in the last two
recruiting cycles are physicianswho were in that middle group.
They've been independent butthey've been working through the
hospital CIN.
So certainly we're seeing thatshift where hospitals are losing
some of their CIN physiciansbecause and again I hope this is
(25:26):
temporary they don't feel theyhave the clinical independence
or the voice in that CIN thatthey would have working with
Allidate or other independentgroups that are truly
physician-led.
I think you've seen a smaller toa much smaller degree, the more
extreme which is in the thirdgroup, employed physicians, the
ones who went either sold theirpractices or went straight out
(25:49):
of training into hospitalemployment.
But I don't think that meansthey're happy into hospital
employment.
But I don't think that meansthey're happy.
We've talked to enough of themand we think there's an
opportunity and we're exploringthis If those physicians saw
like a turnkey solution wherethey could come out of hospital
employment.
What they don't want to do islook for real estate, have to
(26:10):
buy an EHR.
They want to practice medicineright?
Imagine a world where theycould walk into an office
tomorrow, they could have inplace an EHR, staffing and, more
important, value-basedcontracts for their patients and
they could build up a practicefrom a value orientation from
the beginning and they could payfor all that stuff that they
(26:30):
were given through future sharedsavings.
I think if someone and you know, be frank, this is something
Allidade's kicked around Ifsomeone developed a model like
that, I do think you'd see thatthird group of employed
physicians start to move out,because I think they went into
employment for legitimatereasons, but I think they missed
their clinical autonomy and theability to do the right thing,
(26:53):
their clinical autonomy and theability to do the right thing.
John Crew (26:55):
Sean, I have a question.
In relationships specificallyto the MSSP and the successor
models, we are seeing at leastwith our client base we're
seeing a significant shift ofthe traditional red, white and
blue moving to MA.
So we're seeing a decline inthe traditional model and a
significant increase in the MALong term.
(27:17):
Do you see there beingcontinued long term success for
models that are associatedstrictly with the red, white and
blue?
Sean Cavanaugh (27:34):
if you want to be successful in senior care
specifically, you're going tohave to be able to do both.
You're going to have to be goodat MSSP, which is the ACO
program, but you're going tohave to learn how to work in MA
as well.
And I think some practicesdon't want to hear that and I
don't blame them.
The Medicare fee-for-servicepatient is their last patient
where the insurer's notrequiring prior auth and all
(27:55):
that.
But the world is just changing.
As you said, medicare itself isstill growing dramatically with
the aging of the baby boomers.
So senior care as a field isgrowing.
But, as you said, the partthat's growing is the MA
enrollment Seniors choosing toremain in what I call
traditional Medicare, somepeople call fee-for-service.
(28:16):
They're actually decliningsomewhat in an absolute sense.
So even as the program as awhole grows, an absolute number
of people in traditionalMedicare is going down.
So we've talked in our practicequite a bit at this.
If you're going to be reallygood at senior care, you're
going to have to learn how to doMA and at a clinical level it's
(28:37):
very similar, right?
It's the same patients.
It's more the STARS measuresgetting good at that and getting
good at complete and accuratediagnoses, which is the risk
adjustment part of MA and, asyou know, that's where a lot of
people trip up.
There's some who get temptedand do fraudulent things.
We're very careful to tell ourdoctors we're going to do this
(28:58):
the right way, you know, and andwe're coaching them on how to
do that today You've beenlistening to Beyond the
(29:18):
Stethoscope vital conversationswith shp.
Aaron Higgins (29:19):
This has been a production of strategic health
care partners, your news hosttoday for jason crosby and me,
aaron higgins.
It is produced and edited bynyla weave.
Our social media contentproducers are nyla weave and
jeremy miller, and our executiveproducers are mike scrivener
and john crew.
Thanks for listening.
As we gear up for the exciting Season 5 of Beyond
the Stethoscope VitalConversations with SHP, we're
taking a moment to revisit someof our most impactful episodes.
This one from Season 1.
In this replay, we dive deepinto the world of value-based
care with Sean Cavanaugh, theChief Policy and Chief
Commercial Officer for Adelaideand Chief Commercial Officer for
(00:25):
Adelaide.
John Crew and Mike Scribner satdown and they shared valuable
insights with Sean from his timeat CMS and discussed how
Adelaide is empoweringindependent physicians to thrive
in the evolving healthcarelandscape.
So, whether you're curiousabout the future of primary care
, the role of data and improvingpatient outcomes, or the
transition to value-based care,this conversation is as relevant
(00:47):
today as it was when we firstaired it.
Don't miss this chance to catchup on a critical discussion that
sets the stage for what's tocome in healthcare.
Tune in and get ready for morevital conversations when we
return with season five.
Oh, and before we go, don'tforget to rate and like the show
in your favorite podcast app.
It really helps us reach morelisteners.
(01:08):
Let's listen to this vitalconversation.
Jason Crosby (01:18):
Hey everyone, Welcome to Beyond the
Stethoscope Vital Conversationswith SHP.
I'm Jason Crosby of StrategicHealthcare Partners, alongside
our principals Mike Scrinder andJohn Crew, your hosts for
today's episode.
Today, our guest is SeanCavanaugh, Chief Policy Officer
and Chief Commercial Officer forAllidade, who, for the last
several years, have provided thetechnology and services to
(01:40):
independent physicians as partof their successful ACO ventures
.
Previously, he served as theDeputy Administrator and
Director of the Center forMedicare at CMS.
Sean, thanks for joining ustoday and welcome to the podcast
.
Sean Cavanaugh (01:54):
Thanks for having me, guys.
Jason Crosby (01:55):
So with that we'll jump right into the
conversation.
We'll start off with John first.
John Crew (01:59):
Thanks.
This is John, sean.
We appreciate you being with ustoday.
The question I have first isand I think, as Georgia
experienced, as well asnationally, we're seeing primary
care diminished, independentprimary care physicians
diminished.
We're seeing more and more ofthe young residents coming out
or preferring the employmentmodel.
When you look long-term atvalue-based care models, do you
(02:23):
see a direct line where youwould be working eventually with
employed physicians in thesemodels?
Sean Cavanaugh (02:30):
Yeah, I think anybody who's committed to
improving health care, whichmeans doing what's right for the
patient, working within abusiness model where you get
rewarded for preventinghospitalization rather than
doing a hospitalization, I thinkwe'd be willing to work with
them and I think anybody shouldbe willing to work with them.
As you correctly point out, youknow, in my current position
(02:53):
with Allidade, we've very muchfocused on the independent
primary care doc and that'sbecause of alignment.
We think they're already therein their mindset.
They're fully aligned withvalue-based care and doing the
right thing by the patient.
I think and you've probablyexperienced this for hospitals I
have a lot of sympathy forhospitals.
They're in a difficult positionas the world transitions to
(03:15):
value-based care.
If we're really going to reducehospitalizations, how do they
change their business model?
It's not as simple as it is forindependent physicians, but in
the long run I think they'regoing to get there and I think
we'll be happy to work with themand not just us.
We're not the only value-basedcompany out there.
Some already work withhospitals with some success.
(03:36):
If this movement to value-basedcare is going to work, it's
going to have to includeeverybody.
Mike Scribner (03:49):
Allidade's starting with the independent
primary care position, becausewe think there's where you get
the best alignment.
Initially, sean, when you thinkabout the independent primary
care that most interestsAllidade, what are the
characteristics of them thatkind of lead you to believe that
they're going to be mostsuccessful with VBC in the first
place?
Sean Cavanaugh (04:01):
Mike, thanks for that question.
We get that question often frominsurers as well.
Like are you guys, you know,going in and finding the elite
high-performing primary carepractices and forming like a
specialized, high-value network?
And we're?
No, you know, we're not takingjust the high performers.
One thing we look for is somebasics.
People need to be on anelectronic health record, which
(04:24):
most people are, but noteverybody.
They need to have a pretty goodtrack record as far as program
integrity.
You know, not prescribing tonsof opioids, but those are fairly
low bars, hopefully.
Beyond that, what we're lookingfor is, you know, practices
that are tied to their community, that know their patients tied
(04:45):
to their community, that knowtheir patients, that are looking
for a better way to delivercare and are willing to consider
the use.
You know our tools.
You know, as you know, weprovide some data and analytics
and some workflow tools to thepractices.
What we find is, if they givethe tools a chance, they love
them and then it doesn't takeany coaching to get them to use
them.
But that's what we're lookingfor someone who's willing to try
something a little bitdifferent and, you know, do the
(05:07):
right work for their patients.
And what we find is typicallywith independent practices.
They feel like they're doingthat already, and so we're
enhancing their ability to do it.
Mike Scribner (05:17):
Can you talk a little bit more about the kind
of tools that y'all do provideand the things that enhance the
practice's ability to besuccessful?
Sean Cavanaugh (05:27):
Sure, what I usually say is it boils down to
two buckets.
One is who's not in yourpractice.
That should be in your practicetoday, right, rather than
sitting and waiting for someoneto come in.
We're going to give you dataabout your whole population, but
not just dump a bunch of dataon you.
We're going to show you veryabout your whole population, but
not just dump a bunch of dataon you.
We're going to show you veryspecifically who just got
(05:48):
discharged from the hospital.
Yesterday that you should bereaching out to today.
There's all sorts of evidencethat patients that get
discharged from the hospital ifthey see their primary care
physician within a couple ofdays much lower readmission
rates, better for the patient,better for Medicare, better for
the practice.
Better for the patient, betterfor Medicare, better for the
practice, in fact.
(06:10):
I'll tell you a little story, atrue story.
From you heard at the outsetthat I used to work at CMS.
When I was at CMS, there werestudies coming out showing just
that transitional care works.
Patient gets discharged fromhospital.
Some see their PCP they dobetter than those who don't.
So we created a new billingcode in Medicare called
transitional care managementthat specifically pays for
practices to see those patientsand pays pretty well, I think,
(06:32):
compared to some other visits.
And we waited two years and welooked at the data and no one
was using the code.
So you know, the greatest planscoming to failure.
So I went around to thephysician groups and I asked
them why isn't anybody using thecode?
The first thing I heard fromyou know, the family physicians,
the internist was we don't knowwhen our patient's been
(06:54):
discharged from the hospital.
How are we supposed to do that?
So sometimes it's as simple asthat tapping into the local he
to hie, tapping into directly tothe hospitals and not just, you
know, creating a very simpleway for the practice to come in
and turn on their computer inthe morning, get a list of
patients who left the hospitalyesterday, their phone numbers
and a work list, call thesepeople, bring them in.
(07:16):
So, like I said, the first thingis giving you an understanding
of what's happening to thepatients who aren't in the
practice.
A lot of data analytics to showyou which ones really could use
some help if you reached out tothem.
The second bucket is we knowwho's coming into your practice
today and who's in a value-basedcontract.
What's the most important thingfor you to know about these
(07:36):
patients.
What are the quality gaps theyhaven't had filled?
What hospitalizations have theyhad recently?
What specialists are theyseeing?
How many times that the PCPknew you were seeing three
cardiologists?
He or she couldn't do somethingabout that.
So we give this 360-degree viewto PCPs.
We let them do what they dobest, which is provide great
(07:57):
primary care.
We don't, you know, interferewith how they practice medicine.
They know what's best, butwe're making sure they're seeing
the right patients at the righttime.
John Crew (08:07):
John, to that effect, data to be actionable, data
needs to be as current as it can.
Can you share a little bitabout how you receive data and
then how you disseminate thatback to practices as real-time
as possible?
Sean Cavanaugh (08:23):
Yeah, john, you're exactly right.
You know, the ability to taketimely action is only as good as
the datatime as possible.
Yeah, john, you're exactlyright, the ability to take
timely action is only as good asthe data you've got.
First of all, the tool we givepractices and we literally give
it to them, called the Allidateapp.
It ingests data from numeroussources.
So, first of all, we get claimsdata from the payers we have
(08:43):
partnerships with, and sometimesthat's Medicare, sometimes it's
, you know, a commercial insurer.
We get notifications, as I said, of admissions and discharges
and transfers from the local HIEor directly from hospitals.
We get lab results from themajor lab companies, just
massive, you know, script part Dresults on drug utilization.
(09:06):
Massive amounts of data.
But, as you said, what we'reconstantly fighting is the
battle to get it faster and moreaccurate, because finding
something out you know claimsdata can be two months lagged.
Ironically, one of the thingswe found and I'm a little bit
proud of this, having come outof CMS is the data we get the
(09:27):
fastest from a payer on a claimsdata tends to come from
Medicare itself.
And we've been talking to thebig insurers United, aetna and
those guys and saying come on,guys, you got to be able to beat
the government right, and thething is they have these huge
legacy systems that they're allworking to upgrade.
(09:48):
But what we try to convincethem is it's in your interest
too.
The sooner these doctors knowwhat's going on with the
patients, the better the careyour members will get.
But we do have at times, youknow, we can only be as fast as
the payer partners.
Mike Scribner (10:05):
You know we can only be as fast as the payer
partners, but we try to get astimely data as possible.
Sean, as the ACOs you know havematured that you guys operate,
has it been more difficult towhen you get past the
low-hanging fruit?
Is it a little bit tougher toplow the ground to continue to
have success, or does it catch aflow that just continues to
(10:26):
improve?
Sean Cavanaugh (10:29):
Yeah, that's a very fair question.
If we're only gettinglow-hanging fruit.
There's more low-hanging fruitthan I thought because we're
still improving Even ourearliest ACOs, which started in
2015,.
They're still gettingincremental improvements.
They're getting—I think part ofwhat you see is it takes time
Like anybody who's thinking thatyou know this will turn around
(10:51):
and a dime is wrong when we look.
We did a study and we've updatedit several times.
We looked at five differentACOs.
We started in five verydifferent states across the
country back in 2016.
And we followed them every yearsince then.
And this is a study.
This is not using CMS data.
Then, and this is a study, thisis not using CMS data.
(11:13):
This is us using all Medicareclaims data, matching those
people against similarbeneficiaries in their community
, and we see consistently everyyear the same result and
continuing to grow, which ispeople in an Allidate ACO get
more primary care.
So I think we're up to in thefifth year.
Fourth year, it's 35% more thansimilar beneficiaries in the
(11:34):
community 35% more primary care,and what that leads to is about
14% fewer ED visits, about 15%fewer inpatient visits.
We haven't plateaued yet.
It is plausible, but that's whyone of the things we're thinking
about is like what's the secondengine?
Like, how do we expand theability of these practices to do
(11:56):
more?
You know, physicians and theirstaff only have so much time in
the day.
Are there services we canaugment to help them?
So until today, allidade hasalways focused our services on
the practice.
What can we do for the practice?
We've now created a subsidiarycalled Allidade Care Solutions,
which will be patient-focused.
What can we do directly for thepatient?
(12:20):
But this is where there's animportant distinction between us
and Optum and some others.
We're going to do it inpartnership with the practice.
The practice will get to decidewhen the Allidade services are
used, who they're used for, andany data we collect about
patients by servicing themdirectly will go directly back
to the PCP, because we thinkthat's key Keep the PCP in the
(12:40):
driver's seat.
So, to go back to your question, mike, yeah, there's probably
low-hanging fruit out there, butthere's a lot of it.
We're still working on that andas we do, the problem with the
phrase low-hanging fruit youforget.
These are patients.
They're getting better care.
They're going to the hospitalless.
So that's important.
But we think, with adding someservices and helping the
(13:02):
practices directly with patients, we'll be able to move beyond
that too.
John Crew (13:08):
Sean, when you have markets that aren't as
sophisticated as other in termsof the growth of value-based
care and you come into it,there's this perception right,
wrong or indifferent byproviders that this is going to
change my workflows within mypractice.
It's going to be more timeconsuming, I'm going to have to
hire more people, and so I mayor may not see a return.
(13:29):
I'm sure you've been exposed tothat.
How do you deal with that asyou first come in and work with
providers to introduce them tothe value-based model?
Sean Cavanaugh (13:39):
First of all, we tell them we have no interest
in blowing up your practice andmaking your life miserable.
We're going to take youstepwise through this.
We're going to take you throughdifferent steps you can do
incrementally.
We're not going to throw thewhole playbook at you on day one
.
So things will change because,let's be honest, rather than
churning patients through thepractice, like when you need to
(14:01):
make more money right now, yourincentive is to see more
patients for a shorter period oftime, to see the less difficult
patients.
Over time, not on day one yourbusiness model is going to
change, where you're going towant to focus on the harder
patients, you're going to wantto refer out less when you're
capable of treating them.
But that'll happen graduallyover time.
(14:23):
The other thing we tell them isthere's some things that help
you along the way.
Our practice is when we havethem doing more transitional
care visits, more annualwellness visits, they see their
Medicare fee-for-service revenuegoing up day one.
So what we call goodfee-for-service Like if you're
doing these good preventiveservices, you can see practice
revenue going up 10%, 15% beforeyou get a shared savings check.
(14:47):
So there is a transition herethat we can work with practices.
I know you guys have done thesame.
It's not turning things on adime and it's not like seeing a
drop in revenue while you waitfor a shared savings check.
There's a pretty good pathwayhere role of the specialist in
(15:13):
that.
Mike Scribner (15:13):
I get that it's very primary care based and very
cornerstone in that world.
But what is an effectiverelationship with various
specialists look like?
Sean Cavanaugh (15:20):
Yeah, that's a great question.
One of the things I want to sayis I think the whole country's
grappling with that question Iknow CMS is.
Cms has been struggling to comeup with a specialist strategy
and you know they're continuingto talk to people.
What we found that works bestis, you know, especially in
smaller communities wherethere's not just a professional
(15:42):
but often a personalrelationship between the PCP and
a specialist, is to sit downand have communication about
expectations.
So you know in some of ourcommunities that literally we
invite the specialists in and weexplain we're doing an ACO,
here's why we're doing it,here's what our goals are, you
know, and the goals of the ACOare really good for the patient
(16:04):
and so when the specialists seethat they understand like they
want what's good for thepatients too.
But what we find is PCPs oftengo into this conversation
thinking they're going tolecture specialists.
But if you're a neutral partyin these conversations, you hear
the specialists having verygood demands of the PCPs too.
When you send me a patient, bevery specific about what you
(16:26):
want.
How many specialists get apatient walking in who said Dr
So-and-so sent me why, I don'tknow.
He just told me to come see you.
So improving the communicationsand understanding what the
expectations are.
I'm sending you to thespecialist for this very
specific purpose.
I want to hear back what theresults are.
I want the you know, anunderstanding of who's going to
(16:48):
manage that patient.
If this is cardi, you know.
If you're referring to acardiologist is.
Am I turning over management ofthis problem to the
cardiologist or do I just need asecond opinion on something?
When we've seen these two-waycommunication, we've seen some
bonds form that are reallyfantastic, where the specialist
now becomes a preferredspecialist because they're seen
(17:10):
as a partner and their businessdoes better.
But I'm going to be frank withyou.
This is not true everywhere.
I think sometimes there's adistrust is too strong a word,
but misunderstanding what thepurpose of the ACO is.
The other thing is and this iswhere we're all trying to get
better is it's really hard toknow who's a true high-value
(17:33):
specialist.
So the other thing is beingtransparent about the data.
Here's what you know, allidadewe provide our doctors data on
specialists.
You know outcomes, cost, but weencourage them to have a
discussion with the specialistabout it, and the typical PCP
doesn't want to change theirspecialist like meaning switch.
They want their specialist tobe the most efficient and the
(17:56):
highest quality.
So I guess if I used one wordinstead of rambling on, I would
have said communication, likethe communication between the
specialist and the PCP, is socritical, and it's hard because
everybody's so busy taking astep back and talking about what
are we trying to accomplishhere together.
It's hard.
Mike Scribner (18:14):
Where do you see the specialists being involved?
Like where two part question.
Where do you see CMS going interms of coming up with value
based incentives for them?
And then what?
Where is Allidade placed?
Is there any sort of financialmodel around that within y'all's
ACOs?
Sean Cavanaugh (18:34):
Yeah, so I'll answer Allidade first, then CMS.
At Allidade we're experimenting.
We have such a broad networknow, you know, in 40 some states
.
Before we roll anything out toall of our practices, we test it
in some markets.
So we're testing a coupledifferent specialist approaches.
One is you know there are somecompanies that have started up
(18:55):
that will give you real-timeconsults, you know, by phone or
technology.
That's one pathway.
Another pathway is literallytrying to create, trying to
profile specialists in yourcommunity and create a preferred
list of those who are signingcompacts to work with the ACO,
who are shown as high value.
(19:15):
But it's hard work and so wedon't have one single product.
We're rolling out across thecountry, we're collaborating
with doctors locally trying tosee what works, and I think
we're a small part of what CMSis going through.
So I'll tell you, when I was atCMS we got requests from all
different specialty societieswho all wanted a value-based
(19:37):
model for themselves.
So the orthopedists had someideas, and the cardiologists and
the nephrologists, and I thinkwhat CMS quickly learned is it
doesn't have the capacity tocreate new models for every
specialty.
It doesn't have the capacity tocreate new models for every
specialty.
It has had its bundled paymentfor care improvement, which are
(20:01):
certain hospitalization andpost-acute care bundles that are
typically specialist-oriented.
But that's been a mixed bag.
I have seen them out in thecommunity.
This is CMS folks talking tothe specialists, talking to the
ACOs, trying to find a pathforward.
I do think they're looking forsome model where you could embed
a bundled specialist modelwithin an ACO.
What gets really hard there ispricing it accurately.
(20:25):
A number of specialist modelsthat CMS has tried have had
either overly generous prices orthe price has been too low, and
so you've seen results all overthe map.
But I think that's what you'regoing to see is them trying to
embed some sort of specialistbundles as an option or maybe
(20:45):
mandatory, within ACOs.
I don't know, but that seems tobe where they're headed.
John Crew (20:53):
Sean, in your response I caught something that
I want to ask you about.
In your pilot programs youmentioned or at least I thought
that you mentioned a model thatmaybe you're looking at
telemedicine as part of thatdownstream, in terms of
specialists consults, things ofthat nature.
Did I understand that correctly, or is that something that?
Do you see telemedicine playinga role in your models?
Sean Cavanaugh (21:19):
Yes, I think certainly telemedicine has a
role, whether it's extendingprimary care or improving
communication between primaryand specialty care.
The specific test that I wasreferring to is this group that
is willing to.
So if you're a PCP and you havea question about a patient's
cardiac condition, you can get aspecialist consult like within
(21:44):
10 minutes, and what the resultswe've seen from that are
two-thirds of the time what thespecialist is telling the PCP is
what you were planning to domakes sense.
So it's just reaffirming theinstincts of the PCP, but giving
them some comfort.
And then there's a subset wherethey steer them a different way
, like escalating the care orsaying this person does not have
(22:06):
you know, you don't need torefer them to a specialist.
Obviously, that's one level ofsupport you can give to PCPs.
It's not a solution to how do weintegrate specialty care and
primary care better, but itcould be an interesting piece of
it.
And what we found in this testjust because you asked is there
are multiple versions of this.
The one our PCPs liked the mostwas the one where they got
(22:28):
immediate feedback, meaning theydidn't send the patient home
and wait 36 hours to get somefeedback from a specialist.
And that's hard to do, but itseems to be essential to get
that feedback while thepatient's still there and they
can change what they're going todo while the patient's still in
the office.
But we have a lot more to learnhere.
I don't want to suggest wesolve this puzzle here.
Mike Scribner (22:54):
I don't want to suggest we solve this puzzle,
shown as as y'all have, you knowsuch the breath that you do.
Obviously we deal withpractices that are both urban
and rural based.
What differences have y'allseen in the operations of your
ACOs, rule versus urban, andwhat?
What allowances have you had tomake for that?
Sean Cavanaugh (23:10):
Yeah, well, as I said, so one of the differences
is the options for specialists,options for facility partners.
You know, in a rural communityyou know the options can be less
.
The upside is there may be apersonal relationship there, so
you might be easier tocommunicate with the specialist
(23:30):
and have that sit down in thetalk with the specialist.
And have that sit down in thetalk.
We love the rural communitiesand we tend to operate more in
rural communities than a lot ofACOs, and that's because we work
with independent practices andwhen you get into the major
metropolitan areas what you seeis heavy consolidation where the
practices have been bought upby the big health systems.
(23:51):
So that's one of thedifferences we see.
For us, in the near term, theopportunity to work in some of
the major metro areas is limited.
Going back to your firstquestion, though, I don't think
that's a permanent condition.
I think everybody's going to bepivoting to value at some point
and we will be working withpeople you know, employed
(24:11):
physicians, health systems inthe larger urban areas.
Mike Scribner (24:21):
I hope that answers your question.
It does.
It does kind of bring me fullcircle back to a question John
asked way back at the beginning.
Do you see value-based care andthe financial incentives of
that being so great as to shiftthat move toward employment in
the first place to whereindependence is so much more
financially attractive in thefuture that it just shifts that
(24:41):
tide in general?
Sean Cavanaugh (24:42):
Yes, I do see that We've seen small aspects of
it.
So think of the world threeways.
You've got truly independentPCPs, you've got independent
PCPs who've joined a hospitalCIN and you've got people who've
sold their practice to thehospital.
Those people face threedifferent landscapes.
(25:03):
We work with the first two.
Quite a few of the physicianswe've recruited in the last two
recruiting cycles are physicianswho were in that middle group.
They've been independent butthey've been working through the
hospital CIN.
So certainly we're seeing thatshift where hospitals are losing
some of their CIN physiciansbecause and again I hope this is
(25:26):
temporary they don't feel theyhave the clinical independence
or the voice in that CIN thatthey would have working with
Allidate or other independentgroups that are truly
physician-led.
I think you've seen a smaller toa much smaller degree, the more
extreme which is in the thirdgroup, employed physicians, the
ones who went either sold theirpractices or went straight out
(25:49):
of training into hospitalemployment.
But I don't think that meansthey're happy into hospital
employment.
But I don't think that meansthey're happy.
We've talked to enough of themand we think there's an
opportunity and we're exploringthis If those physicians saw
like a turnkey solution wherethey could come out of hospital
employment.
What they don't want to do islook for real estate, have to
(26:10):
buy an EHR.
They want to practice medicineright?
Imagine a world where theycould walk into an office
tomorrow, they could have inplace an EHR, staffing and, more
important, value-basedcontracts for their patients and
they could build up a practicefrom a value orientation from
the beginning and they could payfor all that stuff that they
(26:30):
were given through future sharedsavings.
I think if someone and you know, be frank, this is something
Allidade's kicked around Ifsomeone developed a model like
that, I do think you'd see thatthird group of employed
physicians start to move out,because I think they went into
employment for legitimatereasons, but I think they missed
their clinical autonomy and theability to do the right thing,
(26:53):
their clinical autonomy and theability to do the right thing.
John Crew (26:55):
Sean, I have a question.
In relationships specificallyto the MSSP and the successor
models, we are seeing at leastwith our client base we're
seeing a significant shift ofthe traditional red, white and
blue moving to MA.
So we're seeing a decline inthe traditional model and a
significant increase in the MALong term.
(27:17):
Do you see there beingcontinued long term success for
models that are associatedstrictly with the red, white and
blue?
Sean Cavanaugh (27:34):
if you want to be successful in senior care
specifically, you're going tohave to be able to do both.
You're going to have to be goodat MSSP, which is the ACO
program, but you're going tohave to learn how to work in MA
as well.
And I think some practicesdon't want to hear that and I
don't blame them.
The Medicare fee-for-servicepatient is their last patient
where the insurer's notrequiring prior auth and all
(27:55):
that.
But the world is just changing.
As you said, medicare itself isstill growing dramatically with
the aging of the baby boomers.
So senior care as a field isgrowing.
But, as you said, the partthat's growing is the MA
enrollment Seniors choosing toremain in what I call
traditional Medicare, somepeople call fee-for-service.
(28:16):
They're actually decliningsomewhat in an absolute sense.
So even as the program as awhole grows, an absolute number
of people in traditionalMedicare is going down.
So we've talked in our practicequite a bit at this.
If you're going to be reallygood at senior care, you're
going to have to learn how to doMA and at a clinical level it's
(28:37):
very similar, right?
It's the same patients.
It's more the STARS measuresgetting good at that and getting
good at complete and accuratediagnoses, which is the risk
adjustment part of MA and, asyou know, that's where a lot of
people trip up.
There's some who get temptedand do fraudulent things.
We're very careful to tell ourdoctors we're going to do this
(28:58):
the right way, you know, and andwe're coaching them on how to
do that today You've beenlistening to Beyond the
(29:18):
Stethoscope vital conversationswith shp.
Aaron Higgins (29:19):
This has been a production of strategic health
care partners, your news hosttoday for jason crosby and me,
aaron higgins.
It is produced and edited bynyla weave.
Our social media contentproducers are nyla weave and
jeremy miller, and our executiveproducers are mike scrivener
and john crew.
Thanks for listening.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com