Value Based Care

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Episode Transcript

(00:02):
Welcome the Pulse of the Region,brought to you by the Metro Hertford Alliance.
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(00:25):
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at okillct dot org. Now here'syour host for Pulse of the Region,

(00:49):
Kate Balman. Hello, Hello,and welcome to Pulse of the Region,
the show where we highlight all ofthe great and incredible things happening here throughout
the Hartford Region. I'm your host, Kate Bauman. Thank you so much
for joining us here today. Todaywe are getting the pulse about the healthcare
industry and how value based health isimpacting providers, employees and also employers.

(01:11):
And we have two guests joining theshow today, one who may become a
regular. I'm trying to see ifI can convince her. And we have
a new guest joining, but excitedfor them both to be part of this
conversation because both of them, asindividuals and their organizations are doing so much
within the healthcare industry. So withoutfurther ado, first from Sown Health,
would love to introduce president and CEOand welcome her back to Pulse of the

(01:34):
Region. We welcome Lisa Trumbll.Lisa, so happy to have you here
today. Thanks for having me Kate, it's a pleasure to be back with
you. Of course, that's right, Lisa. We've got to figure out
maybe a contract or something. Ifeel like you're one of our great guests
joining on the show, so we'regonna have to figure this out. Sounds
good. Perfect. And then alsojoining Lisa is John Rhodis. He is

(01:57):
the founder and president of Arisa healthHealth Marisa Health So hopefully I said that
right, John, But John,welcome to the show. Oh thanks for
having me on Kate honored to behere, of course, of course,
so first things first, we alwayslove to do some introductions here on Pulse
of the Region, So Lisa,why not first if you don't mind giving
many listeners are probably familiar, butfor those who may not, be kind

(02:19):
of an introduction and a reintroduction tosone Health that sounds good. Kate again.
My name is Lisa Trumbull. I'mthe President and CEO of Southern New
England Healthcare Organization, or soone Healthas we like to call it. We're
based in Connecticut. We are alocally owned, physician owned and governed entity
that focuses on nothering but value basedcare and population health. We're the only

(02:44):
clinically integrated network in the state ofConnecticut that has demonstrated and has demonstrated clinical
integration and has a proven track recordof results working with health plans, employers
and the community to improve the theoverall health of our population. Fantastic No
excited to chat more today and Johnwould love to get a background. You've

(03:07):
certainly you know, been doing Ialways say a lot within the healthcare industry,
which is probably even selling you shortthere, But would love if you
don't mind giving a little bit aboutyour background, kind of experience and what
you're doing today in the healthcare industry. Sure, kay, I'm happy to
so thank you again. So I'vebeen in the healthcare space for more than
fourty years, and I'm sorry tostakes. I mean, I'm getting old.

(03:28):
You started young, Yeah, No, the first twenty years mostly at
Yukon as I'm a high risk gostetricianby training. I'm Obi Juan Okay well
prankticing highrisk go B for twenty yearsas a provider as an educator, researcher,
and then I took on the nexttwenty years or so, we're mostly
in leadership roles. I ran theresidency program, I became a department chair,

(03:50):
chief medical officer, chief operating officer, and eventually ended up my careers
as a president of Saint Francis Hospital, which I did for five years.
And I also had under my responseability Johnson Memorial and out to sign I
Agreehab Hospital. So I ended asan employer as well, with about you
know, five thousand employees and abillion dollars in annual revenue. So I
think I've had pretty much every jobyou can have, which is good You've

(04:14):
covered all the bases in healthcare.Yeah, and I've started a company,
Iris to Health to really help hospitalsand health systems, you know, pivot
to improve their quality, re safety, patient experience, pace satisfaction. So
that's what I'm doing now. Fantastic, fantastic. Well today, a lot
of the show, you know,really do you want to touch on value
based health? And I think it'sso important, you know, Lisa,

(04:34):
for those of us not within thehealthcare space, if you could just give
us, you know, a veryhigh level overview of what is value based
health. Yeah, I think thisis so important for everyone to understand that
I'm going to use a comparison thatalmost every individual in our community can appreciate.
Perfect. You know, we dropthe acronyms and everything. Let's focus

(04:57):
on owning a car. And youknow, you know, some of us
go out, we buy a car, and as long as the car is
new, things work fine. Youknow, we keep the maintenance up,
we fill it with the right stuff, we change its oil, we change
its tires, and it lasts fora period of time, but eventually,
you know, as the vehicle getsolder, if you're not putting the right

(05:17):
things into the cars. You know, things start to happen and break right
right, and then you go toa mechanics or to a body shop.
But you go somewhere to have yourcar fixed. And our healthcare system is
built on a fix it mode,so that you know when something occurs and
something happens, that's when the healthcaresystem traditionally comes in to repair you,

(05:43):
to fix something. What value basedcare does is it says, you know,
we need to get let's say upthe road, we call it in
healthcare upstream, but get up theroad and talk about what things can help
prevent chronic disease into conditions, whattypes of wellness activities would make sense.
Let's screen you for all the appropriatethings, make sure you're eating the right

(06:05):
things so that we can prevent thatbreakdown in your body. When things break
in your body. Then we deploytools this in value based care, we've
deployed tools called population health and Wellnessservice services to help you manage your conditions
better, get you to the rightproviders on time for the right services,

(06:27):
and improve your quality of life andhealth outcomes. The healthcare system today wasn't
built to do that. It wasbuilt to address the break It was built
to address the break only, andtherefore it is extremely fragmented. And when
you think about the services you can'tget, you can get pretty much anything
you need, whether it's your hipreplaced or something with your heart, you

(06:49):
can get that done at any majorhospital for the most part, you know,
in your neighborhood. But hospitals necessarilyweren't built for a wellness to situation.
You are, quite honestly, we'rephysician position practices initially, but you
know that was that's that's the problemwith our healthcare system today. It's fragmented,

(07:11):
it's costly. It's built to fixthings that are broke enough to prevent
the things that become really costly inthe end from happening. Right, okay,
And now, as a you know, as a patient, as a
consumer, you know, John is, how does someone know if you are,
you know, going the doctor,you're going to the hospital, you're
going to you know, if there, if you're receiving value based care kind

(07:32):
of what from a patient's lens,you know, really would seem as differences
or and again kind of just ona basic level, how would someone know
what type of healthcare they're receiving.Yeah, it's a difficult question actually,
because you know, at least Imight in script this, but I'll stick
with a car analogy for a moment. You know, when you go to
purchase a car, you you makeit a a judgment basically on value,

(07:55):
right, value being defined it asquality over costs, right, and let's
pay more for a higher quality costs. So people pay more for a BMW
of thinking I'm getting a higher qualitycar as an example. And there's plenty
of places you could look to ratecars. There's magazines, there's websites right,
or a television right that they makea purchase. In healthcare, unfortunately,

(08:15):
there's really not a lot of transparencyin either part of that equation,
either in the quality nor in thecost. So it's challenging. I'm always
reminded of Justice Potter Steward's comment whenI was a kid, when he was
trying to define the difference between artand obscenity, and he said, well,
I know it when I see it. So how does a patient know
if they're going to value care?And that's the question I think. Do

(08:37):
you have access to your PARTMENTR carephysician when you need them? Are they
so that after hours someone you couldtalk to to avoid your trip to the
emergency apartment, for example, avery costly venue. Right are they focusing
as leads as a prevention and screeningfor screening, so there's early detection of
disease prevention of diseases in the firstplace. If I have a chronic disease
like diabetes and hypertension because my physiciantreating well and managing a well, or

(09:01):
my blood sugar still out of controland my blood pressures out of control,
if I need a referral, amI getting it to the best person to
manage my problem at the best venue? Or am I getting it to someone
who's either in their neighborhood or partof their system where they don't want to
refer outside. So those are kindof just some of the factors that go
into how do I know if I'mgetting value based care? But if the
focus is on you holistically trying toprevent disease in the first place, manage

(09:26):
a better when you get it,and asking me about my sleep and my
nutrition and my diet and exercise andalcoholic con assumption, all those other things
are so important and ultimately crime diseasedevelopment. I think that's how you kind
of know, okay, fantastic andnow looking at it, you know,
so kind of touch on the patient'slens from an employee lens. So you
know, we're talking nurses, physicians, you know, really, what are

(09:48):
some of the benefits for them towork within a value based care system?
So for the employee of the patient, if you will, or let's make
I don't want to call them patientor calling employees because they're not sick,
right, you want to keep them, You're trying to keep them healthy,
you know, again, prevent thediseases in the first place. Most chronic
disease in this country are preventable.Then if you look at the top ten

(10:11):
cause of death in America, nineout of ten are preventable totally or at
least modifiable delayable. Right, Solet's prevent the diabetes in the first place.
Let's let's manage the high potential betterwhen you get it, what's the
benefit of the employee. They're moreproductive, they have less downtime, and
ultimately they'll be lower costs, right, because I think how much costs they
bear now, high premiums, deductibles, copase, co insurance and their employers

(10:35):
are also paying that. So I'msure the employers are rat to pass on
some of that stavements to deployee inthe form of either better benefits or wages.
Are supposed to spending all this moneyon as least appoints. They are
very inefficient system. And by theway, if they're healthy for all the
years they're working, they'll have amore enjoyable retirement so they can get down
on their knees and play with theirgrandkids instead of being in a dialysis unit

(10:56):
three days a week. Right,And nurses just stance in that part.
I think, you know, fundamentally, physicians want to do the right thing.
But the model today, because it'sbased on a feed for service,
so the more we do, themore we get, is not really geared
to spend time with patients to dothe things we've talked about. So physicians
get a lot of pressure. Ithink to you know, see thirty patients

(11:18):
a day just to generate the revenue, would much rather spend fifteen seek fifteen
patients, really spend time with themto do the things we talked about.
And nurses finally are taking care ofsicker and sicker patients, and with tons
of co morbidities, it's difficult forthem to just even move patients, and
certainly in a hospital setting, Ithink they much rather take care of a
little bit of a healthier population,so they feel that they're making more of

(11:39):
a difference, and by the way, they'll have higher retention because I think
there's a lot of burnout of coursein nursing by taking care of these very
sick, clinically ill patients. Soall very good points there there, John,
and I don't at least if there'sanything you want to add in there,
just kind of looking at, youknow, the benefits of this and
then want to talk a little bitmore about about soones of p Yeah,

(12:01):
I think John hit it on,you know, hit the nail on the
head, so to speak. Thebenefits are you know, across the board,
to employers, you know, quitehonestly, to our communities and our
our you know, federal and UHand state governments who are paying for you
know, excessive costs, and toto the employees and patients within UH in

(12:22):
the community members within our communities.And doing this the right way is absolutely
critical to the overall success. Andit doesn't mean doing things or interventions the
way we have always done that.We need a serious level of change in
our industry to pivot towards a wellnessprevention focus and away from you know,

(12:48):
the repair shop focus. And youknow, honestly, a lot of the
motivations underneath much of this and muchof the cost escalation are some of the
incentives and and deterrence to doing theright thing. Everybody has the best of
intentions, but the incentives are notaligned to support the direction that we want
to go. You make more ina fever service environment. The more you

(13:11):
do, the more you build,the more you collect. If you're a
PBM, you've got spread pricing andall sorts of other factors that that fact
that get pulleded in to the costof drugs when there are more efficient and
effective drugs that are lower price pointsfor people. But because of the complexity

(13:31):
and the lack of transparency in ourindustry, this go this is nearly impossible
for a consumer to figure out.And if you think of automobile, right,
you look at you see the pricebreakdown on the sticker on the car.
Right for the post part, ifyou're buying something new, you can
you know what your options are andwhat you can add in. You know,

(13:52):
and you know if you want thattype. You know, that titanium,
you know, drive shaft, it'sgoing to cost you more money,
right, But there's no way apatient can understand the pricing structure of any
particular procedure that they need to receivetoday. But they can understand if I
treat myself well, and I getinto my doctor annually, and I'm treating

(14:13):
and managing my blood presser, mycholesterol, what I'm eating and all of
that, I can avoid all theseother conditions down the road. And you
know, some of the motivations therewith patients is behavioral financial and some of
it is just educational. Right,Yes, very good point there, And
at least I'd love for you totalk a little bit more. You know,

(14:35):
Son Health really has taken a leadershiprole within this space, within you
know, the value based health arena, especially here in our region. If
you could talk a little bit juston the approach that you've taken and really
where you see things to go inthe near future. Yeah, the approach
we have taken is we have anetwork of providers that are absolutely focused on

(14:56):
this and doing the right thing.They want to be able to see their
patients in the timely fashion, minimallyevery year be able to provide them all
their current needs from a screening andtesting perspective in order to avoid disease.
And what Stone Help does for ourproviders is ensure that the right patients get

(15:20):
into the providers at the right pointin time to get those services. If
they're missing or they have we callgaps in their care, they haven't had
their coorectal screening, making sure theyget their coorectal screening if you know,
God forbid, they happen to havea chronic condition. We have care management
programs, pharmacy programs, disease managementprograms, digital technologies and assets, and

(15:43):
that we wrap around the patient tohelp them manage their condition, optimize their
health as much as they can withinthat condition, or you know, to
some extent eliminate the condition. Andthat's all done by education, navigation,
and coordination and integration with the system. So our providers and SOWN in particular,
integrates with every aspect of the healthcareindustry. Thank you so much for

(16:08):
you know, kind of that deeperlook into just kind of what you guys
are doing on a day to day. I think it's so important. And
one other thing I want to touchon today, and you hit on it
very briefly in the beginning. Butpopulation health and this is another one of
those I'm sure there's nine million acronyms, there's all these things around it.
But if you don't mind kind ofyou know, in a simple way,
Lisa, if you could explain justwhat population health is. Yeah, you

(16:33):
know, population health has you know, a broader term in the industry where
you know, we we look ata population of people, whether it's a
population of a town or a city, or a community or or a county,
and we understand the burden, thedisease burden within that that community.
For us, the population is relationshipswith payers and employers. Okay, this

(16:57):
is a just burden with a particularemployee population with an employer. What chronic
conditions do they have? What doyou know, how are they being navigated
through the system. Are they usingthe highest, most valuable providers that really
generate a preferred level of quality andcost profile? And when they're sick,

(17:21):
what do they need for resources?Do they need pharmacy intervention, do they
need care management or complex care managementor disease management or or you know,
some some other form of digital interventionlike education, And what someone does is
we package all of those services togetherfor the populations that we serve for our

(17:42):
providers that are within our network.And as I said, those populations are
with let's say health plans okay thatemployers might contract with or directly with employers,
And so for us, we considereverything that could possibly contain be contained
within that population of people and understandhow many of them have chronic obstructive pulmonary

(18:08):
disease, how many have HF,how many have diabetes, how many have
muscule skeletal conditions, and what dowe need to do for them in order
to improve those conditions, to improvetheir quality of life, their health outcomes,
and reduce the costs the out ofpocket cost to them because patients don't
really know where to go, Theydon't know how to navigate this. Most

(18:29):
of them know they need to calltheir primary care provider routinely or have a
routine visit. So there's a lotof education that goes along with the services
that we provide to our patients.Fantastic And I think, really, you
know, Lisa, you've touched onI think John toutcha on too. You
know that education piece, and youknow John would love to get from your
perspective. As we are kind ofprepping for this show, you get some

(18:51):
great examples just really, you know, and why does this kind of matter
to patients, you know, inthe short term and in the long term.
So if you don't mind, ifyou can kind of share, you
know, to share some insight there, I think that'd be fantastic. Well,
I think because the basic tenets,certainly of population health as least is
alluding to. Really the emphasis onprevention and early detection, right prevents the

(19:12):
disease in the first place, earlydetection of disease when you get it.
So what are some examples, see, you know, colscub, colooscube and
pap smears perfect examples of screening testsand actually screen not for cancer but for
cancer precursors. Right, you dothose things effectively, the chance of getting
either of those cancer ever developing isis not zero but very very close to

(19:33):
zero today, right, But youhave to be screened. Then your provider
has to remind you, say,it's been seven years since your last goal
on HOSS, but you need toget it. Or if you're a woman,
you need your perapsmears, et cetera. Right, it's early detection.
You know, mammograms again for women. See mammogram is not to prevent breast
cancer, but at least detect itearly, so it's a very treatable so
instead of being a death sentence,it's breast cancer today is probably for the

(19:56):
most part of chronic condition very wellmanaged. And then we're going down that
as leads, we're talking about thekind of upstream and downstream. Let's say
you're now downstream enough that you've developeda chronic disease, and let's the two
big ones are diabetes and hyphpertension thiscountry. Well, we don't do a
great job managing them historically, butlet's do a better job. Let's do

(20:17):
a better job managing them so thatyou're getting the best care possible. Your
high pertension is under good control,You're not just going to the doctor and
the blood trust are still elevated andthey say come back in six months.
But let's adjust your medications. Let'ssee what else we can do. Same
thing regarding diabetes. Right, it'smy blood sugar really under good control.
There is my heat blowing the newand see good am I getty kidney disease.

(20:37):
It might be even screen for kidneydisease, and not to be labored
by doing work, doing some workwith another health system outside the state,
and kidney disease in particular, whichis one of the top ten causes of
death in this country, and ahuge expense, by the way, and
less than a half the people areactually even getting the screen they need to
get the treatment they're supposed to get. So there's huge opportunities from provement.

(21:00):
And I think Lisa hit it onthe hit early on. The healthcare system
really is predominantly a sick care system. It was designed to take care of
people sick. If you fall upyour mic and you break your hip and
your wrist, like I did acouple of years ago, Hey you need
a hospital or finding a heart attack, you need a hospital to go to.
But it wasn't really geared for theprevention screening of disease, and I
think that's the real key differential.Definitely, No, a lot of great

(21:23):
points there, John, And atleast I want to circle back on the
conversation about employers, and you know, certainly both both of you had hit
on you know, some potential costsavings, you know, really benefits for
employees for an employer, you know, Lisa, where would you recommend they
kind of start to get more informationor kind of see how they could potentially

(21:44):
take advantage of, you know,of something for their employees. Yeah,
I think that they can start.Let's let's first admit that employers can't manage
their the clinical care of their populationright right advisor trusted plan structure that they

(22:06):
know we'll be able to execute onthe management of their employee population for the
improvement and costs and quality outcomes.So I would suggest to employers that you
know, they find that trusted advisors, that they also look at health plans
and the results of various health plansand as their health plans they have more

(22:26):
accountability in this space, and todirect them to the entities that are doing
good work like our entity and youknow, and have them recognize that the
employer must recognize that the system isfragmented and unmanaged. So expecting to just
sign a contract for health insurance andeverything's going to be okay without any intervention

(22:48):
and an accountability in the process,that's just not going to happen. You're
going to face increasing expenses. SoI would try to understand what are you
spending your money on what types ofresults are you getting for that money?
Are your employees healthier because of it? And other out of pocket costs and
your costs going down? Right theprocess, it's the answer to all of

(23:11):
those questions are is basically no,Then maybe it's time to find a different
solution, you know, for someoneto administer your health plan for your employees.
And that can be done. Thereare onnest individuals out there, entities
that are doing this work that areinterested in improving the costs and the quality

(23:32):
for employers and making everybody healthy inthe long run. Fantastic, No,
thank you so much, Lisa.Certainly a big world to navigate for employers
especially and you know many of us, but so appreciate you kind of breaking
that down and really kind of thelast piece of the show, what I'd
love to touch on is, youknow, part of what makes you value
based care, value based health successfulis really being able to connect the dots,

(23:56):
which you know, it sounds liketoday the theme of the show is
taking you know, high complex thingsand making them simpler, but you know,
simple simplicity of connecting those dots isyou know, Lisa would love if
you could talk just a bit moreabout this approach, and really, why
do you feel it's so important todo this now, especially well, you
know, the connecting the dots iscritical to getting optimal health care. To

(24:18):
just think of a patient. I'msure all of us have an elderly parent
that we have managed at some pointthat has tried to get care, has
gone through My own mother's had thisgone through multiple providers, only to find
out that she went to the wrongprovider to begin with, got the wrong
tests to begin with, and didn'treceive it in the right place, and

(24:40):
as a result, everything has tobe done all over again. And that
happens every single day in our industry. People do not know how to access
it. So finding providers and entitieslike ours that help you access the system
at the right time for the rightneeds. Okay, integrated between physicians,

(25:03):
hospitals, skilled nursing, pharmacy,and blah blah blah blah blah everything else
that you can you may possibly need. Right that's the navigation piece is incredibly
important to this because the statistics showthat you know, John incorrect me if
I'm wrong, thirty to fifty percentof the dollars you spent or wasted wow.

(25:25):
Right, that's a staggering That isstaggering. It doesn't mean yeah,
it doesn't mean we need to rationcare. It doesn't mean that you can't
get the right care when you needthe care. It means getting you the
right care. And a classic example, because I hear it all the time
in my family. You know,something's wrong with my need, I need
an MRI. Everybody needs an MRI. That's a waste of money, high

(25:49):
copay, highly expensive to employers,you know, hit, your co insurance,
your deductible, all of that costsway more than a playing film X.
Right, the way you get moreradiation right in the process. Right,
But everybody feels that because the technologyis there, that that's the right
modality to be using at that pointin time, when in fact it may

(26:10):
not be okay, When in factyou might not need an MRI at all,
but you might need to be redirectedto physical therapy or to the right
orthopedic you know, practice to helpyou figure out what's wrong with your need
the right way. And that's whatit means to be integrated and navigated.

(26:30):
Otherwise, you know, we're leftup to our own devices and we go
to the wrong place. And itcosts everybody more money. I mean,
this process in this system costs oursociety more money every single day. That's
I mean the thirty to fifty percent. I'm still not over that. The
amount of waste there. My goodness. Wow. So, John, is

(26:52):
there anything you'd love to you know, add on to what Lisa was touching
on there. Yeah, I know, I think she was great. I
think her are playing about people withyou know, hip pain, the paint
back pain. There's a huge opportunitythere to save money because, as she
points out, it's going you knowdown the road with X rays and MRIs
may not need surgery, they maynot need There's a lot of evidence that

(27:15):
you could save a lot of moneythere. But I think the other part,
for you know, employers and againstyou hit it on the head.
It all starts with your analytics,and analytics are what what am I spending
my money on? You know,employers do this for every other part of
their business, but somehow they youknow, close their eyes and ears when
it comes to the healthcare of theiremployees. Who am I paying? What
am I paying for? What amI getting for my money? Where are

(27:37):
my employees going? What are theoutcomes. They don't ask these questions,
but and they're afraid to sometimes,but you need to get the data to
figure it out. Once you havethe data, you could take advantage of
the fact there's a huge variability acrossthe state, across the country. But
I'm telling you across the state inquality, outcomes in cost. So you
could take advantage of that as employeer. If it costs you know, ten

(28:00):
thousand dollars at hospital eight and havea hip or place it's for patient and
needs at twenty thousand dollars a hospitalbe and the outcomes are better at the
less expensive place, why wouldn't Iwant my employees to go to the place
that's going to give them a betteroutcome, less infection, less transfusions.
Oh and by the way, it'sgoing to save the company money, right,
that's in addition exactly so, Andthere's there's a joining examples of that

(28:26):
for things that really are And againit's not unlike the cars, it's not
the more you pay the better thecare is going to be. There's no
real great correlation in this country withquality about care and what you pay for
it. Perfect well, thank youboth so much, really appreciate I know,
for myself, who is not ahealthcare expert, being able to kind
of understand in the way that youguys described today was extremely helpful, and

(28:48):
I'm sure for our audience as well. So thank you so much. And
Lisa would close out with where ifpeople want to learn more about sown health
and you know, really value basedhealth, you know where could they go
to get more information? Sure,they can go to our website, It's
own Health, soonehealth dot com.All right, fantastic, Well, Lisa
and John, thank you for beinghere today, Thanks for having us,

(29:11):
Thanks for having us of course,of course, and for all the details
about today's show, you can visitMetrohartford dot com. We'd always like to
give a big thank you to ourshow partner Okell and of course thanks to
you for listening. I'm Kate Bauman. Go out and make today a good
day here in Connecticut.