Innovate or fade: Payers at the crossroads of senior care

0:03
Hello everyone, and thank you for attending today's webinar Innovate or Fade Payers at the Crossroads of Senior Care presented by Optum Health.

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I'm Rebecca Kushmuter.

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I'll be moderating this webinar.

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Just a few housekeeping notes before we get started.

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You can read full speaker BIOS on the left side of your window by selecting the Speakers tab.

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Use the Q&A tab on the left side of your screen, and we will conclude with the Q&A session.

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All right, I'd like to introduce today's speakers.

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We'll be joined by Heather Jarrett, CEO of Care Transitions and Senior Community Care at Optum Health and Doctor Jamira Duffy, the lead medical director at Optum Care Transitions.

1:01
I think we are ready to go.

1:03
Ladies, please go ahead.

1:05
All right.

1:06
Well, thank you so much for the opportunity to join the the webinar today and the opportunity to present.

1:14
Thank you so much to the Fierce team for supporting the webinar as well.

1:19
So we're excited to be here.

1:21
My name is Heather Jarrett as the moderator stated and I am joined by Doctor Duffy.

1:27
We are excited to discuss innovate or fade payers at the crossroads of senior care.

1:34
We're going to discuss a handful of items today.

1:37
We're going to lay out the ever changing landscape of senior care.

1:42
We'll discuss why now is the moment to create solutions to support our seniors, but we need to rethink how we view seniors and because of these factors, how can we provide patient centered care.

2:00
Finally, we'll review some actual case studies of seniors and talk about through creative solutions and innovative solutions, we can support our seniors holistically.

2:13
All right, let's jump to the next slide and get started.

2:19
So we're all aware of the ageing population.

2:23
A question posed earlier.

2:25
Why now?

2:27
Well, now is the moment because of the staggering number of lives at stake, many with complex care needs.

2:36
And what this slide demonstrates is that the number is going to continue to grow exponentially.

2:43
Let's highlight a few interesting facts.

2:46
The number of people 85 and older is projected to double by 2040.

2:53
The number of people over 100 has doubled since 1980.

2:59
Most of our seniors have at least one chronic condition and probably many.

3:06
Over 10% experience cognitive decline, although I think that I may be experiencing that as well and I'm not a senior yet.

3:16
About a 1/4 of our population assess their health.

3:20
The senior population assess their health as fair or poor and about a third have a disability.

3:27
90% of our seniors use prescription medicines and roughly and sadly 1/4 experience social isolation.

3:40
And I think this, this, these data points really help us to answer why the question is now, why innovate now?

3:49
Let's go to the next slide.

3:54
Here are some additional reasons that can help us answer this.

3:58
This question though, why now what?

4:00
Why now is the moment to innovate?

4:03
Well, the industry is changing.

4:06
Senior populations are changing.

4:09
More than half of the Medicare eligible people are enrolled in MA plans and that number is expected to be 62% by 2033.

4:22
Also, payers may be experiencing financial headwinds for profitability, in other words, a decreased reimbursement per patient.

4:31
While utilization trends are increasing as the MA population ages, COVID is is definitely past.

4:41
It still exists, but yet we are seeing utilization trends beginning to increase again.

4:48
And let's face it, people and seniors can certainly be choosy.

4:54
There are now more than 40 MA plants.

4:57
The competition is high.

5:00
And when that happens, we have to get creative, efficient and innovative.

5:07
I'll turn it over to Doctor Duffy to talk a little bit more about innovation.

5:12
Next slide.

5:17
Thank you, Heather, and thank you to all of you for joining us today.

5:21
So as Heather discussed, why now innovate or fade?

5:27
And I'm going to start off with this quote.

5:29
The variety of disruptions emerging, however, means that the winning strategies of the past five years are unlikely to be sufficient to meet members evolving needs and preferences.

5:42
Success in the future will be determined by bold moves made now.

5:48
So let's talk about change.

5:50
It's hard, but it's inevitable, right?

5:53
And to remain relevant, you have to foster change.

5:57
We have to fight this mindset of how we always did it or how we used to do it, and really start to look at the past as different than from today.

6:09
That will be different in the future.

6:12
We know that in the US that healthcare spending accounts for about 18% of the GDP.

6:19
It's just not sustainable, right?

6:21
As Heather pointed out, the number of people that are going to be aged 65 and above going into Medicare is rapidly growing and the healthcare system that we inherited of the past is just not going to cut it as we are dealing with more complex issues going forward.

6:38
So we really have to start thinking about ourselves as professionals, problem solvers.

6:43
We need to start thinking about ways in which we can provide care to our seniors.

6:49
That's going to be patient centric, that's going to be coordinated and it is really going to allow our members to age successfully and to do it at home.

6:59
Next slide please.

7:04
OK, So what does this innovation actually look like and why does it matter?

7:10
I'm going to start off with yet another quote and this one is from the WHL.

7:14
It's their definition of health, and they define health as a state of complete physical, mental and social well-being and not merely just the absence of disease or infirmity.

7:27
Why is that important?

7:29
Well, when we look back at traditional fee for service reimbursements, that system of care really focuses on patients as problems and problems that need to be solved.

7:42
And it doesn't take into account the whole patient, the whole picture.

7:46
These patients are looked at for episodic visits.

7:51
They come into the doctor's office, they show up in the emergency room, they show up in the ER, they're admitted to hospitals.

7:58
We're trying to figure out what is ailing them, diagnose them, treat them and move them along.

8:05
This fee for service model also focuses more on volume and transactional healthcare and we really need to start to think of ways to move forward, to move past it because we know that that System 1 isn't sustainable from a financial perspective.

8:22
But two, we also realize that it doesn't present the best health outcomes for our patient.

8:28
So what can these new approaches look like?

8:31
One such option could just be value based reimbursements where we stop looking at patients as problems and we start looking at them more holistically.

8:43
We invest in prevention and preventative care and I'm a family medicine physician by training, so that's always been close to my heart.

8:52
We look at longer term care over the course of their life.

8:57
We look at them as people that need to be looked at over time and not as problems that need to be solved in the moment.

9:04
These value based care type systems can also help us to really fully integrate and coordinate the care that our members are asking for and that they deserve.

9:16
And for these innovative approaches to work, we really have to start getting everyone aligned right.

9:22
So that means patients, care providers, payers, family members, caregivers, all on the same page so that we can start to identify disease early and connect our patients to the right care.

9:36
Next slide please.

9:41
All right.

9:41
So leaning in on the theme of innovation versus fading, let's talk more deeply about our seniors.

9:50
Think of I, I too am a clinician.

9:53
And I think back to when, when I first started off in my career and some of the choices that I had, I didn't think I, you know, was interested in taking care of seniors who just to me were older people who didn't have, didn't have a grasp of their health or who had poor health conditions.

10:12
Well, agreed.

10:13
I actually thought I was going with the Pediatrics, right?

10:18
That day has changed.

10:20
I went into labor and delivery.

10:22
So I was like way at the other end of the, the spectrum.

10:27
But but it's, it's, it's interesting right when, when we think about how the senior population has changed and how we care for that population now.

10:38
But let's talk a little bit more about getting to know our customer.

10:43
Think of just the simple analogy of how seniors 65 and older, how the CDC group, seniors 65 to 7475 to 84 and 85 and older.

10:55
So they've grouped individuals in these various categories due to sometimes differences in the health statuses of these individuals and more commonly in these age categories.

11:08
Think of if we just grouped ages 0 to 40 and provided them with the same amount of care, right infant all the way up to someone who is 40 years old.

11:22
So This is why this is so important is that we have to view seniors differently.

11:29
We have to Doctor Duffy.

11:30
I'll talk about it a little in a in a just a few minutes about listening to seniors, spending time with seniors.

11:38
Seniors are living longer.

11:41
They're working.

11:41
Still over 65.

11:43
Many, many folks still do.

11:46
Income varies, ethnically diverse.

11:51
My father, 84 years old, has a cell phone.

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I can't believe it.

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And he's doing virtual business from his assisted living facility.

12:00
So the, the dynamic has changed and the population has changed.

12:07
And also our seniors, they're, they're living longer and their health varies.

12:12
It varies widely within these age, age groups.

12:17
Another interesting fact when we think of payers, seniors also have their pocketbook at stake.

12:26
Healthcare is increasing and it's nearly doubled for for our seniors from what it was 10 years ago.

12:34
So not only for health plans but also payers, we need to look at the landscape and truly understand expense and medical trend and how we can more efficiently and appropriately with the right care solutions effectively support our seniors.

12:54
Next slide.

12:59
So as Heather just discussed, lots of things to take into account and to think about when we are trying to problem solve for the future and think of innovative approaches to provide.

13:14
And one of the ways in which we can start to formulate these conversations and solutioning is to go to the source, is to actually have the discussion with seniors to find out what it is.

13:30
And I think back on my grandmother, who was born in 1914, and she had multiple chronic conditions.

13:38
And as she aged over time, the one thing she was adamant about was that she did not want to go to a old folks home.

13:45
She would say, I'm going to go to old folks home.

13:48
It's depressing there.

13:49
And we would laugh and say, granny, you know, as long as we can keep you at home, we're going to keep you home.

13:56
Fast forward, I'm having those same conversations with my parents now and different generations.

14:03
They were born at different times, but they have some of the same priorities.

14:07
So 88% of our older adults are reporting that it's important to them to continue living safely in their homes as long as possible.

14:16
That's what my great grandmother wanted.

14:18
That's what my parents are wanting as well.

14:21
In addition to being able to stay at home and trying to avoid institutions, they're also requesting to receive that care at home.

14:30
They want to maintain their social connections, but at the same time, they don't want to be a burden, right?

14:35
So they don't want to burden their children, their neighbors, their family members in order to be able to remain in the home and get the care that they need and receive it safely.

14:47
Doesn't sound too far off.

14:49
The other important piece that we're hearing when we actually reach out and talk to our seniors and ask them what it is that they want is they want their providers to talk to each other, right?

14:58
They want that communication.

15:00
They want coordination.

15:02
I can't even tell you how many times someone would come to the office for a follow up hospital visit or follow up ER visit and you'd ask them why they went and they try to give you a little bit about why they were there, but you really didn't have a complete picture.

15:19
Now I remember the days of paper charts.

15:21
So EMR have definitely helped in that aspect, right?

15:26
We're able to connect now more to acute settings to get hospital records, but even then it could be fragmented.

15:33
Maybe we'll only have access to the admission H&P.

15:37
Maybe that discharge summary hasn't been done yet.

15:41
So when we start to think about their desire to want communication and coordination among their providers, it's not a difficult ask.

15:50
And it's really up to us to figure out how to meet that.

15:53
And one such way that we can start thinking about those solutions would be with a personal care coordinator.

15:58
That coordinator would be key to helping to meet these the priorities that the seniors are telling us that they want.

16:05
So we have talked about the why, right, why we need to change.

16:09
We've talked about the in growing population of our seniors.

16:14
We've discussed things that they are requesting and asking of us.

16:18
So next what Heather and I are going to do is we're going to actually talk about what it means to provide care that's centered around our patient and what that looks like in action.

16:29
Next slide.

16:33
I will say I remember the trifold charts, right?

16:39
Trifold charts when I worked in the ICU for, for over 5 years.

16:44
And, and thank goodness we finally moved to digital charting and a nice stylus to make things a lot easier.

16:51
So OK, let's, let's, let's jump into to these examples.

16:57
So we have 3 and we'll highlight these examples of senior case studies and then what potentially could be some innovative solutions that payers may choose to to provide.

17:13
So first we have Phyllis.

17:16
Phyllis is is fairly healthy in this case study.

17:19
67 year old with arthritis, has APCP, golfs and plays bridge, sees her, her grandchildren.

17:29
This this story reminds me of my father.

17:31
This is completely my father and I laugh about the golf piece and maybe I shouldn't chuckle, but he thought wearing his golf spikes outside in the cold weather and icy weather would help him and prevent him from falling.

17:46
Well, unfortunately, like Phyllis, Phyllis fell and broke her hip.

17:51
And this is the exact same thing that my father did while wearing golf spikes in the middle of winter.

17:56
Yes, true stories.

17:58
So in this scenario, just like Phyllis, my father, Phyllis too, went to the ER, received an orthopedic consult, had surgery within a day, and then was up and at him the next day with support, of course, and then was transitioned to a facility so that Phyllis, similar to my father, was able to receive therapy.

18:26
And it's an interesting journey.

18:28
And, and I remember because I was thousands of miles away.

18:32
But yeah, we do have family where my, my father lived.

18:36
And similar to Phyllis's case study, Phyllis also had support in the home.

18:41
But this is a, this is a journey and a process.

18:46
And now you have someone with a broken hip and they're in the post acute facility and there is an integrated care team.

18:53
I've been in into many post acute facilities and and they do a great job with the integrated care team that they have, although sometimes they are short staffed and we're starting to see that more often as a solution potentially for consideration is bringing in a care coordinator to assist Phyllis and her family how to prepare for the stay in the post acute facility, what to expect.

19:25
I've been to I've visited many seniors in post acute facilities and they will say they've had limited information or they're unsure what the plan is.

19:33
So really providing face to face support mixed with ongoing telephonic support to really help with that transition has been tremendous.

19:45
I know not only in my example did my father, but us as a family appreciate it.

19:50
And this example, Phyllis's family did appreciate this as well.

19:56
What a care member an additional care coordinator can help to provide.

20:02
Is coordination with the multi multidisciplinary care team that is on site, that is working with our members or seniors and they can ensure that things are happening timely, that Phyllis is receiving the appropriate amount of therapy, that Phyllis's goals are reasonable.

20:23
A lot of seniors, probably even just those other than seniors think that after something like this happens, they're going to be back to their old self in a week or two.

20:33
And unfortunately that's not always the case.

20:38
So another wonderful aspect of providing additional care coordination within the post acute facility is helping to set reasonable goals with the care team and the member and the family and also estimating A discharge date.

20:56
That's one of the most challenging things to prepare for is really working the family as well as the the member or senior in this case towards that discharge goal and how you set up all of those appropriate milestones and that you can demonstrate that Phyllis in this case is making functional gains.

21:18
And then the most important thing is to ensure that Phyllis has a safe discharge plan.

21:25
How is Phyllis going to go home?

21:27
What should Phyllis expect when she goes home?

21:29
Does Phyllis have stairs in her house?

21:32
And what types of additional therapy needs will Phyllis will Phyllis have?

21:37
And then who's going to help Phyllis?

21:39
Does she need additional support or does she have family members like in this case that she had to support her when she was discharged?

21:48
So this is this is potentially an innovative solution that health plans can consider in order to continue to bridge that gap and really help members during a very challenging and unfamiliar time as they move from an acute stay, having surgery, being discharged to a post acute facility and having therapy based needs and having reasonable goals.

22:16
So Doctor Duffy, I'll turn it to you for the next two examples.

22:23
Thanks, Heather.

22:24
So let's head to the next slide, please.

22:28
OK, let's discuss Frank.

22:31
Frank could be one of many patients that I have taken care of over the course of my career.

22:38
I used to work in a small town in Tennessee and so many of my patients remind me of Frank and his story.

22:45
So Frank is 82.

22:47
He lives at home alone.

22:49
He has multiple chronic conditions including depression.

22:53
Frank is wheelchair bound, he's on 8 medications and he has a primary care physician in addition to three specialists.

23:04
How overwhelming does that feel for anyone?

23:08
And in particular, we know for our seniors, anytime their medication count goes above about four or five, that pill burden is definitely overwhelming.

23:21
So here you have someone, and I really want to paint this picture.

23:24
He's older, he lives alone.

23:28
His mobility is not great because he's in a wheelchair.

23:31
He's managing multiple medications, and he's got a lot of doctors that he's got to try and figure out.

23:38
So how do you help someone like Frank to stay home, to stay home safely so that he can age at home to try to decrease the amount of visits that he needs to the emergency room?

23:54
How do you try to decrease his inpatient hospitalizations with preventative services and close monitoring of these chronic conditions?

24:04
One such solution could be Frank getting a nurse care manager and that care manager could be part of his in home care team.

24:14
That team is an interdisciplinary approach.

24:17
Not only does it include the nurse care manager, it could include a social worker if needed.

24:22
That can help connect Frank to community resources as well as additional resources that are available within the health plan.

24:30
That care team could also consist of an advanced practice clinician who makes visits to Frank in addition to the ones that he has with his primary care physician and the specialist.

24:43
But what it really boils down to is Frank having a team in place that can help to coordinate his care, that can work with him with his medications, to make sure that he's getting the care that he needs at the time that he needs it in the place that he needs it.

25:01
That care coordination, that home care team can also help to decrease that overwhelming sense of doom and burden.

25:09
It can sometimes impact patients when they're dealing with multiple chronic illnesses and they have multiple medications that they're taking.

25:17
That team can also play a wonderful role in making sure that he's getting age appropriate screenings and immunizations.

25:25
And that care team can be a resource for Frank, right?

25:28
Oftentimes these types of patients are very quick to call 911.

25:34
So I currently live in Florida, which we have a large population of seniors and I've had the pleasure of taking care of our first responders.

25:43
And as you can imagine, they've got some interesting stories.

25:47
But I think some of the more poignant ones are the calls that are made to 911 that really are not emergent, sometimes has nothing to do with their health and they still go out and they take care of those patients and they evaluate them.

26:02
But if those type patients had what Frank has right, that in home care coordinated team, a nurse care manager, a telephone number that he could call when he needs help or has questions that is not 911, what would that look like?

26:19
It would look like improved care, that's for sure.

26:22
It would definitely decrease hospitalizations, emergency room visits, and overall help to decrease costs.

26:30
So that's Frank's story.

26:31
We're going to move on to the next slide and we're going to talk about James.

26:37
All righty.

26:38
So James is what we all aim as we mature and we get older, right?

26:45
James is 93 years old, still lives at home, only has two conditions that he's dealing with, high blood pressure and arthritis.

26:55
And let's face it, as we all get older, that wear and tear on the joints is inevitable.

27:01
He's only on three medications and has a primary care physician.

27:05
So when you look at someone like James who's still able to be at home, who's relatively healthy, not on a lot of medications, the question may be, well, what does James need in his home, right?

27:18
What types of in home services could James benefit from?

27:24
And I'll tell you, when you start thinking about these innovative approaches and services that you could provide to someone like James, something as simple as an annual in home risk assessment could be hugely beneficial for him.

27:37
In the past, I've done house call visits as part of a program like this where you go in once a year and you get to meet with the seniors and you sit down with them and you have about an hour, which is amazing.

27:49
And they value that visit so much.

27:53
And as a, you know, as a physician, there's information that I was able to pick up on, on those in home assessments that I never would have been able to pick up on in an office visit, right.

28:05
Something as simple as trip hazards.

28:08
If you think about your house, we all have flooring, be it carpet, hardwood, tile, depending on where you live.

28:15
And many of us have throw rugs.

28:19
Over time, those throw rugs can present trip hazards and those trips can lead to falls and those falls could lead to fractures and those fractures can lead to a prolonged course of treatment and rehabilitation like we saw with Phyllis.

28:33
So being able to have someone come in the home and not only identify risk factors within your home, but also just go through your care, look through at your medication, see what your diagnosis are, have a conversation with you.

28:49
Particularly, we find it beneficial in a lot of our members who live in rural communities.

28:54
These in home assessments are able to connect them to important health screenings that they may not otherwise get.

29:01
Again, immunizations, especially as we're moving into flu season.

29:04
And again, the goal is to help the members stay at home to do it successfully and safely and also to connect them with the care that they need.

29:15
So I am going to turn it back over to Heather now, next slide.

29:20
All right, thank you so much.

29:22
Two additional great examples really helpful to to paint the picture of a wide array of our senior population with innovative approaches and the the goals right better health outcomes.

29:38
We're trying to to assist our seniors to managing their health, giving them as much information how they want it, when they want it, where they want it.

29:48
We talk a lot about that.

29:49
I even think back to years ago, right, how we were doing a lot more home care.

29:53
So it's interesting how the pendulum, you know, sort of swings back again to traditional methods and really being able to meet seniors needs in their home.

30:03
So better health outcomes.

30:05
This also leads to an improved member experience such as in Phyllis's case with an additional supportive service provided by a payer in the post acute setting, roughly around a 95% patient satisfaction rating.

30:22
Because it's just that additional support to really help triangulate all of the discussions and the process and the steps to ensuring that not only Phyllis understands what her expectations are from a transition and discharge plan, but also the family members and that the care team is working together.

30:44
Frank home based medical care.

30:47
So Frank from a utilization standpoint with these types of services that Doctor Duffy described and, and true, right, Not every single person like Frank has to have an APC or a nurse practitioner or a physician visit every month.

31:02
There's ways to to manage are high risk members appropriately through additional through additional lenses such as risk stratification or providing support.

31:13
If Frank perhaps does have an urgent care need and requires a visit sooner than their next scheduled visit in the home.

31:21
With programs like Frank's, the Home based Medical care program, this can lead to a 25% reduction in ER hospital visits and days in a sniff ultimately, right, reducing costs for everybody, not only the the health plan, but also for Frank.

31:40
And then what we're going to see in just a minute is actually a video too that further explains the in home assessment that you described.

31:49
Dr.

31:50
Duffy and I too have been out on these in home assessments, their annual Wellness visits and they are a an amazing visit that roughly right around an hour, which you you stated as well.

32:05
So it's very robust in the members home.

32:09
It's an annual health assessment, more so focused on preventative measures.

32:14
But in the video we're going to show you it also led to saving someone's life.

32:22
During these visits, we are addressing historical medical conditions, potentially identifying medical conditions through in home testing and screening.

32:34
And we're able to conduct assessments that then allow our care teams who are out in the field to further coordinate care, set up visits, established transportation, ensure that the member has APCP if they don't help them find one.

32:51
And ultimately also from an outcome perspective, closing around 87% of start gaps, which is huge.

33:00
So why don't we bring this to life?

33:03
We'll move to the next slide.

33:07
And what we're going to show you is a brief video clip that really helps to bring to light the annual in home Wellness visit and the value that it can bring to our seniors, not only from a preventative standpoint, but again, in this case actually saves someone's life.

33:25
So let's roll the clip please.

33:29
My role as a House Calls nurse practitioner is to meet people in their homes for annual Wellness visits.

33:35
We meet patients wherever they live.

33:38
I'm able to put out fires before they ever start.

33:41
I get to spend an hour with them.

33:43
I'm there to treat and monitor the whole patient, their medical needs, their social needs, and of course, behavioral health needs.

33:52
I want to use my knowledge and experience to advocate for members to get the care that they need.

34:01
We live here in this little country town and I have approximately 11 deer and I get up every morning and feed those deer.

34:08
Got through feeding the deer and breathing a little hard and when I got in, that's when it all started.

34:17
Hi Heather, how are you?

34:19
Jack's blood pressure was dangerously high.

34:22
It was 217 / 110.

34:25
She said there's something going on and she said I'm going to treat you like my daddy.

34:30
She said if my daddy was like his, he would go to the emergency room.

34:35
Heather hadn't come all the way out here.

34:37
I wouldn't have went to the doctor.

34:39
There was no reason to take that chance.

34:42
She knowed what she was doing and if she thought I needed to go, I was going to go.

34:49
They found my widowmaker was 97% stopped up.

34:54
After I got back to the ER and knew that he was there, I got the update that he had had a stent placed in his heart preventing a massive heart attack.

35:04
Wasn't for my Lordian Angel right here.

35:07
The doctor said I wouldn't be here, but you're good now.

35:11
I'm real good now.

35:13
By her coming all the way out here and checking me that day, it, you know, it saved my life.

35:30
All right, it's, it's an amazing story.

35:33
It's a true story.

35:34
And we are just so grateful for our, our nurse practitioner, Heather, and certainly the outcomes of this story.

35:44
It's just a, you know, again, preventative visits, although sometimes things like this can be identified right then and there.

35:51
So it's just an opportunity for us to celebrate programs such as these.

35:56
So let's close things out by answering the question.

36:00
We hope by now we've convinced you innovate or faith.

36:04
Hopefully you all are are listening to the discussion today and some of the approaches and opportunities to innovate and provide care services differently to our senior population than what they once were provided.

36:21
We saw the numbers right, more seniors, less Medicare dollars, more MA plan choices, lower reimbursement rates and increase utilization and making care affordable is going to be really, really challenging.

36:37
And members, seniors, they're looking for someone to fix fragmented care and they're meeting, they're looking for someone to, to meet their needs, how they want the care, where they want the care, when they want the care.

36:52
And the, their dynamics have changed.

36:56
So we're recommending continue to partner and integrate with providers, right?

37:01
All roads lead back to our amazing physicians and our clinical care teams invest in services that will improve outcomes and increase member satisfaction, yet lower costs and lower costs for, for our members too.

37:15
We need to reimagine healthcare in the home.

37:18
We need to think differently about it.

37:21
We need to think about where our seniors are, whether they're in metro areas or rural areas and what are those strategies that we're going to deploy in order to support them wherever they are.

37:31
So it's up to payers to enable providers to deliver through listening, right.

37:36
We talked about that too, really listening to our senior members and, and what is it that they want?

37:41
What is the plan design that they want?

37:43
What are the benefits that are most important to them?

37:47
So thank you so much for the time today.

37:49
We really appreciate the opportunity to speak to all of you who have joined the webinar today.

37:55
Thank you again to my partner, Doctor Duffy, and thank you to the Fierce Healthcare team for supporting this webcast today.

38:03
So now we will go ahead and turn it on over to the Q&A portion of the program.

38:13
All right, Well, thank you both so much.

38:15
As you said, we're going to be turning this into the Q&A portion.

38:18
You can still submit questions using the Q&A tab right there on the left side of your screen.

38:23
I see we have a lot of questions in here already.

38:25
We will get to as many of them as we can.

38:28
All right.

38:28
To begin, social determinants of health, sometimes abbreviated SDOH continues to be a focus in the industry.

38:36
What do health plans need to consider when evaluating their SDOH capabilities when trying to reach the members who are often more isolated and more difficult to reach?

38:47
All right, so I'll, I'll take this one, Doctor Duffy, I'll take a stab at it.

38:51
So social determinants, social determinants of health, the I'll probably list a handful of the the top social determinants of health.

39:03
So food, it's security or insecurity, transportation, we talked a little bit about social isolation and then housing security or insecurity.

39:16
And when meeting with seniors and when understanding that they have some of these challenges that they're facing from a social determinant health standpoint, you may not initially identify these things during the first visit, maybe not identified by the PCP or the specialist.

39:38
And so having programs such as the programs we described, home and community based services, transition services, annual Wellness visits, these are when these social determinants of health opportunities may be identified.

39:54
And it's fairly straightforward to say right If example, if someone is diabetic and doesn't have access to regular, frequent healthy meals, this can lead to poor health outcomes.

40:07
To transportation, if someone can't get to the doctor or get to their specialist visit or get to their therapy again, it's going to lead to poor health outcomes.

40:19
Housing people need rooms over their head, they need shelter in home visits can identify these things like Doctor Duffy said.

40:28
When you go to someone's home or their lack of, you're able to identify that individuals need additional support.

40:34
From a housing standpoint and social isolation, it's very difficult.

40:41
It's challenging when our seniors don't have additional support around them.

40:47
Individuals who can help to do any of the things I listed to help drive them somewhere, to help provide meals for them or to help them just with their care, their Adls or activities of daily living.

41:01
All of these things, all of these needs, if not met, can lead to poor health outcomes, additional visits into the ER or admissions into the acute care setting.

41:13
It can lead to adverse health outcomes such as falls or potentially some medical conditions related to the the side effects of not having these needs met.

41:24
So it's really important that we identify strategies to identify that these needs are not being met.

41:34
And that can be done through various risk assessments through home visits.

41:39
And I think what's really important too is building trust with seniors.

41:43
So repetitive visits can also continue to uncover needs within our senior population so that we can mitigate and close these gaps.

41:54
Thank you.

41:57
All right, thank you.

41:58
Let's move on to our next question.

42:00
Traditionally, we think of primary care as the gatekeeper.

42:03
With your model, could it be the payer becomes the gatekeeper and primary care as one of the many pathways to needed care?

42:12
I can jump on this one, Heather, if that's OK with you.

42:17
So as a primary care physician, I never like that term gatekeeper.

42:23
I like to view myself as someone who was providing the care for that member, making sure that they got to where they needed to be.

42:33
So if it was something that I could manage in the office and was comfortable with, and the member as obviously knows me and is comfortable with me, then I could manage it.

42:44
There are definitely some complex medical conditions that require the input of a specialist.

42:50
And when you're in primary care, you try to build your rapport with the specialists that you refer to and develop those relationships so that you can discuss your patients, you can get information back timely and you can make sure that you are providing good care to your patients, not necessarily gatekeeping the care that they get.

43:12
So what I think when you're starting to discuss these models of home based care, transitions of care, it doesn't necessarily replace the primary care physician, right?

43:25
And it doesn't replace the need for a specialist.

43:29
But what it does is it gives us a really good opportunity to partner, to partner with seniors, to partner with their caregivers and their providers in addition to their home based care team in order to manage their their needs.

43:44
It increases touches and we know that more frequent touches can improve cost as well as improved care that we provide because we're giving good quality care and we're moving away from the quantity of the care.

44:02
Hi, thank you dad.

44:02
This question, this next question goes into some details.

44:06
Can you address the the challenges for seniors in rural regions, regardless of age needs, their age, care needs and accessing the healthcare providers?

44:17
Because the the challenges in rural areas are, you know, transportation to get providers to the home or home care workers to the home, particularly if weather becomes an issue.

44:29
What about discharge planning, accessibility issues, not just in the home, but access for providers or or emergency transport services to get to it, for example, homes on a hill or with many stairs?

44:42
And how do you ensure adequate staffing positions for the care coordinators, follow up providers, Home Care Services, etcetera, etcetera and in rural communities that might have, you know, fewer professionals available?

44:56
Yeah, So I have experience in this.

44:59
This was my life for several years in Tennessee rural communities and our patients that live in rural communities we know are at increased risk because there is a decreased amount of care that's available.

45:14
Hospitals in those areas are shuttering their doors and it's becoming difficult for them to receive the care that they need need in the location.

45:24
And I think that's a big opportunity for technology, for technology based care to really play a role in helping to deliver the care that those members need.

45:35
With COVID, we saw an increase in the number of people using technology to receive care.

45:42
We started doing more telehealth visits.

45:46
It was sort of accelerated by COVID.

45:48
It was always sort of in the pipeline and it was coming and it was offered in certain areas.

45:52
But with COVID we increase the need to do that.

45:56
And I think it was a great opportunity to continue to expand upon that, particularly for our our patients that are in those rural settings.

46:04
You there is a lot that you can do.

46:06
You can't do everything in a telehealth visit and a telehealth visit certainly cannot replace in office visit where you're getting that personal touch.

46:15
But it actually can help to deliver care to our members that are vulnerable, that are in need and that are in locations where they can't get to the specialist.

46:24
That's an hour and 15 minutes away in Chattanooga as the case in my last practice, or an hour and a half in Nashville to get the care that they need.

46:33
So being able to set up those telemedicine visits with their primary care physician, with their specialist in those institutions and those tertiary institutions can be very beneficial.

46:44
And we're going to have to learn how to lean into technology to help us to deliver this care, to assess these conditions that they're coming up with to help to monitor their chronic conditions.

46:55
Right.

46:55
Let's just think about how the diabetes care has changed over the years.

46:59
Where we went from having to have patients do finger checks and manually write down their glucose logs and they'd come into the office with sheets and sheets of glucose, numbers of time of days to now it cannot be done digitally, right?

47:13
They can do continuous glucose monitoring.

47:15
It goes to their cell phone.

47:16
They can upload that data and send it off to their doctor.

47:19
Their specialist can take a look at it.

47:21
They can have that virtual visit with the member, go ahead and make any adjustments and medications that they need and to provide the care for them in the place that the members telling you that they want to get that care, which is in the home.

47:33
So technology definitely gives us a lot of opportunities to improve the care that we provide to our members across the board, but particularly to our members who struggle in those rural settings.

47:44
Yeah.

47:45
And and I would just add to that, I think I think that that is spot on, Doctor Duffy.

47:50
And it's interesting, right, the the telehealth aspect and just to sort of leaning into a couple other things.

47:58
So now right with some of the devices wearables, we can gather more information about our members that the example of diabetes is a good one such as continuous glucose monitoring.

48:10
And then I also think, I think there's a few additional things that payers can look at.

48:19
There's opportunities to partner with what I would call traveling organizations.

48:26
So organizations that do send travelers out to rural areas, there's a handful of organizations to to partner with you.

48:34
I mean you hit on it, it's very difficult sometimes to staff for those areas.

48:39
It's obviously more expensive, right, because they're having to drive far distances between patients.

48:45
And I think as also another opportunity sort of as part of the care team is a care advocate.

48:52
So who is either the family member or the neighbor who is involved, right, with establishing support for that individual that they can peek in or check in on that individual.

49:02
And I think that those are just some additional opportunities to further provide support for our rural members.

49:11
It's one other aspect that I'm sure it's like old as the hills, but it's risk stratification, right?

49:16
Who is who is at higher risk?

49:18
Who does need these services to really help health fund players to be as efficient as possible?

49:24
Who needs a more frequent visit than someone else?

49:27
And I think that can also be an approach as well as using data to potentially predict, right, who may be readmitted based upon their conditions and multiple medications and their their health and social status.

49:42
So just just other additional tools to think about.

49:46
It's not easy.

49:47
It's probably one of the biggest challenges that I think we we, we face as healthcare workers supporting individuals who live in rural communities.

49:59
Agreed.

50:02
All right.

50:02
Thank you so much.

50:03
Moving on, I think this may end up being our last question because we are reaching the top of the hour here, but let's try and fit one more in Referring back to one of the case studies you you discussed in your presentation, how do you manage Frank's relationship with three different specialists?

50:22
That requires a lot of communication and a lot of coordination of care.

50:27
And that's why those in home care teams are so important, particularly for for a patient like Frank who has three specialists and a primary care provider who are managing multiple issues.

50:40
But the specialists tend to focus in on their areas, right?

50:44
So by having that in home healthcare team that may or may not consist of an advanced practice clinician that has that nurse case manager involvement, you now have someone who can kind of step back and take a look at the big picture to make sure that Frank is not only getting to those appointments, but that the information from Provider A reaches provider C.

51:08
And that at the center of it is the primary care physician who can take a look at everything and make sure that Frank's needs are being met.

51:17
Something as simple as medication interactions when you have different prescribers, making sure that the dosing is correct.

51:25
It's really about that communication among the the providers, that coordination of care.

51:31
Again, technology and Ehrs help in that process.

51:35
But we know that it's not a fail proof system.

51:39
And so that's where having that in home care team can really help to step in and fill in the gaps for him.

51:49
OK, well, I do think we are we're reaching the end of our time here.

51:54
I'd like to thank you both once again and thank everyone for attending this fierce healthcare webinar for submitting so many great questions.

52:02
I we weren't able to get to all of them today.

52:04
We will try and get back to as many of you as possible personally after the webinar concludes.

52:10
I'd like to thank Optum Health for presenting today's webinar and to remind you all that you can download download PDF of the materials that were discussed today by clicking on the Handouts tab on the left side of your screen.

52:22
And a recorded version of this webinar will be available for you to access within 24 hours.

52:26
Just use the same audience link that was sent to you earlier.

52:29
Thank you again for joining and we look forward to seeing you at future events.