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Becker’s Healthcare Podcast
Accelerating Value Based Care Through Operational Transformation with Dr. Angelo Sinopoli & Deepak Sadagopan
00:18:26
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- [00:00]
A
This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to have a discussion today on value based care with Dr. Angelo Snopele and Deepak Sodagopin and Deepak's with risen health. Angelo, Dr. Snopoli is with Cone Health. We're talking about value based care. Some of what they're watching, what's going on with the acceleration of value based care and a lot more. Angelo, Dr. Snopele, could you take a second to introduce yourself and then Deepak, I'll ask you to do the same.
- [00:31]
B
Yes, I'm a pulmonary critical care physician by training and practiced for many years in Greenville, South Carolina. Got deeply involved in value based care and value based care leadership for a number of years and have been at Comb Health now for two years as executive Vice president of Value Based Care.
- [00:53]
A
Phenomenal. I know you've got Dr. Krakowicz now is the the new CEO at Cone Health and Greenville happens to be one of those beautiful places in the country. We're just there for a friend's wedding a couple weeks ago in just a gorgeous area as well. I know you spent a lot of time there. Deepak, can you take a moment and introduce yourself and talk a little bit about what brought you to Rise and Tell and more?
- [01:14]
C
Yeah, absolutely. First of all, Scott, thank you for welcoming here. And you, you address me as Dr. Sadagopan. Although I would love to be a physician, I'm not. I'm a health economist and I'm delighted to be here. And I've been with Ryzent for almost a year and a half now. And what brought me to Ryzent is the commitment to pursuing value based care, transformation of care delivery using Kaiser's proven model of value based care and patient centric care and bringing that to more communities across the country in a way that is scalable and leads to lower total cost of care, more benefits to the communities, more benefits to the average consumer of healthcare. So that's the compelling vision that gets us all excited here at Ryzent.
- [02:08]
A
Thank you so much. And I always think about healthcare economist as deeply caring for the economy. Well, doctors deeply care for patients, so there is some great thread there between the two. No, I, I thank you so much for correcting me. Deepak. Thank you so much. Talk a little bit about, there's been obviously talk about value based care forever and the evolution of value based care. Rise and Tell, you know, is part of this great effort to try and accelerate the the true usefulness and value of value based care. Deepak, tell us a little bit about how you're doing that and what you're seeing.
- [02:46]
C
Yeah. The mission of Ryzant Health is expanding access to proven methods and value based care developed originally by Kaiser Permanente and bringing that model to more communities in partnership with like minded health systems. And what it has evolved to is when as we bring in systems like Geisinger Health and Cone Health into the community, we found that these systems already are doing a fantastic job in their respective communities. And there are actually best practices and proven methods that are embedded in the work that they are already doing. So it has evolved to really curating and bringing together a set of common capabilities that we will expand to the rest of the all the communities that we are covering as part of Rise and Health. And these are things like enabling system level transformation and value based care through deployment of an integration of clinical operational technology capabilities. The model really focuses on making the right care, the easy care. And what that means is supporting clinicians with the evidence based care guidance, care coordination and navigation tools so it makes their job easier. Supporting patients or members with the tools so that they can navigate to the right care. They are never left alone to fend for themselves as part of the overall system. So they always know where to go to get the care the system is providing the tools to navigate them to the right door. And from an overall care model transformation standpoint, we are focused on lowering the total cost of care and by really reducing avoidable expenditures and avoidable utilization and really focused on moving transitioning a lot of the care to doing more within the primary care area itself. And that way you're preserving the resources of the system to care for the patients who actually need it to. We can talk a little bit more, but one of the key things, Scott, as you will recognize, is the Kaiser model was originally designed to operate in an integrated care and coverage model where they also have their own insurance. A key part of the work that we do here at Ryzent is take the capabilities that Kaiser has developed, but really contextualize it to a multi payer, multi provider environment, which is the kind of environment that Geisinger and Kohn operate in. And so that's a core part of how we are develop what we call our value based platform that we're bringing to all these communities.
- [05:37]
A
Thank you very, very much. And Deepak, thank you, Angela. Let me ask you this question. In terms of the attraction Cone Health for Ryzent Health, is this effort to accelerate value based care part of the attraction to Cone Health to Join with this effort with Risant Health.
- [05:55]
B
Absolutely. So Cone Health has been in the value based care journey for almost a decade and I think the opportunity to partner with Riseit Kaiser is a once in a lifetime opportunity for a health system. Kaiser through Risant brings decades of experience in their value based care operating model and what it emphasizes, which is what I like is it really focuses to your point on clinical care models and operating model changes. It's not a finance model. And when I talk to people at KP and Risant, the questions are usually tell me about your care models. How are we caring for patients most effectively and most efficiently? Obviously the finance piece has to fit in that to support that model. But that's really the focus is that Ryzent's also been very open and flexible in trying to understand what a community hospital's operating issues are as opposed to a Kaiser model, has been willing to explore those and kind of help us work through those issues too that maybe a Kaiser doesn't and experience.
- [07:06]
A
Fantastic. Angela and Deepak, let me turn back to you. What can Risant do to help different systems it aligns with to make that shift towards value based care? What does that look like and how could that be done? And I love Angela's point that it's not necessarily a financial concept, it's as much a concept of how do we take care of patients well and so they combine with what you said about letting then the health system or the true hospital take care of the most sickest patients. So we've got more room for that. But Deepak, back to you, how do you help make this shift?
- [07:40]
C
Yeah, it's a great question and I love how Angela framed it, which is that this is not a financing model we are after. And I would like to note a couple of things Scott. One is that when you say value based care today predominantly in the industry it is almost synonymous with a lot of work that's done outside the scope of the hospital in primary care predominantly. And most of the CMS CMMI models focus on this area for transformation. The second I would note is that value based care is almost equated to financial model change, which is, you know, new risk models and things like that. And you've seen CMMI evolve a number of different payment, experiment with a number of different payment models over the years. You know, going back to my own experience as you know previously working with large and integrated health systems, one of the key issues that these systems generally face in that transformation to value based care is they don't have in their day to day operations leave them so constrained for additional space that they don't have the additional bandwidth to invest in capabilities necessary to continue to evolve the transformation model. And this is really where Verizon steps in with investment, with capabilities, with tools to be able to enable the shift. And we look at the transformation journey not only from a primary care standpoint, but across the entire continuum of care. We start with primary care. That's kind of where we start. We start with saying we want to bring evidence based practices and deploy them at the desktop for every primary care provider. So and we've done this with a capability called value based care guides within the value based platform. So for over 550 conditions that primary care frequently faces now, every primary care provider in Geisinger and Cone has access to essentially a small set of bite sized guidelines on how to manage those conditions so that a, these conditions are managed in a consistent and standard way, minimizing variation on when you pull specialty in, when you don't refer to specialty, when you can do the workup within a primary care setting. And second, by doing that, you're freeing
- [10:01]
A
up
- [10:03]
C
precious specialist capacity so that those patients who are on a waiting list for like two months or more to get into a specialist office can now get access sooner. And overall, by progressively doing that now, we have freed up specialty. The same thing we do on the ED side where we are, we are redirecting some of the avoidable care into less emergent cases. And also, by the way, this is not just shifting care to less expensive areas, less expensive sites, it is also shifting to the most appropriate site. And our clinical team loves to do say this and emphasize this when we do these implementations, which is if a patient does present with conditions that are, that are requiring more emergent care, we will actually do what's called shift, right? That we will advise them to go to the emergency if that's what's appropriate at that point in time. And so it's really more appropriate care than that we are focused on at this point. So that's, we progressively applied that evidence based criteria at every point in the continuum of care, whether that is primary care, specialty care, emergency, hospital, post acute and so forth. And that's been our journey over the past two, two and a half years, is to put that in place.
- [11:33]
A
Thank you. Deepak and angel, let me ask you sort of two follow up questions. How is it going so far for Cone Health and what's the experience been so far with the acceleration of value based care and then also what Are you most proud of about what's gone on the last six to 18 months? Sort of. How is it going with the acceleration? And what are you most proud of the last 6 to 18 months or so? Dr. Sinopoly?
- [11:57]
B
Yes, thank you. So cone is relatively early in its roll out of the Ryzen Kaise of value based platforms. So although we're involved in quite a number of the two that we have the most experience with right now, one is called Care Without Delay and it's focused mainly on the inpatient setting. So once a patient shows up in the emergency room, is going to need hospitalization and gets admitted. Care without delay brings structure, process and discipline to how that patient is managed expeditiously through that patient's hospital stay and making sure that patient gets all the resources, resources and attention that patient needs throughout the stay on a 24, 7 basis. It does bring significant discipline to the team. I was curious as to how the team was going to respond to that, but they've responded actually exceptionally positively because it has brought that discipline and structure to their work. The physicians have actually made the comment that this process actually brings back the joy of medicine and practicing on the inpatient side. And the nurses have been exceptionally happy because it provides them the resources they need, the escalation processes they need to get patients taken care of. So it's been a very positive response and we're very, very proud of that and proud of our team engagement, which has been tremendous at the first hospital that we rolled that out to. The other platform that we've implemented is our Value Based Care Guides, which are a set of guidelines in the ambulatory SET that help physicians look at evidence based processes for each diagnosis that their patients may have and better be able to manage those patients in the office. That sounds fairly simple, but what it does is standardizes care across the system. The other cultural thing that it did for us is that we had to bring all of our physicians together, the primary care docs, the specialists, to socialize those value based care guides, to agree on those. There's not much opportunities and clinically integrated networks to get to do that together as a broad physician group. So that was exceptionally useful. And now the quality committee of our clinically integrated network have adopted those guidelines and are using that as standard care across the entire network. So that's been a very positive thing and very proud of the engagement that the physicians in the network have had in trying to implement and standardize those things.
- [14:41]
A
It's literally fantastic what you're doing, Deepak And Angelo, let me take us through sort of our two minute drill as we try to wrap up with a few more questions. And I'll ask you each for 30, 60 seconds on each of these. Deepak, let me start with you as you've evolved in this value based care effort in a much more deeper and accelerated way. And I'll ask you Both this question, 30, 60 seconds each. Deepak, what's been most surprising to you and Angela? Let me get your answer to the same question starting with Deepak.
- [15:12]
C
Yeah, what's been surprising has been coming into Ryzen from coming into Ryzen and the KP environment from a non integrated care and coverage type environment. You know, even the initial impression was all the work that we do in value based care is really going to be focused on the ambulatory side and really focused on transforming primary care and related models. It was exciting to see that the Kaiser model placed the entire continuum of care as its focus on care transformation. As Angelo just described, care without delay is front and center of that model and the results are amazing to see. Within a year and a half of deployment of these platform capabilities, we are consistently seeing from a provider perspective almost 20% decrease in self reported provider burnout. 20% of patients who self reported the use of emergency department for a condition after using our navigation tools chose a lower intensity, more affordable option that addressed their care needs immediately. There's a 5% consistent reduction in referral to specialty shifting more of the work that would have previously been done in specialty in primary care itself. And that's about 700 appointments on a monthly basis. So if you translate that, there's a lot of touch patients we are touching and recently most recently in cone for patients who had long length of stay, more than 200 days on an average and there were 70 of those patients on an average in the hospital facility we were able to reduce that to more than 50, by more than 50, 60% and getting these patients back home sooner, reducing their lengths of stay on average. So it's been, the results have been pretty amazing to see and it proves that transformation can be accomplished if you approach that in a very systematic evidence based manner in a finite time frame simply.
- [17:25]
A
Marco and Angela, let me let you wrap up with what are you most surprised by so far? What has surprised you?
- [17:32]
B
Yeah, I think as most systems think about moving into value based care, they immediately go to population health resources. And I think the surprising thing is that those population health resources probably only account for about 20% of the effect that we're looking for. 80% of this transformation is operational transformation. And it's been surprising how much operational enterprise wide operational transformation needs to occur and how hard that is to actually get accomplished, even with senior leadership. Buy in.
- [18:10]
A
Dr. Snopely Deepak, I want to thank you so much for joining us today on the Beckers Healthcare podcast. It's remarkable what Ryzen's health and cone health are doing and the acceleration here. Thank you so much for joining us. Thank you so much.
- [18:22]
B
Thank you.