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Becker’s Healthcare Podcast
Advancing Value Based Care and the Future of Optum Health with Krista Nelson
00:27:50
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- [00:02]
A
This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right up. We're looking forward to hosting you here in Chicago. Hello everyone, this is Jacob Emerson with the Becker's Healthcare Podcast. Thrilled today to be joined by a really special guest. Krista Nelson serves as the CEO of Optum Health. Krista, thank you so much for taking the time to be with me on the podcast today.
- [00:49]
B
Well, thank you, Jacob, for having me. It's great to be here.
- [00:52]
A
Absolutely. It's a pleasure to get to talk with you, Christa. And before we dive into everything, we want to talk with you about today and all the special work going on under your leadership at Optum Health, can you first fill in our audience on your healthcare career background and what it is that you do today at Optum Health?
- [01:10]
B
Of course. So today at Optum Health, I lead the organization and prior to this role I was the chief operating officer for Optum Health. And really before that I have a broad background in healthcare, both on the Optum side in our, you know, data analytics and consulting organization, but also extensive background on the payer side at UnitedHealthcare, leading operations in our Medicare business and then also leading our Medicaid and duals business as well as operations on the UnitedHealthcare side. But I'm delighted to be in this role and really honored to be leading this organization through what is a really incredible time in health care.
- [02:01]
A
Absolutely. So you've been with the broader company for a long time now and serving in different divisions of UnitedHealth and Optum. And now you've stepped into this role, leading Optum Health during, as you know, a really important period, a strategic shift for this part of the company overall, moving from rapid network expansion toward a more focused direct employment model. We heard from Optum CEO publicly last year year talking a little bit about how in the past the company's rapid expansion maybe didn't align with clinically oriented value based models. So given all of that, what's your vision now moving forward for what Optum Health looks like on the other side of this major transition?
- [02:50]
B
Yeah, you know, when I joined Optum Health, we, you know, we quickly assessed the business and the capabilities and our contracts and our work with our payer partners. And it was clear right away that we needed to make the necessary shift to your point, moving from what was really a rapid period of expansion and growth just back towards our core model. Before I answer your question on our vision, I thought I would share just three things that really stood out to me from the very beginning.
- [03:26]
A
Please.
- [03:28]
B
First and foremost is we have just incredible capabilities inside Optum Health. Our primary and specialty care, behavioral health care, home health, hospice, palliative care, as well as surgery centers. We care for people in clinic as well as in their homes and in their community. And we also support transitions of care. And our model is anchored in primary care. And when we employ and deeply partner across these various service lines with an aligned payment model, our value based care model delivers superior outcomes at a lower total cost of care. While we see improved patient experiences and provider satisfaction. And maybe just give one example, one of our markets, Houston, where we serve almost a million patients across more than 50 different clinical settings, we offer that full suite of services that I mentioned, Primary care labs, imaging, specialty care, surgery, care, coordination. In this market we have a four and a half star health plan, total cost of care that is 15 to 30% lower than the alternative patient satisfaction scores in the 90s and really low provider turnover. Again, first, it's just this incredible set of capabilities inside Optum Health. The second thing I want to call out is just while we have a number of really strong examples like I just mentioned, like Houston, you know, we have seen and we've discussed this publicly, there's, we do have some variation in our performance across our markets. And you know, whether it's attributed to some of the funding headwinds from V28 or you know, consistently elevated medical trends and really just that significant growth in our risk membership, you know, our operating performance is, you know, is inconsistent across employed and contracted providers. We have some opportunity in our current contracts with our payer partners and with our network providers. That is really creating a lot of opportunity for us. The third thing I would just say is the culture, the mission, the passion for value based care is still alive and well and just really deeply rooted in the organization. Those three things are really incredible signals that have helped me think about kind of what could the other side of this look like. And I guess to answer your question now you should expect Optum Health on the other side of this to really more consistently deliver market leading, integrated value based care. A system that is anchored with our employed groups, but with the help of technology and operational improvements, more scale and a more tightly managed network to help enhance that scale. We will have a much stronger base to grow on, whether that's in our existing markets or in new service lines and in new markets. What does that mean? What does that mean for patients? It means improved health status and quality of life. For example, today, even with those challenges I mentioned that we're navigating our Medicare Advantage. Patients served by our model have 21% fewer hospitalization admissions. Overall, our patient outcomes improve, care coordination increases and really patients should continue to expect a high quality experience when they come to optum health. For clinicians and care teams that work here and partner with us, it means we'll have more technology enabled, improved workflows that are focused deeply on reducing administrative burden. We talk a lot about reducing pajama time, improving the consistency in our clinical excellence and our clinical workflows. And then last, I would just say for payers and health system partners, more reliable execution, deeper reach in our existing markets so we can serve more patients across more service lines and continue to execute really the promise of value based care and the outcomes that we continue to generate.
- [08:22]
A
Understood. So really building on and improving that base to deliver more market leading care, that's your vision for the other side of this, Krista? And of course you know, as you know at the center of that is your clinicians and you mentioned just the incredible abilities of Optum Health all over the country with primary and specialty care, home health, palliative surgery centers, behavioral. So as the company evolves as how are you working to intentionally improve that clinician experience? I know you just touched on that a bit, but how are you actually on the ground enabling those care teams so that they can practice at the top of their licenses and then ultimately ensure that they feel heard and aligned with this massive organization across markets, individual markets, all over the country?
- [09:10]
B
Yeah, for me this is critically important. And improving the clinician experience for me starts with listening, listening to our clinical teams, observing the workflow, the experience and really ensuring that we design our system that supports how they practice value based care and their needs, relieving burden, like I mentioned, kind of making it easier for them to practice that model. And in addition to listening to our clinicians, I would also say it's deeply important to listen and understand how advanced technology and how rapidly technology is changing and making sure we're taking advantage of modernized technology to enable that clinician experience. But there are three other things that come to mind. The first is what's important to us here is really Strong dyad models. So our physician leaders and our operating leaders and partners being aligned and leading the change really together across our markets to make sure we're advancing our models and that dyad partnership at the top of the organization, all the way through the organization at the local care delivery level is critically important to to enabling our care teams to be practicing at the top of your license. Like you mentioned, the second thing is having strong engineering and product teams paired with our dyads to build technology solutions and workflow capabilities that actually work and to do that with speed. Today we have really good relationships and partnerships with our Optum Insight partners and we've done a lot of intentional work to again make sure that our engineering and product teams are really co located with our strong dyad partners again so that we're listening, we're learning and we're actively adapting and we're deploying capabilities faster at the market level to get that real time feedback and scaling quickly. And that really is part of some of what we're doing to improve our operating performance is making some of those scaled improvements happen faster across our practices and across our delivery service lines. And then third, we just continue to remain deeply committed to value based care and that is at the core of our mission, our purpose and our why. And I think to have a really good clinician experience, we need to stay rooted in that core, which is really why we exist. Our clinicians and our care teams are passionate about value based care. It allows them to deliver holistic care, it allows them to spend time with their patients to avoid chronic disease instead of rushing through high patient volumes. They came and they're choosing value based care because it reduces burnout and stress and allows them to practice medicine the way they want to practice it. And so while we stay focused on operational improvements, we are certainly not losing sight of why we exist in the environment that attracted physicians and incredible care teams to work here and keeping that core to everything we do to make sure we're bringing value based care at scale with the appropriate outcomes, cost management and an improved patient and provider experience each and every single day.
- [13:00]
A
Absolutely. It's very clear that you see value based care as a core model to continue moving towards improving, certainly not straying away from that as your core mission. Krista, and you mentioned Medicare Advantage there in your last answer. And I wonder if we're talking a little bit about what's going on in the industry more broadly. Of course, CMS put out their proposed rates for Medicare Advantage for next year. Basically flat funding overall for the program if, if that proposal stands and the federal government received record comments from the industry this year about that proposed rate. And it comes as a time, as you know, where utilization is up, care costs are up for caring for seniors. So everybody is talking about this. You'd be hard pressed to find an insurer that is satisfied with the proposal. So from from your perspective and given your your piece because of your long career in this industry, can you talk to us a little bit about how stability in Medicare Advantage policy and in funding going beyond the payer perspective and how that enables providers like yourself to invest in better care models and then ultimately of course, delivering better outcomes and experiences over time for seniors?
- [14:23]
B
Yeah, it's an important topic and I think just to reiterate where you started, our deep conviction and belief in value based care being the right path forward, maybe I'll just unpack that for a moment and then definitely want to get to the question around the advanced rate notice. I think again we've continued to reiterate this, but I think it's just incredibly important to remember that a major contributor to high costs and low value care in the U.S. is this current system's reliance on fee for service payment models which reward for volume of products and services consumed. It's a system that's really built on the intensity of treating people when they're sick, rather than one that's focused on proactively keeping people healthy and keeping them cared for. And I mentioned some of the outcomes. Today our Medicare Advantage patients served by value based care models have 21% fewer hospitalization admissions. Overall those numbers actually grow for members with certain conditions. For example members with hypertension. It's 35% reduction in hospital admissions and 44% reduction in hospital admissions for those with COPD and asthma and other acute and chronic conditions. So we have the data and the support to support value based care and why it's really needed now more than ever. And as we think about the advance rate notice and what's kind of just sparked significant discussion is bottom line, when there's rate pressure and lack of rate stability, it does squeeze funding which does unfortunately impact value based care. We've seen that with the changes with V28. We've seen that with the growth rate maybe not keeping up with medical cost trends and that cost trend impacting value based care. And frankly it also payers respond in that environment. And while we're all focused on reducing administrative cost and waste in the system, unfortunately some of those rate cuts do result in benefit cuts for seniors and Then it also results in some cases mispricing, which that has been a effect of what's happened in value based care. And for us in particular, that mispricing kind of does impact downstream value based care providers like us. And so we just believe in stability in Medicare Advantage funding because we continue to see the outcomes are better, the quality is better, the costs are lower, you have more benefits inside Medicare Advantage than compared to Medicare supplement or Medicare fee for service. And I think the last thing I would say is when that funding is not stable, what happens is then we are going to need to make choices in how we manage that cost environment and that cost reduction. I mentioned benefit cuts for seniors, but it also means maybe less time spent on preventive care or it means us having to think about trade offs with wraparound services or investments we make in care teams and care coordination. What happens then is patients may end up in the ER or getting fewer preventive screenings or things of that nature. We're advocating strongly on behalf of our patients, on behalf of our providers and in partnership with our payer partners to ensure that we can continue to advance and scale the value of value based care. Because we again, we believe that it is the right approach to reward a system and really incent a system to focus more on preventive, holistic care for Americans.
- [18:40]
A
Certainly. And to your point, Krista, I mean, we've already heard from industry groups, from individual insurers about what this, this advance rate notice, what it would mean for benefits for seniors down the line if it, if it becomes reality as currently proposed. So it will be fascinating to see what happens there. But, and I know that's something we could talk about during this entire conversation, Medicare Advantage alone. But I want to also make sure to ask you a little bit about AI. I know it squeezes its way into every conversation right now, but, but we've been hearing from UnitedHealth more broadly about how much work the company and investment the company is making into this technology. We heard about how the company has deployed more than 2,000 engineers into AI initiatives and integrated over a thousand AI use cases across the broader business. So where you, in the part of the company that you lead, where you already seen AI technology more broadly meaningfully reduce burden or improve the experience overall for your patients, for your care teams on the ground. What is that looking like?
- [19:51]
B
Yeah, there's really, there's so much opportunity here and I'm, we remain deeply committed and really excited about what AI can do to again reduce administrative burden, kind of reduce, you know, waste in the system and really enable our care teams to operate at the top of their license and also really create more access for people so they can focus on care and not as much on the, whether it's the documentation side or the summarization side. So a couple of examples that are already live on our end. First is just ambient scribing, which allows clinicians to really focus more on that face to face conversation with their patient. And you know, that scribe, you know, really taking all the notes and allowing physicians again to focus on their patient and really just kind of review and approve the notes at the end of the day so they're not, you know, face down in a computer or having to work on notes in their pajamas at home later at the end of the day. That's just, you know, one example. Another is, you know, beyond that documentation using technology to really kind of summarize care. So kind of pull different medical records, charts, claims, labs, history, information that the patients are sending us in advance, their appointment, kind of pull all that together to help care teams be more prepared for the visit and have a kind of a prioritized set of things that they want to make sure they're addressing with the patient in addition to listening to what the patient needs are. You know, that's one and third a way in which that comes to life not just in a clinical setting, but as you know, we have a number of nurses that do home health visits and we use that same kind of summarization tool to help our nurses that are driving to patients homes by allowing them to have this summary and like an easy to listen to audio summary. So again, they get to know their patients, they get to digest that history on their way to the visit. So they're not having to spend as much time kind of redoing all that history, but instead validating it and focusing more on the patient needs in front of them. I would just say these are three very simple examples, but the opportunity is truly vast. We are absolutely investing dollars and resources and putting teams deployed to these exact same things. Go back to what I said in the beginning, which is really starting with listening to our clinicians and starting with what they need to improve patient care and patient outcomes and always making sure that, you know, they're operating at the top of their license. One other thing I just want to mention here, which is really important to us, is while I will be able to do a lot in healthcare, I think there's something really critically important in healthcare which is kind of humanity and empathy and care. And that's Something that, you know, AI isn't replacing yet and may not. And that's where our clinicians and care teams being able to practice medicine, enjoying their work environment, focus on value based care, being able to bring that empathy into every one of our visits and our experiences with our patients is always going to remain critically important.
- [23:09]
A
Understood. So it really sounds like at the core of these investments you want to make sure that, that you're enabling and better supporting that human to patient to clinician connection. Krista, before we go today, we've talked a lot about the pivotal time for Optum Health, what's going on in the industry more broadly and then your conviction that value based care, that that strategy is the correct one moving forward. Has anything surprised you so far in, in your role? I know you've, you're coming up on just about six months of leading Optum Health. How, how is leading such a critical company for the industry overall? How has it shaped your, your personal view of where this industry is headed?
- [24:00]
B
You know, I, I am even more convinced that value based care is truly the answer right now in health care. When people aren't getting the quality care they deserve, when costs are rising and not affordable, when patients aren't satisfied with the experiences and providers are burned out, I continue to remain convinced that we have the right value based care model and there's a lot more opportunity to grow and to scale this to even more and more, more people. And you know, you, you mentioned what has surprised me the most. This business has really been going through significant change and we've, you know, we've talked at the beginning about, you know, operational opportunities to improve performance. But what is really alive and well is, you know, resilience, a deep purpose and commitment to our patients and to the promise of value based care. And truly an innovative spirit and kind of that growth oriented spirit to always show up and do better tomorrow for our patients than we're doing today. And I just think maybe I shouldn't have been surprised by that. But I am so pleasantly surprised with that purpose and the potential of this business. And I couldn't be more thrilled to be here at this time when healthcare needs us now more than ever. And you've got a team that is truly ready to deliver better outcomes for our patients that we serve and just honored to be here.
- [25:38]
A
Yeah, I'm sure it's a very satisfying thing to be surprised by. My last question for you super quick. You know, we're being listened to by thousands of hospital executives around the country, health insurance executives, all facing similar problems, pressures as you and your colleagues. Anything else you'd want to share with them? Final bits of advice?
- [26:03]
B
You know, I think there's never going to be just one simple answer, one simple solution or, you know, to the challenges that we're facing in health care. It is really going to take all of us to work together, find common ground, align incentives, and work together to deliver a better experience for patients and better quality outcomes for society. And we welcome those partnerships. We welcome those conversations and those relationships and the ability to work through those aligned incentive models to make sure that we are improving for all of us. We have that responsibility to improve what we do each and every day for the patients that need us the most. And I think I'm really optimistic that we have great relationships today. But I'm even more optimistic that with the results that we have in our clinical models today and with the relationships that we have and frankly, the momentum we're gaining, that I think we're in a great position to come together with, whether it's hospital system partners or payer partners, other clinical leaders, network providers in our communities, and actually just start to action against this and continue to hold ourselves accountable to do that together as a society and together as partners.
- [27:26]
A
Wonderful. Well, Krista, I can't thank you enough for taking the time to chat with me today on the podcast and for sharing your insights, your expertise with our listeners. We truly appreciate it.
- [27:38]
B
Thank you so much for having me.
- [27:40]
A
And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Becker's Hospital Review.
- [27:47]
B
Com.