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Becker’s Healthcare Podcast
The Future of Integrated Care, and What Leaders Need to Do Now to Achieve This at Scale
00:16:06
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- [00:00]
A
Hi everyone, this is Erica Spicer Mason with Becker's Healthcare. Thank you so much for tuning into the Becker's Healthcare podcast series. So today we're going to talk about the future of integrated care and what leaders need to do now to achieve this at scale. And joining me for this discussion today is Shaina Hoffman, the president and CEO of Lucid. Shaina, welcome. Thank you so much again for joining the podcast today.
- [00:23]
B
Thanks so much Erica for having me on.
- [00:25]
A
We're thrilled to have you with us. And before we get into our discussion about integrated care, wanted to just check in with you to see if you could share a little bit more about yourself, your work in healthcare, whatever you think is helpful for our listeners to know.
- [00:38]
B
Sure. Well, again, great to be here with you. Shana Hoffman, President and CEO here at Lucid. So I've spent my whole career in healthcare. I always joke when people talk to me that I'm somewhat jaded for my age in healthcare, but I feel like I've sort of seen it all. I was at davita for a couple years, then sort of in the VC backed tech space working on patient access and sort of very small early stage companies and then spent the better part of the last probably close to 10 years now in the behavioral health space, a mix of private equity backed players. And then here at Lucid, which is a unique payer owned company and really have been passionate about how do we get behavioral health to the forefront. And we're really excited and we'll talk about this, I'm sure today we believe, really, and I believe throughout my career that behavioral health is the unlock. And if you could actually unlock behavioral health needs for an individual patient member, that's what's going to allow you to really transform their health care journey broadly across all the different dimensions.
- [01:39]
A
What a great quote. Behavioral health is the unlock. I think that is so well said, Shana. So thank you for sharing a bit more about your background and kind of this ethos that's guiding you in your work at Lucid. And just in that same vein as of behavioral health being getting it to the forefront, acknowledging its importance, I think there is a growing recognition that chronic disease overlaps with behavioral health needs in many cases. And while that acknowledgement it seems to be there increasingly care can be frustrating for patients and for providers and payers especially because we're seeing a lot of fragmentation between the two care journeys. So what do you see as the most significant risks and the consequences of fragmentation like this?
- [02:23]
B
Yeah, I mean Erica, it's a great point. I think for a long time we've known that behavioral health and chronic medical conditions are intersected. To your point around fragmentation though, it's very interesting. When you talk to anyone that's sort of bearing risk, whether that's a payer, whether that's a risk bearing primary care organization, they look at high cost needs, claimants and they generally look at those folks in two buckets, right? They look at folks on the medical side and sort of high risk, high needs. And then they're also looking at people that are high utilizers. From a behavioral health perspective, what I've noticed throughout the years is that if you actually look at the percentage of people that are utilizing behavioral health services within, in the high risk, high needs and working to drive up those members that are connected into care, there's a much lower percent of those people that are in behavioral health care. And so it's sort of long been this question in my mind of why are we not trying to drive up behavioral health care and looking at it at the intersection of those things. But to your point, this sort of system of care doesn't actually put behavioral health and medical health together in a lot of cases. And that's why I'm super excited about the work that we're doing at Lucid. So we've been purpose built behavioral health company for 27 years now, knowing that we were trying to get as many people screen, triage and connected into behavioral health care. And that was our mission and purpose is how do we do that reliably, repeatedly, at scale. But now because of this knowledge that again, behavioral health is the unlock and the force multiplier on medical expense, we've actually brought a medical care delivery company into the fold at Lucid. So now we're able to actually put that behavioral health at the forefront and break down some of that fragmentation because we actually have a company that delivers care in the home. And so now you can think about sort of that tip of spear for us of that looking at that patient. Yes, we know their medical needs, but we're looking at every patient through a behavioral health lens and being able to say how do we make sure that their behavioral health needs are met? Because that's going to allow us to then unlock on the medical side. So I think you're right that a lot of that fragmentation exists in the industry. I think we were trying to break through it in the form of hey, we have a great behavioral health solution that can help you. I think now we've said, hey, we're going to take matters into our own hands and bring that medical care delivery asset into the fold. And I'm incredibly excited about some of the outcomes we're already seeing and what we can actually drive and deliver that to the system to be that integrated care solution where I think execution has been challenging in the past. And we're seeing really great opportunities to actually drive that integration.
- [04:58]
A
Shayna, what an exciting development. Thank you so much for sharing about how lucid is bringing medical care delivery kind of into the fold as you've developed, described. I'm looking forward to hearing about some, some of those outcomes that you're seeing as well. But just want to say too that it's a fascinating approach because I think sometimes, I would say most times we hear about the reverse approach. It's normally medical providers bringing behavioral health into the fold. But you know, you're, I think this is certainly seems like lucid must be a front runner in this position. So really exciting to hear this development and it reminds me of what we hear about a lot in healthcare today, which is this whole person approach to care. So combining medical, behavioral health, social supports, and I know that that can have a big impact on health outcomes. So from your perspective, what role do multidisciplinary teams and community based interventions play in making care both effective and also accessible?
- [05:49]
B
Yeah, I mean, I think it's a multidisciplinary approach and team is a huge part of the solution. Again, I think the hallmark really of lucid has been how do you break down to sort of execution some of these things that we all talk. Everyone I think has known multidisciplinary care teams being able to weave in social determinants of health, being able to kind of bring a holistic solution to the patient, but it's not as simple in a lot of cases. The way that then manifests in the system is that you have a care manager from your health plan. Maybe you're in a particular chronic disease program through that health plan. So now you might have a care manager through that specific kidney care, for example, disease program. Then you go to your primary care provider. If they're in a risk arrangement, you might also have a care manager. Right? You might have one through the eight. So everyone's I think, recognized the importance and critical nature of those different systems of care. But then kind of it's where the rubber meets the road and the execution that I think things struggle because if you're a patient on the other side, and this is where, you know, we've been very focused on being member centric or patient centric now sort of in the world of both living in payer and care delivery. But how do you really make that into a reality that if it's your mom or your dad on the other side of that paper that they're not getting four or five calls of outreach because they're trying to engage the that individual. Right. And so, you know, to me I think there's again, this is one of those times when there's been such strong recognition really about multidisciplinary care teams as well as kind of the need to integrate behavioral health. But it's all kind of comes down to the execution. And so I think that's going to be really for lucid and for other organizations is how do you start to say what is really best for that member patient and break down some of those workflows? Again, it's really challenging when it's five different companies that are all out for their own, you know, financials and economics and they need to engage that patient. But we've been able to sort of simplify some of that because we're doing this kind of handhold with the payer and there's been more trust and willingness if you're taking kind of the medical and behavioral to be kind of that one central partner and really quarterback that care in a really meaningful way that, that can integrate and really deliver on that promise from a, from a multidisciplinary approach.
- [08:02]
A
Yeah, Shayna, a really helpful overview and so I want to go a little bit deeper there and then also we'll be sure to touch on some outcomes too. But you're saying that to really bring this whole person approach to life, it sounds like it's complex and at the same time it requires a lot of simplification too, making things simpler for payers as they're navigating this space. So I want to talk a little bit about scaling this model. What's really needed from health plans and providers to deliver integrated care at scale. And if you could ask leaders to make one change right now to head in that direction, what would it be?
- [08:37]
B
Yeah, I mean, I think a lot of the work that we're doing is around operational and clinical transparency. And what I mean by that is everyone kind of sitting at the table and sharing what they are uniquely positioned to do well, and not, I think again, and we've sort of benefited in not being a VC backed company that's sort of trying to raise the next round and having to kind of promise on certain outcomes but really deeply rooted in the execution and delivering results. And so coming to the table and saying, hey, if you pass me a population, I'm going to cut that population and look at it in all these different ways and I'm going to see where I can actually drive impact. So if I have chronic disease members in a certain condition type and they have underlying behavioral health needs, we're going to one, look at those things together and then two, we're going to pick where we know we can drive impact and actually have both production, sales, pricing model that matches to that. And so having a very transparent conversation to a health plan around this is where I can drive impact with, with your members. This is where I think maybe you can drive impact with your members. And then of course you need to bring the provider piece into the fold as well in terms of where you know the role of those, particularly the risk bearing primary care players in that. But really sort of dividing up that population to drive impact, that is different from kind of the hey, give me everybody and I'm going to have some sort of arbitrage opportunity where there's some people that are not going to need care and I'm going to be able to sort of make it up on that and maybe, or maybe not be well positioned to deliver for those acute populations. So I think it's this very, I know everyone always talks about sort of the data sharing and sort of why hasn't value based care kind of come to fruition in the way that everybody wants it to? And that being a data problem, I'm saying something slightly different, which is it's around kind of taking that data and then having a very transparent approach and even in the operational side too, in terms of what can you drive actually from an engagement metric perspective, not having the what's the promise of what it is, but what is actually possible relative to staffing and outcomes. And I think the more that those conversations happen, you start to be able to sort of divvy up the work to where the impact and outcomes can be driven. And that also simplifies things for the patient because essentially you don't have five different parties trying to engage that patient or member.
- [10:59]
A
So interesting, Shayna, what you're saying here about in value based care, from your point of view, it's not necessarily a data problem making it hard for this model to really come to life to the full extent. It's about taking a transparent approach with that data. Operationally speaking, it sounds almost like a surgical approach. What you described earlier, it was such a great, great way that you described it and I appreciate you sharing that with our listeners. And it sounds like two bidirectional communication is really important for payers and providers in this, in this way. But before we wrap, this has been such a great conversation. I did want to give you the chance to just highlight any outcomes you're seeing either at the patient or population level with this approach of truly integrating care, you know, lucid, bringing medical care into the fold or whatever. You'd like to highlight any metrics that you're proud of. We'd love to hear about those too.
- [11:48]
B
Yeah.
- [11:48]
C
So it's been really exciting. You know, your comments are right around sort of that surgical approach. I am an engineer by background and so we've taken a very sort of methodical approach to this actually, both on the behavioral health side and now on the integrated care side. So, you know, many folks in the market may know lucit for our access to care product, the Navigate Connect product. And it's been an interesting sort of evolution of the company where we've been, you know, focused on innovating on the behavioral health offerings for health plans and bringing this Navigate Connect product that was focused on getting patients connected quickly to high quality care. And so that's been the, you know, starting point. So we have now that product up and running. 83% of patients are booked into care within seven days. There's been a really significant increase, 5.2 days, the average time between booking and care. And then the really exciting thing is 81% of those patients that we are connecting to, the initial visits, are actually going for a second visit. And so we've seen in the data that the patients that are coming to us through the various channels that we deploy this through one actually have a higher acuity on the medical side. So again, this is sort of the starting point of that integration piece, but also though are continuing on into care. And it's actually interesting on the behavioral health side, you don't need that many outpatient interactions in many cases to actually start to bend both the patient outcomes and the cost curve. But it is really critical that you get beyond that first visit. We've also done over 15 million assessments. And so we actually have one of the largest repositories of sort of provider agnostic behavioral health assessment data in the country. And then, you know, we've seen again in the data from getting those numbers connected into high quality care, a $227PMPM total medical expense saving. So all of that data on the behavioral health side is what then led us to say, hey, if you bring together the medical piece kind of again into the fold. And so it's early days for us on that, but we know from the we acquired a company called McEra and now have relaunched that Lucid at home product, that the McEra Lucid at Home product delivers 26% reduction in admissions, 6% reduction in emergency department visits. And again, this is without that BH at the forefront component. And so we're really excited. Hopefully next time, you know, I come on, in a year or so we'll have the data because we're already starting to really combine those pieces together in the product to say what's going to be the impact if you layer in those outcomes. I've shared on the behavioral health side, couple that up with the medical side and look at what you can drive as far as the healthy days at home, which we look at, which is obviously the human element of providing that, as well as on the financial measures. So I think super exciting what has already been delivered on both behavioral and medical. And of course we spend a lot of time figuring out what to measure here. But to me, there's going to be a significant multiplier effect when you combine these pieces together.
- [14:51]
A
Yeah, Shayna, I appreciate everything that you just shared. Some really impressive metrics. And as you said, if we hopefully speak again a year from now, I can't wait to see how those numbers change and what's on the horizon for Lucit with this new approach. Coach, it's been a great time talking to you today, Shaina. Just wanted to give you the space to share any final thoughts or takeaways before we close our time together.
- [15:13]
C
No, I really appreciated that time today. Again, I think excited to start to have, you know, the market talk about BH at the forefront. I think you pointed it out well that most times we think about medical primary and BH secondary or tertiary in some cases. And so the idea of putting behavioral health primary again, we're leading the charge on that, but excited to see the market come along because I think obviously that, you know, from my perspective is better for patients if we take that approach. So, really appreciated the time today and excited to keep in touch over the next coming months.
- [15:46]
A
Well, Shayna, thank you so much again for your time and your insights today. It's been a great conversation and of course we'd also like to thank the sponsor for today's podcast episode. Lucet listeners, you can tune into more podcasts from Becker's by visiting our podcast page at beckershospitalreview. Dot com.