Encore! EP361: The Gap in Closing Care Gaps, With Carly Eckert, MD, PhD(c), MPH
You can listen to the episode here.
[00:00:00] Stacey Richter: Encore episode, "The Gap In Closing Care Gaps". Today, I speak with Carly Eckert, MD.
American Healthcare Entrepreneurs and Executives You Want To Know Talking. Relentlessly Seeking Value.
I decided to encore this episode with Dr. Carly Eckert because I keep finding myself quoting Dr. Eckert in conversations, even a year later.
First off, if you're not familiar, a care gap is what happens when there is a bad transition of care. Patient has no idea what their discharge instructions actually mean, so they wind up back in the hospital. Patient didn't pick up their prescription, so they wind up in the hospital or back in the hospital.
Patient still has uncontrolled hypertension long after being diagnosed with uncontrolled hypertension or uncontrolled diabetes. It's crazy how many patients keep going to their doctor and being told they have high blood pressure or high blood sugar and their care plans are not adjusted. Or they don't take their meds due to cost or a lack of trust or whatever other reason.
Or care gaps exist because the patients don't go to their doctor in the first place. So they settle right into a care gap that no doctor can fix because down there in the bottom of that care gap, there's no medical professionals.
So a year later and the year after that, their blood sugar or their blood pressure is still high. These are patients in care gaps.
I mean, consider that heart failure. I heard it called the a little too late disease by Dr. William Besterman the other day. You don't just spontaneously develop heart failure after all. If you have uncontrolled hypertension and or uncontrolled diabetes for too long, you will get heart failure and you'll also probably get chronic kidney disease.
Chronic kidney disease, by the way, is often the cause of most heart failure readmissions, so think about the entire impact of heart failure and most kidney disease when you think about the cost of care gaps.
This is what we talk about today. And with that, here's your Encore.
Today, I'm speaking with Carly Eckert, MD. It's kind of funny, actually, I originally wanted to get Dr. Eckert on the show to talk about care gaps and how to close them. But this show did not wind up going how I thought it was going to go.
Because Carly Eckert is a physician by training who got really interested in the upstream causes of what she was seeing in clinical practice. Despite my best efforts, she refused to be lured into my closing care gaps conversation. So instead, this conversation is about the Construct of care gaps and thinking about them in context.
Closing care gaps is a model of care and maybe not a particularly great one, relatively speaking. In fact, here's another name for the model of care called closing care gaps, care gap, whack a mole, care gap pops up, we whack it, care gap pops up. We try to close it. Another care gap pops up. We try to close it.
Another care gap. You get the idea. Carly Eckert has worked in epidemiology and public health and also clinical informatics for health systems and payers. I recorded this show with Dr. Eckert prior to episode 359 with Dan O'Neill. In that interview, which you should go back and listen to when you have a sec, but Dan O'Neill cleared up a couple of things that I struggled with during this interview today.
Here's the big one that I could not figure out. Why with the whack a mole? Why do we still insist as a nation on waiting for someone to show up in clinic to retroactively and reactively address a missed preventative care opportunity? Why don't so many more provider organizations create pop health programs that consider the whole person proactively?
Like, why don't they take the time to operationalize whole person care in a meaningful way? Ah, yes, to the surprise of exactly no one, it's all about the Benjamins. As Dan O'Neill put it, if all a provider organization is doing is slapping a sheet on a doc's desk every morning with a list of care gaps for all the patients that he slash she will see that day, it's highly likely that incentives or penalties to do anything else are very weak.
It's a sign that From a paying for value perspective, we're not paying enough for value that it's worth it or maybe even feasible for any provider organization to take the time and capital expense to switch up their business model in any meaningful way. So the provider gets a little bump or a little knock if they don't meet some quality standard.
Okay, great. So then they'll minimally tweak their workflow and have doctors within their 7 to 15 minute visit suss out and try to close care gaps. I don't want to say this is entirely negative. It's known that when provider organizations do close care gaps, patient outcomes do tend to get better. So not arguing that.
But there's opportunities that get left on the table with all this reactiveness. Bottom line, you insurers, you purchasers of health care, pay for value, for real. But you provider organizations, if you don't fix this stuff yourself, you're going to get doctors and other clinicians, as we're seeing, burning out and quitting because there's only so much you can jam into a seven or 15 minute visit, number one.
But number two, doing population health reactively like this is suboptimal and everybody knows it. So what winds up happening is dedicated doctors and nurses. desperately want to do the right thing, but simply do not have the time. And they watch patient after patient suffer for it. That sucks. So fix it.
I mean, at the end of the day, it's probably cheaper than having to recruit all new doctors and hire traveling nurses when all of the current staff quits due to burnout and or moral injury.
My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
Carly Eckert, MD, welcome to Relentless Health Value.
[00:05:31] Dr. Carly Eckert: Hey, it's great to be here.
[00:05:32] Stacey Richter: If we're going to talk about population health, what are we shooting for here at the end of the day? How do we know that we've been successful?
[00:05:38] Dr. Carly Eckert: There's lots of different definitions of population health from enabling better care through services, policies, and resource allocation.
I think about population health as a way to combine the patient in front of you in the larger context of the world they live in. And thinking about how can we really provide that opportunity for care, both the personal level and the holistic level that's empathetic, that's high value, and it's evidence based.
[00:05:59] Stacey Richter: In terms of population health, how does the clinical pathway have to manifest to attain the results that we're looking for here?
[00:06:07] Dr. Carly Eckert: You can't take the patient really out of the context in which they live. We can certainly address the issues for which the patient might be in clinic or the patient is being seen, but when we're talking about population health, we really need to zoom out and we really need to think through what are the challenges this person faces on a daily basis?
What are the stressors? What are really, what are the, the non clinical challenges that, that are affecting this person's health and health status?
[00:06:29] Stacey Richter: I have definitely heard it said, I think by you, my friend, that, you know, one of the things that we have to think about as an endgame here is to try to figure out how to get a non fragmented state of care.
[00:06:41] Dr. Carly Eckert: I mean, when we think about the goals of care, I've read some great stories about Paul Farmer over the last few days, who unfortunately passed, was really a giant in the world of public health. He used the word accompaniment and he would accompany his patients. And we think about the best model of care, right, is one in which we're really accompanying our patients through their care journeys.
We know that with increasingly complex patient needs and with aging populations, the care that many of us get now and the care that, that many of us deliver now is very fragmented. We have specialists for almost everything. As a result, when there are balls dropped, or many people actually experience this very fragmented nature of different care intensities and different care providers, it really disrupts that continuous goal of a patient journey and patient care.
[00:07:23] Stacey Richter: And I could see also that if you're accompanying patients throughout their journey, then as a necessity. You're taking them within the context within which they live. And the more that the care is fragmented, the more chances that context gets lost.
[00:07:41] Dr. Carly Eckert: Yeah, I think so. In my mind, it's kind of like the difference in filming a movie and taking snapshots, right?
Often in a fragmented system, we only see the patient when they are in the clinic, when they are coming back for a follow up visit, or when they are bouncing back in the emergency department. Thankfully, so little of our life should be lived in those moments, right? The vast majority of our life is not in those snapshots.
And so how do we think about the needs of the patients outside of those hopefully briefer interactions?
[00:08:07] Stacey Richter: Let's talk about care gaps for a second and how closing care gaps might fit into the getting populations into a non fragmented state, you know, cause a lot of times when We think about population health somehow or another care gaps are going to wind up coming up in the conversation as a way to bridge a population into all of the care that they really should be getting or the essentials of care.
How are you thinking about this?
[00:08:37] Dr. Carly Eckert: Identifying and addressing care gaps is an important element population health approach. But I think again that it is one element of how do we, we have evidence based practice, right? We know that that women should get mammograms on a regular basis and we know about colorectal screening.
We know what the evidence says about these practices and that it is very important to ensure that patients and people, particularly Those in certain risk categories should, should receive these preventive health measures as well as receive their prescription referrals and, and all the other elements of care, right?
So I think it's certainly important that we address them and that we think through ways that we can correctly and accurately identify folks who are potentially at risk for falling into a care gap. But I think it's interesting to think about the reasons why that's happening. Because if you don't think through the upstream factors that are leading to that, then you're just going to have to.
address that care gap time and time again. Closing the care gap once for a patient doesn't necessarily mean that it will, that you're kind of solving that problem for the next time. And hopefully you are, right? Hopefully you are, it's enabling you to refigure that relationship with the patient and to really bring them into the fold.
[00:09:42] Stacey Richter: Effectively, like, you know, a care gap might be this patient has uncontrolled A1C. You can fix it that one time, like you can prescribe meds or whatever you're going to do to close that care gap. But the point that you're making is. Unless you really understand why that care gap was open to begin with, they're just going to show up in three months not having taken their meds and you've got the same care gap again.
[00:10:06] Dr. Carly Eckert: Yeah, absolutely. I mean, there's a, there's a root cause for much of what we're talking about here. Those causes are incredibly variable, right? And that's kind of the interesting part is thinking through and really getting to know the people and the populations and understanding. what might be leading to that potentially persistent care gap and how that might be addressed.
Because you're exactly right. You may be able to, to address it in the clinical setting, whether that be a medication modification, but you really need to move upstream to make that, , stick.
[00:10:31] Stacey Richter: I'm starting to cotton on to maybe the reasons why this is so, or at least one of them. I just heard the other day about a health system that had 8,000 known care gaps amongst their patient population, right?
Like they had identified. 8,000 instances where patients needed to do something to meet some clinical guideline. And first of all, just the fact that there's this many could be a clue that maybe those earlier factors were not being addressed. Like how do you wind up with 8, 000 care gaps? So it definitely feels like there's more at play here than the execution of closing those care gaps being problematic.
It's that those care gaps opened up to begin with.
[00:11:13] Dr. Carly Eckert: Yeah, I think that's exactly right. I mean, I read somewhere that I think only 8 percent of U. S. adults have actually received all the kind of preventive care services that they're potentially eligible for. So this is a widespread problem. And I think there's many reasons for it, but fixing it once is not going to fix it in the long term.
[00:11:30] Stacey Richter: It's just funny, in this country, we've got this game of whack a mole as a standard operating procedure, it almost seems like, I definitely hear much more about closing care gaps as opposed to creating a non fragmented system of care or treating, figuring out what the context that patients live in.
Although, granted, social determinants of health keep popping up, but sometimes also in the context of closing care gaps.
[00:11:56] Dr. Carly Eckert: I mean, our U.S. healthcare system, I think it's very reactive the way that it's grown and matured over the decades. We also have this relationship between providers and payers, right? I really do assume positive intent for everybody involved and that we really do want to make sure that people are getting the right tests and evaluations and medications and treatments.
But this kind of transaction and how do we show that is, is I think how care gaps have become elevated to where they are.
[00:12:18] Stacey Richter: I have heard more than once incentive plans that are called value based care that are basically an initiative to close care gaps or providers getting paid to close care gaps. I don't see as part of those any efforts really or as much effort being put into understanding the root causes and the context within which patients live.
I mean it very much seems to me, maybe I don't know what I'm talking about, but it very much seems to me like people are getting paid to close care gaps period.
[00:12:47] Dr. Carly Eckert: I was listening to a podcast that Mickey Tripathi from the ONC was on last week and he was talking about really how do you design systems with equity in mind.
And he mentioned a system, I think it's in Texas. One thing they've learned is to actually treat a referral to a community group with the same sort of priority as you would treat a referral to a cardiologist or a specialist. It's interesting to start thinking about that. This is not specific to care gaps or just almost a priority upon which we place treatment.
Do we really? Do we value that, that prescription, right, just as much as we value instructing somebody how to get to a food pantry, for example. So I think there's really a lot of potential in how we engage upstream and how do we think through what are some ways that we can help folks by being connected to their community.
[00:13:26] Stacey Richter: But I think this whole idea of closing care gaps being synonymous with value based care, obviously that has patient consequences because the things like you just talked about don't get prioritized.
[00:13:39] Dr. Carly Eckert: Well, I mean, I think you bring up a really good point, right? And I mean, we also know that right now providers are exhausted, our providers are overwhelmed, and they're, they've really been through it.
And not just our, our physicians, right, but all of our, all of our teams that are really doing the work of helping our patients. So in these very short, you know, time visits, that it is unnatural to have to have all of these different talking points and conversations. And yeah, it's, too much for that setting.
Is there a better setting or a better place to have these conversations about preventive care and addressing care gaps and things like that than in this PCP's office, for example?
[00:14:11] Stacey Richter: A fee for service chassis that has some, in air quotes, value based care incentive to close care gaps. Like, that is the payment model that we're talking about.
Because it's a fee for service chassis, you have these 15 minute patient visits. Right, like throughput is still a thing in that model. And because you have that basis of care, then the clinical workflow is built on a fee for service thinking, not necessarily contemplating like, hey, we have to achieve a non fragmented care journey, how are we going to reconceive or build that care journey in a different kind of way?
To your point, maybe it's not the best use of the both the patient and the clinician's time in that exact moment in that clinical visit where the patient came in for something else. And now we're kind of reactively because the patient happened to show up gonna bring up their A1C or something like that, you know, because there's a lot of downsides there. One of them is it's might not be necessarily appropriate. Number two is there might be a better way to do it that we're not really contemplative of, which I think is the point that you're making. Like maybe there should be a proactive reach out and have the patients come in just to talk about those things or it's a telemedicine thing or something.
[00:15:26] Dr. Carly Eckert: Yeah, no, I agree with all of that. I think, I think the messenger is often more important than the message in these situations. I think when we are talking about some of the complexities of the system and people interacting and health literacy and some of those issues, I think, I think you have to take small steps with people.
That is one of the keys to trust and to hopefully kind of bring them into the fold. To your last point about where is that setting, you know, I think there's a lot of interesting things being done in peer groups and in community health navigators and work like that that also has a lot of potential.
[00:15:54] Stacey Richter: Yeah, so just putting together a couple of things that that you've said and that we've been talking about you said that sometimes the messenger is often more important than the message. So you were talking about community peer groups, for example, and then you were mentioning the context of that care.
So I'm understanding what you're talking about. You're saying there is that maybe a workflow could potentially be when a patient is identified as one who is at risk of something that the referral be to some sort of community. peer group so that their journey can begin relative to addressing the context within which their care happens.
Also, there's some selection bias there, right? Like the only people that you're picking up are ones who are willing to go to the doctor. Is that what you're saying?
[00:16:41] Dr. Carly Eckert: Yeah, I think so. I think there's a lot of potential. There's a lot of power in peer support. There's community based organizations who are doing this work.
There's groups that are reaching out and that are having, you know, colorectal screening discussions among their community. There's groups that are out there doing this. It's just how do we make sure that that patients and providers are, that everyone is connected. The other thing to address is there's, there can be real fear in how people think about going to the doctor when you're there for a flu shot and someone tells you need a colonoscopy, right?
That can be scary and that's also a reason I know why people defer on their care gaps and things. So there's some potentially really interesting approaches to how we can address that and how we can really get people more comfortable with this.
[00:17:18] Stacey Richter: Before thinking about giving advice to provider organizations who are out there, it definitely sounds like one thing that you're advising is to try to figure out how to do referrals to community groups that may already exist, who are able to embrace the patient, meet them where they're at, and potentially help the identify some of these root causes that sit really behind that manifests in these care gaps, but closing any given care gap is not going to solve for.
[00:17:47] Dr. Carly Eckert: Yeah, exactly. I think more partnerships between right organizations and those groups that are already doing the work in the community would really be. potentially powerful.
[00:17:56] Stacey Richter: If I'm a provider organization and I'm like, this sounds like a good idea, what should I do?
[00:18:01] Dr. Carly Eckert: Talk to your social workers. If you have them on staff, talk to the people who work in your office and see what their connections are in the community.
Talk to a diverse group of people that work with you to see what groups they might be a part of or might know about. Many communities, you know, will have lists of community based organizations in their county, which can also be a good place to start. There's been a real increase in community health workers during the course of the pandemic, and so community health workers typically work with community based organizations, and they can also be found, I think, just by searching online with your location.
[00:18:34] Stacey Richter: Yeah, and I do believe that there are organizations that are popping up that help healthcare organizations do this. Like for example, and this is probably five years ago, but I did have someone from Healthify, which is one of them on the podcast and there's another one called United Us that's getting some press.
So there's definitely organizations that facilitate this too. Yeah, there's some great groups out there. Are there any other points of advice that you might have, like, for example, one of the things that you've said is to find the best channel of engagement for each population. Is that something you want to riff on?
[00:19:05] Dr. Carly Eckert: Really, the key is that it's not going to be the same for everybody. There's been some interesting research looking at kind of the administrative burden that Orchestrating healthcare has on patients and how that might affect patient engagement. Of course, with increasing media channels and devices, right, there's many different ways that we can engage.
We have to take in mind things like age and language and working hours and things like that and take note of how people are able to engage with the system.
[00:19:30] Stacey Richter: You had mentioned a postcard example. Do you want to talk about that?
[00:19:33] Dr. Carly Eckert: Brynn told me a story about a system that was really struggling with some of their colorectal screening numbers.
They tried many different kind of approaches and techniques, and eventually I think they settled on a postcard that was effectively enabled you to check a box to just have a kit sent to your home. And that, I think, simple action really showed them the best efficacy of all the different approaches. And so again, just being willing to try many different things, and sometimes it's something very small, they can unlock that patient engagement channel.
[00:20:00] Stacey Richter: Everybody is in a room trying to think of very complicated ways to engage patients and someone sends a postcard and it actually does better than any amount of SEO or something.
[00:20:12] Dr. Carly Eckert: We had some similar examples in early 2021. Many vaccination sites required email addresses for patients to receive the vaccine.
Think about who that excludes, right? If you, if you require an email. A group I was working with, we were able to, you know, basically generate emails for. Many people who didn't previously have them, they were then able to get vaccinated. And so it's just fascinating to think through these rather low tech approaches that can be very effective.
[00:20:35] Stacey Richter: The example of requiring an email address and who that excludes. If you're trying to create a non fragmented care journey, and so much of what goes on right now might require an email address, you know, like you go online to fill out a form or something like that, and there's that field with a mandatory little star by it that says, put your email address here.
Who did you just exclude? So like, thinking through what these barriers are and really getting patient feedback to identify them, I could certainly see as being really important here. Okay, so we've got, we went through sort of two things here. One is to look for CBOs, community based organization, and getting their help in this whole operation.
But then also making sure that we're finding the best channel of engagement for each population, not losing track of maybe some of the simple ones, maybe while you're trying to figure out your really complicated approach, just send a postcard, which actually could be the best idea. Do you have any more on the list here that you want to bring up?
Advice?
[00:21:29] Dr. Carly Eckert: Advice for providers, I think one thing is how we think about IT and connectedness of data, right? So much of the fragmentation in healthcare is because data is not shared. And granted, you know, this is not necessarily a problem that a single provider's office could solve. And we obviously know this is interoperability and things like that are problems.
Also, just how data is collected. I think about the data footprint really that each patient has. But there's also kind of data marginalization, which is kind of the flip side. And are we collecting the right data? Are we collecting data elements that really reflect what we're trying to untangle and trying to understand?
There's certainly predictive modeling and modeling that can go into identifying patients who are at high risk for care gaps. Um, and when we think about machine learning and how these models work. They certainly kind of know where the data is. So patients who may have sparse data, patients who may have a very fragmented care journey because of where they're seen, they might not have many data elements within a provider system.
And so then when you think about who's identified for care gaps, sometimes those folks with a really light footprint who have perhaps, you know, not had as much data to that, to that model, they might not be identified as readily. So thinking through, right, we're not just on those folks with whom you've captured a lot of data and with whom you can easily identify the care gaps, but also those others that might fall below the fold.
[00:22:37] Stacey Richter: So, understanding that as we're doing predictive modeling here, patients that have some pretty risky care gaps or gaps in their care might not show up in the predictive modeling simply because they haven't utilized services, which actually puts them at higher risk.
[00:22:54] Dr. Carly Eckert: Exactly. Yeah, there's going to be a potential right to lose people just even at that point.
[00:22:58] Stacey Richter: Okay, so we've got CBOs using them. We have the finding the best channel of engagement for each population. We have recognizing that data might be sparse on the highest risk patients. What else?
[00:23:09] Dr. Carly Eckert: I think a diversity of workforce is really key. I said a few minutes ago, I talked about the importance of both the message as well as the messenger, right?
And that is very true in, in health care. We know that people are more likely to receive preventive services if their provider looks like them. And so the more diverse of a provider workforce that we have, the more we can really enable diverse populations to to come and seek care.
[00:23:33] Stacey Richter: We had Dr. Monica Lipson on the show who talked about this at length, also Dr. Ian Tong. The other thing that I wonder in a way why there isn't more of this. But that's shared medical appointments, instead of just one patient seeing the doctor at a time for certain conditions, you know, maybe for example, diabetes, it could make sense to have a shared medical appointment in which you've got several patients meet with the care team together, A, because there's obviously a shortage of clinicians in this country.
So it could help ease that to a certain extent. But also it could, I could see be superior just because of the power of peers, as you're just saying. I'm just rereading Switch, that book by the Heath brothers, that really talks about how important it is. And everybody knows this, you've got a buddy that you go to the gym with, you are much more likely to go to the gym than if you have to actually get there yourself.
I could definitely see that having a number of individuals who are on that journey together could actually be superior. But that requires practice modification But it requires someone sitting down and figuring out how to do all that. You know, if you're trying to build this on a fee for service chassis, like somebody's actually going to have to spend extra time trying to figure it out.
[00:24:45] Dr. Carly Eckert: I just love the example of shared appointments. OB has a few examples of this with a program that's called Centering in Pregnancy.
Cohorts of women who have timing of their pregnancies are the same, so they can actually come together and have shared appointments and share kind of their experience. It lends itself well to that given the timing and nature of pregnancy, but It seems like other potentials, right, to really share experiences, to share fears and expectations.
And I mean, agreed that our current certainly fee for service model does not lend itself well to that. But it certainly seems like there's some potential there.
[00:25:16] Stacey Richter: We're both sort of agreeing that trying to do all this within the context of a 15 minute PCP visit is not optimal by any stretch. But if it is going to go down in that fashion, what advice might you have for any involved?
[00:25:30] Dr. Carly Eckert: I would, you know, encourage providers and provider teams to continue to have these discussions around evidence based practice, around care gaps, around what is appropriate treatment for the condition or for the care. I think that is the best course of action. We're also learning, right, that repetition helps so that hopefully, perhaps the next time this patient comes to the office, that having that same conversation gets that person one step closer to receiving that care.
So, I think they're... is a lot of potential for some of the things we talked about. The providers are really doing the hard work and I think, um, just want to continue to encourage that.
[00:26:03] Stacey Richter: It's funny because I brought up the closing the care gaps within the clinical workflow issues and I did get someone who was pushing back kind of hard on that saying since the ERs, for example, emergency rooms have started bringing up did you get your colonoscopy at the opportunity that they have with the patient who just happened to show up in the emergency room.
The rate of colonoscopies actually increased. Point that they were making is despite the fact that this is not the best way to do it, the amount of preventative care, evidence based preventative care did in fact increase. So there is It's an upside here, although, to be fair, we're counting the upside, but not necessarily the downside.
Or maybe the emergency room is a better place to do it because people are just sitting around for so long, as opposed to they're in the PCP visit trying to remember all their questions and this is just a distraction. So I don't necessarily. Yeah. Think also that you can kind of lump everything into one category as you're contemplating upsides and downsides for sure.
[00:27:06] Dr. Carly Eckert: But you bring up a good point, which is when we do have that continuity of data exchange, when we have people who are in a non fragmented system, is that we can then have the ED provider who can then have visibility in what that care gap is. There's a lot to be said for that. There's also a lot in the trauma literature about, you know, when is the right time to have what they call a micro intervention.
And sometimes it is in the emergency department. It's based on their research was more in kind of screening for alcohol abuse. But I think the point is that there is often a right time for something and that sometimes it might be during that ED visit. I think that's really good news.
[00:27:36] Stacey Richter: If we're talking about changing care models with EHR systems, again, if you have the data, there is the possibility to pull up lists of patients who haven't had certain interventions and obviously just with our fragmented healthcare system, there's going to be just like how many of us have gotten the data email or whatever, you need to get a flu shot and you already had one at Walgreens. Obviously there's no interoperability there, so no one knows it. There's some downsides there, but another way to kind of get it out of the clinical workflow would be to pull lists of patients with potential care gaps and then have some other kind of intervention like send a postcard as opposed to waiting for that patient to show up and then pouncing on them with 13 things.
[00:28:18] Dr. Carly Eckert: Definitely giving them the opportunity to kind of digest what is needed and providing the appropriate resources to, to learn those next steps are and giving them space to, to do that is critical.
[00:28:27] Stacey Richter: We kind of went through five or six pieces of advice that you might have for provider organizations who are looking to close care gaps in a different way. Is there anything that you want to add?
[00:28:39] Dr. Carly Eckert: The one thing we haven't talked about is just around transparency and how we can communicate as transparently as possible with our patients.
There can be a lot of fear around, around payment and around billing for, that can often interfere with patients and their care gaps and obviously the larger kind of population health aspects. So I think anything we can do, I know there's a lot at the federal level happening as well. So this is kind of more of a push for that, but I think, you know, any added transparency we can provide to, to patients around costs and fees and expectations can only improve that relationship.
[00:29:08] Stacey Richter: Are you seeing instances, it sounds like you are, where patients are not closing care gaps or not continuing along their care journey because they are so worried that if they show up in a care setting, they're going to be bankrupted?
[00:29:23] Dr. Carly Eckert: Yeah. Sure. This is again, drawing on anecdote. Yes. That there's certainly a fear of, of what that cost might be and people delaying that care due to that sense of the unknown.
[00:29:33] Stacey Richter: So addressing financial toxicity and making people feel comfortable with the financial aspects of their care definitely sounds like another thing to add to the list here. Exactly. Yeah. Carly Eckert, MD. If someone is interested in learning more about the work that you are doing, you're on LinkedIn, Twitter.
[00:29:49] Dr. Carly Eckert: Yes, I am. Both of those.
[00:29:51] Stacey Richter: Carly Eckert, MD. Thank you so much for being on Relentless Health Value today.
[00:29:55] Dr. Carly Eckert: Thanks so much. fun.
[00:29:56] Stacey Richter: Links to everything discussed on the program today can be found at relentlrelentlesshealthvalue.com visit the website, relentlrelentlesshealthvalue.com, you will also find a complete listing of all of the shows that we have published thus far with leading entrepreneurs and executives in the healthcare space today.
Another cool feature is, you know, you can subscribe to the show so that every week the episode is automatically sent to you so you don't have to remember to go to the website to download it.
Thanks so much for listening.