A rate critical to attain better care for patients, I’m gonna say, is enlightened leadership—maybe dyad leadership—at a clinical organization. I am saying this because without enlightened leaders, it’d be harder to build from the blueprint that Beau Raymond, MD, talks about today on the show.
For a full transcript of this episode, click here.
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I’d say an enlightened leader is someone—and this is my definition, but it’s a term that Tom Lee, MD, brought up first in an earlier episode (EP445)—an enlightened leader really cares about providing better patient care at an affordable price. They have a manifesto to that end, if you will.
They also have studied, likely, and understand how change management works because every improvement requires change. They get the bit about people, processes, and technology being intertwined and what operational excellence means.
Further, they are probably doing or considering many of the things that Robert Pearl, MD, talked about in episode 412. On the opposite end of the spectrum, there’s a new term floating around called administrative harm. There’s a study. Admin harm refers as much to what administrators—who I refuse to call leaders at this context because I’m talking about the not good administrators, so let’s be clear—but I’d say administrative harm results from what the administrators choose not to do as much as what they choose to do.
It is actually a thing to be an enlightened leader, especially in these profit-driven times. It’s really tough, actually, and nothing anyone should take for granted. So, maybe this whole show is kind of a shout-out to the enlightened leaders out there. Thanks for doing what you do.
Okay, so this said, and it needed to be said, let’s talk blueprint for better care in the conversation that follows.
Dr. Beau Raymond says, step 1, right out of the gate, set clear goals.
Then step 2, engage others throughout the organization to together build the framework needed to achieve said goals. Engaging frontline folks and others is really the only way that any proposed framework will actually work in the real world. Listen to the shows with Karen Root (EP381) and Ashleigh Gunter (EP447) for just one proof point after another that what I say is based in fact.
Step 3 of the blueprint to better outcomes that Beau Raymond, MD, talks about today is get your data. We talk a lot about plan sponsors and the getting of data, but same thing applies to clinical organizations. For clinical organizations, the getting of data means longitudinal data. The need for longitudinal data has come up in multiple shows, most recently the one with Dan Nardi (Spotlight Episode), and this is just one example of why getting the whole bag of data really matters.
Dan said on that earlier show, it’s often a thing that oncologists are unaware of how many of their patients are winding up in the ER for nausea after chemo, which, by the way, is the most common cause for readmission. And the reason for this is lots of patients travel to their oncologist but go to a local ER in a different health system.
The show with Brendan Keeler (EP454) about the Particle v Epic lawsuit in general dustup over who gets the data is super relevant here. That’s what I was thinking when I was talking with Dr. Raymond, and maybe it just popped in your head, too. Or just continuing this topic of the importance of longitudinal data, how many specialists, in almost any specialty, see a patient and then don’t know what happened to that patient subsequently? Or even primary care in transactional models?
So, step 3 here is get your data and also, as part of that, figure out how to make sure everybody understands the data and also understands that it is fair. Eric Gallagher (EP405), Dr. Raymond’s dyad counterpart over at Ochsner, talked about this some in that episode. So did Kenny Cole, MD (EP431), interestingly, also from Ochsner. Amy Scanlan, MD (EP402) mentions it as well.
Step 4 in the blueprint to measurably better outcomes that I discuss with Dr. Beau Raymond, data collection and data management probably need to be system-wide because … yeah, longitudinal and etc. But the “What are you gonna do now with the insights that you derived from the data?” is pretty local.
The obstacles and enablers are going to be different depending on the geography. For example, an area with a large Vietnamese population and a big variation in colorectal screening rates as a priority, just logically, is gonna have a program that is in no way suited to roll out in an area with, say, a large Black or African American population with high hypertension rates.
Priorities and programs are just different depending on the geography. So, step 4 here is, ask each region, based on the data, what fixes they’re going to own. What will they take ownership on and commit to improving?
What I thought was interesting in this interview is kind of the way that equity comes up between ethnic groups or between genders. In and of itself, obviously, striving for equity is critical. But also, if you’re trying to improve quality across the board and you see disparities in care, figuring out what is going on with the group experiencing the worse outcomes is also just operational excellence. You don’t want to be a solution looking around for a problem, after all; so, you need to figure out the actual problems for the actual people experiencing the problems to avoid that.
Those are the only solutions that are actually gonna work.
Step 5 is to learn from each other. Maybe not a whole program is flat-out transferable from one geography to another, but that doesn’t mean that nothing is transferable either. As usual, it’s about being thoughtful and nuanced and finding that productive middle.
At Ochsner, they do these cool weekly primary care huddles to share learnings and goings-on that Dr. Raymond explains in the show that follows.
Throughout all of these steps in this blueprint, there is obviously a need to align how the practice or system is getting paid for the time and capital expenditures, of course. And Dr. Raymond addresses this and interestingly says something similar to what Dr. Tom Lee (EP445) and Scott Conard, MD (EP391) have said on earlier shows: that a lot of times compensation for improving care, if you do it in an operationally excellent way, can be revenue positive for systems with a combination of both FFS (fee for service) and value-based reimbursement.
Underline, however, the part about having an enlightened leader who cares about clinical quality for that to work out.
Dr. Beau Raymond, my guest today is chief medical officer for Ochsner Health Network. Ochsner Health Network, by the way, includes Ochsner and some other health system partners. There’s also a bunch of small independent practices of one to two docs.
Ochsner patients, in case you are unaware, are in the entire state of Louisiana, a little bit of Mississippi, Alabama, and also Texas.
Also mentioned in this episode are Ochsner Health; Tom X. Lee, MD; Robert Pearl, MD; Karen Root, MBA, CCXP; Ashleigh Gunter; Dan Nardi; Brendan Keeler; Eric Gallagher; Kenny Cole, MD; Amy Scanlan, MD; Scott Conard, MD; Joshua Liu, MD; Eboni Price-Haywood, MD, MPH, MMM, FACP; and Chris Skisak, PhD.
You can learn more at Ochsner Health Network and by following Dr. Raymond on LinkedIn.
Sidney H. “Beau” Raymond, MD, MMM, FACP, is a board-certified internist now serving as the chief medical officer of Ochsner Health Network and medical director and executive director of Ochsner Accountable Care Network.
Prior to joining Ochsner, Dr. Raymond was vice president, physician practice administrator, and chief medical information officer at East Jefferson General Hospital (EJGH). His experience included serving on the steering committee and later as a board member for Gulf South Quality Network. Beyond the administrative roles at EJGH, Dr. Raymond was involved with medical staff committees, including serving as chief of staff. He is also a past president of the Jefferson Parish Medical Society.
Dr. Raymond earned a bachelor’s degree in biology from Loyola University, earned a medical degree from the Louisiana State University School of Medicine, and completed his residency in internal medicine at LSU-New Orleans. He has also earned a Master of Medical Management from Tulane University.
07:50 What is step 1 of improving care for healthcare leaders?
10:44 Why is it important to be flexible while keeping your goals in sight?
11:48 Dr. Eboni Price-Haywood’s article on disparities in COVID.
12:29 How is equity a data point to achieving overall care improvement?
15:01 “If you can’t measure it … accurately, you’re not going to be able to do anything differently.”
20:52 What strategies have been successful in using data to improve healthcare outcomes?
23:17 Why did Ochsner Health avoid looking at the individual physician standpoint in regard to an equity standpoint?
30:40 Why engaging patients in their healthcare actually improved patient visits and did not necessarily reduce patient visits.
34:49 “It’s really about engaging with the patient.”
Recent past interviews:
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Brendan Keeler, Claire Brockbank, Cora Opsahl, Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413)
[00:00:00] Episode 455, A Leadership Blueprint for Measurably Better Care. Today I am talking with Beau Raymond, MD, who is the CMO, Chief Medical Officer at Ochsner Health Network.
[00:00:21] American healthcare entrepreneurs and executives you want to know. Talking. Relentlessly seeking value.
[00:00:29] A rate critical to attain better care for patients, I'm going to say, is enlightened leadership, maybe dyad leadership at a clinical organization.
[00:00:39] I am saying this because without enlightened leaders, it'd be harder to build from the blueprint that Beau Raymond, MD, talks about today on the show.
[00:00:49] I'd say an enlightened leader is someone, and this is my definition, but it's a term that Dr. Tom Lee brought up first in an earlier episode, link in the show notes.
[00:00:56] An enlightened leader really cares about providing better patient care at an affordable price.
[00:01:02] They have a manifesto to that end, if you will.
[00:01:05] They also have studied, likely, and understand how change management works because every improvement requires change.
[00:01:13] They get the bit about people, processes, and technology being intertwined and what operational excellence means.
[00:01:20] Further, they are probably doing or considering many of the things that Dr. Robert Pearl talked about in episode 412.
[00:01:28] On the opposite end of the spectrum, there's a new term floating around called administrative harm.
[00:01:34] There's a study. I'll link to it again in the show notes.
[00:01:37] Admin harm refers as much to what administrators, who I refuse to call leaders at this context because I'm talking about the not good administrators.
[00:01:45] Let's be clear. But I'd say administrative harm results from what the administrators choose not to do as much as what they choose to do.
[00:01:54] It is actually a thing to be an enlightened leader, especially in these profit-driven times.
[00:02:00] It's really tough, actually, and nothing anyone should take for granted.
[00:02:03] So maybe this whole show is kind of a shout out to the enlightened leaders out there.
[00:02:08] Thanks for doing what you do.
[00:02:09] Okay, so this said, and it needed to be said, let's talk blueprint for better care.
[00:02:15] In the conversation that follows, Dr. Bo Raymond says step one, right out of the gate, set clear goals.
[00:02:22] Then step two, engage others throughout the organization to together build the framework needed to achieve said goals.
[00:02:31] Engaging frontline folks and others is really the only way that any proposed framework will actually work in the real world.
[00:02:40] Listen to the shows with Karen Root, Ashley Gunter.
[00:02:43] Links in the show notes for just one proof point after another that what I say is based in fact.
[00:02:48] Step three of the blueprint to better outcomes that Bo Raymond MD talks about today is get your data.
[00:02:54] We talk a lot about plan sponsors and the getting of data, but same thing applies to clinical organizations.
[00:03:01] For clinical organizations, the getting of data means longitudinal data.
[00:03:05] The need for longitudinal data has come up in multiple shows, most recently the one with Dan Nardi.
[00:03:11] And this is just one example of why getting the whole bag of data really matters.
[00:03:15] Dan said on that earlier show, it's often a thing that oncologists are unaware of how many of their patients are winding up in the ER for nausea after chemo,
[00:03:24] which, by the way, is the most common cause for readmission.
[00:03:26] And the reason for this is lots of patients travel to their oncologist, but go to a local ER in a different health system.
[00:03:33] The show with Brendan Keeler about the Particle v.
[00:03:37] Epic lawsuit in general dust up over who gets the data is super relevant here.
[00:03:42] That's what I was thinking when I was talking with Dr.
[00:03:44] Raymond's and maybe it just popped in your head too.
[00:03:47] Or just continuing this topic of the importance of longitudinal data.
[00:03:50] How many specialists in almost any specialty see a patient and then don't know what happened to that patient subsequently?
[00:03:56] Or even primary care in transactional models.
[00:03:59] So step three here is get your data.
[00:04:02] And also as part of that, figure out how to make sure everybody understands the data and also understands that it is fair.
[00:04:09] Eric Gallagher, Dr. Raymond's dyad counterpart over at Oshner, talked about this some in that episode.
[00:04:16] So did Dr. Kenny Cole, interestingly, also from Oshner.
[00:04:19] Amy Scanlon, MD, mentions it as well.
[00:04:21] And I'm going to stop saying all of these links are in the show notes because you will find everything I mention in the show notes.
[00:04:27] Step four in the blueprint to measurably better outcomes that I discussed with Dr.
[00:04:33] Bo Raymond.
[00:04:33] Data collection and data management probably need to be system wide because, yeah, longitudinal and etc.
[00:04:40] But the what are you going to do now with the insights that you derived from the data is pretty local.
[00:04:47] The obstacles and enablers are going to be different depending on the geography.
[00:04:52] For example, an area with a large Vietnamese population and a big variation in colorectal screening rates as a priority, just logically, is going to have a program that is in no way suited to roll out in an area with, say, a large black or African-American population with high hypertension rates.
[00:05:10] Priorities and programs are just different depending on the geography.
[00:05:14] So step four here is ask each region based on the data, what fixes they're going to own, what will they take ownership on and commit to improving?
[00:05:25] What I thought was interesting in this interview is kind of the way that equity comes up between ethnic groups or between genders.
[00:05:31] In and of itself, obviously, striving for equity is critical.
[00:05:36] But also, if you're trying to improve quality across the board and you see disparities in care, figuring out what is going on with the group experiencing the worst outcomes is also just operational excellence.
[00:05:51] You don't want to be a solution looking around for a problem after all.
[00:05:54] So you need to figure out the actual problems for the actual people experiencing the problems to avoid that.
[00:06:00] Those are the only solutions that are actually going to work.
[00:06:04] Step five is to learn from each other.
[00:06:07] Maybe not a whole program is flat out transferable from one geography to another, but that doesn't mean that nothing is transferable either.
[00:06:14] As usual, it's about being thoughtful and nuanced and finding that productive middle.
[00:06:19] At Ochsner, they do these cool weekly primary care huddles to share learnings and goings on that Dr. Raymond explains in the show that follows.
[00:06:26] Throughout all of these steps in this blueprint, there is obviously a need to align how the practice or system is getting paid for the time and capital expenditures, of course.
[00:06:36] And Dr. Raymond addresses this and interestingly says something similar to what Dr. Tom Lee and Dr. Scott Kennard have said on earlier shows,
[00:06:43] that a lot of times compensation for improving care, if you do it in an operationally excellent way,
[00:06:50] can be revenue positive for systems with a combination of both FFS fee-for-service and value-based reimbursement.
[00:06:57] Underline, however, the part about having an enlightened leader who cares about clinical quality for that to work out.
[00:07:05] Dr. Bo Raymond, my guest today is chief medical officer for Ochsner Health Network.
[00:07:10] Ochsner Health Network, by the way, includes Ochsner and some other health system partners.
[00:07:15] There's also a bunch of small independent practices of one to two docs.
[00:07:20] Ochsner patients, in case you are unaware, are in the entire state of Louisiana, a little bit of Mississippi, Alabama, and also Texas.
[00:07:27] My name is Stacey Richter.
[00:07:29] This podcast is sponsored by Aventria Health Group.
[00:07:32] Dr. Bo Raymond, welcome to Relentless Health Value.
[00:07:35] Thanks so much for having me.
[00:07:36] I asked a couple of people, what would you ask Dr. Bo Raymond if you had a chance
[00:07:40] and got a laundry list of people jumping in very enthusiastically with thoughts?
[00:07:45] I think one of the things that keeps surfacing is this idea that if we're going to provide actually better care,
[00:07:54] some combination of a financial metric, a patient-reported outcome, a clinical-reported outcome,
[00:08:01] and maybe some kind of performance metric, if we're going to improve care and outcomes,
[00:08:04] you have to do something across the board.
[00:08:08] There has to be some operational excellence, like some kind of plan strategically.
[00:08:14] How do you think about like, all right, improve care?
[00:08:17] Step one, what is it?
[00:08:20] Step one is determine your goal because you got to know where you're trying to head.
[00:08:25] Thankfully, I have a bunch of people I get to collaborate with who are very smart individuals.
[00:08:29] And so we'll talk through what we think is how we need to get to that goal.
[00:08:34] We'll create a framework, but then it's really about engaging different people along the way to make it happen.
[00:08:40] And so I can't sit there and say, you know, we're going to do this and just poof, magically it happens.
[00:08:48] It has to be that I have the buy-in and wherewithal of different clinicians or frontline staff or nurses or whomever
[00:08:58] have to be part of that initiative to make something happen.
[00:09:02] It's not a straight from us saying this is how to do it.
[00:09:06] This is the one way to do it.
[00:09:07] This is the only way to do it.
[00:09:08] That is not how we operate at all because we're never going to be successful.
[00:09:12] You're not going to have the buy-in because people are going to have ownership of the part that they're responsible for.
[00:09:16] It's really trying to set forward like this is where we want to be.
[00:09:20] How do we want to get there?
[00:09:21] What do you think as someone who's involved with this every single day?
[00:09:25] How do you think we can do something better and differently to get to a better result than we have right now?
[00:09:31] One thing about the value-based world is that we get to align incentives.
[00:09:35] We want better health outcomes to keep people healthier and keep them out of the hospital.
[00:09:40] I mean, the whole system got created around sick care.
[00:09:43] We need to change that to where it's more about trying to keep people healthy.
[00:09:46] What I'm hearing is actually something that Tom, Dr. Tom Lee brought up.
[00:09:50] This whole idea of enlightened leadership and what is enlightened leadership?
[00:09:53] And it sounds like in a way, you have your definition of what that looks like.
[00:09:59] You started out, you said, what's the goal?
[00:10:01] It's you got to define the goal.
[00:10:02] And then later you use the word vision.
[00:10:05] So the step one probably starts with a leader saying, all right, we got to figure out exactly what our goal is, what our vision is.
[00:10:11] Then creating that framework that you mentioned.
[00:10:14] Then you started talking about engagement.
[00:10:16] And one of the things that you said, you're not going to engage very many people if you crush their soul by telling them to do it exactly the way that you have specified.
[00:10:26] Inherent in this engagement is enabling and empowering people to be responsible and accountable and take ownership for the work that they're doing.
[00:10:37] Did I get that right?
[00:10:39] I completely agree with that.
[00:10:40] That's the only way to really get to something that's going to last.
[00:10:43] If you were just saying, this is how we're going to get from A to B, and we're only going to do it this one way, there's going to be issues there.
[00:10:53] You need to be flexible.
[00:10:54] You need to be agile.
[00:10:55] You need to be whatever is the term you want to use to understand what has changed in the world and how you still need to keep that goal in sight.
[00:11:02] And how are you going to adjust that to get there?
[00:11:04] There was a tweet, actually, by Joseph Liu that I was very fixated by, actually.
[00:11:10] I started at it for probably an embarrassingly long time.
[00:11:13] It's just this idea of everything has to be a balance of humans, processes and technology.
[00:11:18] And I think that's effectively also what you're saying.
[00:11:21] And what I'm connecting the dots to right now is a program you and team were running at Ochsner, where I think you took a look around.
[00:11:33] You came up with your goal.
[00:11:34] You came up with a vision.
[00:11:36] But then realized because of the geographic area that you serve, there's a lot of different local markets with a lot of different needs.
[00:11:44] So that's probably a pretty good case study of what we're talking about.
[00:11:48] One of the people I get to work with, Dr. Ebony Price-Haywood, she published an article about disparities in COVID that was witnessed here in our region.
[00:11:58] It shone a huge light on what we need to be doing differently and what exists.
[00:12:03] We took it as an internal thing that we're going to try to figure out how are we doing from a health equity standpoint.
[00:12:09] What is our current performance?
[00:12:11] So we've had ambulatory quality measures where we look at cancer screening rates, diabetes control, blood pressure control.
[00:12:18] We get all those things.
[00:12:19] We've looked at inpatient quality measures regarding CLABSI and CAUTI and the like.
[00:12:25] We also have some other measures throughout the entire organization.
[00:12:28] So first things first, we had to get more accurate about how we're capturing people's race, ethnicity, the language that they spoke,
[00:12:36] all those pieces of data information, we had to get that information right in the system.
[00:12:41] From there, we've actually developed a dashboard which allows us to have great insights into how we're performing across all these different measures.
[00:12:49] I'm more focused on the ambulatory quality ones.
[00:12:52] We have another doctor who's focused more on the inpatient quality ones.
[00:12:55] So ambulatory quality, okay, how are we doing?
[00:12:58] When we looked at cancer screenings, it was interesting.
[00:13:02] There wasn't a huge gap between our two major populations.
[00:13:06] For reference, in our entire service area, two-thirds of the people are white.
[00:13:12] And then nearly 25 to 30 percent are Black or African American, depending on where you are.
[00:13:19] And then the rest is made up of different groups.
[00:13:22] When we looked at it, there wasn't this huge gap when we looked at colorectal cancer screening, breast cancer screening, cervical cancer screening between the white and the Black African American population.
[00:13:33] Not in those areas.
[00:13:35] Clearly, the stuff that we put in place year over year about making sure we were doing really well on those measures was working kind of across the board.
[00:13:42] Now, when it came to hypertension and diabetes, however, we noticed there was a gap there.
[00:13:47] Things that we'd been doing year over year to improve, we were improving the entire group, but there still had a gap.
[00:13:56] Now, it got a little bit smaller over time, but it still existed between those two populations.
[00:14:02] And then also, we belonged to another group where we looked at statins for people with cardiovascular disease, and we noticed a gap between men and women.
[00:14:12] Those were three that really stood out to us.
[00:14:16] And we said, okay, we need to do something differently.
[00:14:18] The overall goal here, as you just said, is how do you improve care?
[00:14:24] How do you improve outcomes?
[00:14:25] You realize equity is a data point to achieve that.
[00:14:29] Like if you are realizing there is inequity in high quality care, right?
[00:14:35] And you listed a couple of things.
[00:14:37] If hypertension isn't controlled, diabetes isn't controlled, and people aren't taking statins.
[00:14:44] It's a really important and actionable insight that then can be used to target and segment and make sure then the actions which are taken are appropriate for those who you are trying to reach and influence.
[00:15:00] Right, because if you can't measure it and can't measure it accurately, you're not going to be able to do anything differently.
[00:15:07] If you're blind to what's going on because you don't have the insights, then you're not going to be able to create any change.
[00:15:15] This allows us to create the changes necessary to try to address those issues.
[00:15:19] Okay, so first there was the whole idea.
[00:15:22] You kind of inferred that the data might have been very dirty, like you had to get in there and do some tinkering around, you know, garbage in, garbage out.
[00:15:30] Yeah, we had to change exactly what the choices were within our EMR to make sure that we had the right choices there.
[00:15:37] That would be accurate.
[00:15:38] That was one thing.
[00:15:39] But then we also had to educate all the frontline folks as to what we were doing and why.
[00:15:45] They had to be better at making sure they had the right information going in and were actually capturing it on a regular basis.
[00:15:53] That alone was a huge educational effort to make sure people understood the importance of what we were trying to do.
[00:15:59] Because there were some questions I would say were a little upward for people initially.
[00:16:03] All of this included, you know, how do you identify yourself?
[00:16:06] For some people, that was a question they never, ever wanted to ask about, you know, which or gender identity was a foreign question to a lot of people.
[00:16:16] So that was something that had to be asked on a regular basis, which created some awkward conversations for some patients because they were questioning, why are you even asking me this?
[00:16:27] But it was something we knew was important into trying to get this information.
[00:16:31] This is something then now that you're doing across the board.
[00:16:34] And I think so people that are listening also, I just want to connect another dot.
[00:16:38] Ashley Gunter, we just had on the show and she would term what you just said as creating the case for change.
[00:16:44] You know, like making sure that there was a why that was identified because as has been well proven and why change management processes are, you know, a thing is because if you ask someone to do something and they have no idea why you're asking,
[00:16:57] chances are it's going to be asking, chances are it's going to be asking, chances are it's going to be tough to have them actually follow your directions.
[00:17:04] But, you know, originally when we started talking about this, we were like, what do you leave to individuals to figure out or local areas to figure out?
[00:17:11] And then what are you doing from a system wide perspective?
[00:17:15] And it definitely sounds like you figured this out system wide.
[00:17:18] You looked at the data and you're like, system wide, we got an issue here.
[00:17:20] You created the case for change system wide.
[00:17:24] Like, OK, one of the things that we need to do is this and this is why.
[00:17:28] And it sounds like also there's another thing that you're doing system wide, which is making sure that everybody is feeding the data in consistently across the system because you obviously have one centralized data warehouse or data analytic capacity.
[00:17:43] So like we're still talking at the system wide here, despite the varied and various geographic areas that are in play.
[00:17:51] Correct.
[00:17:52] The change comes when you start looking at the data by the different regions, by the different sites.
[00:17:59] And that's where you see that there's a lot more variability.
[00:18:03] So in one region, you may have a significant opportunity regarding blood pressure control or diabetes control between white and black or African Americans.
[00:18:15] Another region may not have that issue as much.
[00:18:18] They may have something different.
[00:18:19] Like, for example, one of our regions has a larger Vietnamese population.
[00:18:23] Their issue, we saw there was a difference in colorectal cancer screening between the Asian population and everyone else.
[00:18:31] They were 10 percentage points less than everyone else.
[00:18:34] And that's a huge difference.
[00:18:36] So, you know, with having a decent population with a big gap, the ask was, what are you going to do differently in that region?
[00:18:45] And that's how we approached this.
[00:18:47] Every single region, we brought them the data.
[00:18:50] We said, here's where you are.
[00:18:52] Here's where the opportunities are.
[00:18:54] What would you like to own as the initiative for your region to start driving something different, to try to make a change?
[00:19:02] It can't be doing the same thing that we've been doing because we know we're going to get those same results.
[00:19:06] What are you going to do extra?
[00:19:08] What are you going to do differently?
[00:19:09] Because in every region, it's going to vary as to what the obstacles or enablers are or whatever the other drivers are that has created that delta between one group and another.
[00:19:21] So we brought that forward and we're asking them, create a plan, share with us what the plan is.
[00:19:29] We'll help track it.
[00:19:30] We'll give you the information as to how you're doing.
[00:19:32] And we'll look at that over time.
[00:19:34] And from that, we're going to learn, did your trial work?
[00:19:38] Did it make a difference?
[00:19:40] Did it not?
[00:19:40] And let's learn from that and take that and share that with other regions as to what they're doing.
[00:19:45] The fun thing about this is that I get to go and talk to multiple regions about this.
[00:19:49] We started numerous initiatives on the same aspect of trying to improve health equity.
[00:19:58] But everybody's going to do something differently that they feel ownership over.
[00:20:01] And then from there, we'll take that and we'll create something new and something different throughout the entire system because we're going to say, okay, this works really well over here.
[00:20:09] This may also work really well over in your area, too.
[00:20:12] So why don't we try it?
[00:20:13] Maybe it becomes something that becomes throughout an entire system.
[00:20:16] We do it that one way differently.
[00:20:18] So it's a great learning opportunity for all of us.
[00:20:21] You did the data in a centralized way, which enabled you to consistently be able to report back to the individual, the local medical teams and say, look, here's how you're doing.
[00:20:34] Then figure out what you want to do locally.
[00:20:37] Because as you said, both opportunities are going to change.
[00:20:40] What you're working on is going to change as well as the obstacles to that, as well as the enablers to do that.
[00:20:47] So everyone always says healthcare is local.
[00:20:50] And I think this is probably just another validation of that.
[00:20:52] What's an example of what somebody did?
[00:20:54] Or what would be the template for what you have seen as being very successful?
[00:21:00] What's been done in a couple areas.
[00:21:03] So I'll pick on a couple different things.
[00:21:06] One area really wanted to focus on the statin difference between men and women.
[00:21:11] So they wanted to focus on that one because that was dramatic in their area.
[00:21:15] And they said, you know, we need to do something differently, trying to get better outcomes for the women we're taking care of.
[00:21:21] They started doing more direct outreach to those women that had indication to be on a statin and talked to them about their concerns.
[00:21:31] They had pharmacists involved and the like to try to come up with something different and involving how they engage regarding education and the like and try to get people on them.
[00:21:39] And also give them opportunities, the patient's opportunities to understand why it was important and not just something that was dismissed years ago and never got revisited.
[00:21:50] That was one thing that's been done.
[00:21:52] Again, it's kind of early for some of these.
[00:21:54] So we like longer term data.
[00:21:56] So I'm not going to quote that any of these are super successful at this moment.
[00:21:59] But that's one.
[00:22:00] In another area, because of the difference between hypertension and diabetes control, it just became a much more proactive looking at the information, reaching out to patients, making sure they were coming back in a timely fashion.
[00:22:14] Whereas before was they might have just simply relied on the portal messages.
[00:22:18] They're now asking people to make phone calls, to get in touch, to actually get them back and to get retested or to adjust their medications and things like that.
[00:22:27] When you say get people to make those calls, it sounds like it's not, for example, primary care doctors who are doing these outreaches.
[00:22:34] Like this is definitely a team based thing where there's nurses or navigators or coaches who are making those calls and then working as a team with the physicians when the patient comes back.
[00:22:45] You know, there's a there's a process here.
[00:22:47] Right.
[00:22:48] Completely.
[00:22:48] These are mailing nurses who are or MAs who are doing these outreaches.
[00:22:52] I mean, one of the other things that one of them wanted to make sure that we advocated for getting people into our digital diabetes programs and digital hypertension programs because we knew that those worked.
[00:23:02] How do we get more people involved?
[00:23:03] So it was outreach to say, hey, you know, you're eligible for this program.
[00:23:07] Why don't we get you enrolled in it?
[00:23:09] And so that was another one that one of the groups is doing as well.
[00:23:12] They're just trying to increase their enrollment into the digital diabetes and hypertension programs.
[00:23:16] Was there and the reason I'm asking this is because within that region, there probably were some physicians who had, you know, 95 percent hypertension results and there was probably others who had 65 percent.
[00:23:29] Was there any thought relative to trying to figure out what the high performers were doing and spreading that as a best practice?
[00:23:39] For these initiatives, we really intentionally did not want to go all the way down to the physician level regarding differences in performance from an equity standpoint.
[00:23:50] Because what we wanted to make sure we avoided was any physician feeling targeted that they were doing something differently for one population than the next.
[00:23:59] And we don't really think that that's probably the driver because usually this is going to be from the social drivers of health or other things, not really from how a physician is practicing.
[00:24:11] And so certainly we did education regarding what health equity is and how we can do things differently and make sure that we're listening to people and everything along those lines.
[00:24:21] But really, this was geared towards it being something broader than just at an individual level as to what they're doing.
[00:24:29] So I just we were very, very intentional of not going down to the physician level from an equity standpoint.
[00:24:37] And another question along those lines that has come up in more than one conversation I've had lately is just the overwhelm that many in primary care are feeling, you know, like everybody thinks to themselves, oh, it's just a 20 word.
[00:24:50] We'll just train 20 minutes on the importance of colorectal screening and how to communicate with patients or diabetes or, you know, whatever it is.
[00:24:57] Except you've got the the nephrology team who wants to talk 20 minutes on CKD and then the heptologists are like, we got to talk about liver for 20 minutes.
[00:25:06] Right. Like, I mean, you wind up with the situation that the primary care team could basically be sitting in lunch and learns for days on end.
[00:25:13] How do you do this in such a way?
[00:25:15] There is actually education, but it's kind of like, I guess, ruthlessly prioritized.
[00:25:20] It's interesting you bring up the lunch and learn.
[00:25:22] So I will say we have some things that are put out as education modules that go to everyone in the system and it's required for us to do.
[00:25:30] And we actually quiz as we do them.
[00:25:32] So to verify that we're paying attention to what's actually in there.
[00:25:35] So there's that.
[00:25:36] But within primary care, we created primary care huddles.
[00:25:40] So there I shouldn't say we the leader of primary care created primary care huddles.
[00:25:44] We have a large primary care group.
[00:25:47] I mean, it spans the state.
[00:25:49] And so it is a regular weekly huddle where there is a topic that's put out every single week that allows for people to tune in and get educated on.
[00:26:01] So the topic is pushed out in advance and people know what the topic is.
[00:26:05] The attendance on this huddle is crazy.
[00:26:07] Tuning in to hear the latest and greatest as to what we have going on and what we have to offer and how something new has come out or how there's been a change.
[00:26:15] It's been amazing.
[00:26:16] It's remarkable.
[00:26:17] The physicians are able to ask questions right then and there.
[00:26:20] And it is considered a very safe zone.
[00:26:22] Dr. Miller, who's the leader of it, has been making sure people are being heard.
[00:26:27] And it's a way for us to get, honestly, feedback.
[00:26:30] So there are times that we think we got this great idea.
[00:26:33] We bring it to initially the small group of physician leaders in primary care and they think it's a great idea.
[00:26:39] And then we share it in the huddle and then they don't think it's a great idea.
[00:26:43] We listen to what they have to say because these are the frontline people are going to have to enact anything we're putting forward.
[00:26:48] And so if they're not buying into it and we need to go back to the drawing board, we will.
[00:26:52] In those huddles, you're not necessarily talking about, oh, we just learned something new about sugar in the diet or HRTs.
[00:26:59] Who knew?
[00:27:00] Right. So this isn't necessarily updates in science.
[00:27:05] This is more as a health system.
[00:27:08] We now have a new connected health tool or something like people are getting updated on what resources may be available.
[00:27:16] It's all the above.
[00:27:18] There are times that something novel has come about, something that's significant change.
[00:27:23] We will have someone who is a leader in that field come on to that huddle and talk about it.
[00:27:29] But it is all the above.
[00:27:31] And so the advantage of having this on a regular basis, we can do whatever we need to do, depending on whatever is the most important thing of the week.
[00:27:41] Another thing that keeps coming up lately is just the increasing difficulty to get all these things paid for.
[00:27:46] We talked about a really interesting initiative that you're rolling out system wide, enabling the different regions to figure out exactly how they want to go about administering or operationalizing the goal.
[00:28:00] Obviously, this takes time.
[00:28:03] How do you make sure that you're aligning getting paid with this value mindset?
[00:28:08] So I guess conveniently for us, we're in a decent number of value-based contracts.
[00:28:14] We're certainly not all value.
[00:28:16] We certainly have a lot of fee-for-service.
[00:28:18] We are very much in both canoes or as I've heard it said, and actually I like it better, we're in a catamaran and we need to figure out how to navigate the catamaran.
[00:28:27] With that, we do have extra revenue that's coming to us.
[00:28:30] We do have population-based payments that are coming to us.
[00:28:33] And so some of these initiatives may be based just on those populations, but this one, for example, is not.
[00:28:39] We're doing things intentionally to make sure that we are giving the funds in the right way to help drive performance.
[00:28:45] Because it's really going to drive performance across all of our value-based contracts, which is what we're looking for anyway.
[00:28:52] And so when we're talking about the held equity standpoint, what we do there, if you're taking, if you're 85% for one group and you're 80% for another group,
[00:29:00] if you say we want to get that group that's at 80%, get them up to 82%, then the overall number is now going to go up even higher.
[00:29:07] It's going to help us on our other contracts as well that are value-based contracts.
[00:29:10] So we don't see it as separating one from another.
[00:29:13] It's really about how we take care of our patients in our community and how we make sure that we're successful in that.
[00:29:19] I have heard, and Dr. Scott Canard said this on a show a while back, that if you do things like you outreach and you get people to come in for a visit,
[00:29:29] like that actually works for fee-for-service as well.
[00:29:31] You know, if you have patients who normally only show up when they're sick and now all of a sudden due to outreach,
[00:29:39] they are engaged in coming in for visits.
[00:29:41] Well, that's volume as well as value.
[00:29:44] Yeah, when we launched our digital programs for hypertension and diabetes.
[00:29:48] So in these programs, you have patients who are connected via Bluetooth.
[00:29:54] Their monitor is connected, and it sends information from their phone directly to our system.
[00:29:59] We're able to put them into a dashboard, which then triggers for people, for health coaches,
[00:30:05] triggers for pharmacists to make adjustments and the like.
[00:30:08] My primary care initially got concerned that now, okay, you're taking away some of the easier visits for me.
[00:30:16] You're taking away the diabetic that I'm monitoring to make sure you take away the hypertensive that I just need to adjust their medications.
[00:30:23] Those are easier visits than some of the more complicated patients, right?
[00:30:26] So you're taking those away.
[00:30:27] The reality is, is that patients became more engaged with their health care.
[00:30:32] And so they still came in the same amount of time as they did before, but those visits were much more meaningful.
[00:30:38] So it did not do that at all.
[00:30:40] When you're engaging people in their health care, regardless of how you're doing it,
[00:30:44] it's going to be beneficial for you in either a value or a fee-for-service model,
[00:30:48] because patients are going to want to come in and be seen.
[00:30:50] When you say the visits were more meaningful, what do you mean?
[00:30:54] If, say, their hypertension or diabetes was under better control,
[00:30:58] then you're able to focus on some of the other things that are going on with them.
[00:31:01] So if somebody's coming up with a list of problems,
[00:31:04] and you're saying that their hypertension is good or their diabetes is good,
[00:31:07] then you're not as worried about that part anymore.
[00:31:10] You can focus on other issues that are going on with that patient instead.
[00:31:13] Got it.
[00:31:14] So two things for you.
[00:31:16] And they both involve data.
[00:31:17] One of them is you brought up your digital diabetes program,
[00:31:20] and you said, well, we know it works.
[00:31:24] Which, just getting it out in the open, I've heard a lot about digital diabetes programs.
[00:31:29] And then if you talk to, you know, the employer,
[00:31:34] the plan sponsor experiencing point solution fatigue or whatever,
[00:31:37] you may get a different answer on that.
[00:31:40] How do you know that your solution works?
[00:31:43] And why does it matter if it does?
[00:31:45] Like, how is this whole thing funded?
[00:31:47] First of all, we know it works because we've studied the data.
[00:31:50] So we know that patients are under better control.
[00:31:52] And we know that they go into the emergency department less.
[00:31:55] We know they get admitted less when they're in the program.
[00:31:58] And a big difference between remote patient monitoring
[00:32:00] and what we do is we do remote patient management.
[00:32:03] So we're not just having numbers fly in.
[00:32:07] We also have coaches and pharmacists who are following an algorithm
[00:32:11] that's been put in place by endocrinologists and cardiologists.
[00:32:14] And so they're actually adjusting the medications as they go.
[00:32:18] So it's different from just simply a system of just collecting data
[00:32:23] and sending it in and hopefully somebody looks at it.
[00:32:25] So that's a big difference.
[00:32:27] And we actually, we did a pilot now, it's been a couple of years,
[00:32:31] in a Medicaid population.
[00:32:34] And with that, we now have thousands of people who are on it
[00:32:37] in a Medicaid population.
[00:32:38] And the results were phenomenal for them
[00:32:41] because they didn't have people who were engaging with them on a regular basis.
[00:32:44] So now their blood pressure is controlled.
[00:32:47] Their hypertension is controlled.
[00:32:49] Their diabetes is controlled.
[00:32:51] And so they're getting somebody who's responsive to them
[00:32:55] every time that they have an issue going on saying,
[00:32:57] hey, what's going on?
[00:32:59] Why is your blood pressure high today?
[00:33:01] Or, oh, you didn't do your reading in the past three, four days.
[00:33:04] Is there something going on?
[00:33:06] So this is very different for somebody who is in a Medicaid program,
[00:33:10] especially in the states of Louisiana, Mississippi,
[00:33:12] which, you know, we're, in case you didn't know,
[00:33:15] we're number 49 and 50.
[00:33:16] We fight with each other for who's going to be worse.
[00:33:19] So we have a population that really has lots of opportunity,
[00:33:23] as we like to put it.
[00:33:24] And so we're interacting with them
[00:33:26] and getting those patients much more engaging
[00:33:28] than they ever have been before.
[00:33:30] From a funding aspect, you asked about that.
[00:33:32] We started this initially within our own capitated Humana program.
[00:33:36] And that's where it started.
[00:33:38] So we proved there was a value
[00:33:40] because of the fact that it kept people out of the emergency department
[00:33:43] and kept people from being admitted.
[00:33:45] It is actually now several Medicaid providers have picked it up
[00:33:49] and they're included as part of their benefits design.
[00:33:52] It is also a direct to employer strategy.
[00:33:54] It's, you know, I sound like I'm the salesman for it.
[00:33:57] I'm not the one who runs the program,
[00:33:59] but I know it works.
[00:34:00] It does a great job.
[00:34:01] That's why I am an advocate for it.
[00:34:03] Do you feel like there's a difference between what you're doing
[00:34:06] and what most would consider a point solution
[00:34:08] in that you are a medical group with a value mindset
[00:34:13] that is using a tool in order to achieve outcomes
[00:34:18] as opposed to a tech first?
[00:34:21] Maybe this is actually goes back to the humans,
[00:34:23] processes and technology.
[00:34:25] It completely does because it is really about engaging with the patient.
[00:34:29] The tool is a way for us to get the data inputs,
[00:34:35] but it's really the health coaching
[00:34:37] and the engagement with the patient that makes the difference
[00:34:41] because they're giving them dietary recommendations.
[00:34:44] They're giving them all sorts of things
[00:34:45] as to what they can do differently regarding their lifestyle.
[00:34:48] It's really about engaging with the patient.
[00:34:51] And this is the cuff or the glucometer
[00:34:54] is a way to get the data
[00:34:56] to help enable the relationship that exists
[00:35:00] between the health coaches and the patients.
[00:35:04] So validating the theme here
[00:35:05] where you start out with the data,
[00:35:07] you figure out what the goal is,
[00:35:08] you figure out what the vision is,
[00:35:09] you figure out what that clinical guideline is
[00:35:11] that you want all of your patients to,
[00:35:13] you know, in general have or be on.
[00:35:17] Once you know that,
[00:35:18] you can figure out how you're going to do the outreach.
[00:35:20] And it sounds like probably you're doing some training.
[00:35:24] Maybe you're using your huddles
[00:35:25] to facilitate the clinical team
[00:35:28] being aligned behind the case for change there
[00:35:30] and what the opportunities are.
[00:35:32] And then on the other side,
[00:35:33] also probably doing things similar
[00:35:35] to what we were talking about
[00:35:36] when we were talking about the local market stuff.
[00:35:38] So you'd have to kind of do that in a considered way
[00:35:41] and then measuring how it worked.
[00:35:43] Yeah, I mean, we would take the information,
[00:35:46] share that with the leaders
[00:35:48] of whatever group that might be,
[00:35:51] let them blow holes in it.
[00:35:53] If there's anything that they have questions about,
[00:35:55] because last thing we want to do
[00:35:57] is bring bad data to anybody who's frontline.
[00:36:00] One way to surely lose all ability to drive change
[00:36:05] is to bring flawed information forward.
[00:36:08] So we'd rather go ahead
[00:36:10] and have somebody check it out
[00:36:12] and engage with the teams and say,
[00:36:14] okay, what's the best way for us to address this?
[00:36:17] But really you need to identify
[00:36:19] where the opportunities are.
[00:36:20] And if you don't have that information in front of you,
[00:36:23] you will never know.
[00:36:24] I mean, I still think about the first time
[00:36:26] out of an EMR, we were able to run data
[00:36:29] and see how people were doing
[00:36:30] regarding blood rush control and diabetes control.
[00:36:33] And I will tell you,
[00:36:34] I thought I was great until I saw my data.
[00:36:37] And then I was like, I really need to get better.
[00:36:40] But you never really know until you see it
[00:36:42] because you're concentrating on one patient at a time.
[00:36:45] And until you see all that put together,
[00:36:48] you don't realize exactly where you are.
[00:36:50] You may be great.
[00:36:51] You may be fantastic.
[00:36:52] But until you actually have it put in front of you
[00:36:54] in that sort of way, you really don't know.
[00:36:57] And it's interesting how rare it is actually
[00:37:00] that clinicians,
[00:37:01] the one thing I hear from frustrated clinicians
[00:37:05] across the country is just how difficult it actually is
[00:37:08] to understand what's going on with the patient panel.
[00:37:10] It's just, it's very unique in a way
[00:37:14] to be able to see in a short enough timeframe
[00:37:18] that you actually can do something about it.
[00:37:21] You know, like you're getting your feedback loop
[00:37:23] a year and a half later.
[00:37:25] Right.
[00:37:25] It makes it really tough to incrementally improve.
[00:37:28] Dr. Bo Raymond,
[00:37:30] thank you so much for being on Relentless Health Value today.
[00:37:32] My pleasure.
[00:37:33] Thanks for having me.
[00:37:34] It's been fun.
[00:37:35] Hi, my name is Chris Skizak.
[00:37:37] I am the executive director
[00:37:39] of the Houston Business Coalition on Health,
[00:37:42] as well as Texas Employers for Affordable Healthcare.
[00:37:45] I've been a long time listener
[00:37:47] and have had the privilege of getting to know
[00:37:50] and work with Stacey Richter.
[00:37:52] There is no doubt in my mind
[00:37:53] that Relentless Health Value
[00:37:55] is the best podcast out there
[00:37:58] that addresses the financial challenges
[00:38:00] and opportunities in healthcare delivery.
[00:38:03] Episode 452 with Cora Opsil
[00:38:06] is a perfect example of the challenges employers face
[00:38:10] with legacy stakeholders
[00:38:11] that have little incentive to change market dynamics.
[00:38:15] The episode does a great job
[00:38:17] of describing some of these challenges,
[00:38:19] but most important,
[00:38:21] I think it gives hope and encouragement
[00:38:24] to what can be accomplished
[00:38:26] through collective perseverance and resolve.
[00:38:30] I highly encourage listeners
[00:38:32] to pay attention to this episode
[00:38:34] as it truly will require
[00:38:36] a village of employers locally
[00:38:39] at the local market level
[00:38:41] to change what needs to be changed.
[00:38:43] Thank you very much.
