EP473: Keeping Patients out of the ER: How Trusted Relationships in Primary Care Should Work. A Take 2 With Kenny Cole, MD

I’m revisiting, in a take two, this episode with Dr. Kenny Cole because I’m listening to it this time with a new focus. That focus is the theme that keeps coming up over and over and over again on Relentless Health Value these past few months.

For a full transcript of this episode, click here.

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If primary care teams do not have, among other things, but if care teams or somebody on the care team doesn’t build a trusted relationship with plan members/patients, then in a moment that really matters, the patient/member will suboptimally wind up in the ER.

And if this happens across an entire plan sponsor’s member population—all these pilgrimages to the ER—it comes at great cost to the patient, the plan, and society really, both clinically and financially. ER spend these days is about 6% of average plan spend. That’s nuts … 6%!

And this is why, as Denise Wiseman, PhD, MBA, CPXP, wrote the other day on LinkedIn—and I loved how she put it—she said, “Primary care is absolutely an investment in health and wellness, not a cost … Trust is the foundation. Without trusted relationships between patients and care teams, we’re not investing—we’re just reacting. And as you, Stacey Richter [that’s me], and others have pointed out, we’re reacting in the most expensive setting possible: the ER.”

So, thanks for writing that, Denise.

But this whole concept, a trusted relationship with a primary care team, it could feel soft and squishy. And it is so easy for someone looking at a spreadsheet to cross off as wasted spend or wasted time—and time is money—so cross off the things that it will take to build these relationships. Either this or good primary care falls victim to the very, very real perverse incentives to drive commercial ER volume or volume to high-revenue service lines. Just stating facts. It’s logical.

Listen to the show with Vivian Ho, PhD (EP466) about some of the perverse financial incentives in play here for hospitals; one with Scott Conard, MD (EP462); and the show with Al Lewis (EP464). There’s a bunch of adjacent points. So, yeah, let’s consider this conversation with Dr. Kenny Cole today through the lens actually of what is required so that primary care can live up to its potential to be an investment in the real world.

And that means recognizing what it actually takes to deliver great primary care. Trust being a piece of this—yeah, I’m gonna echo what Matt McQuide (EP468) said—if you aren’t getting your members a trusted advisor who will be there for them when it matters and when there’s important decisions being made about where to go for something big, someone else is gonna steer that member. And they’re steering based on their own financial incentives and interests.

Dr. Kenny Cole is from Ochsner Health System, and I loved this conversation. I loved it the first time, and I loved it the second time because it has lessons for plan sponsors on what to look for, that’s for sure.

But it also will speak to anybody working in a clinic or managing a clinic or who wants to learn from a master. This show is also very intriguing for anybody who’s trying to work with or for a clinical practice or a health system that is pulling away from the status quo—one that is earning the trust of its patients and also one that is figuring out how to reinvent the business model such that the best-practice clinical pathways and care flows are aligned with financial viability. That’s really the holy grail there.

We talk about how to achieve this clinical and financial success, even if the financial models are all over the map, which they so often are.

The show today sums up four main points by my counting, and they are as follows. I’m just gonna recap them here, but Dr. Kenny Cole gets into them from a level of deep personal understanding, so please do listen to the show. The four points are:

1. Clinical teams have to deliver care in such a way that those clinical teams are accountable for the outcomes that are generated.

2. Clinical teams need to really see with their own two eyes and believe that a clinical goal that has been set is possible.

3. Care flows are critical here, which means getting everyone on the same page about what best-practice care looks like and operationalizing how that clinical excellence will be achieved.

4. The theme that keeps coming up, building trust with patients and connecting with patients, cannot be underestimated. And care flows need to not only standardize care so that it can be delivered quicker and easier but also facilitate patient relationships.

There are a whole bunch of shows besides even what I already mentioned that are relevant and adjacent to this one: EP467 (Stacey), EP437 (Brian Klepper, PhD), EP472 (Eric Bricker, MD), EP343 (David Carmouche, MD), and EP405 (Eric Gallagher).

Dr. Kenny Cole, as I mentioned, works at Ochsner. He is a primary care internist. He sees patients one day a week and the other days serves as a system vice president. In this role, he designs and develops new care models.

New topic for just a sec: What always warms my heart is when it comes to you lot, you listening, there’s so much that is wonderful about this Relentless Tribe of ours.

To that end, I wanted to share with you that I got a call recently from Kelly Paul from Idaho. Kelly said that she wants to sponsor an episode because she wants to contribute to Relentless Health Value. She says she listens all the time and just wanted to give back. Let me tell you, it’s people like Kelly who keep me motivated here.

I had a chance to meet Kelly, and I learned a lot. And this is not her day job, but she has a small business. So, on the side, she makes functional accessories for cochlear implants for kids and adults to help keep their devices in place. And as soon as I heard that, of course I wanted to mention it, even if it’s just to honor a small business owner solving a problem that needs to be solved.

I mean, it’s hard enough to have a kid. It’s hard enough to deal with deafness and also have an expensive device that could easily go missing.

Kelly’s Web site is ciretentionsolutions.com, so check it out if you have a need. Support Kelly, and thanks so much to Kelly for sponsoring this show with Dr. Kenny Cole.

Oh, also … hey, you lot, you tribe. Did you know that the last time that we got a review on Apple Podcasts was last December? Do you believe that? It was an amazing review, don’t get me wrong. It starts, “Why this New York City nurse trusts Relentless Health Value,” from the one and only Michelle Bernabe, RN, KAT, who I thank from the bottom of my heart—and I could not have appreciated it more.

Read a great post by Michelle Bernabe on how we can get the heart back into healthcare.

But yeah, if you have not yet written a review, please give me a shout-out. There’s instructions for how to do this on the Web site. It does really matter, and if you take the time to do it, please know you rock.

And with that, here is my conversation with Dr. Kenny Cole.

This episode is sponsored by, as I just said, Kelly Paul. Thank you so much. And also by Aventria Health Group.

Also mentioned in this episode are Ochsner Health; Denise Wiseman, PhD, MBA, CPXP; Vivian Ho, PhD; Scott Conard, MD; Al Lewis; Matt McQuide; Brian Klepper, PhD; Eric Bricker, MD; David Carmouche, MD; Eric Gallagher; Kelly Paul; CI Retention Solutions; Michelle Bernabe, RN, KAT; Robert Pearl, MD; John Rodis, MD, MBA, FACHE, CPHQ; Bob Matthews; Marty Makary, MD, MPH; Rik Renard; Sanat Dixit, MD, MBA, FACS; Rob Andrews; Beau Raymond, MD; and Dave Chase. 

You can learn more at Ochsner Health. You can also follow Dr. Cole on LinkedIn.

Kenny Cole, MD, began his role as System VP, Clinical Improvement, for Ochsner Health in New Orleans in September 2019. He is a practicing primary care internist with advanced degrees from LSU Health Sciences Center and Dartmouth, as well as executive training from Harvard Business School. Prior to joining Ochsner Health, Dr. Cole was the chief clinical transformation officer for Baton Rouge General Medical Center, where he designed, developed, and implemented a completely reimagined multidisciplinary team-based model of primary care that focused on aligning clinical with financial outcomes. His current work at Ochsner Health built on that prior foundation to design and help develop Ochsner 65 Plus, a group of redesigned primary care clinics focused on the needs of older adults.

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15:44 How do you scale clinical excellence?

18:18 EP315 with Bob Matthews.

19:12 EP242 with Marty Makary, MD.

21:29 Why is it important simply to demonstrate what’s possible for better health outcomes?

22:33 EP427 with Rik Renard.

23:18 How do we reinvent the business model of healthcare?

24:51 EP466 with Vivian Ho, PhD.

25:06 EP415 with Rob Andrews.

26:51 EP391 with Scott Conard, MD.

30:14 EP455 with Beau Raymond, MD.

34:22 Dr. Cole is published in various healthcare journals; check out his most recent article.

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Dr Eric Bricker, Dr Christine Hale, Nikki King, James Gelfand (Part 2), James Gelfand (Part 1), Matt McQuide, Stacey Richter (EP467), Vivian Ho, Chris Crawford (EP465), Al Lewis, Betsy Seals