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Imagine this. You're at the Swiss Hotel in

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Welcome to Becker's fall pair issues roundtable, November

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and price transparency.

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Now imagine being inspired by keynotes from boxing

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Hello, everyone. This is Jacob Emerson with the

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Becker's Healthcare Podcast.

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Thanks so much for tuning in today where

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we're joined by a very special guest. Doctor

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Wyatt Decker is an executive vice president at

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UnitedHealth Group and the chief physician for value

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based care and innovation.

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Doctor. Decker, thank you so much for taking

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the time to be with me on the

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podcast today.

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Well, thanks, Jacob. Great to be here with

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you.

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Likewise, Doctor. Decker. And before we dive into

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everything that we wanna talk with you about,

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can you tell us a little bit more

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about your background in healthcare and what it

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is that you're doing today at UnitedHealth Group?

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You bet. So I'm an emergency medicine physician,

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spent 22 years practicing,

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teaching,

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and leading,

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in various,

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capacities for the Mayo Clinic before I joined

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UnitedHealthcare.

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And one thing that every emergency physician will

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tell you, Jacob, is that

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our nation's emergency departments

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are overcrowded.

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That's not exactly news.

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But when you really look at why our

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nation's emergency department's overcrowded,

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we almost unanimously

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agree that half to 2 thirds of the

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patients in an emergency department represent

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failures of the US health care system in

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one way, shape, or form.

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So when I decided to head out for

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my next chapter, I was looking for an

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organization that I thought could really make a

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difference in making health care better for the

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United States, and that's UnitedHealth Group. I spent

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5 years serving as the CEO of

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OptumHealth, which is the care delivery arm of

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the organization,

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advancing value based care kind of on the

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front lines and,

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and have spent the past year, year and

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a half as, in a newly creative position

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as chief physician focusing on value based care

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and innovation.

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Fantastic. So you've had a really amazing career

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as an emergency physician, and you just mentioned,

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fixes for creating a better health care system

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in the United States. In that vein, Doctor.

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Decker, UnitedHealth Group just issued a paper this

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month called a a path forward which outlines

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the company's policy solutions centered around the transition

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to a value based care approach

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to our health care system.

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So can you tell our listeners who might

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not be familiar

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a little bit more about UnitedHealth Group's vision

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for a path forward

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within our health care system?

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Yes. Absolutely. So path forward is UnitedHealth

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Group's best thinking on how do we address

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some of the well documented and and well

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known deficiencies

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in US health care. And I I always

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like to frame it by, you know, as

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many of of your listeners are aware,

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United States has a lot to be proud

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of when it comes to healthcare delivery, but

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we have massive problems too. So we have

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fantastic

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physicians.

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We have fantastic referral medical centers. We have

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an amazing

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clinician workforce of nurses, advanced practitioners,

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and allied health care providers of all type.

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So there's so much there that that should

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work.

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Yet when you when you look at the

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macro level,

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as we all recognize, you see a system

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that's nearly twice as expensive as most industrialized

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nations

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that actually falls short on many public health

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measures

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that are considered sort of barometers of how

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your health care system is doing. So

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for me, the path forward was an opportunity

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to begin to articulate

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the opportunity that's in front of us. And

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as you noticed it noticed in reading it,

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it's,

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a big focus is on value based care.

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Absolutely. So a lot of things to be

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proud of within our health care system, but

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certainly a lot of metrics that leave room

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for improvement,

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as you just said.

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And you mentioned value based care. You know,

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I think it might be important to take

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a step back for a second and

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talk a little bit about

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what that means in the simplest terms for

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UnitedHealth Group specifically because there are so many

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different stakeholders and so many different organizations.

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What is value based care from from the

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UnitedHealth Group perspective?

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Absolutely. And you're right. There's many different interpretations

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of the phrase. So, for us, it really

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means creating the health care system that most

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people want, which is a health care system

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that

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focuses on keeping you healthy and well,

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but, of course, has your back if you

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get sick and, you know, need intense or

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acute care.

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And

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when you think about the term value based

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care, it's it's a little misleading, but

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to us, it means creating the the financial

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model that rewards

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doctors, nurses,

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hospital systems, etcetera, for keeping people healthy and

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well.

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That's key because the fee for service system

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is largely a sick care system, meaning,

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yeah, it'll it will, by and large, cover,

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acute events,

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you know, trauma case, an acute coronary

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blockage

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will get treated in a cath lab, super

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expensive,

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and, again, with some exceptions in rural America,

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largely available to most Americans.

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Now where is that system

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in the 10 years that led up to

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that person's heart attack?

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That's the question.

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First to acknowledge there's we have we have

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some great examples of of how we're addressing

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it and so do others. So there's a

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there's a widespread movement underway to begin to

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align the financial models and create the clinical

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models that get upstream,

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whether it's addressing simple things like high cholesterol,

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high blood sugars that are creeping up into

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true type 2 diabetes,

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hypertension.

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These are relatively straightforward things

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that unfortunately

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tend to get ignored in the largely fee

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for service system.

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Absolutely. And you bring up a great point,

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Doctor. Decker, in terms of conditions that can

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get ignored,

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under a traditional system. How would you say

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that UnitedHealth Group's transition to a value based

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care model has improved patient outcomes,

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particularly for the so many vulnerable populations that

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the company Yeah. That's just so critical. Yeah,

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absolutely.

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Well, this is something that,

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we are very, very serious about. And,

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I personally and our organization

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recognizes that we need to be able to

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show if we're you know, sort of put

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your data where your mouth is, if you

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will. Well, what's the data show? And the

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data shows that in serious chronic conditions let's

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take COPD as an example.

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Our value based care are seniors that are

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in Medicare Advantage, and when we create the

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kinds of wraparound solutions where there's a team

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focusing on making sure that population gets the

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care that they need, that that individual COPD

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is on their meds, able to fill their

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meds, able to get in to see their

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primary care doctor, might have a how a

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home visit.

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When that all happens, we see about a

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44%

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reduction

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in emergency department visits and unplanned hospitalizations

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for that population.

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And when you see it across the board,

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if you were to take all seniors that

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when they're in our Medicare Advantage program

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and we're able to find the kind of

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wrap around solutions,

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that get at prevention

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and early diagnosing

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and intervention in chronic diseases,

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then we see about a 10 to 12

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percent overall reduction in emergency department visits

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and hospital,

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hospitalizations.

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So to us, that's important data that's in

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the peer reviewed literature that validates our, our

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belief

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that value based care can truly make a

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difference in both clinical outcomes and reducing overall

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costs.

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Wow. I mean, some amazing figures you just

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cited there, doctor Decker, in terms of patient

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outcomes. But I I think fair to say,

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that wasn't an easy transition for the company

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to make. And I would say for for

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our listeners, they're in different stages of their

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journeys from in that transition from fee for

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service to a value based system.

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So when thinking about that transition,

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what what would you say are some of

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the primary challenges that health care providers are

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facing right now? Yes. And how can these

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obstacles be effectively addressed through some of the

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policy solutions we've heard about already to ensure

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those better patient outcomes and cost efficiencies

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that you've already highlighted. Yeah. So, Jacob, you

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really hit the nail on the head with

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this transition

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is difficult.

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There's no question about it. And

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there are 3 key elements that I'm gonna

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highlight. There's others as well. But

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but three critical ones that have to be

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done right and, frankly, aren't easy. First one

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is it's recognizing

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it's a culture shift.

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When you have busy primary care physicians, nurse

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practitioners in a clinic

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who have been on a durable will for

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years doing 15 minute visits with no real

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team around them,

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and switching them,

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to a team based model that focuses on

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getting to know a population or a panel

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of patients,

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and figuring out who's high risk for,

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falling off the wagon, if you will, meaning

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having an acute event, having, say, their heart

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failure get a little bit worse, and needing

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to go to the emergency department, how can

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you get upstream?

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And,

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so you need the culture shift, which says,

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hey. We're gonna do this. Then you need

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the clinical model and the team in place.

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So you need the right people.

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And, certainly,

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the nurses and doctors in a fee for

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service system have the technical skills,

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to deliver outstanding care, and that's one of

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the strengths again of the US healthcare system.

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But really then it's adding members to the

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team. Think of case managers,

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think of care coordinators,

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think of RNs that are trained in how

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to do effective home visits.

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And as you add those kind of, members,

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so that's the second item. 1st is culture,

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second is people, and making sure that you

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have that expertise,

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on the team to help you really care

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for that population, identify the high risk patients,

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and reach out to them instead of waiting

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for them to call your office to schedule

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an appointment. And then the third is really

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data and technology.

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So part of the reason it isn't easy

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is because the systems that are used in

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fee for service

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are important. We still need to, say, have

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an electronic health record and document the the

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comings and goings of a patient. But we

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also need data and analytics to help us

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monitor the health and well-being of that population

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and identify

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if a patient didn't make it to the

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pharmacy to fill their prescription, as an example,

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or missed an appointment.

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So you need systems in place to, to

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be able to identify early

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a patient that might be struggling. And it

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might be a medical issue. Of course, it

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might be a behavioral issue, but it might

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be a a social determinants issue that they're

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isolated, they're lonely,

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they have,

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inability to get to a doctor's office because

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they need help with transportation.

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And and value based care creates the incentive

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for the provider to help solve

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not only for the

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physical challenges, the physical care for diabetes, hypertension,

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etc,

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but also for the social determinants and the

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behavioral issues that can overlap and compound those

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kinds of challenges.

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Yeah. It's such great advice. And just to

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recap for our listeners,

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it's it's going to take a a shift

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in culture, the right people and expertise, and

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the right data and technology

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for providers to really measure the transition

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from fee for service to value based care.

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Now, Doctor. Decker, as an emergency physician, you've

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been on the front lines of care delivery

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for decades, as you mentioned in the beginning,

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serving with some of the most,

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leading healthcare organizations in the country,

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and currently as well. So from that perspective,

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why is value based care more attractive than

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than fee for service from the physician's perspective?

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Well, as you're aware, Jacob,

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our nation is struggling with,

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incredibly

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high rates of physician and clinician burnout.

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And there's a variety of factors, the administrative

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burden, the, the sort of hassle factor in

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doing your job, trying to help people in

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their health care journey is a big one.

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And when you transition to value based care,

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a true value based care model,

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what we see is primary care physicians in

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particular

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who start loving their work again. Because instead

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of seeing 25 patients who happen to call

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their receptionist to get on their schedule without

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any real continuity,

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they can we can move them to seeing,

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say, 12, 15 patients in,

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less hurried environment

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where the team has already teed up and

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identified the concerns,

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and now they're visiting with that patient trying

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to use their top medical skills and experience

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to determine best next steps, and that actually

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is what doctors love to do, and frankly,

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same with advanced practitioners. And so for the

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physicians,

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I would say the ability to

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get back to the work they love,

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is incredibly appealing. There I would also add

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that there's challenges during the transition because there's

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this period where you feel like you have

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a foot in both canoes, as we say.

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So you've got fee for service patients and

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value based. So there's there's this camel's hump

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that you have to get over as you

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begin to move to a value based care

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practice, but once you're there,

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you see really high rates of physician satisfaction.

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Absolutely. Yeah. It's really fascinating to think about.

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Well, doctor Decker, if you were gonna look

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into your crystal ball 10 years from now,

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what does a perfect health care system look

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like for you and for UnitedHealth Group?

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00:14:50,625 --> 00:14:52,225
Yeah. I I would say it's a health

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care system that is

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far more seamless in today's health care experience

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for most people. What do I mean by

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that? It means that your team is proactive,

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that you have an ongoing relationship with your

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health care team, even if you're relatively healthy

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and not just for seniors.

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And we also serve a huge number of

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dual special needs individuals, which are typically underserved,

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really complex patients. They need the attention. Seniors

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need the attention. But frankly, in in maybe

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a lighter touch for many people, but so

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do so does the workforce, so does children,

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so do those who are on Medicaid. And

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so I think 10 years from now, having

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a system in the United States that proactively

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identifies

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risks in individuals healthcare journeys and helps them

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address those and identify serious chronic conditions early

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so that we have fewer people transitioning to

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dialysis for kidney failure because they didn't ever

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get there. We have fewer people getting below

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knee amputations.

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USC is about a, eightfold

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increase in

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what what I would say are preventable lower

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extremity amputations compared to the rest of the

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developed world. It's because of peripheral vascular disease

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and diabetic foot ulcers that go untreated until

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they're a disaster.

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How do we get upstream? And in that

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perfect health care system,

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we identify those kinds of conditions early before

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they result in losing your limb. And those

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are just brief examples of the kind of

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power of moving to a predominantly

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value based care system in the United States.

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Some really great insights.

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What else are we missing, doctor Decker? You've

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got the ears of a lot of health

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care leaders from all over the country. Any

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00:16:35,544 --> 00:16:37,144
any final thoughts you'd like to share with

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them? Absolutely. I mean, recognizing that change is

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00:16:40,825 --> 00:16:43,225
hard and that we all have to give

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00:16:43,225 --> 00:16:45,884
a little bit. The US health care system

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00:16:45,945 --> 00:16:47,485
is full of incumbents

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00:16:48,269 --> 00:16:52,290
that fiercely defend their territory in, you know,

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00:16:52,590 --> 00:16:54,750
in a what feels like a shrinking health

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00:16:54,750 --> 00:16:57,149
care pie. And for us to make this

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00:16:57,149 --> 00:16:57,649
transition,

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00:16:58,590 --> 00:17:00,990
we've all got to take the high road

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and say, how do we make health care

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00:17:02,670 --> 00:17:03,170
work?

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00:17:03,674 --> 00:17:05,375
What are what are the challenges,

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00:17:05,835 --> 00:17:07,355
and and what are we willing to give

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00:17:07,355 --> 00:17:10,555
up as a payer, as a provider, as

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00:17:10,555 --> 00:17:12,315
a health care system, as a drug or

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00:17:12,315 --> 00:17:13,375
device manufacturer

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00:17:13,755 --> 00:17:15,595
so that we can get I mentioned the

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00:17:15,595 --> 00:17:18,450
Campbell's hump, the challenge of a practice moving

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00:17:18,450 --> 00:17:20,690
to value based care. Well, there's a massive

447
00:17:20,690 --> 00:17:23,009
camel hump ahead of us as the US

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00:17:23,009 --> 00:17:23,990
health care system

449
00:17:24,289 --> 00:17:27,569
moves to, frankly, a a more rational, more

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00:17:27,569 --> 00:17:28,390
person centered

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00:17:29,250 --> 00:17:30,309
way of caring

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for people. And as we do that,

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00:17:33,335 --> 00:17:35,174
we're all gonna have to lean in and

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have those tough conversations, but it's critical. It's

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frankly

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00:17:38,694 --> 00:17:39,194
necessary

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for us to move forward.

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00:17:41,974 --> 00:17:44,680
Fantastic. I think some great parting words. So

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doctor Decker, thank you so much for taking

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the time to be with us and for

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sharing your insights with our listeners. We truly

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00:17:51,400 --> 00:17:54,140
appreciate it. Great to be with you. Fantastic

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00:17:54,279 --> 00:17:56,811
conversation. Thanks for including me. If you'd like

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00:17:56,811 --> 00:17:59,051
to listen to more podcasts from Becker's Health

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00:17:59,051 --> 00:18:00,511
Care, you can visit beckershospitalreview.com.