Imagine this. You're at the Swiss Hotel in
Chicago surrounded by top executives from leading insurance
companies and health systems.
Welcome to Becker's fall pair issues roundtable, November
4th through 6, 2024.
Picture the excitement as you gather business cards
from over 500 executive level attendees,
building invaluable connections.
Feel the energy as you participate in over
26 educational sessions led by 90 elite speakers.
Envision yourself engaging in lively discussions about new
health plans, hospital at home models, behavioral health,
and price transparency.
Now imagine being inspired by keynotes from boxing
legend, Sugar Ray Leonard, and 4 time NBA
All Star, Chris Webber. Their stories will leave
you motivated and ready to innovate.
Don't miss out on this unique opportunity. Get
registered today. Visit beckershospital
hospitalreview.com
and click on the events page to find
the conference website. That's the beckershospitalreview.com
events page. See you in Chicago.
Hello, everyone. This is Jacob Emerson with the
Becker's Healthcare Podcast.
Thanks so much for tuning in today where
we're joined by a very special guest. Doctor
Wyatt Decker is an executive vice president at
UnitedHealth Group and the chief physician for value
based care and innovation.
Doctor. Decker, thank you so much for taking
the time to be with me on the
podcast today.
Well, thanks, Jacob. Great to be here with
you.
Likewise, Doctor. Decker. And before we dive into
everything that we wanna talk with you about,
can you tell us a little bit more
about your background in healthcare and what it
is that you're doing today at UnitedHealth Group?
You bet. So I'm an emergency medicine physician,
spent 22 years practicing,
teaching,
and leading,
in various,
capacities for the Mayo Clinic before I joined
UnitedHealthcare.
And one thing that every emergency physician will
tell you, Jacob, is that
our nation's emergency departments
are overcrowded.
That's not exactly news.
But when you really look at why our
nation's emergency department's overcrowded,
we almost unanimously
agree that half to 2 thirds of the
patients in an emergency department represent
failures of the US health care system in
one way, shape, or form.
So when I decided to head out for
my next chapter, I was looking for an
organization that I thought could really make a
difference in making health care better for the
United States, and that's UnitedHealth Group. I spent
5 years serving as the CEO of
OptumHealth, which is the care delivery arm of
the organization,
advancing value based care kind of on the
front lines and,
and have spent the past year, year and
a half as, in a newly creative position
as chief physician focusing on value based care
and innovation.
Fantastic. So you've had a really amazing career
as an emergency physician, and you just mentioned,
fixes for creating a better health care system
in the United States. In that vein, Doctor.
Decker, UnitedHealth Group just issued a paper this
month called a a path forward which outlines
the company's policy solutions centered around the transition
to a value based care approach
to our health care system.
So can you tell our listeners who might
not be familiar
a little bit more about UnitedHealth Group's vision
for a path forward
within our health care system?
Yes. Absolutely. So path forward is UnitedHealth
Group's best thinking on how do we address
some of the well documented and and well
known deficiencies
in US health care. And I I always
like to frame it by, you know, as
many of of your listeners are aware,
United States has a lot to be proud
of when it comes to healthcare delivery, but
we have massive problems too. So we have
fantastic
physicians.
We have fantastic referral medical centers. We have
an amazing
clinician workforce of nurses, advanced practitioners,
and allied health care providers of all type.
So there's so much there that that should
work.
Yet when you when you look at the
macro level,
as we all recognize, you see a system
that's nearly twice as expensive as most industrialized
nations
that actually falls short on many public health
measures
that are considered sort of barometers of how
your health care system is doing. So
for me, the path forward was an opportunity
to begin to articulate
the opportunity that's in front of us. And
as you noticed it noticed in reading it,
it's,
a big focus is on value based care.
Absolutely. So a lot of things to be
proud of within our health care system, but
certainly a lot of metrics that leave room
for improvement,
as you just said.
And you mentioned value based care. You know,
I think it might be important to take
a step back for a second and
talk a little bit about
what that means in the simplest terms for
UnitedHealth Group specifically because there are so many
different stakeholders and so many different organizations.
What is value based care from from the
UnitedHealth Group perspective?
Absolutely. And you're right. There's many different interpretations
of the phrase. So, for us, it really
means creating the health care system that most
people want, which is a health care system
that
focuses on keeping you healthy and well,
but, of course, has your back if you
get sick and, you know, need intense or
acute care.
And
when you think about the term value based
care, it's it's a little misleading, but
to us, it means creating the the financial
model that rewards
doctors, nurses,
hospital systems, etcetera, for keeping people healthy and
well.
That's key because the fee for service system
is largely a sick care system, meaning,
yeah, it'll it will, by and large, cover,
acute events,
you know, trauma case, an acute coronary
blockage
will get treated in a cath lab, super
expensive,
and, again, with some exceptions in rural America,
largely available to most Americans.
Now where is that system
in the 10 years that led up to
that person's heart attack?
That's the question.
First to acknowledge there's we have we have
some great examples of of how we're addressing
it and so do others. So there's a
there's a widespread movement underway to begin to
align the financial models and create the clinical
models that get upstream,
whether it's addressing simple things like high cholesterol,
high blood sugars that are creeping up into
true type 2 diabetes,
hypertension.
These are relatively straightforward things
that unfortunately
tend to get ignored in the largely fee
for service system.
Absolutely. And you bring up a great point,
Doctor. Decker, in terms of conditions that can
get ignored,
under a traditional system. How would you say
that UnitedHealth Group's transition to a value based
care model has improved patient outcomes,
particularly for the so many vulnerable populations that
the company Yeah. That's just so critical. Yeah,
absolutely.
Well, this is something that,
we are very, very serious about. And,
I personally and our organization
recognizes that we need to be able to
show if we're you know, sort of put
your data where your mouth is, if you
will. Well, what's the data show? And the
data shows that in serious chronic conditions let's
take COPD as an example.
Our value based care are seniors that are
in Medicare Advantage, and when we create the
kinds of wraparound solutions where there's a team
focusing on making sure that population gets the
care that they need, that that individual COPD
is on their meds, able to fill their
meds, able to get in to see their
primary care doctor, might have a how a
home visit.
When that all happens, we see about a
44%
reduction
in emergency department visits and unplanned hospitalizations
for that population.
And when you see it across the board,
if you were to take all seniors that
when they're in our Medicare Advantage program
and we're able to find the kind of
wrap around solutions,
that get at prevention
and early diagnosing
and intervention in chronic diseases,
then we see about a 10 to 12
percent overall reduction in emergency department visits
and hospital,
hospitalizations.
So to us, that's important data that's in
the peer reviewed literature that validates our, our
belief
that value based care can truly make a
difference in both clinical outcomes and reducing overall
costs.
Wow. I mean, some amazing figures you just
cited there, doctor Decker, in terms of patient
outcomes. But I I think fair to say,
that wasn't an easy transition for the company
to make. And I would say for for
our listeners, they're in different stages of their
journeys from in that transition from fee for
service to a value based system.
So when thinking about that transition,
what what would you say are some of
the primary challenges that health care providers are
facing right now? Yes. And how can these
obstacles be effectively addressed through some of the
policy solutions we've heard about already to ensure
those better patient outcomes and cost efficiencies
that you've already highlighted. Yeah. So, Jacob, you
really hit the nail on the head with
this transition
is difficult.
There's no question about it. And
there are 3 key elements that I'm gonna
highlight. There's others as well. But
but three critical ones that have to be
done right and, frankly, aren't easy. First one
is it's recognizing
it's a culture shift.
When you have busy primary care physicians, nurse
practitioners in a clinic
who have been on a durable will for
years doing 15 minute visits with no real
team around them,
and switching them,
to a team based model that focuses on
getting to know a population or a panel
of patients,
and figuring out who's high risk for,
falling off the wagon, if you will, meaning
having an acute event, having, say, their heart
failure get a little bit worse, and needing
to go to the emergency department, how can
you get upstream?
And,
so you need the culture shift, which says,
hey. We're gonna do this. Then you need
the clinical model and the team in place.
So you need the right people.
And, certainly,
the nurses and doctors in a fee for
service system have the technical skills,
to deliver outstanding care, and that's one of
the strengths again of the US healthcare system.
But really then it's adding members to the
team. Think of case managers,
think of care coordinators,
think of RNs that are trained in how
to do effective home visits.
And as you add those kind of, members,
so that's the second item. 1st is culture,
second is people, and making sure that you
have that expertise,
on the team to help you really care
for that population, identify the high risk patients,
and reach out to them instead of waiting
for them to call your office to schedule
an appointment. And then the third is really
data and technology.
So part of the reason it isn't easy
is because the systems that are used in
fee for service
are important. We still need to, say, have
an electronic health record and document the the
comings and goings of a patient. But we
also need data and analytics to help us
monitor the health and well-being of that population
and identify
if a patient didn't make it to the
pharmacy to fill their prescription, as an example,
or missed an appointment.
So you need systems in place to, to
be able to identify early
a patient that might be struggling. And it
might be a medical issue. Of course, it
might be a behavioral issue, but it might
be a a social determinants issue that they're
isolated, they're lonely,
they have,
inability to get to a doctor's office because
they need help with transportation.
And and value based care creates the incentive
for the provider to help solve
not only for the
physical challenges, the physical care for diabetes, hypertension,
etc,
but also for the social determinants and the
behavioral issues that can overlap and compound those
kinds of challenges.
Yeah. It's such great advice. And just to
recap for our listeners,
it's it's going to take a a shift
in culture, the right people and expertise, and
the right data and technology
for providers to really measure the transition
from fee for service to value based care.
Now, Doctor. Decker, as an emergency physician, you've
been on the front lines of care delivery
for decades, as you mentioned in the beginning,
serving with some of the most,
leading healthcare organizations in the country,
and currently as well. So from that perspective,
why is value based care more attractive than
than fee for service from the physician's perspective?
Well, as you're aware, Jacob,
our nation is struggling with,
incredibly
high rates of physician and clinician burnout.
And there's a variety of factors, the administrative
burden, the, the sort of hassle factor in
doing your job, trying to help people in
their health care journey is a big one.
And when you transition to value based care,
a true value based care model,
what we see is primary care physicians in
particular
who start loving their work again. Because instead
of seeing 25 patients who happen to call
their receptionist to get on their schedule without
any real continuity,
they can we can move them to seeing,
say, 12, 15 patients in,
less hurried environment
where the team has already teed up and
identified the concerns,
and now they're visiting with that patient trying
to use their top medical skills and experience
to determine best next steps, and that actually
is what doctors love to do, and frankly,
same with advanced practitioners. And so for the
physicians,
I would say the ability to
get back to the work they love,
is incredibly appealing. There I would also add
that there's challenges during the transition because there's
this period where you feel like you have
a foot in both canoes, as we say.
So you've got fee for service patients and
value based. So there's there's this camel's hump
that you have to get over as you
begin to move to a value based care
practice, but once you're there,
you see really high rates of physician satisfaction.
Absolutely. Yeah. It's really fascinating to think about.
Well, doctor Decker, if you were gonna look
into your crystal ball 10 years from now,
what does a perfect health care system look
like for you and for UnitedHealth Group?
Yeah. I I would say it's a health
care system that is
far more seamless in today's health care experience
for most people. What do I mean by
that? It means that your team is proactive,
that you have an ongoing relationship with your
health care team, even if you're relatively healthy
and not just for seniors.
And we also serve a huge number of
dual special needs individuals, which are typically underserved,
really complex patients. They need the attention. Seniors
need the attention. But frankly, in in maybe
a lighter touch for many people, but so
do so does the workforce, so does children,
so do those who are on Medicaid. And
so I think 10 years from now, having
a system in the United States that proactively
identifies
risks in individuals healthcare journeys and helps them
address those and identify serious chronic conditions early
so that we have fewer people transitioning to
dialysis for kidney failure because they didn't ever
get there. We have fewer people getting below
knee amputations.
USC is about a, eightfold
increase in
what what I would say are preventable lower
extremity amputations compared to the rest of the
developed world. It's because of peripheral vascular disease
and diabetic foot ulcers that go untreated until
they're a disaster.
How do we get upstream? And in that
perfect health care system,
we identify those kinds of conditions early before
they result in losing your limb. And those
are just brief examples of the kind of
power of moving to a predominantly
value based care system in the United States.
Some really great insights.
What else are we missing, doctor Decker? You've
got the ears of a lot of health
care leaders from all over the country. Any
any final thoughts you'd like to share with
them? Absolutely. I mean, recognizing that change is
hard and that we all have to give
a little bit. The US health care system
is full of incumbents
that fiercely defend their territory in, you know,
in a what feels like a shrinking health
care pie. And for us to make this
transition,
we've all got to take the high road
and say, how do we make health care
work?
What are what are the challenges,
and and what are we willing to give
up as a payer, as a provider, as
a health care system, as a drug or
device manufacturer
so that we can get I mentioned the
Campbell's hump, the challenge of a practice moving
to value based care. Well, there's a massive
camel hump ahead of us as the US
health care system
moves to, frankly, a a more rational, more
person centered
way of caring
for people. And as we do that,
we're all gonna have to lean in and
have those tough conversations, but it's critical. It's
frankly
necessary
for us to move forward.
Fantastic. I think some great parting words. So
doctor Decker, thank you so much for taking
the time to be with us and for
sharing your insights with our listeners. We truly
appreciate it. Great to be with you. Fantastic
conversation. Thanks for including me. If you'd like
to listen to more podcasts from Becker's Health
Care, you can visit beckershospitalreview.com.