1 00:00:00,160 --> 00:00:02,899 Evernorth brings the power of wonder and relentless 2 00:00:02,960 --> 00:00:05,919 innovation to create world class pharmacy care and 3 00:00:05,919 --> 00:00:09,199 benefit solutions. Our connected health services make the 4 00:00:09,199 --> 00:00:12,080 treatment, prediction, and prevention of health care's most 5 00:00:12,080 --> 00:00:13,059 complex conditions 6 00:00:13,605 --> 00:00:16,344 easier and more accessible as we drive organizations 7 00:00:16,725 --> 00:00:19,524 and people forward. Ever North Home Based Care 8 00:00:19,524 --> 00:00:22,004 provides value based care that helps patients with 9 00:00:22,004 --> 00:00:23,384 multiple chronic conditions 10 00:00:23,844 --> 00:00:26,085 and social determinant of health barriers get the 11 00:00:26,085 --> 00:00:28,884 care they need and the personalized experience they 12 00:00:28,884 --> 00:00:31,660 deserve. We serve patients who struggle to navigate 13 00:00:31,660 --> 00:00:34,060 the health care system by bringing high quality 14 00:00:34,060 --> 00:00:34,560 primary 15 00:00:35,020 --> 00:00:37,739 and preventative care services to the home. By 16 00:00:37,739 --> 00:00:40,619 providing clinical care and support services that provide 17 00:00:40,619 --> 00:00:44,105 whole person care, we improve health equity, access, 18 00:00:44,105 --> 00:00:46,605 and outcomes for the populations we serve. 19 00:00:47,225 --> 00:00:49,405 Hello, and welcome to the Becker's Healthcare podcast. 20 00:00:49,465 --> 00:00:51,304 My name is Chanel Bunger. And right now, 21 00:00:51,304 --> 00:00:54,185 I'm thrilled to be joined by doctor Yvette 22 00:00:54,185 --> 00:00:54,685 Lefebvre, 23 00:00:55,039 --> 00:00:57,359 the chief medical officer, home based care, Ever 24 00:00:57,359 --> 00:00:58,500 North Health Services. 25 00:00:59,039 --> 00:01:00,640 Thank you so much for joining me today. 26 00:01:00,640 --> 00:01:02,559 Thank you. Thanks for having me. Perfect. Well, 27 00:01:02,559 --> 00:01:03,920 to get us started, could you please tell 28 00:01:03,920 --> 00:01:05,920 us a little bit about your background? Sure. 29 00:01:05,920 --> 00:01:08,579 So I'm an emergency medicine physician by background. 30 00:01:08,734 --> 00:01:10,575 And as you said, I'm I'm currently the 31 00:01:10,575 --> 00:01:12,655 chief medical officer for home based care at 32 00:01:12,655 --> 00:01:13,155 EverNorth. 33 00:01:13,534 --> 00:01:15,314 And so kind of an interesting, 34 00:01:15,854 --> 00:01:18,494 I'd say circuitous route to get here. Started 35 00:01:18,494 --> 00:01:20,814 off my career in emergency medicine and have 36 00:01:20,814 --> 00:01:23,215 now transitioned into home based care. And it's 37 00:01:23,215 --> 00:01:26,090 kind of a a great full circle experience, 38 00:01:26,090 --> 00:01:27,609 if you will, because I feel like now 39 00:01:27,689 --> 00:01:30,090 so at EverNorth home based care, we provide 40 00:01:30,090 --> 00:01:32,250 in home care in a few different programs. 41 00:01:32,250 --> 00:01:34,030 We have an in home primary care program. 42 00:01:34,250 --> 00:01:36,569 We have a health risk solutions program, and 43 00:01:36,569 --> 00:01:38,329 we have a post acute care and transitions 44 00:01:38,329 --> 00:01:40,325 of care program. And so if I think 45 00:01:40,325 --> 00:01:42,005 back to my days in the emergency room 46 00:01:42,005 --> 00:01:42,665 where I 47 00:01:42,965 --> 00:01:45,284 struggled with giving the time and attention to 48 00:01:45,284 --> 00:01:47,045 patients with a lot of chronic conditions who 49 00:01:47,045 --> 00:01:49,145 would come into the emergency room for care, 50 00:01:49,365 --> 00:01:50,645 usually in the middle of the night when 51 00:01:50,645 --> 00:01:52,564 there was a lot going on because they 52 00:01:52,564 --> 00:01:54,905 weren't getting the primary care that they needed, 53 00:01:55,109 --> 00:01:57,270 That was a stressful time for me. And 54 00:01:57,270 --> 00:01:59,349 so now I feel like working at EverNorth 55 00:01:59,349 --> 00:02:01,290 home based care, I'm actually starting to 56 00:02:01,590 --> 00:02:03,510 address the root causes of the problems that 57 00:02:03,510 --> 00:02:05,750 those patients were having. And so it's it's 58 00:02:05,750 --> 00:02:07,670 a great program and happy to talk more 59 00:02:07,670 --> 00:02:10,485 about that offline at some time. Perfect. And 60 00:02:10,485 --> 00:02:11,465 speaking of problems, 61 00:02:12,084 --> 00:02:13,465 from a clinical perspective, 62 00:02:13,764 --> 00:02:16,084 how would you describe the biggest barriers to 63 00:02:16,084 --> 00:02:19,465 effectively serving and engaging members? And what opportunities 64 00:02:19,685 --> 00:02:21,384 do you have for large scale improvements? 65 00:02:21,860 --> 00:02:23,620 And how are you applying this in your 66 00:02:23,620 --> 00:02:24,599 current strategies? 67 00:02:25,060 --> 00:02:26,659 That's a lot, and probably more than we 68 00:02:26,659 --> 00:02:29,219 can cover in a 15 minute podcast. But 69 00:02:29,219 --> 00:02:30,979 so high level, I think some of the 70 00:02:30,979 --> 00:02:33,780 biggest challenges that we're facing together when we're 71 00:02:33,780 --> 00:02:35,539 looking at health care across the country right 72 00:02:35,539 --> 00:02:38,335 now, we're looking at an aging population. The 73 00:02:38,335 --> 00:02:40,655 population reference bureau is telling us that by 74 00:02:40,655 --> 00:02:42,675 the year 2050, we're going to have 75 00:02:42,974 --> 00:02:43,474 85,000,000 76 00:02:43,855 --> 00:02:46,655 people who are aged 65 or over. That's 77 00:02:46,655 --> 00:02:47,395 a 47% 78 00:02:47,855 --> 00:02:50,175 increase over what we saw in 2022. Wow. 79 00:02:50,175 --> 00:02:52,409 Yeah. So that's a lot of aging patients 80 00:02:52,409 --> 00:02:53,849 that we need to be prepared to take 81 00:02:53,849 --> 00:02:54,510 care of. 82 00:02:54,969 --> 00:02:57,210 And then coupled with that, we're actually seeing 83 00:02:57,210 --> 00:02:59,689 a sicker younger generation, if you will. So 84 00:02:59,689 --> 00:03:01,210 when you look at patients who are under 85 00:03:01,210 --> 00:03:01,710 45, 86 00:03:02,250 --> 00:03:03,150 we're seeing 87 00:03:03,455 --> 00:03:05,615 an increase in obesity. We're seeing an increase 88 00:03:05,615 --> 00:03:07,775 in cancers. We're seeing an increased risk of 89 00:03:07,775 --> 00:03:10,175 death from heart failure, and that's patients under 90 00:03:10,175 --> 00:03:10,675 45. 91 00:03:11,055 --> 00:03:12,895 So we've got sicker patients, and we've got 92 00:03:12,895 --> 00:03:14,034 patients who are aging. 93 00:03:14,335 --> 00:03:15,935 So we've got a lot of challenges in 94 00:03:15,935 --> 00:03:18,289 how we're going to deliver the care that 95 00:03:18,289 --> 00:03:19,430 those patients need. 96 00:03:20,050 --> 00:03:21,650 And then coupled with that, there's 2 other 97 00:03:21,650 --> 00:03:23,830 things that I think it's worth addressing or 98 00:03:24,050 --> 00:03:25,889 trying to address. We're not gonna fix it 99 00:03:25,889 --> 00:03:27,889 again in 15 minutes, but we need to 100 00:03:27,889 --> 00:03:30,610 acknowledge that there's been an erosion of trust 101 00:03:30,610 --> 00:03:31,830 of the health care system. 102 00:03:32,129 --> 00:03:34,224 I think it's been happening gradually over time, 103 00:03:34,224 --> 00:03:35,585 but I think over the last 5 to 104 00:03:35,585 --> 00:03:37,425 10 years, we've really seen a lot of 105 00:03:37,425 --> 00:03:39,745 erosion of trust in the traditional health care 106 00:03:39,745 --> 00:03:40,245 relationships 107 00:03:40,625 --> 00:03:41,525 with our patients. 108 00:03:42,385 --> 00:03:44,064 And then last but not least, I would 109 00:03:44,064 --> 00:03:45,629 call out the fact that we've got a 110 00:03:45,790 --> 00:03:47,950 a provider shortage in our country, and that's 111 00:03:47,950 --> 00:03:49,790 only going to get worse. First of all, 112 00:03:49,790 --> 00:03:51,790 providers are not immune to aging. Right? So 113 00:03:51,790 --> 00:03:53,870 we're gonna see more and more providers getting 114 00:03:53,870 --> 00:03:56,110 ready to retire in the coming years. And 115 00:03:56,110 --> 00:03:57,790 we've also got providers who are burning out. 116 00:03:57,790 --> 00:03:59,389 Right? Probably as a result of all those 117 00:03:59,389 --> 00:04:01,169 other challenges that we've been facing. 118 00:04:01,544 --> 00:04:03,305 So those are what I would highlight as 119 00:04:03,305 --> 00:04:05,245 kind of my my hit list, my top 120 00:04:05,625 --> 00:04:06,284 five challenges. 121 00:04:07,144 --> 00:04:09,305 And then as far as opportunities and how 122 00:04:09,305 --> 00:04:11,704 we're addressing that from home based care, I 123 00:04:11,704 --> 00:04:12,444 would say, 124 00:04:12,984 --> 00:04:14,424 flip those on their head. Right? So if 125 00:04:14,424 --> 00:04:16,685 we look at those challenges as as opportunities, 126 00:04:17,410 --> 00:04:19,490 at Evernorth home based care, we're doubling down 127 00:04:19,490 --> 00:04:21,490 on population health. And so if you think 128 00:04:21,490 --> 00:04:25,170 about population health as the health outcomes for 129 00:04:25,170 --> 00:04:26,230 a group of individuals, 130 00:04:27,170 --> 00:04:29,269 including the spectrum of 131 00:04:29,865 --> 00:04:33,004 outcomes for those patients across the group. Okay? 132 00:04:33,625 --> 00:04:36,345 By identifying the patients who are at highest 133 00:04:36,345 --> 00:04:38,024 risk or rising risk, like the ones I 134 00:04:38,024 --> 00:04:39,865 just outlined. Right? The patients who are aging, 135 00:04:39,865 --> 00:04:42,045 the patients who are younger and sicker, 136 00:04:42,370 --> 00:04:44,689 patients who are disenfranchised for one reason or 137 00:04:44,689 --> 00:04:47,250 another from the health care system, patients who 138 00:04:47,250 --> 00:04:50,069 don't have access to providers because they're leaving 139 00:04:50,129 --> 00:04:50,949 health care, 140 00:04:51,490 --> 00:04:54,069 standing up population health. First of all, identifying 141 00:04:54,129 --> 00:04:56,335 where they are, who they are, and having 142 00:04:56,335 --> 00:04:57,774 the data to show us where we need 143 00:04:57,774 --> 00:04:58,835 to focus our efforts, 144 00:04:59,214 --> 00:05:01,134 and then working to stand up programs to 145 00:05:01,134 --> 00:05:02,115 help specifically 146 00:05:02,574 --> 00:05:04,835 assist those patient populations. 147 00:05:05,455 --> 00:05:07,535 That's how we're starting to tackle some of 148 00:05:07,535 --> 00:05:08,194 those challenges, 149 00:05:08,509 --> 00:05:10,269 and I think it's a great opportunity for 150 00:05:10,269 --> 00:05:12,370 us to meet those patients where they are 151 00:05:12,430 --> 00:05:14,430 and to start addressing kind of the challenges 152 00:05:14,430 --> 00:05:15,169 that they're facing. 153 00:05:16,269 --> 00:05:17,709 Got it. Thank you so much for walking 154 00:05:17,709 --> 00:05:19,550 us through that. Now kind of switching gears 155 00:05:19,550 --> 00:05:22,509 here. In an ever evolving regulatory environment, what 156 00:05:22,509 --> 00:05:24,915 tools or key strategies have helped your organization 157 00:05:25,134 --> 00:05:26,355 improve quality 158 00:05:26,735 --> 00:05:29,555 and clinical outcomes for members while staying compliant? 159 00:05:30,175 --> 00:05:32,175 Yeah. So, that's another big one to tackle 160 00:05:32,175 --> 00:05:33,215 in few minutes. But, 161 00:05:34,014 --> 00:05:36,310 at Evernorth, I would say actually that home 162 00:05:36,310 --> 00:05:39,050 based care is a live living, breathing example 163 00:05:39,110 --> 00:05:41,209 of one way that that larger 164 00:05:41,750 --> 00:05:44,410 organizations are starting to address that challenge. 165 00:05:45,110 --> 00:05:47,189 By leaning into care delivery, and that's what 166 00:05:47,189 --> 00:05:48,709 home based care is, we are we are 167 00:05:48,709 --> 00:05:51,529 actually providing care to these patients. We're sending 168 00:05:51,615 --> 00:05:53,774 our in home primary care providers and our 169 00:05:53,774 --> 00:05:56,574 nurses and our social workers into the home 170 00:05:56,574 --> 00:05:58,414 to take care of patients, to touch them, 171 00:05:58,414 --> 00:06:00,754 and to help them through their care journey. 172 00:06:01,214 --> 00:06:03,055 That's a great way that a lot of 173 00:06:03,055 --> 00:06:04,035 larger organizations 174 00:06:04,414 --> 00:06:05,069 are really 175 00:06:05,389 --> 00:06:07,569 leaning in to drive quality outcomes 176 00:06:08,110 --> 00:06:09,649 for their membership as a whole. 177 00:06:09,949 --> 00:06:12,350 I would also say that for our health 178 00:06:12,350 --> 00:06:13,250 plan clients, 179 00:06:14,029 --> 00:06:16,990 taking advantage of the of the drive towards 180 00:06:16,990 --> 00:06:19,365 value based care is is a great opportunity. 181 00:06:19,365 --> 00:06:20,884 And, actually, it's a great opportunity for both 182 00:06:20,884 --> 00:06:22,884 providers and the health plan clients. Right? Because 183 00:06:22,884 --> 00:06:24,824 the health plan clients have the opportunity 184 00:06:25,444 --> 00:06:27,764 to support providers in those value based care 185 00:06:27,764 --> 00:06:28,264 arrangements. 186 00:06:28,964 --> 00:06:32,024 The value based care arrangements enable these providers 187 00:06:32,245 --> 00:06:34,449 to provide the care that they always wanna 188 00:06:34,830 --> 00:06:37,150 deliver in order to drive great outcomes. And 189 00:06:37,150 --> 00:06:39,310 so I think, obviously, we've been talking about 190 00:06:39,310 --> 00:06:40,750 value based care for, what, at least a 191 00:06:40,750 --> 00:06:42,930 decade? Probably more now. And so 192 00:06:43,550 --> 00:06:45,710 it's definitely going to happen. We're definitely going 193 00:06:45,710 --> 00:06:47,355 in that direction. And then so I see 194 00:06:47,355 --> 00:06:49,855 that as another great opportunity for organizations 195 00:06:50,555 --> 00:06:52,334 to drive quality outcomes 196 00:06:52,954 --> 00:06:54,975 even though we're seeing more and more regulation 197 00:06:55,355 --> 00:06:55,855 around 198 00:06:56,394 --> 00:06:59,435 how health plans can interact with providers and 199 00:06:59,435 --> 00:07:00,095 with patients. 200 00:07:00,600 --> 00:07:03,479 That makes sense. Absolutely. And you spoke on 201 00:07:03,479 --> 00:07:06,139 a panel focused on fostering health equity. 202 00:07:06,519 --> 00:07:09,100 How do you define what health equity truly 203 00:07:09,160 --> 00:07:10,139 means in practice? 204 00:07:10,439 --> 00:07:13,720 And how would how should health plans redefine 205 00:07:13,720 --> 00:07:15,180 strategies to ensure 206 00:07:15,644 --> 00:07:18,785 equitable outcomes across diverse patient populations? 207 00:07:19,485 --> 00:07:21,884 That's another good one. So if we think 208 00:07:21,884 --> 00:07:24,524 about health equity as a state in which 209 00:07:24,524 --> 00:07:27,324 everyone has a fair and just opportunity to 210 00:07:27,324 --> 00:07:28,785 be as healthy as possible, 211 00:07:29,180 --> 00:07:30,160 And then we recognize 212 00:07:30,860 --> 00:07:31,360 that 213 00:07:31,899 --> 00:07:34,860 equity and equality are 2 different things. Right? 214 00:07:34,860 --> 00:07:36,160 So health care 215 00:07:36,779 --> 00:07:37,279 equality 216 00:07:37,740 --> 00:07:38,240 is, 217 00:07:38,540 --> 00:07:39,980 unfortunately, what we've seen in the past in 218 00:07:39,980 --> 00:07:41,580 this country, right, where we build a care 219 00:07:41,580 --> 00:07:43,500 model, we build a health care system delivery, 220 00:07:43,500 --> 00:07:45,045 and we try to spread it peanut butter 221 00:07:45,045 --> 00:07:46,024 across the country. 222 00:07:46,485 --> 00:07:48,644 And then we wonder why wait. These patients 223 00:07:48,644 --> 00:07:50,165 are doing well with that, but these patients 224 00:07:50,165 --> 00:07:51,225 aren't. Right? 225 00:07:51,605 --> 00:07:53,605 Equity says, you know what? We need to 226 00:07:53,605 --> 00:07:55,605 look at those patients who aren't doing as 227 00:07:55,605 --> 00:07:59,430 well and figure out what additional resources, what 228 00:07:59,430 --> 00:08:02,149 different care models they need because they're starting 229 00:08:02,149 --> 00:08:04,389 from an uneven starting point. Right? They're it's 230 00:08:04,389 --> 00:08:06,229 not even playing ground, so to speak. So 231 00:08:06,229 --> 00:08:08,069 they're starting from a different place. And so 232 00:08:08,069 --> 00:08:10,704 there are populations who need different programs. There 233 00:08:10,704 --> 00:08:13,584 are populations who need additional resources in order 234 00:08:13,584 --> 00:08:15,904 to attain the same outcomes. Right? So we 235 00:08:15,904 --> 00:08:17,985 can't just say, here's how we treat CHF 236 00:08:17,985 --> 00:08:19,904 across the country. We need to figure out 237 00:08:19,904 --> 00:08:23,044 what each population needs. Equity, not equality. Exactly. 238 00:08:23,185 --> 00:08:23,685 Exactly. 239 00:08:24,189 --> 00:08:26,269 And so how do we do that and 240 00:08:26,269 --> 00:08:28,269 how do health plans do that? I would 241 00:08:28,269 --> 00:08:29,790 I would come back to where I started, 242 00:08:29,790 --> 00:08:31,949 which is with population health. Right? So coming 243 00:08:31,949 --> 00:08:34,029 back to the idea that population health is 244 00:08:34,029 --> 00:08:36,029 looking at the outcomes of a group of 245 00:08:36,029 --> 00:08:36,529 patients, 246 00:08:36,990 --> 00:08:40,125 but also looking at the individuals across that 247 00:08:40,125 --> 00:08:42,945 continuum to see how they're responding to programs. 248 00:08:43,725 --> 00:08:45,725 Another way to think about population health is 249 00:08:45,725 --> 00:08:47,985 how do we treat individuals at scale? 250 00:08:48,285 --> 00:08:49,024 And so 251 00:08:49,404 --> 00:08:51,644 population health, I started earlier saying that we 252 00:08:51,644 --> 00:08:53,420 need data. Right? So we can identify the 253 00:08:53,420 --> 00:08:56,399 populations who need different programs that need additional 254 00:08:56,460 --> 00:08:59,120 resources to obtain health care equity. 255 00:08:59,500 --> 00:09:01,179 But I would also submit that once we 256 00:09:01,179 --> 00:09:03,420 have that data, we also need to spend 257 00:09:03,420 --> 00:09:05,019 time with the individuals. And we need to 258 00:09:05,019 --> 00:09:06,764 spend time with the caregivers, and we need 259 00:09:06,764 --> 00:09:08,764 to spend time in the communities because I 260 00:09:08,764 --> 00:09:09,264 can't 261 00:09:09,644 --> 00:09:11,804 I shouldn't. Sitting in my office, look at 262 00:09:11,804 --> 00:09:13,964 data and say, okay. Here's a population that 263 00:09:13,964 --> 00:09:16,684 needs a a different program. I'm gonna design 264 00:09:16,684 --> 00:09:18,365 it in my program and and send it 265 00:09:18,365 --> 00:09:19,884 in my office and send it out to 266 00:09:19,884 --> 00:09:21,850 be, you know, implemented. Right? We need to 267 00:09:21,850 --> 00:09:23,389 spend time with those communities 268 00:09:23,769 --> 00:09:24,889 so that we can hear from them what 269 00:09:24,889 --> 00:09:26,970 they need. Because I don't know what they 270 00:09:26,970 --> 00:09:28,570 need. They know what they need. So so 271 00:09:28,570 --> 00:09:30,970 getting back to the root of where health 272 00:09:30,970 --> 00:09:33,210 care started. Right? Spending time with our patients, 273 00:09:33,210 --> 00:09:35,264 hearing from them, hearing from what they need, 274 00:09:35,424 --> 00:09:37,264 and then taking that back and saying, okay. 275 00:09:37,264 --> 00:09:39,504 This is how now we can operationalize that 276 00:09:39,504 --> 00:09:40,325 at scale. 277 00:09:40,705 --> 00:09:42,225 I think that's how we're going to start 278 00:09:42,225 --> 00:09:44,485 to really address health equity 279 00:09:44,785 --> 00:09:46,625 within our care models, and then that can 280 00:09:46,625 --> 00:09:48,225 spread right across the country as far as 281 00:09:48,225 --> 00:09:50,200 our health care system goes. Got it. Got 282 00:09:50,200 --> 00:09:51,960 it. Well, Yvette, I wanna thank you for 283 00:09:51,960 --> 00:09:53,879 sharing your insights today on the Becker's healthcare 284 00:09:53,879 --> 00:09:56,200 podcast. And to our listeners, thank you for 285 00:09:56,200 --> 00:09:57,960 joining us, and please be sure to check 286 00:09:57,960 --> 00:10:00,600 out other Becker's podcast. Have a wonderful rest 287 00:10:00,600 --> 00:10:02,120 of your day. Thanks so much for having 288 00:10:02,120 --> 00:10:02,620 me.