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 00:00:34,939 --> 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 00:00:47,545 --> 00:00:49,465 This is Gracelyn Keller with the Becker's Health 20 00:00:49,465 --> 00:00:51,704 Care podcast, and we are recording live at 21 00:00:51,704 --> 00:00:52,445 the 2024 22 00:00:52,905 --> 00:00:54,524 fall payer issues roundtable. 23 00:00:55,039 --> 00:00:56,799 I'm joined right now by Eric Sharp, who's 24 00:00:56,799 --> 00:00:58,879 the CEO of value based care at Clover 25 00:00:58,879 --> 00:01:00,640 Health. So, Eric, thank you for being here 26 00:01:00,640 --> 00:01:02,320 today. We'd love to have you start off 27 00:01:02,320 --> 00:01:04,159 by introducing yourself and telling us a little 28 00:01:04,159 --> 00:01:05,459 bit more about your role. 29 00:01:05,920 --> 00:01:07,280 Sure. It's great to be here. 30 00:01:07,920 --> 00:01:10,079 In my role as CEO of value based 31 00:01:10,079 --> 00:01:11,834 care with Clover Health, 32 00:01:12,295 --> 00:01:13,754 I'm really charged with 33 00:01:14,134 --> 00:01:17,594 driving value based care for payers and providers 34 00:01:17,734 --> 00:01:19,754 out in the industry. So at Clover, 35 00:01:20,694 --> 00:01:22,394 we're very technology centric 36 00:01:23,094 --> 00:01:24,795 and have developed our own 37 00:01:25,310 --> 00:01:27,709 technology stack that we use to drive value 38 00:01:27,709 --> 00:01:28,530 based care. 39 00:01:29,310 --> 00:01:32,030 Again, my challenge is to help others outside 40 00:01:32,030 --> 00:01:33,170 of Clover Markets 41 00:01:33,469 --> 00:01:35,149 do that very same thing. 42 00:01:35,469 --> 00:01:37,310 So it's been a, a fun role. I've 43 00:01:37,310 --> 00:01:38,849 been here for about 3 years now. 44 00:01:39,265 --> 00:01:40,944 Wonderful. Well, thank you for taking the time 45 00:01:40,944 --> 00:01:42,305 to sit down with me today. 46 00:01:42,784 --> 00:01:45,204 And let's start our conversation talking about, 47 00:01:45,505 --> 00:01:48,545 at an industry level, what opportunities are you 48 00:01:48,545 --> 00:01:50,405 seeing for large scale improvements? 49 00:01:51,349 --> 00:01:53,670 Sure. So one of the things that that 50 00:01:53,670 --> 00:01:54,489 I've observed 51 00:01:54,950 --> 00:01:57,829 from my experience in being involved in value 52 00:01:57,829 --> 00:01:59,269 based care for the past, 53 00:01:59,750 --> 00:02:02,310 decade, really, probably closer to 12, 13 years 54 00:02:02,310 --> 00:02:02,810 now, 55 00:02:03,349 --> 00:02:05,369 is that while there's a lot of approaches 56 00:02:05,974 --> 00:02:08,155 to try to drive performance improvement, 57 00:02:08,775 --> 00:02:10,694 as an industry, we're actually making that pretty 58 00:02:10,694 --> 00:02:11,914 difficult on physicians. 59 00:02:12,694 --> 00:02:14,455 So if you think of that about that 60 00:02:14,455 --> 00:02:15,754 from the payer lens, 61 00:02:16,055 --> 00:02:18,235 we have a lot of different insurance companies 62 00:02:18,375 --> 00:02:21,750 action asking physicians to do a lot of 63 00:02:21,750 --> 00:02:22,810 additional work 64 00:02:23,189 --> 00:02:24,709 and do it in a lot of different 65 00:02:24,709 --> 00:02:25,689 ways. So, 66 00:02:26,629 --> 00:02:28,810 forms are different, processes are different, 67 00:02:29,430 --> 00:02:31,689 websites are different. And it creates, 68 00:02:32,310 --> 00:02:35,245 a lot of chaos, a lot of administrative 69 00:02:35,465 --> 00:02:35,965 burden. 70 00:02:36,425 --> 00:02:38,185 And I think that there's opportunity to try 71 00:02:38,185 --> 00:02:39,325 to streamline that, 72 00:02:40,025 --> 00:02:42,825 in in ways that can be easier for 73 00:02:42,825 --> 00:02:43,325 physicians. 74 00:02:44,185 --> 00:02:46,745 Pull back some of that administrative burden, begin 75 00:02:46,745 --> 00:02:47,885 to provide them 76 00:02:48,280 --> 00:02:50,060 the tools to do better clinically 77 00:02:50,360 --> 00:02:52,780 and really harness the data that's available 78 00:02:53,239 --> 00:02:55,099 now in the industry and is increasingly 79 00:02:55,479 --> 00:02:58,280 it's growing, as there's more transparency and there's 80 00:02:58,280 --> 00:02:58,939 more interoperability, 81 00:03:00,120 --> 00:03:01,959 to really leverage those things. So I think 82 00:03:01,959 --> 00:03:03,814 that's the next season coming, 83 00:03:04,355 --> 00:03:05,955 in value based care. And it's something we've 84 00:03:05,955 --> 00:03:07,895 been focusing on at Clover Health. 85 00:03:09,075 --> 00:03:11,314 And let's shift a little bit toward digital 86 00:03:11,314 --> 00:03:13,314 innovation. So I'd love to know what role 87 00:03:13,314 --> 00:03:16,215 technology is playing in your organization's growth strategies. 88 00:03:16,569 --> 00:03:18,810 And if you could share specific examples, that'd 89 00:03:18,810 --> 00:03:19,389 be great. 90 00:03:20,169 --> 00:03:22,669 Yeah. So, just building off of the, 91 00:03:23,290 --> 00:03:25,290 the points around how to improve things in 92 00:03:25,290 --> 00:03:27,710 the industry, particularly with value based care. 93 00:03:28,090 --> 00:03:30,894 At Clover, we're a very tech centric organization 94 00:03:31,914 --> 00:03:34,715 with a very tight focus on driving clinical 95 00:03:34,715 --> 00:03:36,094 improvement. We wanna improve, 96 00:03:36,875 --> 00:03:38,334 the health of every life. 97 00:03:38,794 --> 00:03:41,034 And so we set out years ago to 98 00:03:41,034 --> 00:03:42,814 build a technology stack 99 00:03:43,500 --> 00:03:45,840 that would make it easier for physicians 100 00:03:46,699 --> 00:03:47,919 to diagnose, 101 00:03:48,699 --> 00:03:50,000 chronic disease earlier. 102 00:03:50,780 --> 00:03:52,939 To have better insights at the point of 103 00:03:52,939 --> 00:03:54,860 care as to what was going on with 104 00:03:54,860 --> 00:03:56,879 the patient, a more holistic view. 105 00:03:57,375 --> 00:03:59,395 And so this technology that we've built, 106 00:03:59,935 --> 00:04:02,655 we are going out and harnessing a 100 107 00:04:02,655 --> 00:04:03,955 plus sources of data. 108 00:04:04,414 --> 00:04:06,034 We're pulling that together, 109 00:04:06,495 --> 00:04:09,555 normalizing it, putting it into our warehouse, running, 110 00:04:10,610 --> 00:04:14,310 hundreds of AI algorithms, machine learning algorithms to 111 00:04:14,770 --> 00:04:17,730 surface insights right at the point of care 112 00:04:17,730 --> 00:04:18,629 at the visit, 113 00:04:19,250 --> 00:04:20,149 where the physician, 114 00:04:20,930 --> 00:04:22,790 and the patient are face to face. 115 00:04:23,144 --> 00:04:24,125 And what we're finding, 116 00:04:24,745 --> 00:04:27,384 from a results perspective, just to double click 117 00:04:27,384 --> 00:04:28,444 into one example, 118 00:04:29,064 --> 00:04:31,485 is that physicians are truly diagnosing earlier. 119 00:04:32,104 --> 00:04:33,724 They're also also 120 00:04:34,425 --> 00:04:36,985 able to see insights into medication adherence and 121 00:04:36,985 --> 00:04:39,439 transitions in care and close gaps in care. 122 00:04:40,300 --> 00:04:41,979 But that double click, I'll just share with 123 00:04:41,979 --> 00:04:42,959 you around diabetes. 124 00:04:43,660 --> 00:04:46,139 Where we see our physician users of the 125 00:04:46,139 --> 00:04:48,379 technology when compared to those that are not 126 00:04:48,379 --> 00:04:49,360 using the technology. 127 00:04:49,899 --> 00:04:51,180 And we have this out on a white 128 00:04:51,180 --> 00:04:51,680 paper. 129 00:04:52,204 --> 00:04:54,785 Are diagnosing diabetes about 3 years earlier. 130 00:04:55,324 --> 00:04:57,824 That's allowing them to then intervene, 131 00:04:58,204 --> 00:04:59,824 and treat 3 years earlier. 132 00:05:00,444 --> 00:05:02,685 And you sort of, you know, ask the 133 00:05:02,685 --> 00:05:04,605 the follow-up questions to that of is it 134 00:05:04,605 --> 00:05:06,444 really producing a difference in outcomes? And we're 135 00:05:06,444 --> 00:05:07,470 finding that it is. 136 00:05:08,430 --> 00:05:09,649 It's leading to, 137 00:05:10,350 --> 00:05:10,850 better 138 00:05:11,230 --> 00:05:13,870 control of blood sugar earlier. About again, about 139 00:05:13,870 --> 00:05:15,810 3 years earlier because we're treating earlier. 140 00:05:16,829 --> 00:05:18,689 Lower complications like hypoglycemia, 141 00:05:19,629 --> 00:05:21,009 lower insulin use. 142 00:05:21,644 --> 00:05:23,884 All these things are important. And the physicians 143 00:05:23,884 --> 00:05:25,805 that are using the technology see that as 144 00:05:25,805 --> 00:05:28,625 a value add. It's not uncommon for them 145 00:05:28,845 --> 00:05:30,464 to share stories about, 146 00:05:31,084 --> 00:05:33,165 the insights they were sharing that they just 147 00:05:33,165 --> 00:05:34,544 didn't know existed 148 00:05:35,040 --> 00:05:37,060 for the patients that they serve every day. 149 00:05:37,439 --> 00:05:39,279 Patient could have had a cancer diagnosis. They 150 00:05:39,279 --> 00:05:40,879 may have been in the hospital. They may 151 00:05:40,879 --> 00:05:42,800 have had an elevated lab study at a 152 00:05:42,800 --> 00:05:44,100 different health care facility. 153 00:05:44,639 --> 00:05:46,899 And so harnessing that big data 154 00:05:47,199 --> 00:05:48,259 and making it 155 00:05:48,925 --> 00:05:51,485 easy for the physician to use has been 156 00:05:51,485 --> 00:05:53,105 a differentiator for us. 157 00:05:53,405 --> 00:05:55,504 We're a 4 star Medicare Advantage plan. 158 00:05:55,805 --> 00:05:56,625 We have, 159 00:05:57,324 --> 00:05:59,745 we looked at the recent HEDIS metrics. 160 00:06:00,525 --> 00:06:01,025 And, 161 00:06:01,564 --> 00:06:04,100 our HEDIS score on the core quality metrics 162 00:06:04,100 --> 00:06:04,839 is 4.94. 163 00:06:05,300 --> 00:06:06,519 We've shared that publicly. 164 00:06:07,220 --> 00:06:08,819 That is one of the top, if not 165 00:06:08,819 --> 00:06:11,620 the top, HEDIS score, in the country for 166 00:06:11,620 --> 00:06:13,800 plans that are greater than 2,000 lives. 167 00:06:14,100 --> 00:06:17,139 And it really underscores the value of what 168 00:06:17,139 --> 00:06:17,879 we're doing 169 00:06:18,415 --> 00:06:20,915 and why we're continuing to improve the technology, 170 00:06:21,855 --> 00:06:23,855 for physicians at at the point of care 171 00:06:23,855 --> 00:06:24,915 each and every day. 172 00:06:26,014 --> 00:06:28,735 And how is technology supporting value based care 173 00:06:28,735 --> 00:06:31,535 or member focused initiatives at your organization? And 174 00:06:31,535 --> 00:06:33,899 what is exciting you in this space? Yeah. 175 00:06:33,899 --> 00:06:35,819 So this really is exciting for me because 176 00:06:35,819 --> 00:06:37,980 it's, right in the wheelhouse of what I've 177 00:06:37,980 --> 00:06:39,199 been charged to do. 178 00:06:39,740 --> 00:06:41,660 Is we've now taken that technology that we've 179 00:06:41,660 --> 00:06:43,120 been using for some time, 180 00:06:43,740 --> 00:06:44,379 for our, 181 00:06:45,180 --> 00:06:47,040 Clover Medicare Advantage members, 182 00:06:47,420 --> 00:06:49,439 in New Jersey and and in Georgia. 183 00:06:50,514 --> 00:06:52,835 And we've we've moved that technology into a 184 00:06:52,835 --> 00:06:54,855 subsidiary called Counterpart Health. 185 00:06:55,235 --> 00:06:56,855 We did that intentionally because 186 00:06:57,235 --> 00:06:58,855 we believe that the technology 187 00:06:59,314 --> 00:07:00,915 is not only proven, but it can make 188 00:07:00,915 --> 00:07:02,694 a difference at an industry level. 189 00:07:03,480 --> 00:07:05,000 It's it's designed in a way that it 190 00:07:05,000 --> 00:07:05,819 can be scalable. 191 00:07:06,199 --> 00:07:08,360 And so the exciting part is, is I 192 00:07:08,360 --> 00:07:09,900 get to help lead the effort 193 00:07:10,279 --> 00:07:11,500 to take that technology 194 00:07:11,800 --> 00:07:12,779 out to providers 195 00:07:13,480 --> 00:07:15,819 and to payers to help them also drive 196 00:07:16,214 --> 00:07:19,035 performance improvement like we've seen at at Clover. 197 00:07:20,055 --> 00:07:22,774 And, the the real exciting part about it 198 00:07:22,774 --> 00:07:25,274 is that today, physicians get inundated 199 00:07:25,574 --> 00:07:29,194 again from multiple insurance companies about these processes 200 00:07:29,254 --> 00:07:31,194 and things that they wanna drive and improve. 201 00:07:31,279 --> 00:07:33,840 And as we're deploying it, we're we're hearing 202 00:07:33,840 --> 00:07:35,680 from them of we want to do this 203 00:07:35,680 --> 00:07:36,580 type of work, 204 00:07:36,960 --> 00:07:39,199 value based care work in the same way, 205 00:07:39,199 --> 00:07:41,379 in a common way, in a similar workflow. 206 00:07:41,920 --> 00:07:43,860 And so the technology now is available, 207 00:07:44,164 --> 00:07:46,084 not just to implement our providers, but other 208 00:07:46,084 --> 00:07:48,485 payers can plug into it as well. They 209 00:07:48,485 --> 00:07:50,964 can make that decision to say, let's make 210 00:07:50,964 --> 00:07:52,904 this easier on on the physician. 211 00:07:53,365 --> 00:07:55,365 Let's allow them to work in a common 212 00:07:55,365 --> 00:07:57,224 format and leverage the technology, 213 00:07:58,084 --> 00:07:59,384 that we've made available. 214 00:08:00,050 --> 00:08:01,810 And I think that that over time in 215 00:08:01,810 --> 00:08:02,709 the coming years 216 00:08:03,250 --> 00:08:05,329 is not just gonna set us apart. It's 217 00:08:05,329 --> 00:08:06,629 gonna set a new, 218 00:08:07,569 --> 00:08:09,670 standard for best practice in the industry 219 00:08:10,129 --> 00:08:11,910 as an increasing number of, 220 00:08:12,384 --> 00:08:15,024 providers and payers plug into the technology. So 221 00:08:15,024 --> 00:08:16,724 we're just super excited about that. 222 00:08:17,584 --> 00:08:19,584 Wonderful. Well, Eric, thanks so much for joining 223 00:08:19,584 --> 00:08:21,745 me today on the Becker's Healthcare Podcast and 224 00:08:21,745 --> 00:08:23,904 sharing your insights on these topics. Again, we 225 00:08:23,904 --> 00:08:25,764 are recording live at the 2024 226 00:08:26,682 --> 00:08:29,402 fall payer issues roundtable. Thanks so much. Thank 227 00:08:29,402 --> 00:08:29,902 you.