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 --> 00:00:13,139 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 --> 00:00:40,700 providing clinical care and support services that provide 17 00:00:40,700 --> 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 00:00:47,785 --> 00:00:49,865 This is Gracelyn Keller with the Becker's Health 20 00:00:49,865 --> 00:00:52,185 Care podcast, and we are live at the 21 00:00:52,185 --> 00:00:52,685 2024 22 00:00:53,704 --> 00:00:54,925 payer issues roundtable. 23 00:00:55,409 --> 00:00:57,810 I'm currently joined right now by Eric Witty, 24 00:00:57,810 --> 00:01:00,289 who is the chief operating officer at Genesis 25 00:01:00,289 --> 00:01:03,250 Orthopedics and Sports Medicine. So, Eric, thanks for 26 00:01:03,250 --> 00:01:04,849 joining me today. I'd love to have our 27 00:01:04,849 --> 00:01:07,650 conversation start with a brief introduction about yourself 28 00:01:07,650 --> 00:01:08,469 and your role. 29 00:01:08,825 --> 00:01:10,665 Yeah. Great. Thanks so much, Grace. Delighted to 30 00:01:10,665 --> 00:01:11,645 be here with you. 31 00:01:12,105 --> 00:01:14,924 So I come from the payer world originally. 32 00:01:15,545 --> 00:01:17,305 So starting out with a clinical doctor in 33 00:01:17,305 --> 00:01:20,105 physical therapy before moving into kind of management 34 00:01:20,105 --> 00:01:22,984 roles, it's been nice to come to the 35 00:01:22,984 --> 00:01:23,805 payer issues, 36 00:01:24,480 --> 00:01:26,879 and see all the great collaboration that's happening. 37 00:01:26,879 --> 00:01:29,280 Now that I work for Genesis Orthopedics and 38 00:01:29,280 --> 00:01:31,540 Sports Medicine as the chief operating officer, 39 00:01:32,079 --> 00:01:34,000 it's great to come into a context like 40 00:01:34,000 --> 00:01:34,500 this 41 00:01:34,879 --> 00:01:35,280 and, 42 00:01:35,680 --> 00:01:37,599 collaborate with all the work that's happening on 43 00:01:37,599 --> 00:01:40,474 the on the payer side. So, Genesis Orthopedics 44 00:01:40,534 --> 00:01:41,435 and Sports Medicine 45 00:01:41,894 --> 00:01:44,155 is a private orthopedic 46 00:01:44,454 --> 00:01:46,935 multi specialty group that has, you know, orthopedic 47 00:01:46,935 --> 00:01:47,435 surgeons, 48 00:01:48,375 --> 00:01:49,754 advanced practice providers, 49 00:01:50,295 --> 00:01:53,354 physical therapy, and occupational therapy across Chicagoland area, 50 00:01:54,129 --> 00:01:55,729 and has been doing a lot of really 51 00:01:55,729 --> 00:01:57,409 amazing stuff across the area with a lot 52 00:01:57,409 --> 00:01:58,469 of growth that's underway. 53 00:01:59,090 --> 00:02:01,489 Wonderful. Well, thank you for being here. And 54 00:02:01,489 --> 00:02:02,950 let's start our conversation 55 00:02:03,489 --> 00:02:06,049 talking about growth goals. So from improving member 56 00:02:06,049 --> 00:02:09,014 experience and expanding value based care to controlling 57 00:02:09,235 --> 00:02:12,995 costs, payer executives have ambitious growth goals for 58 00:02:12,995 --> 00:02:14,594 the rest of this year and looking ahead 59 00:02:14,594 --> 00:02:15,574 into 2025. 60 00:02:16,194 --> 00:02:17,715 So in your role, what is your top 61 00:02:17,715 --> 00:02:19,314 priority, and how are you planning to get 62 00:02:19,314 --> 00:02:19,814 there? 63 00:02:20,354 --> 00:02:22,114 Yeah. That's a great question. Thanks so much 64 00:02:22,114 --> 00:02:24,610 for asking. So Genesis has one of the 65 00:02:24,610 --> 00:02:26,930 more interesting organizations I've ever come across in 66 00:02:26,930 --> 00:02:27,990 my career. So 67 00:02:28,290 --> 00:02:31,030 organization decided about 6 years or so ago, 68 00:02:31,569 --> 00:02:33,490 based on their values that they were going 69 00:02:33,490 --> 00:02:36,449 to see all patients and payers regardless of 70 00:02:36,449 --> 00:02:37,750 their ability to pay 71 00:02:38,245 --> 00:02:40,324 and regardless of the payer type that they 72 00:02:40,324 --> 00:02:42,884 had. So it's made us a really great, 73 00:02:42,884 --> 00:02:45,284 I think, opportunity to collaborate with health plans 74 00:02:45,284 --> 00:02:47,384 who have a great vision for their community, 75 00:02:48,085 --> 00:02:49,625 to build these kinds of partnerships. 76 00:02:49,925 --> 00:02:51,284 So one of the ways in which I 77 00:02:51,284 --> 00:02:53,544 think we're most excited about is advancing, 78 00:02:54,460 --> 00:02:55,760 value based care strategies. 79 00:02:56,379 --> 00:02:58,140 Having seen a lot of waste across the 80 00:02:58,140 --> 00:03:01,020 industry, I think Genesys is well poised to 81 00:03:01,020 --> 00:03:02,080 to partner with 82 00:03:02,540 --> 00:03:04,860 the great intellectual capital that's been put into 83 00:03:04,860 --> 00:03:06,465 value based care in recent years. 84 00:03:07,025 --> 00:03:08,884 So most of this has started out with 85 00:03:08,944 --> 00:03:10,644 primary care based opportunities. 86 00:03:11,104 --> 00:03:14,064 And the whole industry seems right to figure 87 00:03:14,064 --> 00:03:16,625 out how specialists can move from fee for 88 00:03:16,625 --> 00:03:19,905 service and to help collaborate with identifying ways 89 00:03:19,905 --> 00:03:21,685 and opportunities within their communities 90 00:03:22,099 --> 00:03:24,099 and advancing that out. So that's one area 91 00:03:24,099 --> 00:03:26,580 in which we're particularly excited for the opportunities 92 00:03:26,580 --> 00:03:27,080 ahead. 93 00:03:27,699 --> 00:03:30,099 Absolutely. And going along with that at an 94 00:03:30,099 --> 00:03:32,659 industry level, how would you describe the biggest 95 00:03:32,659 --> 00:03:35,479 barriers to effectively serving and engaging members? 96 00:03:36,075 --> 00:03:38,635 What opportunities do you see for larger scale 97 00:03:38,635 --> 00:03:40,715 improvements, and how are you applying all of 98 00:03:40,715 --> 00:03:41,935 this to your current strategies? 99 00:03:42,474 --> 00:03:43,775 Yeah. That's great. 100 00:03:44,075 --> 00:03:45,055 And this is a 101 00:03:45,754 --> 00:03:47,915 a huge problem that exists across the industry. 102 00:03:47,915 --> 00:03:49,729 So, you know, as most of us have 103 00:03:49,729 --> 00:03:51,810 realized, when you get sick, your first phone 104 00:03:51,810 --> 00:03:53,569 call is usually not to your payer to 105 00:03:53,569 --> 00:03:55,590 figure out what they're gonna do with you. 106 00:03:56,050 --> 00:03:58,530 And so, having struggled with these kinds of 107 00:03:58,530 --> 00:04:01,435 programs on the health plan side, our providers 108 00:04:01,435 --> 00:04:03,854 are really adept at engaging with their members, 109 00:04:03,914 --> 00:04:04,395 you know. 110 00:04:05,034 --> 00:04:07,134 No one's more interested to, 111 00:04:07,435 --> 00:04:09,594 you know, solve problems as when they're sitting 112 00:04:09,594 --> 00:04:11,275 down and talking to their doctor dealing with 113 00:04:11,275 --> 00:04:12,254 an active illness. 114 00:04:12,715 --> 00:04:14,254 So I continue to think that 115 00:04:14,700 --> 00:04:17,180 provider risk delegation is the best way for 116 00:04:17,180 --> 00:04:19,500 us to solve these kinds of issues. And 117 00:04:19,500 --> 00:04:22,000 so rather than have the payer struggle to, 118 00:04:22,699 --> 00:04:25,420 pull certain levers that are very hard, rusty 119 00:04:25,420 --> 00:04:27,535 levers for them to pull on, if they 120 00:04:27,535 --> 00:04:29,214 can delegate the risk over to the provider 121 00:04:29,214 --> 00:04:31,455 side and leverage the tools that they have 122 00:04:31,455 --> 00:04:31,955 through, 123 00:04:32,495 --> 00:04:34,335 existing in the communities that they live and 124 00:04:34,335 --> 00:04:36,415 work in. That, I think, is gonna be 125 00:04:36,415 --> 00:04:36,915 the, 126 00:04:37,455 --> 00:04:40,189 the best opportunity for for health plans and 127 00:04:40,189 --> 00:04:43,089 partnerships to deal with the, kind of engagement 128 00:04:43,149 --> 00:04:44,610 quandary that we all have. 129 00:04:45,550 --> 00:04:48,750 Absolutely. And let's shift gears here to health 130 00:04:48,750 --> 00:04:51,389 equity. So as this becomes increasingly cemented in 131 00:04:51,389 --> 00:04:52,209 payer strategies, 132 00:04:52,705 --> 00:04:53,605 how is your organization 133 00:04:54,225 --> 00:04:57,365 addressing health disparities? And can you share specific 134 00:04:57,504 --> 00:05:00,165 examples of measurable successes to date? 135 00:05:01,105 --> 00:05:03,285 Yeah. Thanks for the question. So 136 00:05:03,585 --> 00:05:05,665 I loved years ago, I was on the 137 00:05:05,665 --> 00:05:07,959 board of directors with the National Association For 138 00:05:07,959 --> 00:05:08,860 Healthcare Quality, 139 00:05:09,240 --> 00:05:11,560 and Stephanie Mercado had done this very interesting 140 00:05:11,560 --> 00:05:14,120 thing on all of our, board placards as 141 00:05:14,120 --> 00:05:15,500 we would sit down in our meetings. 142 00:05:15,879 --> 00:05:18,520 And they put the values at the back 143 00:05:18,520 --> 00:05:20,279 of them. So when we sat down, it 144 00:05:20,279 --> 00:05:22,245 was front and center for all of the 145 00:05:22,245 --> 00:05:24,745 decisions and conversations that we were making. 146 00:05:25,205 --> 00:05:27,865 And so I've loved being here at Genesis 147 00:05:27,925 --> 00:05:30,264 and having the values not just be some 148 00:05:30,485 --> 00:05:30,985 ethereal, 149 00:05:31,365 --> 00:05:34,165 theoretical construct that we have, but something that's 150 00:05:34,165 --> 00:05:36,004 front and center for the decisions that we 151 00:05:36,004 --> 00:05:38,620 make. And so, in line with that, 152 00:05:39,100 --> 00:05:42,060 values first mindset of saying, what would it 153 00:05:42,060 --> 00:05:44,060 look like if we actually believe that all 154 00:05:44,060 --> 00:05:46,639 patients mattered and had equal dignity and worth 155 00:05:46,939 --> 00:05:49,259 and to see them regardless of, kind of 156 00:05:49,259 --> 00:05:50,160 payer type? 157 00:05:50,654 --> 00:05:52,754 Genesis has gone in and said, 158 00:05:53,055 --> 00:05:54,654 Not only do we want to just open 159 00:05:54,654 --> 00:05:56,654 the door and allow any patient to be 160 00:05:56,654 --> 00:05:59,055 able to come to us, they realized after 161 00:05:59,055 --> 00:06:01,074 doing that experiment for a little while, despite 162 00:06:01,134 --> 00:06:02,435 going, you know, 163 00:06:02,975 --> 00:06:03,475 significantly 164 00:06:03,855 --> 00:06:06,810 higher Medicaid payer type for our orthopedic practice, 165 00:06:07,350 --> 00:06:09,029 they said, if we really cared about this 166 00:06:09,029 --> 00:06:10,550 work, we wouldn't just sit out here and 167 00:06:10,550 --> 00:06:12,230 wait for these patients to come to us. 168 00:06:12,230 --> 00:06:14,250 We would go and move into the neighborhood 169 00:06:14,709 --> 00:06:16,949 for people who are struggling with access. And 170 00:06:16,949 --> 00:06:19,425 so, one of the best measures that we 171 00:06:19,425 --> 00:06:21,345 found to help inform this work is something 172 00:06:21,345 --> 00:06:23,444 called the area deprivation index, 173 00:06:24,064 --> 00:06:25,824 which, if you've not heard of this before, 174 00:06:25,824 --> 00:06:28,225 is, it was considered by Health Affairs as 175 00:06:28,225 --> 00:06:30,805 the most powerful tool in advancing health equity. 176 00:06:31,264 --> 00:06:33,529 And so, this practice that started out years 177 00:06:33,529 --> 00:06:36,329 ago with, with an area deprivation index of 178 00:06:36,329 --> 00:06:36,829 1.5, 179 00:06:37,370 --> 00:06:38,669 that essentially means 180 00:06:39,209 --> 00:06:39,709 wealthy, 181 00:06:40,410 --> 00:06:40,910 healthy 182 00:06:41,449 --> 00:06:41,949 individuals. 183 00:06:42,410 --> 00:06:44,490 We started planting clinics in the areas that 184 00:06:44,490 --> 00:06:45,149 were underserved, 185 00:06:45,694 --> 00:06:48,254 and our health equity, index has now gone 186 00:06:48,254 --> 00:06:50,334 to to 5 out of 10, which is, 187 00:06:50,414 --> 00:06:52,735 you know, a significant advancement that we're really 188 00:06:52,735 --> 00:06:54,595 proud of in trying to mitigate this issue. 189 00:06:55,134 --> 00:06:55,634 Absolutely. 190 00:06:56,334 --> 00:06:59,550 And how is your organization ensuring equitable access 191 00:06:59,550 --> 00:07:01,810 to care across diverse member populations? 192 00:07:02,430 --> 00:07:04,430 And what strategies have worked well for you 193 00:07:04,430 --> 00:07:06,689 or on the other hand have been challenging 194 00:07:06,750 --> 00:07:07,730 for you in this? 195 00:07:08,829 --> 00:07:10,750 Yeah. As far as what's going well, you 196 00:07:10,750 --> 00:07:12,910 know, when you move clinics into neighborhoods that 197 00:07:12,910 --> 00:07:14,370 are have vulnerable populations, 198 00:07:15,024 --> 00:07:15,764 it becomes 199 00:07:16,064 --> 00:07:18,865 easier to recruit people to staff these clinics 200 00:07:18,865 --> 00:07:19,745 too. So, 201 00:07:20,464 --> 00:07:22,485 when you care about a community 202 00:07:23,024 --> 00:07:25,104 and you start by asking questions, you can 203 00:07:25,104 --> 00:07:26,704 find out what are the issues and you 204 00:07:26,704 --> 00:07:27,444 can recruit, 205 00:07:27,904 --> 00:07:28,404 providers 206 00:07:28,740 --> 00:07:29,560 and staff, 207 00:07:30,180 --> 00:07:31,860 to go in and start to listen. And 208 00:07:31,860 --> 00:07:33,699 the more connected you are into the community, 209 00:07:33,699 --> 00:07:35,379 I think the more able you are to 210 00:07:35,379 --> 00:07:37,379 solve the challenges that are unique to those 211 00:07:37,379 --> 00:07:37,879 populations. 212 00:07:38,899 --> 00:07:40,579 There certainly have been a number of challenges 213 00:07:40,579 --> 00:07:42,995 that we've had too, and including, 214 00:07:43,375 --> 00:07:45,294 you know, this issue that exists across the 215 00:07:45,294 --> 00:07:49,134 payer world. There's member churn. Most of our 216 00:07:49,134 --> 00:07:51,854 quality issues that we're looking for are risk 217 00:07:51,854 --> 00:07:54,360 adjustment. These are annual based kinds of things. 218 00:07:54,759 --> 00:07:56,279 And so as much as, 219 00:07:56,680 --> 00:07:58,919 we found some tremendous payer partners out there 220 00:07:58,919 --> 00:08:00,759 who are willing to collaborate with us on 221 00:08:00,759 --> 00:08:02,620 data, help us figure out where 222 00:08:03,000 --> 00:08:05,579 access is poor, where quality is poor, 223 00:08:06,279 --> 00:08:09,165 you know, because most of our economic models 224 00:08:09,165 --> 00:08:11,504 are built around annual constructs 225 00:08:12,285 --> 00:08:13,745 with the Medicaid redeterminations 226 00:08:14,685 --> 00:08:16,225 and annual enrollments, 227 00:08:16,605 --> 00:08:17,585 churn issues, 228 00:08:18,125 --> 00:08:19,964 it's hard for us as an industry to 229 00:08:19,964 --> 00:08:22,625 figure out how to create these healthy communities 230 00:08:22,685 --> 00:08:24,384 over a longitudinal basis. 231 00:08:24,790 --> 00:08:27,350 And so I look forward to finding innovations 232 00:08:27,350 --> 00:08:28,949 that are gonna let us get out of 233 00:08:28,949 --> 00:08:31,189 this 12 month cycle of figuring out what 234 00:08:31,189 --> 00:08:33,670 success looks like and figuring out how we 235 00:08:33,670 --> 00:08:35,210 can collaborate in these communities 236 00:08:35,670 --> 00:08:38,054 and agree on what success looks like. And 237 00:08:38,054 --> 00:08:39,495 I think it's gonna mean something that's a 238 00:08:39,495 --> 00:08:41,115 longer term view than just, 239 00:08:41,975 --> 00:08:45,095 teaching to the tests and dealing with annual 240 00:08:45,095 --> 00:08:46,534 process based measures that, 241 00:08:47,095 --> 00:08:48,934 won't give us the kinds of outcomes that 242 00:08:48,934 --> 00:08:50,875 I know that we want for flourishing communities. 243 00:08:52,169 --> 00:08:54,570 Wonderful. Well, thank you so much for taking 244 00:08:54,570 --> 00:08:56,250 the time to join me today on the 245 00:08:56,250 --> 00:08:59,370 Becker's Healthcare Podcast and share these insights. Again, 246 00:08:59,370 --> 00:09:01,389 we are recording live at the 2024 247 00:09:02,089 --> 00:09:03,309 payer issues roundtable. 248 00:09:04,009 --> 00:09:05,710 My pleasure. Thank you so much, Grace.