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Hello, everyone. This is Jacob Emerson with the

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Becker's Payer Issues podcast. Thrilled today to be

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joined by a special guest. Doctor Todd May

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is vice president and medical director at Health

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Net. Doctor May, thank you so much for

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taking the time to be with me on

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the podcast today.

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Jacob, thank you for having me. I'm I'm

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very pleased to be here.

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I'll just mention,

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importantly that I am a practicing family physician,

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and I've been practicing

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primary care for over thirty years. So I

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I have deep, deep experience in the in

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this area and, a lot of interest. Fantastic.

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And I appreciate you you diving in,

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to your career background, Todd. And before we

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get started with everything you want we wanna

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talk with you about, can you tell us

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a little bit more about your current role

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at Health Net and what you do?

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Sure. Sure. I,

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I am the executive representing the commercial line

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of business. I am involved in in all

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things,

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clinical, sup supporting supporting the business.

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I'm very deeply involved in population health management,

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which is our,

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approach to optimizing the care for,

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all of our members, across all lines of

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business,

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deeply involved in quality improvement,

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health equity,

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looking at,

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member engagement platforms, digital tools,

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that kind of thing to to

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maximize engagement

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of our members in their in their own

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health care.

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Fantastic. So, Todd, we're we're here today to

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talk with you about a really big and

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special initiative.

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If multiple insurers are are coming together to

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or or have. They've launched a shared value

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based payment model for reimbursing primary care physicians

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in California.

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That initiative includes collaboration from Aetna, Blue Shield

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of California,

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and, of course, HealthNets

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along with 11 providers

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across the state.

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So talk to us a little bit about

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this. What what does this mean? What were

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some of the key factors in bringing all

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these stakeholders together?

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Well, Jacob, first, thank you for recognizing how

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big of a deal this is. This is

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unique, innovative,

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groundbreaking work.

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And and, you know, there's been we have

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a we have a fragmented health care system.

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Right, and there's been realization for the health

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plans

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for some time that to have a real

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impact on broad systems like health care delivery

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and primary care specifically

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that we can work together to align with

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a cohesive multi plan strategy.

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And and this demonstration project

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stems from a partnership,

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agreement that we made, in July 2022

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with HealthEd and, and, and several other payer

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organizations.

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And we've all been deeply engaged, in this

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work,

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from the very beginning.

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It was

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California

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Quality Collaborative, the CQC,

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and Integrated Healthcare Association, IHA,

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who brought us together. They were the conveners,

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of this group, and they can continue to

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facilitate

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the project.

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And,

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you know, there's real value,

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in this approach when

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offering provider organizations a cohesive, aligned strategy

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that really helps them transform

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into becoming higher functioning

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advanced primary care practices.

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And and a high functioning primary care

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is is a foundation for a high quality

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and cost effective health care system.

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And when this happens, we're better able to

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meet the needs of patients and improve health

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outcomes

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that really matter. For for example,

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you know, the sweet spot for for primary

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care

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are are managing chronic conditions like

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diabetes and and high blood pressure. And,

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you know, why are these important? Well, these

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are

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two of the most prevalent conditions in The

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United States and their

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underlying causes of cardiovascular

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disease, which is the primary,

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cause of,

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death in our country. And we also focus

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on

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prevention, like cancer screening vaccinations,

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that kind of thing that really impacts impacts

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health.

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Absolutely. And and, Todd, let's dive into this

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a little bit more because this new model

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is shifting

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individual payment systems to a single shared system

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that rewards

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high quality care.

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How does that approach differ from the traditional

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fee for service models we all know,

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and what are some of the specific metrics

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or outcomes that are being used to measure

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and reward,

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physicians' performances?

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Yeah. You know, value based care differs from

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traditional health care by prior prioritizing patient outcomes

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and the quality of care over the volume

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of services provided. And that and that means,

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our providers are financially rewarded for achieving positive

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health results for their patients

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rather than the number of services delivered.

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In the traditional long standing fee for service

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models,

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providers are paid for the volume of preserve

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services they provide. And, you know, that that's

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irrespective of the impact

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on or or outcomes that they achieve. I

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mean, whether they do any good or not

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doesn't actually factor into the equation. They get

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paid for

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doing things.

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So this shift,

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really encourages a more holistic and proactive

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approach to patient care. We're focusing on preventioning,

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prevention, mind managing chronic conditions,

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and really looking at the overall overall health

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status of patients

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rather than just treating acute issues or or

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whatever they, happen to come in with that

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day.

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And, you know, HealthNet and other health plans

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have been engaged in

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in this value based purchasing,

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arrangement for some time. This is not a

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new concept.

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But we we all did as individual plans

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with individual models and priorities,

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you know, so help, you know, provider groups

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just have,

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a bunch of different health plans,

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providing different incentives and that kind of thing.

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So so what we're doing here with this

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demonstration project

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that's that's really revolutionary

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is this multi plan alignment.

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We're all rowing in the same direction, and

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the practices know,

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what's expected. And we're we're really amplifying the

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impact,

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that we have in producing high quality,

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high value results.

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And, you know, the the health plans all

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came together with CQC, NIAJ.

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We developed this together from the very beginning

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from the conception design payment models.

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We developed the metrics, which I'll get to

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in a moment.

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We got the implementation plan, then we're gonna

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assess the outcomes.

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Now in terms of metrics,

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we jointly developed key performance metrics that reflect,

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high quality and high value member outcomes.

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And these metrics this is really important. These

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are closely aligned with the priority metrics

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that our major purchasers

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have identified

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as well as key leaders in the industry.

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So at a high level, these metrics include

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health outcomes and prevention.

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Talked about diabetes, high blood pressure,

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immunizations, and cancer screenings.

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We're looking at patient reported outcomes and focusing

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on

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depression status.

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We're looking at patient safety,

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looking at minimizing high risk drug combinations.

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We're looking at patient experience using industry standard

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surveys.

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That's really key. We really hope to move

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the dial, the the needle there,

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and also high value care, which is, you

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know, minimizing you know, with with really strong,

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primary care, we hope to minimize

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emergency departments and, inpatient hospital utilization.

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Those are the those are the key metrics

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that we are targeting and that we are

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rewarding

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the practices

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for achieving.

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Absolutely. And going off of that, Todd, with

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everything you just said and and these and

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how these metrics were developed,

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why were small

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independent practices chosen as the starting point for

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this new model?

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And have you learned any lessons so far,

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being only just a short amount of time,

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since implementation?

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Yeah. That that's a really great question. So

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so like I said, primary care is the

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foundation of a high functioning

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health system.

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And we have while while we have

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growing

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consolidation in in health care delivery,

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we still have, you know, a vast, vast

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number of small independent practices out there providing

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a substantial portion of primary care.

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Now this advanced primary care model is an

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integrated, comprehensive,

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patient centered, team based care model, and we're

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supporting these practices

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in in adopting

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this broader,

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broader approach to care. It's not just contingent

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on that doctor in the room,

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but it's more of a team approach. So

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everybody in the office,

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can contribute

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to, this population health,

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management approach. And together, they look at all

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the patients,

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use data,

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identify their needs, and then proactively

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reach out to to their patients and close

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their care care gaps.

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Now we've we've focused on these small independent

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practices because they're they're largely under resourced,

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and they they lack the size and infrastructure

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to implement these changes on their own. I

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mean, it takes work. It takes effort to

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do this, to to change your,

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your, you know, standard way of doing things.

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Now larger provider groups tend to be better

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resourced,

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to enact these kinds of changes. So,

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with the with the, demonstration project, we're excited,

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with where we're, where we're at and what

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we're seeing.

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I'll just mention we're calling this a demonstration

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project instead of a pilot, and there's a

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reason for that.

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Pilots are, like, initial attempts to just test

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out a new idea,

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But this this project is based on science

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and experience, and this methodology has been proven.

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We we know that advanced primary care works,

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so we we are we're moving ahead beyond

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just a a test pilot.

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And so far, we've,

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we've learned that health plans can indeed come

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together collaboratively,

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get in the same room, elbow to elbow,

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align around key innovations and operational interventions,

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and, we've been able to successfully

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engage targeted practices,

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to commit to practice transformation

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in in adopting this advanced primary care model.

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And we're also finding high interest from these

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practices. They're eager to receive support. They wanna

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be helped. They wanna do better.

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They know it's hard work and and that

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they can't do it on their own. So

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they really appreciate,

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both the financial resources, but also

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the the training and coaching,

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that we're providing,

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to to make this transition.

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Yeah. And, Todd, let me follow-up with a

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point, one of those last points you just

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made that this is really bringing together a

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lot of organizations that in the past may

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have been directly competing

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with one another. So how do you see

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this demonstration

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project setting a precedent for for other insurers,

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for other providers throughout the country?

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Well, like I say I mean, this is

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what's groundbreaking.

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Right? I mean, who would imagine,

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the health plans

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competitors, yes, getting together literally in the same

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room

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and talking this all through, working this all

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out, coming to

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common

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agreements,

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with a focus on

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you know, we we we keep we keep

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the business separate. Right? This is this is

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really about

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quality. When you get down to it, we're

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all it's all about quality, improving outcomes, improving

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the care, improving the value of care that

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the people of California receive.

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And we can all agree on that. Right?

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I mean, there there's

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we we should we should be

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all,

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promoting that across the board for all Californians,

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and that's what we're doing here. And we

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found that through this alignment,

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we can really amplify our impact and make

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a difference, and it just makes a lot

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of sense. Now what we what we hope

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to do with this demonstration

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project is,

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show that, yes, indeed, health plans can do

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this. They can align. They can come together

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with strength in numbers

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and the and the amplification

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that we can,

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really help practices,

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adopt this model and provide,

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higher value care

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with it. Obviously,

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the long term goal here, demonstrate this works,

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and then scale it. Scale it across the

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across the state, maybe across the country,

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get other plans to to come on board

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and

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and really, really move the dial.

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Yeah. I mean, it's really exciting to to

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think about the potentials here, Todd. But let

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me ask you one last question about some

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of the technical

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aspects of this model,

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because as you've said throughout our our conversation

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today, you're really looking to address reimbursement challenges,

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improve health equity, and boost health outcomes among

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your your members,

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particularly those who may have been underserved

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in the past. So

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how are you specifically addressing some of those

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disparities in care, and how does a tool

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like the like the Coziva platform play in

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ensuring that those goals can be met?

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Great.

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So

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the the key here,

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is data.

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Timely, accurate, and actionable data is the key

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to all performance improvement efforts across the board,

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and that's especially,

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true with health equity. And so we're making

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it easier for the provider organizations to access

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their patient data.

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You know, we we like I mentioned, we

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have a fragmented system.

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Our data, our information, our medical records

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is equally

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fragmented, and that makes it really difficult to

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get a comprehensive view

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of the care that patients have had and

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identify their needs.

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So

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with this demonstration project,

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the three plans together

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are providing access to a uniform data platform,

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a single source of data, a single source

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of information

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where the pro practices can view key patient

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clinical information for our members

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for all of the plans

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in one place, on one dashboard.

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And

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access to and use of accurate data foundation

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of health equity work, and the way that

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that works is we stratify

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data. So we have a you know, look

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at a practice. They have their full panel

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patients. It's a diverse,

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array of folks in in any given practice.

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What you do in health equity is you

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take that data and then stratify

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by race, ethnicity,

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language,

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and other parameters,

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and then you compare the groups. And that

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reveals

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disparities

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in the services that that are provided.

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It uncovers

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things that you would not see unless you

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look at the data and stratify the data.

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So then we can identify those gaps in

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care,

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and then practices

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can proactively,

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address those gaps to mitigate health, health disparities.

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So the, you know, the goal here is

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visibility,

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see where the gaps of care are,

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take action,

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proactively

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outreach to specific especially

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underserved members. Now these are folks who may

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have fewer resources

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and fewer opportunities to access this care on

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their own. So

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by reaching out, bringing them in, or delivering

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the services to them, we can promote health

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equity.

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Fantastic. Well, Todd, we've got a lot of

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other health plan and health system leaders listening

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00:16:00,195 --> 00:16:03,475
in right now. Any other final thoughts or

429
00:16:03,475 --> 00:16:05,634
final bits of advice you wanna offer them

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00:16:05,634 --> 00:16:07,735
based off of everything we've just chatted about?

431
00:16:08,675 --> 00:16:10,134
Yeah. Well, first of all,

432
00:16:10,589 --> 00:16:12,829
watch this. Pay attention to what we're doing

433
00:16:12,829 --> 00:16:16,129
here. We follow this along. We'll we'll obviously,

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00:16:16,829 --> 00:16:19,169
give status reports as we go, and,

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00:16:20,029 --> 00:16:20,589
and we'll,

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00:16:21,230 --> 00:16:23,389
share the results, that we demonstrate. We hope

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00:16:23,389 --> 00:16:25,329
to show very positive results.

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00:16:25,815 --> 00:16:27,735
So that's one, keep a close eye on

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00:16:27,735 --> 00:16:28,235
this.

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00:16:28,695 --> 00:16:29,835
And two,

441
00:16:30,375 --> 00:16:32,294
don't be afraid to jump in. Don't you

442
00:16:32,294 --> 00:16:34,534
know, it's it I know it seems foreign,

443
00:16:34,534 --> 00:16:35,034
sounds,

444
00:16:36,054 --> 00:16:36,955
sounds counterintuitive

445
00:16:37,495 --> 00:16:38,715
for competitors

446
00:16:39,549 --> 00:16:40,290
to get together

447
00:16:40,990 --> 00:16:42,610
and do good work together,

448
00:16:42,990 --> 00:16:44,990
but it makes sense. Okay. Then we're not,

449
00:16:45,309 --> 00:16:46,370
violating any

450
00:16:46,670 --> 00:16:49,730
any business comp competition practices or

451
00:16:50,110 --> 00:16:53,309
sharing proprietary information. There's none of that. We

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00:16:53,309 --> 00:16:54,769
are focused on

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00:16:55,575 --> 00:16:58,554
improving the health outcomes of all Californians, and

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everybody can get behind that.

455
00:17:01,095 --> 00:17:03,575
Wonderful. Well, doctor May, thank you so much

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00:17:03,575 --> 00:17:05,575
for taking the time to sit down with

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us and for sharing your insights with our

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00:17:07,894 --> 00:17:09,755
listeners. We really appreciate it.

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00:17:10,090 --> 00:17:11,769
Jacob, thank you very much for having me

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00:17:11,769 --> 00:17:12,269
today.

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00:17:12,730 --> 00:17:14,730
If you'd like to listen to more podcasts

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00:17:14,730 --> 00:17:18,670
from Becker's HealthCare, you can visit beckershospitalreview.com.