1 00:00:00,160 --> 00:00:02,399 Everyone. This is Jacob Emerson with the Becker's 2 00:00:02,399 --> 00:00:04,799 Health Care podcast. Thrilled today to be joined 3 00:00:04,799 --> 00:00:07,759 by a special guest. Doctor Ken Cohen is 4 00:00:07,759 --> 00:00:10,880 executive director of translational research at Optum Health, 5 00:00:10,880 --> 00:00:12,880 and he also leads the Optum Center for 6 00:00:12,880 --> 00:00:14,179 Research and Innovation. 7 00:00:14,585 --> 00:00:16,344 Doctor Cohen, thank you so much for taking 8 00:00:16,344 --> 00:00:17,704 the time to be with us on the 9 00:00:17,704 --> 00:00:18,605 podcast today. 10 00:00:19,304 --> 00:00:20,684 Happy to be here, Jacob. 11 00:00:21,225 --> 00:00:22,904 So, Ken, before we dive into everything we 12 00:00:22,904 --> 00:00:24,105 wanna talk with you about, can you tell 13 00:00:24,105 --> 00:00:26,345 us a little bit more about yourself, your 14 00:00:26,345 --> 00:00:28,105 background in health care, and what it is 15 00:00:28,105 --> 00:00:30,125 that you do today at Optum Health? 16 00:00:31,259 --> 00:00:32,859 Yeah. I'm happy to do that. So I'm 17 00:00:32,859 --> 00:00:35,259 an internist by training. I spent my first 18 00:00:35,259 --> 00:00:36,879 ten years at one of the academic, 19 00:00:37,179 --> 00:00:38,879 medical centers in Philadelphia. 20 00:00:39,820 --> 00:00:42,219 And then the next twenty five years as 21 00:00:42,219 --> 00:00:44,865 the chief medical officer of a large primary 22 00:00:44,865 --> 00:00:47,185 care group in Denver, known as New West 23 00:00:47,185 --> 00:00:47,685 Physicians. 24 00:00:48,304 --> 00:00:49,984 And while at New West, I built a 25 00:00:49,984 --> 00:00:52,704 care model that used level one and level 26 00:00:52,704 --> 00:00:54,965 two evidence at the point of care 27 00:00:55,370 --> 00:00:58,250 to drive improvements in patient outcomes as well 28 00:00:58,250 --> 00:01:00,909 as the elimination of wasted and harmful care. 29 00:01:01,370 --> 00:01:02,670 In 2,018, 30 00:01:03,289 --> 00:01:06,329 Optum became interested in that model, and they 31 00:01:06,329 --> 00:01:09,130 acquired our group, with the understanding that I 32 00:01:09,130 --> 00:01:10,189 would take that model 33 00:01:10,495 --> 00:01:12,575 and scale it across the rest of the 34 00:01:12,575 --> 00:01:13,795 Optum health practices 35 00:01:14,094 --> 00:01:14,594 nationally. 36 00:01:15,454 --> 00:01:18,734 So today, I have two fundamental roles. One 37 00:01:18,734 --> 00:01:20,594 is that role that I just described. 38 00:01:21,055 --> 00:01:21,954 And then additionally, 39 00:01:22,575 --> 00:01:23,634 I have a translational 40 00:01:24,015 --> 00:01:24,994 research team, 41 00:01:25,569 --> 00:01:28,950 and together, we do health outcomes research specifically 42 00:01:29,090 --> 00:01:30,950 focused on value based care. 43 00:01:31,890 --> 00:01:34,689 Fantastic. So decades at New West Physicians and 44 00:01:34,689 --> 00:01:37,109 now helping lead research at Optum Health. 45 00:01:38,075 --> 00:01:40,234 Ken, before we dive into your research that 46 00:01:40,234 --> 00:01:41,614 you've done for Optum, 47 00:01:41,915 --> 00:01:44,415 I wanted to level set for our audience 48 00:01:44,635 --> 00:01:46,875 and get your perspective on on a term 49 00:01:46,875 --> 00:01:49,034 that we, of course, hear often in the 50 00:01:49,034 --> 00:01:51,694 health care industry, and that's value based care. 51 00:01:51,834 --> 00:01:54,560 So we hear that from different stakeholders across 52 00:01:54,560 --> 00:01:56,560 the health care spectrum, and I'm wondering if 53 00:01:56,560 --> 00:01:57,299 you could, 54 00:01:57,760 --> 00:01:59,840 put it in simple terms for us how 55 00:01:59,840 --> 00:02:01,859 UnitedHealth Group and Optum specifically 56 00:02:02,479 --> 00:02:04,420 define value based care today. 57 00:02:05,405 --> 00:02:06,385 Certainly. So 58 00:02:06,685 --> 00:02:09,025 value based care is where physicians 59 00:02:10,044 --> 00:02:11,025 accept accountability 60 00:02:11,485 --> 00:02:12,705 for the care outcomes. 61 00:02:13,405 --> 00:02:15,344 And under value based care, 62 00:02:15,645 --> 00:02:18,385 primary care providers engage with patients, 63 00:02:19,110 --> 00:02:22,229 use high quality evidence based medicine combined with 64 00:02:22,229 --> 00:02:23,530 shared decision making 65 00:02:23,909 --> 00:02:26,310 to arrive at the decisions that align best 66 00:02:26,310 --> 00:02:28,009 with patients' values and preferences. 67 00:02:28,629 --> 00:02:30,409 There's a focus on prevention, 68 00:02:31,125 --> 00:02:31,625 early 69 00:02:32,245 --> 00:02:33,144 detection, and importantly, 70 00:02:33,525 --> 00:02:35,064 management of chronic diseases. 71 00:02:35,844 --> 00:02:37,544 And this approach emphasizes 72 00:02:38,004 --> 00:02:38,824 a proactive 73 00:02:39,204 --> 00:02:42,025 preventive care that looks at the patient's overall 74 00:02:42,084 --> 00:02:42,584 health. 75 00:02:43,120 --> 00:02:46,020 It increases the chances of early disease identification, 76 00:02:46,800 --> 00:02:50,099 and it ensures that patients receive optimal, particularly 77 00:02:50,400 --> 00:02:51,620 evidence based care. 78 00:02:52,000 --> 00:02:55,760 Primary care physicians receive financial incentive, hence the 79 00:02:55,760 --> 00:02:56,260 accountability, 80 00:02:57,115 --> 00:03:00,415 for effectively improving both health outcomes and costs 81 00:03:00,715 --> 00:03:03,194 by keeping their patients healthier and reducing their 82 00:03:03,194 --> 00:03:04,415 total cost of care. 83 00:03:05,194 --> 00:03:08,155 Wonderful. Appreciate that overview, Ken. And I wanted 84 00:03:08,155 --> 00:03:10,235 to specifically talk with you today about some 85 00:03:10,235 --> 00:03:12,659 of the research you've done into value based 86 00:03:12,819 --> 00:03:13,800 care for Optum. 87 00:03:14,500 --> 00:03:16,180 Actually, I wanna talk about two two of 88 00:03:16,180 --> 00:03:18,520 your most recent research projects that you coauthored, 89 00:03:18,980 --> 00:03:21,460 and that was in partnership with America's Physician 90 00:03:21,460 --> 00:03:21,960 Groups. 91 00:03:22,260 --> 00:03:24,980 And, ultimately, it validated the benefits of a 92 00:03:24,980 --> 00:03:26,520 value based care model. 93 00:03:26,895 --> 00:03:28,655 So your first study, it was peer reviewed 94 00:03:28,655 --> 00:03:31,694 research published within the JAMA network open, and 95 00:03:31,694 --> 00:03:34,735 that showed that Medicare Advantage members in value 96 00:03:34,735 --> 00:03:35,794 based arrangements 97 00:03:36,334 --> 00:03:38,995 receive better care compared to beneficiaries 98 00:03:39,294 --> 00:03:40,115 in traditional 99 00:03:40,590 --> 00:03:43,950 Medicare Advantage arrangements. So from from your perspective, 100 00:03:43,950 --> 00:03:45,650 Ken, what were some of the most significant 101 00:03:45,790 --> 00:03:46,290 takeaways 102 00:03:46,590 --> 00:03:47,969 from the JAMA research 103 00:03:48,349 --> 00:03:50,290 in terms of patient outcomes 104 00:03:50,670 --> 00:03:52,610 under value based care models? 105 00:03:54,064 --> 00:03:54,564 Importantly, 106 00:03:55,104 --> 00:03:57,204 what it really focused on 107 00:03:57,504 --> 00:04:00,164 is trying to isolate the impact 108 00:04:00,625 --> 00:04:03,204 of different Medicare Advantage payment models. 109 00:04:03,824 --> 00:04:06,719 So the study looked at 17 physician groups. 110 00:04:07,120 --> 00:04:09,540 All of these groups were part of America's 111 00:04:09,599 --> 00:04:12,659 Physician Groups, one of the large physician advocacy 112 00:04:12,719 --> 00:04:13,219 organizations 113 00:04:13,680 --> 00:04:15,599 that is really focused on, 114 00:04:16,079 --> 00:04:18,660 developing skill sets around value based care. 115 00:04:19,485 --> 00:04:22,764 In those 17 physician groups, we included over 116 00:04:22,764 --> 00:04:23,645 15,000 117 00:04:23,645 --> 00:04:24,865 primary care physicians, 118 00:04:25,324 --> 00:04:28,205 and it included over 5,000,000 patient years of 119 00:04:28,205 --> 00:04:30,125 data. So this was a very, very large 120 00:04:30,125 --> 00:04:30,625 dataset. 121 00:04:31,389 --> 00:04:34,290 And it compared two groups of Medicare Advantage 122 00:04:34,430 --> 00:04:34,930 enrollees. 123 00:04:35,870 --> 00:04:38,350 One was in value based care arrangements. So 124 00:04:38,350 --> 00:04:41,389 these were either fully accountable two sided risk 125 00:04:41,389 --> 00:04:41,889 arrangements 126 00:04:42,350 --> 00:04:44,625 or at a minimum full professional risk. 127 00:04:45,185 --> 00:04:47,444 And the other group that it compared to 128 00:04:47,665 --> 00:04:50,964 were standard fee for service Medicare Advantage contracts. 129 00:04:51,745 --> 00:04:53,985 And the unique feature of the study was 130 00:04:53,985 --> 00:04:56,305 that all of the patients were cared for 131 00:04:56,305 --> 00:04:58,785 by the same physicians and the same physician 132 00:04:58,785 --> 00:04:59,285 groups. 133 00:05:00,029 --> 00:05:02,830 So again, this allowed us to isolate and 134 00:05:02,830 --> 00:05:03,330 highlight 135 00:05:03,710 --> 00:05:06,350 the impact of the fully accountable value based 136 00:05:06,350 --> 00:05:09,389 care model since the physicians caring for patients 137 00:05:09,389 --> 00:05:11,009 were the same in both groups. 138 00:05:12,044 --> 00:05:12,944 And the findings 139 00:05:13,485 --> 00:05:15,504 highlight that Medicare Advantage 140 00:05:15,884 --> 00:05:17,425 value based care arrangements, 141 00:05:18,204 --> 00:05:21,985 which emphasize, as I mentioned, preventive screenings, integrated 142 00:05:22,285 --> 00:05:24,064 medical and behavioral care, 143 00:05:24,610 --> 00:05:25,350 care coordination, 144 00:05:26,370 --> 00:05:28,069 population risk stratification, 145 00:05:28,930 --> 00:05:31,810 embedded pharmacy services, so a whole range of 146 00:05:31,810 --> 00:05:34,550 infrastructure associated with value based care. 147 00:05:35,009 --> 00:05:37,110 But this model delivered higher 148 00:05:37,454 --> 00:05:40,115 quality clinical care and better health outcomes 149 00:05:40,654 --> 00:05:41,875 compared to the traditional 150 00:05:42,254 --> 00:05:44,415 Medicare Advantage models that were paid fee for 151 00:05:44,415 --> 00:05:44,915 service. 152 00:05:45,375 --> 00:05:48,035 And these arrangements resulted in fewer hospitalizations, 153 00:05:48,735 --> 00:05:52,334 fewer emergency visits, and safer medication use among 154 00:05:52,334 --> 00:05:52,834 others. 155 00:05:53,960 --> 00:05:57,400 Understood. So your study confirmed that these these 156 00:05:57,400 --> 00:06:00,600 patients, these Medicare Advantage patients in value based 157 00:06:00,600 --> 00:06:01,100 arrangements, 158 00:06:01,400 --> 00:06:03,879 they're they're getting better clinical care, and overall, 159 00:06:03,879 --> 00:06:06,680 they're seeing better health outcomes. It's it's, so 160 00:06:06,680 --> 00:06:08,975 fascinating that that's the conclusion that you you 161 00:06:08,975 --> 00:06:10,194 came to in your research. 162 00:06:10,574 --> 00:06:12,654 Let's talk about another study that you published 163 00:06:12,654 --> 00:06:15,214 in the American Journal of Managed Care recently, 164 00:06:15,214 --> 00:06:18,435 which showed that Medicare fee for service patients 165 00:06:18,574 --> 00:06:21,410 cared for by physician groups who also care 166 00:06:21,410 --> 00:06:24,449 for patients under at risk payment arrangements with 167 00:06:24,449 --> 00:06:25,829 Medicare Advantage Plans, 168 00:06:26,290 --> 00:06:28,470 they experienced better health outcomes. 169 00:06:29,410 --> 00:06:32,930 What that's that's fascinating, Ken. And what about 170 00:06:32,930 --> 00:06:34,550 individuals that were not engaged 171 00:06:34,850 --> 00:06:36,705 in value based care models? Can can you 172 00:06:36,705 --> 00:06:37,925 explain for our listeners, 173 00:06:38,705 --> 00:06:41,205 the spillover effect that that you highlighted 174 00:06:41,584 --> 00:06:44,645 in that most recent paper for AGMC? 175 00:06:46,145 --> 00:06:47,985 Yes. And and I agree with you, Jacob. 176 00:06:47,985 --> 00:06:50,004 I think this is an an absolutely 177 00:06:50,384 --> 00:06:53,360 fascinating finding, And I've been wanting to do 178 00:06:53,360 --> 00:06:55,360 this study for a very long time, but 179 00:06:55,360 --> 00:06:58,000 it wasn't until I had the data assets 180 00:06:58,000 --> 00:07:00,399 available that I could really study this in 181 00:07:00,399 --> 00:07:00,899 detail. 182 00:07:01,839 --> 00:07:03,939 So we examined care 183 00:07:04,334 --> 00:07:07,535 that was provided by nine large physician groups, 184 00:07:07,535 --> 00:07:08,834 again, part of APG. 185 00:07:09,694 --> 00:07:12,095 And in this case, these physician groups cared 186 00:07:12,095 --> 00:07:14,995 for over one point four million traditional 187 00:07:15,295 --> 00:07:16,274 Medicare patients. 188 00:07:16,930 --> 00:07:20,209 And this study occurred with data between 02/2016 189 00:07:20,209 --> 00:07:21,269 and 02/2019. 190 00:07:21,649 --> 00:07:25,089 So again, these were APG physicians highly experienced 191 00:07:25,089 --> 00:07:26,470 in value based care, 192 00:07:26,849 --> 00:07:29,569 but now we're examining their traditional Medicare patients 193 00:07:29,569 --> 00:07:31,750 who were not in value based care contracts. 194 00:07:32,175 --> 00:07:34,735 So that was the intervention group. And the 195 00:07:34,735 --> 00:07:36,834 control group is we compared outcomes 196 00:07:37,694 --> 00:07:39,794 for those traditional Medicare patients 197 00:07:40,574 --> 00:07:43,454 to the broader community of physicians caring for 198 00:07:43,454 --> 00:07:46,550 traditional Medicare patients. So, again, the entire population 199 00:07:46,610 --> 00:07:49,730 are traditional Medicare patients, but the intervention group 200 00:07:49,730 --> 00:07:52,790 being those with experience and value based care 201 00:07:53,009 --> 00:07:56,050 and the control group being the broader traditional 202 00:07:56,050 --> 00:07:57,110 Medicare population. 203 00:07:58,465 --> 00:08:00,384 And this study is the first to show 204 00:08:00,384 --> 00:08:02,805 that the benefits of value based care, 205 00:08:03,264 --> 00:08:06,884 including fewer hospitalizations for chronic illnesses, fewer emergency 206 00:08:07,025 --> 00:08:10,645 visits, more wellness visits, and better medication adherence, 207 00:08:11,550 --> 00:08:14,829 that these improvements in overall care quality and 208 00:08:14,829 --> 00:08:15,329 efficiency 209 00:08:15,949 --> 00:08:19,149 actually spill over from the Medicare Advantage patients 210 00:08:19,149 --> 00:08:21,790 onto the Medicare recipients when their physicians are 211 00:08:21,790 --> 00:08:23,324 skilled at value based care. 212 00:08:23,805 --> 00:08:26,845 And this has just an absolutely enormous impact 213 00:08:26,845 --> 00:08:28,625 on the traditional Medicare program. 214 00:08:28,925 --> 00:08:31,245 So you can imagine what those benefits might 215 00:08:31,245 --> 00:08:34,524 look like where the entire physician cohort taking 216 00:08:34,524 --> 00:08:36,304 care of traditional Medicare patients 217 00:08:36,684 --> 00:08:38,544 skilled in value based care arrangements. 218 00:08:39,790 --> 00:08:42,750 And on average, about seventy percent of these 219 00:08:42,750 --> 00:08:45,629 groups Medicare Advantage patients were under value based 220 00:08:45,629 --> 00:08:46,129 care, 221 00:08:46,430 --> 00:08:48,750 where the groups were responsible for the quality 222 00:08:48,750 --> 00:08:49,970 and the cost of care. 223 00:08:50,350 --> 00:08:53,149 And because these physician groups also treated many 224 00:08:53,149 --> 00:08:56,154 traditional Medicare patients using the same advanced care 225 00:08:56,154 --> 00:08:56,654 practices, 226 00:08:57,355 --> 00:09:00,154 it was these advanced care practices that led 227 00:09:00,154 --> 00:09:01,855 to the improved health outcomes, 228 00:09:02,394 --> 00:09:04,174 not only for their MA patients, 229 00:09:04,554 --> 00:09:07,274 but also meaningfully better care for their traditional 230 00:09:07,274 --> 00:09:08,174 Medicare patients. 231 00:09:09,360 --> 00:09:11,040 Wow. I mean, so just to confirm there, 232 00:09:11,040 --> 00:09:13,360 because that's an amazing statement, Ken, in conclusion 233 00:09:13,360 --> 00:09:16,100 from the study that that Medicare Advantage, 234 00:09:17,360 --> 00:09:19,600 members and these value based care models for 235 00:09:19,600 --> 00:09:22,924 physicians that participate in, that's spilling over to 236 00:09:22,924 --> 00:09:23,824 also positively 237 00:09:24,125 --> 00:09:24,625 impact 238 00:09:25,245 --> 00:09:27,824 fee for service Medicare patients. Is that correct? 239 00:09:28,764 --> 00:09:30,445 And that's correct. And and if you think 240 00:09:30,445 --> 00:09:33,004 about it, it makes sense because what we're 241 00:09:33,004 --> 00:09:33,904 talking about 242 00:09:34,809 --> 00:09:36,350 is that when physicians 243 00:09:36,889 --> 00:09:39,769 are skilled at a certain care model, so 244 00:09:39,769 --> 00:09:42,269 for example, engaging in preventive services, 245 00:09:43,050 --> 00:09:44,750 use of evidence based medicine, 246 00:09:45,450 --> 00:09:48,490 careful selection of specialist cohorts, so you're referring 247 00:09:48,490 --> 00:09:50,110 to the highest quality specialists, 248 00:09:50,705 --> 00:09:54,945 Careful selection of hospitals and ambulatory surgery centers, 249 00:09:54,945 --> 00:09:57,264 so you're using the highest quality and most 250 00:09:57,264 --> 00:09:58,644 efficient sites of service. 251 00:09:59,345 --> 00:10:01,264 All of these are not unique to a 252 00:10:01,264 --> 00:10:02,644 Medicare Advantage population. 253 00:10:03,370 --> 00:10:06,330 And once physicians learn that skill set and 254 00:10:06,330 --> 00:10:08,330 see the positive impact that it has on 255 00:10:08,330 --> 00:10:09,470 their MA population, 256 00:10:09,929 --> 00:10:11,850 it's only natural that they would use that 257 00:10:11,850 --> 00:10:13,929 same skill set when caring for their traditional 258 00:10:13,929 --> 00:10:14,830 Medicare patient. 259 00:10:15,210 --> 00:10:17,564 Absolutely. It makes complete sense. And and in 260 00:10:17,564 --> 00:10:19,644 that vein, Ken, we we have a lot 261 00:10:19,644 --> 00:10:22,524 of hospital and insurance leaders listening in right 262 00:10:22,524 --> 00:10:23,024 now. 263 00:10:23,804 --> 00:10:26,204 If we're considering both the pay papers that 264 00:10:26,204 --> 00:10:28,365 you just gave us an overview of, what's 265 00:10:28,365 --> 00:10:30,845 the most important point or takeaway that you 266 00:10:30,845 --> 00:10:33,299 wanna make sure our listeners remember? 267 00:10:34,480 --> 00:10:37,519 Well, let's talk about the JAMA network paper 268 00:10:37,519 --> 00:10:38,019 first. 269 00:10:38,320 --> 00:10:41,600 And recall that that paper examined two different 270 00:10:41,600 --> 00:10:45,120 Medicare payment arrangements. One, a fully accountable two 271 00:10:45,120 --> 00:10:47,279 sided risk and the other fee for service 272 00:10:47,279 --> 00:10:47,779 MA. 273 00:10:48,554 --> 00:10:51,595 And ultimately, the Medicare Advantage value based care 274 00:10:51,595 --> 00:10:54,495 arrangements delivered exceptional results for their patients. 275 00:10:55,115 --> 00:10:58,654 There's already a substantial literature showing that overall 276 00:10:59,675 --> 00:11:02,250 MA patients receive care of higher quality and 277 00:11:02,250 --> 00:11:04,589 efficiency compared to traditional Medicare. 278 00:11:05,449 --> 00:11:08,190 However, it's important to recognize that MA plans 279 00:11:08,250 --> 00:11:11,289 pay physicians differently and physician groups can either 280 00:11:11,289 --> 00:11:13,449 be paid in a fully accountable model or 281 00:11:13,449 --> 00:11:14,909 in a fee for service arrangement. 282 00:11:15,375 --> 00:11:17,695 What was different about this study is that 283 00:11:17,695 --> 00:11:19,294 it was one of the first and certainly 284 00:11:19,294 --> 00:11:22,034 the largest and most comprehensive study to date 285 00:11:22,654 --> 00:11:24,754 showing that within Medicare Advantage, 286 00:11:25,294 --> 00:11:28,115 when physicians are paid in accountable care arrangements, 287 00:11:28,654 --> 00:11:31,075 the care delivered to their patients is better 288 00:11:31,529 --> 00:11:32,970 than when they are paid in fee for 289 00:11:32,970 --> 00:11:33,789 service arrangements. 290 00:11:34,329 --> 00:11:35,949 And some of those key results 291 00:11:36,570 --> 00:11:38,990 included the patients in value based care arrangements 292 00:11:39,049 --> 00:11:41,049 were twenty two percent less likely to be 293 00:11:41,049 --> 00:11:43,529 admitted to the hospital for chronic chronic common 294 00:11:43,529 --> 00:11:45,389 conditions like COPD or asthma. 295 00:11:46,115 --> 00:11:48,514 They were fifteen percent less likely to use 296 00:11:48,514 --> 00:11:51,235 high risk medications that can cause serious side 297 00:11:51,235 --> 00:11:52,615 effects if used incorrectly. 298 00:11:53,554 --> 00:11:55,794 And overall, there are nine percent less likely 299 00:11:55,794 --> 00:11:57,174 to be admitted to the hospital 300 00:11:57,554 --> 00:11:59,794 and nine percent less likely to visit hospital 301 00:11:59,794 --> 00:12:00,774 emergency departments. 302 00:12:02,129 --> 00:12:04,129 So so these studies then and then data 303 00:12:04,129 --> 00:12:06,769 you just shared, Ken, they clearly validate the 304 00:12:06,769 --> 00:12:08,949 impactful and the innovative work happening 305 00:12:09,329 --> 00:12:11,809 at UnitedHealth and at Optum. If we were 306 00:12:11,809 --> 00:12:14,789 looking ahead, how do we move the broader 307 00:12:15,009 --> 00:12:17,055 transaction based health care 308 00:12:17,435 --> 00:12:19,915 system to these value based care models that 309 00:12:19,915 --> 00:12:21,855 you've been discussing with us today? 310 00:12:22,235 --> 00:12:22,735 Ultimately, 311 00:12:23,435 --> 00:12:25,615 how do we get these models moving forward, 312 00:12:26,075 --> 00:12:26,815 so that 313 00:12:27,274 --> 00:12:28,254 we're more proactive 314 00:12:28,555 --> 00:12:31,340 with people's health and and we're keeping patients 315 00:12:31,340 --> 00:12:33,740 and members healthy over the course of their 316 00:12:33,740 --> 00:12:34,240 lifetimes. 317 00:12:35,340 --> 00:12:37,100 I think that's the critical issue. And and 318 00:12:37,100 --> 00:12:38,860 before I get there, let me spend a 319 00:12:38,860 --> 00:12:41,500 little bit more time, just discussing the spillover 320 00:12:41,500 --> 00:12:43,820 paper and looking at the specific impacts of 321 00:12:43,820 --> 00:12:44,480 that paper. 322 00:12:45,434 --> 00:12:47,674 And here, there was a clear indication that 323 00:12:47,674 --> 00:12:50,715 the superior care outcomes achieved by physician groups 324 00:12:50,715 --> 00:12:53,434 that are participating in accountable value based care 325 00:12:53,434 --> 00:12:55,215 arrangements for quality and costs 326 00:12:55,915 --> 00:12:58,315 spill over to the traditional Medicare patients, as 327 00:12:58,315 --> 00:12:59,129 I just mentioned. 328 00:12:59,610 --> 00:13:02,009 And the results of that paper further validate 329 00:13:02,009 --> 00:13:04,090 that value based care models are improving health 330 00:13:04,090 --> 00:13:05,870 outcomes across different populations, 331 00:13:06,570 --> 00:13:08,830 including the traditional Medicare population. 332 00:13:09,450 --> 00:13:10,750 And in that study, 333 00:13:11,144 --> 00:13:13,485 what we showed is that the traditional Medicare 334 00:13:13,545 --> 00:13:15,884 patients who were being cared for by these 335 00:13:16,105 --> 00:13:18,524 physicians' skilled and value based care 336 00:13:18,985 --> 00:13:20,985 were ten percent less likely to have acute 337 00:13:20,985 --> 00:13:21,965 hospital admissions, 338 00:13:22,745 --> 00:13:25,304 twelve percent less likely to be readmitted within 339 00:13:25,304 --> 00:13:26,125 thirty days, 340 00:13:26,679 --> 00:13:28,920 twenty one percent less likely to use emergency 341 00:13:28,920 --> 00:13:29,420 departments, 342 00:13:29,879 --> 00:13:32,040 and eighty two percent more likely to have 343 00:13:32,040 --> 00:13:33,340 annual wellness visits. 344 00:13:33,800 --> 00:13:36,040 They were nine to thirteen percent more likely 345 00:13:36,040 --> 00:13:38,139 to adhere to medications for hypertension, 346 00:13:38,840 --> 00:13:39,340 diabetes, 347 00:13:39,720 --> 00:13:40,460 and hyperlipidemia, 348 00:13:41,585 --> 00:13:43,665 and they were five percent less likely to 349 00:13:43,665 --> 00:13:45,445 be prescribed high risk medications. 350 00:13:46,225 --> 00:13:48,725 So putting these two papers together, 351 00:13:49,184 --> 00:13:51,184 I think we can begin to answer the 352 00:13:51,184 --> 00:13:52,644 question that you're asking. 353 00:13:53,440 --> 00:13:55,840 And I think one point is that value 354 00:13:55,840 --> 00:13:57,700 based care arrangements are working, 355 00:13:58,240 --> 00:14:00,960 not only for Medicare Advantage patients, but across 356 00:14:00,960 --> 00:14:04,240 traditional Medicare patients as well. And, frankly, although 357 00:14:04,240 --> 00:14:06,320 we didn't study it, there's every reason to 358 00:14:06,320 --> 00:14:06,820 expect 359 00:14:07,225 --> 00:14:09,705 that these same skills would also spill over 360 00:14:09,705 --> 00:14:11,804 into a commercial or a Medicaid population. 361 00:14:12,825 --> 00:14:15,144 And the second critical point is that all 362 00:14:15,144 --> 00:14:16,284 Medicare beneficiaries 363 00:14:16,664 --> 00:14:19,404 are now benefiting from these advanced practices 364 00:14:19,980 --> 00:14:20,720 that prioritize 365 00:14:21,179 --> 00:14:23,600 whole person patient specific care. 366 00:14:24,459 --> 00:14:26,940 So clearly, the benefits of these models are 367 00:14:26,940 --> 00:14:27,839 are are known. 368 00:14:28,139 --> 00:14:30,720 It's been validated by this research, Ken. 369 00:14:31,980 --> 00:14:34,059 From your perspective, from where you're sitting at 370 00:14:34,059 --> 00:14:34,559 Optum, 371 00:14:34,985 --> 00:14:36,365 as a health care system, 372 00:14:36,745 --> 00:14:39,225 where where is the rest of the the 373 00:14:39,225 --> 00:14:41,965 the health care system on this journey of 374 00:14:42,185 --> 00:14:42,925 broad adoption 375 00:14:43,384 --> 00:14:45,965 of this model? Is it being widely accepted? 376 00:14:46,264 --> 00:14:47,865 And where are you seeing some of the 377 00:14:47,865 --> 00:14:48,365 hesitancies 378 00:14:48,825 --> 00:14:49,485 out there? 379 00:14:50,500 --> 00:14:52,919 Well, part of the problem is that 380 00:14:53,860 --> 00:14:54,679 the definition 381 00:14:55,379 --> 00:14:57,080 of value based care, 382 00:14:57,940 --> 00:15:00,679 varies depending on who is looking at it. 383 00:15:01,539 --> 00:15:03,825 So some folks will look at value based 384 00:15:03,904 --> 00:15:06,625 care and they'll think that fee for service 385 00:15:06,625 --> 00:15:09,585 with an upside bonus potential is value based 386 00:15:09,585 --> 00:15:12,085 care, and I wish push back on that. 387 00:15:12,304 --> 00:15:14,465 We've been studying this for a long period 388 00:15:14,465 --> 00:15:16,945 of time now, and, ours aren't the only 389 00:15:16,945 --> 00:15:19,980 studies that demonstrate this. But what moves the 390 00:15:19,980 --> 00:15:20,480 needle 391 00:15:21,100 --> 00:15:22,160 is that accountability 392 00:15:22,540 --> 00:15:23,759 for costs and outcomes. 393 00:15:24,700 --> 00:15:27,500 So, for example, there are studies that show 394 00:15:27,500 --> 00:15:31,519 that in a Medicare Advantage model that, pays 395 00:15:31,660 --> 00:15:34,424 physicians either by fee for service, fee for 396 00:15:34,424 --> 00:15:37,544 service with upside bonus, or in two sided 397 00:15:37,544 --> 00:15:39,085 risk fully accountable models. 398 00:15:39,544 --> 00:15:42,524 That the needle on outcomes doesn't really improve 399 00:15:43,225 --> 00:15:45,705 until you move to that accountable for two 400 00:15:45,705 --> 00:15:47,085 sided outcomes model. 401 00:15:47,990 --> 00:15:50,409 So it's really critical that we understand 402 00:15:50,789 --> 00:15:54,009 what is the definition of value based care 403 00:15:54,389 --> 00:15:55,929 that actually will drive 404 00:15:56,389 --> 00:15:57,850 improvements in health outcomes. 405 00:15:58,709 --> 00:16:01,850 And UnitedHealth Group through Optum and UnitedHealthcare 406 00:16:02,904 --> 00:16:05,384 really aims to lead the shift towards a 407 00:16:05,384 --> 00:16:06,205 health system 408 00:16:06,585 --> 00:16:09,164 where the needs of all patients, care providers, 409 00:16:09,225 --> 00:16:11,404 and payers are closely aligned 410 00:16:11,865 --> 00:16:14,825 to deliver coordinated and seamless care in a 411 00:16:14,825 --> 00:16:16,125 value based care model. 412 00:16:16,740 --> 00:16:18,740 For example, home care can play a vital 413 00:16:18,740 --> 00:16:19,799 role in this approach, 414 00:16:20,340 --> 00:16:23,940 ensuring patient centered, equitable, and accessible care that 415 00:16:23,940 --> 00:16:27,860 addresses complex conditions, medication adherence, social needs, and 416 00:16:27,860 --> 00:16:29,240 behavioral health challenges 417 00:16:29,745 --> 00:16:31,605 for patients that aren't able to reliably 418 00:16:31,985 --> 00:16:33,605 reach the office for their care. 419 00:16:33,985 --> 00:16:36,384 We have systems in place where patients' entire 420 00:16:36,384 --> 00:16:37,445 health care journey, 421 00:16:37,904 --> 00:16:39,684 takes place entirely in the home. 422 00:16:40,544 --> 00:16:42,804 Another important point is that the Medicare 423 00:16:43,299 --> 00:16:46,019 alternative payment models are also an important part 424 00:16:46,019 --> 00:16:46,840 of the strategy, 425 00:16:47,379 --> 00:16:50,899 driving value, improving quality, and lowering costs for 426 00:16:50,899 --> 00:16:52,440 original Medicare beneficiaries, 427 00:16:53,379 --> 00:16:54,600 again, with the caveat 428 00:16:55,059 --> 00:16:57,139 that there should be a component of two 429 00:16:57,139 --> 00:17:00,134 sided risk to them. So ACO reach, for 430 00:17:00,134 --> 00:17:02,774 example, is an excellent example of that, and 431 00:17:02,774 --> 00:17:03,274 MSSP 432 00:17:03,815 --> 00:17:06,535 now has significant components of risk associated with 433 00:17:06,535 --> 00:17:09,095 it as well. So the expectation is that 434 00:17:09,095 --> 00:17:11,494 both of those models should also improve patient 435 00:17:11,494 --> 00:17:11,994 outcomes, 436 00:17:12,619 --> 00:17:15,980 reduce wasted and and harmful care, and overall 437 00:17:15,980 --> 00:17:17,440 reduce total cost of care. 438 00:17:18,380 --> 00:17:20,220 Certainly. Well, I know I speak for all 439 00:17:20,220 --> 00:17:21,660 of us here at Becker's, Ken, when I 440 00:17:21,660 --> 00:17:23,980 say that we look forward to your further 441 00:17:23,980 --> 00:17:26,460 research into these important issues and and some 442 00:17:26,460 --> 00:17:28,434 of those ones that you just mentioned. But 443 00:17:28,434 --> 00:17:30,035 before we go, is there anything else that 444 00:17:30,035 --> 00:17:32,755 we're missing? Any final thoughts or pieces of 445 00:17:32,755 --> 00:17:35,335 advice you wanna offer our listeners today? 446 00:17:36,115 --> 00:17:38,275 In closing, Jacob, the last point I'd like 447 00:17:38,275 --> 00:17:40,115 to make is that our research and others 448 00:17:40,115 --> 00:17:42,940 now have clearly shown that patients in value 449 00:17:42,940 --> 00:17:44,079 based care arrangements 450 00:17:44,460 --> 00:17:47,420 have better outcomes and overall efficiency of care 451 00:17:47,420 --> 00:17:48,079 has improved. 452 00:17:48,539 --> 00:17:50,539 For over two decades now, there has been 453 00:17:50,539 --> 00:17:54,000 bipartisan agreement among healthcare experts and policy makers 454 00:17:54,365 --> 00:17:57,345 that value based care outperforms fee for service 455 00:17:57,484 --> 00:18:00,285 in terms of health outcomes, consumer experience, and 456 00:18:00,285 --> 00:18:00,785 cost. 457 00:18:01,404 --> 00:18:04,045 Most value based care arrangements are currently within 458 00:18:04,045 --> 00:18:07,005 Medicare Advantage, but CMS is targeting one hundred 459 00:18:07,005 --> 00:18:09,210 percent of Medicare members to be in VBC 460 00:18:09,210 --> 00:18:10,910 arrangements by 02/1930. 461 00:18:11,289 --> 00:18:14,089 Additionally, the number of individuals in commercial value 462 00:18:14,089 --> 00:18:16,329 based plans has grown by nearly fifty percent 463 00:18:16,329 --> 00:18:18,890 over the past two years, and many patients 464 00:18:18,890 --> 00:18:21,150 are in Medicaid managed care as well. 465 00:18:21,615 --> 00:18:23,535 We know that this is a better model. 466 00:18:23,535 --> 00:18:26,015 The tipping point is almost upon us, but 467 00:18:26,015 --> 00:18:28,015 we're not there yet, and it is time 468 00:18:28,015 --> 00:18:29,474 to push fully accountable 469 00:18:29,934 --> 00:18:32,355 value based care models over the finish line. 470 00:18:33,295 --> 00:18:35,055 Absolutely. It's a great piece of advice for 471 00:18:35,055 --> 00:18:37,140 us to leave things at today. Doctor. Cohen, 472 00:18:37,140 --> 00:18:38,820 I want to thank you for taking the 473 00:18:38,820 --> 00:18:40,340 time to sit down with us and for 474 00:18:40,340 --> 00:18:42,820 sharing your insights with our listeners. We truly 475 00:18:42,820 --> 00:18:43,640 appreciate it. 476 00:18:44,420 --> 00:18:46,420 I was happy to have the opportunity to 477 00:18:46,420 --> 00:18:47,480 speak with you, Jacob. 478 00:18:48,099 --> 00:18:50,019 And if you'd like to listen to more 479 00:18:50,019 --> 00:18:54,359 podcasts from Becker's HealthCare, you can visit beckershospitalreview.com.