1 00:00:00,080 --> 00:00:02,000 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,000 --> 00:00:04,879 Becker's Payer Issues podcast. Thrilled today to be 3 00:00:04,879 --> 00:00:07,919 joined by doctor Ravi Kavasari, who's the chief 4 00:00:07,919 --> 00:00:10,179 medical officer at Blue Shield of California. 5 00:00:10,719 --> 00:00:12,799 Doctor Kavasari, thank you so much for taking 6 00:00:12,799 --> 00:00:14,080 the time to be with me on the 7 00:00:14,080 --> 00:00:14,980 podcast today. 8 00:00:15,464 --> 00:00:18,105 Good morning, Jacob. Thanks for having me. Yeah. 9 00:00:18,105 --> 00:00:19,945 Absolutely. And and before we dive into everything 10 00:00:19,945 --> 00:00:21,304 we wanna talk with you about, can you 11 00:00:21,304 --> 00:00:23,085 tell us a little bit more about yourself, 12 00:00:23,144 --> 00:00:24,984 your background in health care, and what it 13 00:00:24,984 --> 00:00:27,085 is that you're doing today at Blue Shield? 14 00:00:28,039 --> 00:00:28,779 You bet. 15 00:00:29,160 --> 00:00:29,899 My background, 16 00:00:30,439 --> 00:00:31,260 I am a, 17 00:00:32,039 --> 00:00:35,000 internist by training, and I practiced primary care 18 00:00:35,000 --> 00:00:36,920 for a number of years before coming to 19 00:00:36,920 --> 00:00:37,420 work, 20 00:00:37,879 --> 00:00:39,100 for Blue Shield of California. 21 00:00:39,640 --> 00:00:40,619 I still practice, 22 00:00:41,000 --> 00:00:42,859 on Friday afternoons. I see patients, 23 00:00:43,585 --> 00:00:44,325 here in, 24 00:00:44,945 --> 00:00:45,445 California. 25 00:00:46,225 --> 00:00:48,784 I have worked in value based care models 26 00:00:48,784 --> 00:00:50,885 for a number of years, and, 27 00:00:51,265 --> 00:00:53,024 you know, my role now today as chief 28 00:00:53,024 --> 00:00:54,804 medical officer for Blue Shield of California, 29 00:00:55,280 --> 00:00:56,960 folks often ask me, you know, how do 30 00:00:56,960 --> 00:00:58,880 you still find time to practice? And and 31 00:00:58,880 --> 00:01:01,440 I tell them it's precisely because I practice 32 00:01:01,440 --> 00:01:02,799 that I work at a health plan. I 33 00:01:02,799 --> 00:01:04,020 think it helps me 34 00:01:04,480 --> 00:01:06,980 to understand we've got 6,000,000 members, 35 00:01:07,755 --> 00:01:09,275 here that we serve at Blue Shield of 36 00:01:09,275 --> 00:01:11,775 California. We're a non for profit 37 00:01:12,155 --> 00:01:14,795 mission driven health plan, that's in every ZIP 38 00:01:14,795 --> 00:01:16,155 code in the state of California, and we've 39 00:01:16,155 --> 00:01:18,015 got members across the nation too. 40 00:01:18,954 --> 00:01:20,895 And, you know, we're really committed 41 00:01:22,159 --> 00:01:23,700 to our mission of driving 42 00:01:24,400 --> 00:01:26,099 higher quality care and affordability 43 00:01:26,400 --> 00:01:28,020 within The US health care system. 44 00:01:28,400 --> 00:01:29,760 And so when I think about my role 45 00:01:29,760 --> 00:01:31,760 as chief medical officer of a health plan, 46 00:01:31,760 --> 00:01:32,659 it's really, 47 00:01:33,280 --> 00:01:35,359 how do we, with the levers that a 48 00:01:35,359 --> 00:01:36,420 health plan has, 49 00:01:36,895 --> 00:01:39,055 really drive across that integrated aim of health 50 00:01:39,055 --> 00:01:42,275 care for better member experience, better health outcomes, 51 00:01:42,734 --> 00:01:43,234 and, 52 00:01:43,615 --> 00:01:44,915 affordability of care? 53 00:01:45,215 --> 00:01:46,655 And that's how I show up to work 54 00:01:46,655 --> 00:01:47,855 every day, and and that's the work that 55 00:01:47,855 --> 00:01:48,755 we're doing together. 56 00:01:49,540 --> 00:01:51,780 Fantastic. So you're a practicing physician, but you're 57 00:01:51,780 --> 00:01:53,619 also helping lead clinical decisions at one of 58 00:01:53,619 --> 00:01:56,180 the largest health plans in the country. And 59 00:01:56,180 --> 00:01:57,700 as part of that, Ravi, we're here today 60 00:01:57,700 --> 00:01:59,159 to talk with you a little bit about 61 00:01:59,459 --> 00:02:02,840 the company committing to shifting 90% of eligible 62 00:02:02,979 --> 00:02:03,959 health care spending 63 00:02:04,415 --> 00:02:07,295 through pay for value models. So for our 64 00:02:07,295 --> 00:02:08,814 listeners who might not be familiar, can you 65 00:02:08,814 --> 00:02:11,215 give us a quick overview of exactly what 66 00:02:11,215 --> 00:02:12,514 these models entail? 67 00:02:13,455 --> 00:02:14,435 You bet, Jacob. 68 00:02:14,735 --> 00:02:16,254 You know, in a nutshell, I mean, I 69 00:02:16,254 --> 00:02:19,055 think your audience is well attuned to the 70 00:02:19,055 --> 00:02:21,250 fact, no secret, that The US health care 71 00:02:21,250 --> 00:02:21,750 system, 72 00:02:22,370 --> 00:02:25,189 part of its brokenness is just fundamentally around 73 00:02:25,490 --> 00:02:25,990 misalignment 74 00:02:26,370 --> 00:02:27,270 of incentives. 75 00:02:28,370 --> 00:02:30,230 We don't pay providers 76 00:02:30,610 --> 00:02:31,349 at scale 77 00:02:31,650 --> 00:02:33,750 for the outcomes that matter to our patients. 78 00:02:34,370 --> 00:02:36,014 And so I'm sure you can think about 79 00:02:36,014 --> 00:02:37,534 that from a personal experience that you've had. 80 00:02:37,534 --> 00:02:39,234 Many of our listeners can as well. 81 00:02:40,174 --> 00:02:42,574 And so our work formatively, right, when we 82 00:02:42,574 --> 00:02:44,275 think about how to solve this problem, 83 00:02:45,375 --> 00:02:46,674 and in the ecosystem 84 00:02:46,974 --> 00:02:47,954 of care delivery, 85 00:02:48,495 --> 00:02:50,340 we are the payer. And so the lever 86 00:02:50,340 --> 00:02:52,819 that we have that's most foundational is changing 87 00:02:52,819 --> 00:02:54,659 how we pay for care, and very much 88 00:02:54,659 --> 00:02:57,080 that means aligning incentives around care. 89 00:02:58,020 --> 00:02:59,860 I'll share this. You know, Blue Shield of 90 00:02:59,860 --> 00:03:03,080 California has a bold mission around shifting 90% 91 00:03:03,385 --> 00:03:05,064 of health care spending through these pay for 92 00:03:05,064 --> 00:03:07,245 value models, but I wanna also be clear, 93 00:03:07,385 --> 00:03:08,745 you know, we're not new to this. 94 00:03:09,224 --> 00:03:10,825 This has made sense for us for many 95 00:03:10,825 --> 00:03:13,064 years and, you know, just kind of going 96 00:03:13,064 --> 00:03:13,865 back in, 97 00:03:14,185 --> 00:03:15,085 time here, 98 00:03:15,784 --> 00:03:16,525 in California. 99 00:03:17,530 --> 00:03:18,650 Blue Shield of California is one of the 100 00:03:18,650 --> 00:03:20,169 original authors of the, 101 00:03:20,569 --> 00:03:21,789 accountable care organizations 102 00:03:22,169 --> 00:03:24,330 back in the late nineties, the early two 103 00:03:24,330 --> 00:03:24,830 thousands, 104 00:03:25,289 --> 00:03:26,989 launching those here in California. 105 00:03:28,489 --> 00:03:28,989 And, 106 00:03:30,034 --> 00:03:32,775 in California, we've had delegated and capitated models 107 00:03:32,835 --> 00:03:35,074 for many years. And Blue Shield of California, 108 00:03:35,074 --> 00:03:37,574 again, has really been committed to, 109 00:03:38,194 --> 00:03:39,974 driving not just cost, 110 00:03:40,435 --> 00:03:42,615 affordability structures, but driving value 111 00:03:43,159 --> 00:03:45,319 and improve quality and health outcomes through those 112 00:03:45,319 --> 00:03:47,719 structures. So, you know, that that rich history, 113 00:03:47,719 --> 00:03:49,419 I think, is just really important for 114 00:03:49,719 --> 00:03:51,719 this group to understand because it's based off 115 00:03:51,719 --> 00:03:53,659 of that foundation when we think about this, 116 00:03:54,280 --> 00:03:55,639 which is, you know, we look at that 117 00:03:55,639 --> 00:03:56,680 and we say, well, where do we need 118 00:03:56,680 --> 00:03:57,879 to get to? Because that has not gotten 119 00:03:57,879 --> 00:03:59,702 us as a health care system where we 120 00:03:59,702 --> 00:04:02,317 need to be. It has not meaningfully moved 121 00:04:02,317 --> 00:04:04,932 the cost trends and the cost of health 122 00:04:04,932 --> 00:04:07,547 care and the affordability of health care. It 123 00:04:07,547 --> 00:04:10,488 has not, moved to the degree needed, the, 124 00:04:10,815 --> 00:04:12,123 health outcomes, for, 125 00:04:12,689 --> 00:04:14,870 for the state of California. And so, 126 00:04:15,569 --> 00:04:16,930 we've gone back and looked at these models 127 00:04:16,930 --> 00:04:18,529 and said, look, you know, what what needs 128 00:04:18,529 --> 00:04:20,610 to really improve here in this? And we've 129 00:04:20,610 --> 00:04:22,769 come to a few key conclusions that really 130 00:04:22,769 --> 00:04:24,149 guide us around this work. 131 00:04:24,625 --> 00:04:26,084 The first one is, 132 00:04:27,105 --> 00:04:28,944 you know, some of these earlier accountable care 133 00:04:28,944 --> 00:04:31,345 models really were predicated more around cost and 134 00:04:31,345 --> 00:04:33,745 not quality. And so, you know, a big 135 00:04:33,745 --> 00:04:35,425 part of our guiding principles is just that 136 00:04:35,425 --> 00:04:37,904 quality has gotta be baked into everything. It's 137 00:04:37,904 --> 00:04:39,665 core to these models when we pay for 138 00:04:39,665 --> 00:04:41,610 value. We're paying for outcomes. We're paying for 139 00:04:41,610 --> 00:04:42,110 quality. 140 00:04:43,210 --> 00:04:44,509 The second is 141 00:04:44,810 --> 00:04:47,050 that some of the earlier models were, 142 00:04:47,850 --> 00:04:50,590 not as deeply integrated on two sided risk. 143 00:04:51,050 --> 00:04:52,350 So there were incentives 144 00:04:52,925 --> 00:04:54,545 to incentivize the right behaviors, 145 00:04:55,084 --> 00:04:55,584 but, 146 00:04:56,045 --> 00:04:57,644 there was not enough skin in the game 147 00:04:57,644 --> 00:04:58,464 and alignment 148 00:04:59,004 --> 00:05:01,564 around understanding that, yes, it's gotta make sense 149 00:05:01,564 --> 00:05:02,785 to drive health outcomes, 150 00:05:03,644 --> 00:05:05,564 at cost. But if we don't make our 151 00:05:05,564 --> 00:05:07,564 members and our patients healthier and improve their 152 00:05:07,564 --> 00:05:09,600 quality of care and do that affordably, there 153 00:05:09,600 --> 00:05:11,280 have to be consequences around that too. We've 154 00:05:11,280 --> 00:05:13,840 got to make sure, again, it's all about 155 00:05:13,840 --> 00:05:15,460 align aligning these incentives. 156 00:05:16,240 --> 00:05:18,240 And then the third one is really around 157 00:05:18,240 --> 00:05:19,220 the idea that, 158 00:05:19,600 --> 00:05:21,680 again, here in California, much of the work 159 00:05:21,680 --> 00:05:23,975 that had been done to date was around 160 00:05:24,115 --> 00:05:24,615 delegated 161 00:05:25,154 --> 00:05:27,014 capitated models around capitation. 162 00:05:27,875 --> 00:05:29,394 But if we look for example for us 163 00:05:29,394 --> 00:05:31,074 here at Blue Shield of California and it's 164 00:05:31,074 --> 00:05:33,095 the experience for most of the nation too, 165 00:05:33,714 --> 00:05:36,274 most of our patients and members are getting 166 00:05:36,274 --> 00:05:39,089 their care in PPO models. Right? And so 167 00:05:39,089 --> 00:05:40,949 here at Blue Shield of California, for example, 168 00:05:41,089 --> 00:05:43,409 when we serve 6,000,000 members, 800,000 of those 169 00:05:43,409 --> 00:05:45,589 members are served in an HMO arrangement. 170 00:05:46,129 --> 00:05:47,810 But the vast majority are in a PPO 171 00:05:47,810 --> 00:05:50,370 arrangement. And so, again, as we drive value 172 00:05:50,370 --> 00:05:53,584 based care, it's really about aligning the incentives 173 00:05:53,584 --> 00:05:56,064 and the PPO model structure as well. And 174 00:05:56,064 --> 00:05:58,165 so those became just some of the foundational 175 00:05:58,384 --> 00:06:01,045 pieces of the models that we have today. 176 00:06:02,464 --> 00:06:05,105 So we have today models that stretch across 177 00:06:05,105 --> 00:06:07,480 the entire continuum of care from primary care 178 00:06:07,480 --> 00:06:09,660 settings to specialty care settings 179 00:06:10,120 --> 00:06:12,540 to, acute and hospital care settings. 180 00:06:12,920 --> 00:06:14,360 We've got over 60,000 181 00:06:14,360 --> 00:06:16,360 providers. We've got the largest network, 182 00:06:17,480 --> 00:06:18,459 here in California. 183 00:06:18,759 --> 00:06:20,600 And, again, we're the only statewide health plan 184 00:06:20,600 --> 00:06:22,214 here in California. And so, 185 00:06:23,095 --> 00:06:25,095 as part of that work too, we have 186 00:06:25,095 --> 00:06:26,314 realized, like, you know, 187 00:06:27,254 --> 00:06:29,735 single models are, not gonna be good because 188 00:06:29,735 --> 00:06:30,935 they're not gonna work for everyone, but too 189 00:06:30,935 --> 00:06:32,294 many models are gonna be difficult because then 190 00:06:32,294 --> 00:06:33,495 we're not gonna be able to scale and 191 00:06:33,495 --> 00:06:34,230 implement those. 192 00:06:34,710 --> 00:06:36,629 But we do need the right types of 193 00:06:36,629 --> 00:06:38,730 models across that continuum. And so, 194 00:06:39,110 --> 00:06:41,509 we've got ACO models today that are we 195 00:06:41,509 --> 00:06:43,270 call them ACO two point o models that 196 00:06:43,270 --> 00:06:46,889 are much more predicated around driving quality 197 00:06:47,365 --> 00:06:48,104 and affordability 198 00:06:48,805 --> 00:06:52,004 and two sided risk. They exist within the 199 00:06:52,004 --> 00:06:55,125 HMO and the PPO spaces today. And in 200 00:06:55,125 --> 00:06:57,764 addition to that, we've got specialty care models 201 00:06:57,764 --> 00:06:59,064 to incentivize care, 202 00:06:59,444 --> 00:07:01,980 around specialty care and then models for our 203 00:07:01,980 --> 00:07:04,639 hospitals linking their reimbursement back to quality outcomes. 204 00:07:05,740 --> 00:07:07,899 Certainly. And it seems like needless to say, 205 00:07:07,899 --> 00:07:10,800 Roby, that that this is tough work, transitioning 206 00:07:11,180 --> 00:07:13,660 your members and your provider network into more 207 00:07:13,660 --> 00:07:16,160 value based reimbursement and care models. 208 00:07:16,595 --> 00:07:19,154 So from from your perspective, both as a 209 00:07:19,154 --> 00:07:21,574 practicing physician, but also as CMO, 210 00:07:22,115 --> 00:07:23,714 can you explain for us some of these 211 00:07:23,714 --> 00:07:26,914 key challenges you've encountered in this transition from 212 00:07:26,914 --> 00:07:29,040 fee for service to to VBC? And how 213 00:07:29,040 --> 00:07:31,160 are you addressing these hurdles, to really ensure 214 00:07:31,160 --> 00:07:34,040 that this shift benefits both your members and, 215 00:07:34,040 --> 00:07:36,779 like you mentioned, that very large provider network? 216 00:07:37,560 --> 00:07:40,040 Yeah. That's a good question, Jacob. You know, 217 00:07:40,199 --> 00:07:41,560 as I shared at the top of the 218 00:07:41,560 --> 00:07:42,060 podcast, 219 00:07:42,680 --> 00:07:43,884 you know, the lens that I bring to 220 00:07:43,884 --> 00:07:46,125 this work is as a practicing physician, and 221 00:07:46,125 --> 00:07:47,985 I straddle both worlds across, 222 00:07:49,085 --> 00:07:52,205 what care looks and feels like when providers 223 00:07:52,205 --> 00:07:53,564 are trying to do the right thing for 224 00:07:53,564 --> 00:07:54,064 patients 225 00:07:54,525 --> 00:07:55,025 and, 226 00:07:55,485 --> 00:07:56,705 where payer systems 227 00:07:57,290 --> 00:07:58,889 facilitate and make it easier to do the 228 00:07:58,889 --> 00:08:00,970 right thing and where they make it difficult 229 00:08:00,970 --> 00:08:02,350 to do the right thing. And, 230 00:08:02,810 --> 00:08:04,970 I'd say the following, which is, you know, 231 00:08:04,970 --> 00:08:06,410 one of the key challenges for us as 232 00:08:06,410 --> 00:08:07,870 we do this work is, 233 00:08:08,649 --> 00:08:10,810 if we're gonna be successful around this, we're 234 00:08:10,810 --> 00:08:12,410 gonna have to do this work and scale 235 00:08:12,410 --> 00:08:14,754 it with the providers and in partnership with 236 00:08:14,754 --> 00:08:15,495 our providers, 237 00:08:16,194 --> 00:08:18,995 not at the expense of or done to 238 00:08:18,995 --> 00:08:21,555 the providers. Right? So that's just a key 239 00:08:21,555 --> 00:08:23,634 design principle for us as we've done this 240 00:08:23,634 --> 00:08:24,134 work, 241 00:08:24,435 --> 00:08:26,430 and it's something that I'm very proud of 242 00:08:26,589 --> 00:08:28,669 of our teams and our organization around the 243 00:08:28,669 --> 00:08:31,410 work we've done. We work very closely 244 00:08:32,190 --> 00:08:35,789 with the specialty organizations and providers in designing 245 00:08:35,789 --> 00:08:36,610 our models. 246 00:08:37,149 --> 00:08:38,750 And the reason this matters is this is 247 00:08:38,750 --> 00:08:40,830 really differentiating for us in the quality of 248 00:08:40,830 --> 00:08:42,975 the value based models that we develop. 249 00:08:43,434 --> 00:08:45,034 I'll give you a couple small examples around 250 00:08:45,034 --> 00:08:45,534 this. 251 00:08:46,235 --> 00:08:47,914 You know, when you work with one physician, 252 00:08:47,914 --> 00:08:49,674 you work with one physician when you're developing 253 00:08:49,674 --> 00:08:51,595 something. When you start working with the specialty 254 00:08:51,595 --> 00:08:52,954 associations, you know, the, 255 00:08:53,720 --> 00:08:56,360 the orthopedics associations or you start working with 256 00:08:56,360 --> 00:08:58,600 the California Medical Association or you start working 257 00:08:58,600 --> 00:09:00,299 with the American College of Cardiology, 258 00:09:01,240 --> 00:09:03,820 you're working with the groups that really represent 259 00:09:04,040 --> 00:09:05,340 the specialists across, 260 00:09:05,720 --> 00:09:06,779 that entire organization. 261 00:09:07,355 --> 00:09:08,795 We work with them. We come to them 262 00:09:08,795 --> 00:09:11,115 with the models we're developing and the problems 263 00:09:11,115 --> 00:09:13,274 we're trying to solve. We get their input, 264 00:09:13,274 --> 00:09:15,615 and we incorporate their input, because, 265 00:09:16,235 --> 00:09:16,894 we believe 266 00:09:17,274 --> 00:09:17,774 fundamentally 267 00:09:18,475 --> 00:09:20,715 that all doctors want to deliver value for 268 00:09:20,715 --> 00:09:21,419 their patients. 269 00:09:21,899 --> 00:09:22,379 And, 270 00:09:22,860 --> 00:09:25,179 often the practice settings and the payment structures 271 00:09:25,179 --> 00:09:26,000 that they're in, 272 00:09:26,779 --> 00:09:28,779 can complicate their abilities to do that to 273 00:09:28,779 --> 00:09:30,620 the best of their ability. And so I 274 00:09:30,620 --> 00:09:32,459 would just say that's a really important one 275 00:09:32,459 --> 00:09:33,120 for us, 276 00:09:33,659 --> 00:09:35,360 and, a key challenge 277 00:09:35,740 --> 00:09:36,139 that, 278 00:09:37,304 --> 00:09:38,665 we need to make sure we get really 279 00:09:38,665 --> 00:09:40,665 right as we effectively transition to value based 280 00:09:40,665 --> 00:09:42,504 care. The other one that I would point 281 00:09:42,504 --> 00:09:44,205 out, the second one is, 282 00:09:45,065 --> 00:09:47,384 you know, as we ask our providers to 283 00:09:47,384 --> 00:09:48,985 be held accountable for the patients that they 284 00:09:48,985 --> 00:09:50,764 treat over longer term health outcomes, 285 00:09:51,480 --> 00:09:53,480 it requires a mindset shift in the way 286 00:09:53,480 --> 00:09:54,840 of thinking. You know, it makes a lot 287 00:09:54,840 --> 00:09:55,820 of sense to providers. 288 00:09:56,279 --> 00:09:58,440 But what that also requires too is that, 289 00:09:58,440 --> 00:10:00,220 you know, our providers need the data, 290 00:10:00,600 --> 00:10:03,080 to actually effectively transition and take care of 291 00:10:03,080 --> 00:10:05,504 their members around these outcomes. And that's been 292 00:10:05,504 --> 00:10:06,945 really one of the big wins that I 293 00:10:06,945 --> 00:10:08,725 think around this work is just, 294 00:10:09,105 --> 00:10:12,225 hearing our providers tell us, you know, I'll 295 00:10:12,225 --> 00:10:14,545 just give you some small examples here. When 296 00:10:14,545 --> 00:10:17,425 you've got 60,000 providers, you're ranging from really 297 00:10:17,425 --> 00:10:19,825 large academic tertiary care systems that have a 298 00:10:19,825 --> 00:10:20,644 ton of infrastructure 299 00:10:21,240 --> 00:10:22,620 to, you know, 300 00:10:23,240 --> 00:10:26,360 single solo practices that exist. Right? Independent practices 301 00:10:26,360 --> 00:10:28,519 that exist where, some of them have never 302 00:10:28,519 --> 00:10:31,399 really received the data back on how their 303 00:10:31,399 --> 00:10:32,919 members are doing or how many of their 304 00:10:32,919 --> 00:10:36,059 members are, uncontrolled around health outcomes. 305 00:10:36,575 --> 00:10:38,254 And so being able to pipe that data 306 00:10:38,254 --> 00:10:38,995 back in, 307 00:10:39,615 --> 00:10:42,735 so that the physicians can then take that 308 00:10:42,735 --> 00:10:44,195 data meaningfully and, 309 00:10:45,054 --> 00:10:47,774 take care of, not just the individual patients 310 00:10:47,774 --> 00:10:48,975 that they're seeing during the day, but the 311 00:10:48,975 --> 00:10:50,754 population that they're responsible for. 312 00:10:51,215 --> 00:10:53,920 Again, the data is a challenge, but also 313 00:10:53,920 --> 00:10:55,779 a key opportunity for us. And, 314 00:10:56,480 --> 00:10:57,920 those are two of the key things that 315 00:10:57,920 --> 00:10:59,940 I'd say that we've encountered as we, 316 00:11:01,279 --> 00:11:02,800 do this important work and and how we're 317 00:11:02,800 --> 00:11:03,940 addressing those hurdles. 318 00:11:04,695 --> 00:11:05,894 Absolutely. And let me, 319 00:11:06,455 --> 00:11:08,295 follow-up with you there on something you just 320 00:11:08,295 --> 00:11:10,455 said about the the wide range of diversity 321 00:11:10,455 --> 00:11:13,254 of providers in California and also talk about 322 00:11:13,254 --> 00:11:14,634 some of these specific models. 323 00:11:15,415 --> 00:11:18,295 There's the new hospital value model, which, as 324 00:11:18,295 --> 00:11:18,965 I understand, ties reimbursement to hospital quality outcomes. 325 00:11:18,965 --> 00:11:19,595 So in a state like California, how do 326 00:11:19,815 --> 00:11:20,315 you 327 00:11:30,980 --> 00:11:35,000 resources or health system maturity or independent 328 00:11:35,644 --> 00:11:36,144 facilities. 329 00:11:36,764 --> 00:11:38,705 How do you measure all of this, Ravi? 330 00:11:39,085 --> 00:11:40,924 Yeah. It's a it's a good question, Jacob. 331 00:11:40,924 --> 00:11:42,205 And and what you're pointing to, and I 332 00:11:42,205 --> 00:11:44,044 think this is really important, right, is just, 333 00:11:45,245 --> 00:11:46,465 California is a great 334 00:11:47,325 --> 00:11:49,264 example of, you know, we've got some 335 00:11:49,990 --> 00:11:52,309 very large urban centers, but we've also got, 336 00:11:52,629 --> 00:11:54,730 some very rural areas that have, 337 00:11:55,829 --> 00:11:58,009 real access challenges around care. 338 00:11:58,389 --> 00:11:59,769 And that includes sometimes, 339 00:12:00,149 --> 00:12:02,470 you know, a single hospital system that exists 340 00:12:02,470 --> 00:12:03,209 in that area 341 00:12:03,534 --> 00:12:05,215 that may not have the same level of 342 00:12:05,215 --> 00:12:05,715 resources 343 00:12:06,174 --> 00:12:08,654 or access that other, regions have too. And 344 00:12:08,654 --> 00:12:10,575 so I'd say this in a nutshell. You 345 00:12:10,575 --> 00:12:12,095 know, the the model that we create on 346 00:12:12,095 --> 00:12:14,654 the hospital value model is really, as you 347 00:12:14,654 --> 00:12:17,554 shared, around tying reimbursement to hospital quality outcomes. 348 00:12:18,230 --> 00:12:20,709 Our model rewards hospitals for either improving their 349 00:12:20,709 --> 00:12:21,529 quality score 350 00:12:21,990 --> 00:12:24,789 or maintaining high quality outcomes. And so what 351 00:12:24,789 --> 00:12:27,049 this allows is those that have less resources, 352 00:12:27,589 --> 00:12:29,669 the opportunity to earn incentives based on making 353 00:12:29,669 --> 00:12:32,169 meaningful improvements. And, again, I think just 354 00:12:32,924 --> 00:12:35,404 highlights the types of things that we're doing 355 00:12:35,404 --> 00:12:35,904 today 356 00:12:36,285 --> 00:12:37,745 to really design 357 00:12:38,285 --> 00:12:41,424 in partnership with providers and scale with providers, 358 00:12:42,285 --> 00:12:44,285 that sit in different types of setting with 359 00:12:44,285 --> 00:12:45,504 different kinds of challenges, 360 00:12:46,960 --> 00:12:48,559 as we try to, you know, align the 361 00:12:48,559 --> 00:12:49,059 incentives 362 00:12:49,679 --> 00:12:51,220 across the continuum of care. 363 00:12:52,000 --> 00:12:54,080 Let me ask you about another model, Ravi, 364 00:12:54,080 --> 00:12:57,379 the the primary care reimagined model, which focuses 365 00:12:57,519 --> 00:13:00,514 specifically on preventive care. How are you measuring 366 00:13:00,514 --> 00:13:03,315 the the success of this initiative, and what's 367 00:13:03,315 --> 00:13:05,154 the impact that you've seen so far in 368 00:13:05,154 --> 00:13:08,115 terms of long term health outcomes, short term 369 00:13:08,115 --> 00:13:10,035 health outcomes, and then also, of course, the 370 00:13:10,035 --> 00:13:12,915 cost reductions for both your members and and 371 00:13:12,915 --> 00:13:14,055 the wider ecosystem? 372 00:13:15,269 --> 00:13:17,669 Yeah. The the primary care model for us, 373 00:13:17,909 --> 00:13:20,470 you know, foundationally, primary care needs to be 374 00:13:20,470 --> 00:13:22,789 a a cornerstone of the care delivery system 375 00:13:22,789 --> 00:13:24,149 and the health care system in this country 376 00:13:24,149 --> 00:13:25,450 as a first point of contact. 377 00:13:26,149 --> 00:13:27,589 And the way that we pay our providers 378 00:13:27,589 --> 00:13:29,174 today, it's not set up that way. I 379 00:13:29,174 --> 00:13:30,835 know this from firsthand experience, 380 00:13:31,215 --> 00:13:32,914 working as a primary care physician. 381 00:13:33,774 --> 00:13:36,014 You know, when we develop these models today 382 00:13:36,014 --> 00:13:37,475 for what we can scale, 383 00:13:39,054 --> 00:13:41,534 what we've developed is a hybrid payment model. 384 00:13:41,534 --> 00:13:43,294 And, again, this hybrid payment model has gotten 385 00:13:43,294 --> 00:13:44,730 a lot of attention. I'll just note, you 386 00:13:44,809 --> 00:13:46,409 know, CMS has expressed a lot of interest 387 00:13:46,409 --> 00:13:47,850 in this model too as the model for 388 00:13:47,850 --> 00:13:48,509 us to scale. 389 00:13:48,889 --> 00:13:50,730 And what's really good about this is, you 390 00:13:50,730 --> 00:13:52,509 know, when we say hybrid, it's basically 391 00:13:53,049 --> 00:13:55,129 there is a capitation that exists, and the 392 00:13:55,129 --> 00:13:56,350 capitation is, 393 00:13:56,809 --> 00:13:58,829 it goes to the primary care 394 00:13:59,465 --> 00:14:01,865 providers and the groups so that they have 395 00:14:01,865 --> 00:14:02,684 a reliable, 396 00:14:03,384 --> 00:14:04,684 steady source of revenue 397 00:14:05,144 --> 00:14:06,524 that they can depend on 398 00:14:06,985 --> 00:14:07,965 to make the infrastructure, 399 00:14:08,425 --> 00:14:10,524 the infrastructure investments that they need to make 400 00:14:10,745 --> 00:14:12,840 in order to take care of, you know, 401 00:14:13,080 --> 00:14:16,680 patients and, really take responsibility and accountability for 402 00:14:16,680 --> 00:14:18,840 their health outcomes. Right? Because the idea is 403 00:14:18,840 --> 00:14:19,980 we really want them, 404 00:14:20,759 --> 00:14:22,759 to, practice at the scope of the top 405 00:14:22,759 --> 00:14:23,980 of their scope of their license. 406 00:14:24,519 --> 00:14:26,279 But what it does do is the hybrid 407 00:14:26,279 --> 00:14:27,559 part also is it has a fee for 408 00:14:27,559 --> 00:14:28,300 service component 409 00:14:28,725 --> 00:14:29,464 that incentivizes, 410 00:14:29,924 --> 00:14:31,684 you know, what we would think about today 411 00:14:31,684 --> 00:14:32,424 is probably 412 00:14:32,804 --> 00:14:34,404 the parts of fee for service that are 413 00:14:34,404 --> 00:14:36,404 less broken and less perverse. Right? Which is 414 00:14:36,404 --> 00:14:37,704 where do you wanna actually 415 00:14:38,004 --> 00:14:41,065 encourage utilization? You wanna encourage utilization around immunizations. 416 00:14:41,365 --> 00:14:44,179 You wanna encourage utilization around folks coming in 417 00:14:44,240 --> 00:14:45,700 for preventive screenings, 418 00:14:46,840 --> 00:14:49,919 and, chronic condition monitoring. And so that kind 419 00:14:49,919 --> 00:14:50,419 of 420 00:14:50,799 --> 00:14:52,259 care is incentivized. 421 00:14:52,879 --> 00:14:55,455 And what we're seeing today is, you know, 422 00:14:55,455 --> 00:14:57,855 we've had these models in place. And, again, 423 00:14:57,855 --> 00:15:00,035 you know, it's grabbing national attention. 424 00:15:00,575 --> 00:15:02,735 Members who have high blood pressure, twenty seven 425 00:15:02,735 --> 00:15:04,335 percent more likely to have their blood pressure 426 00:15:04,335 --> 00:15:06,014 controlled than those that are not seeing a 427 00:15:06,014 --> 00:15:07,455 provider in this model today. That's what we're 428 00:15:07,455 --> 00:15:09,389 seeing from our own internal data. Providers that 429 00:15:09,389 --> 00:15:10,529 treat members with diabetes, 430 00:15:10,990 --> 00:15:13,470 thirteen more percent effective at getting their sugar 431 00:15:13,470 --> 00:15:14,690 levels under control. 432 00:15:15,549 --> 00:15:16,990 You know, on the cost piece that you 433 00:15:16,990 --> 00:15:17,490 asked, 434 00:15:18,269 --> 00:15:20,829 keeping chronic condition control, is gonna have longer 435 00:15:20,829 --> 00:15:22,669 term health impacts for the for our patients, 436 00:15:22,669 --> 00:15:24,269 just overall health and cost of health care. 437 00:15:24,269 --> 00:15:24,884 We know that. 438 00:15:25,445 --> 00:15:27,924 We are still evaluating the definitive data on 439 00:15:27,924 --> 00:15:28,904 cost for this. 440 00:15:29,365 --> 00:15:31,445 We're optimistic from what we're seeing around the 441 00:15:31,445 --> 00:15:33,125 work, but it's still a little bit too 442 00:15:33,125 --> 00:15:34,585 early for us to say, 443 00:15:35,125 --> 00:15:36,665 conclusively what that is. 444 00:15:37,240 --> 00:15:39,799 Sure. Makes complete sense, but really fascinating to 445 00:15:39,799 --> 00:15:41,879 hear that CMS has its eyes on this 446 00:15:41,879 --> 00:15:43,399 model. I'm I'm sure it'll be of a 447 00:15:43,399 --> 00:15:45,000 lot of interest to our listeners as well 448 00:15:45,000 --> 00:15:47,320 as this continues to develop, Ravi. And and 449 00:15:47,320 --> 00:15:49,274 in that vein, before we go, 450 00:15:49,835 --> 00:15:51,514 we have a lot of other health plan 451 00:15:51,514 --> 00:15:53,995 leaders listening in right now. So is there 452 00:15:53,995 --> 00:15:56,475 any final thoughts or final bits of advice 453 00:15:56,475 --> 00:15:58,235 you wanna offer them as they continue to 454 00:15:58,235 --> 00:15:59,855 navigate similar challenges? 455 00:16:00,634 --> 00:16:01,915 You know, I think the number one thing 456 00:16:01,915 --> 00:16:04,350 I'd share here for your listeners, right, is 457 00:16:04,589 --> 00:16:07,250 there is, you know, no culture of optionality 458 00:16:07,309 --> 00:16:09,470 around this work. Right? We we are fully 459 00:16:09,470 --> 00:16:11,549 committed to doing this work and to doing 460 00:16:11,549 --> 00:16:13,709 it at scale and scaling it rapidly throughout 461 00:16:13,709 --> 00:16:15,149 the system. We know this needs to be 462 00:16:15,149 --> 00:16:15,649 done, 463 00:16:16,029 --> 00:16:18,129 and we know that, we have a responsibility 464 00:16:18,190 --> 00:16:19,870 in the system to drive this work. And 465 00:16:19,870 --> 00:16:20,325 so, 466 00:16:21,285 --> 00:16:22,804 I'm very proud of the work that Blue 467 00:16:22,804 --> 00:16:24,485 Shield of California does in this space. I'm 468 00:16:24,485 --> 00:16:26,345 very proud of the partnerships that we have 469 00:16:26,404 --> 00:16:29,205 with our providers and the associations and the 470 00:16:29,205 --> 00:16:30,904 groups that we work with around this. 471 00:16:31,605 --> 00:16:33,910 And I'll just share here, you know, no 472 00:16:33,910 --> 00:16:35,669 meaningful change occurs in The US health care 473 00:16:35,669 --> 00:16:37,529 system without multi stakeholder partnership 474 00:16:38,149 --> 00:16:41,590 and, advancing payment innovation and aligning incentives for 475 00:16:41,590 --> 00:16:42,090 payment 476 00:16:42,549 --> 00:16:44,870 for providers to serve our patients the way 477 00:16:44,870 --> 00:16:46,549 that they came into the profession to do 478 00:16:46,549 --> 00:16:49,445 so really requires that multi stakeholder partnership. 479 00:16:50,305 --> 00:16:52,065 Fantastic. Well, I think that's a great place 480 00:16:52,065 --> 00:16:54,545 to leave things. So, Doctor. Cavasseri, thank you 481 00:16:54,545 --> 00:16:56,305 so much for taking the time to sit 482 00:16:56,305 --> 00:16:58,565 down with us and for sharing your insights 483 00:16:58,625 --> 00:17:01,379 with our listeners. We really appreciate it. Jacob, 484 00:17:01,379 --> 00:17:02,519 thank you for the opportunity. 485 00:17:02,899 --> 00:17:05,460 Yeah. Absolutely. And to our listeners, if you'd 486 00:17:05,460 --> 00:17:07,539 like to listen to more podcasts from Becker's 487 00:17:07,539 --> 00:17:10,839 Healthcare, you can visit beckershospitalreview.com.