Hello, everyone. This is Jacob Emerson with the
Becker's Payer Issues podcast. Thrilled today to be
joined by doctor Rishi Tawar, who is a
medical director in the office of episodes of
Care Population Health at Vanderbilt Health. Doctor Talwar,
thank you so much for taking the time
to be with me on the podcast today.
Thank you. I really appreciate the opportunity to
share a bit more about the work we're
doing here at Vanderbilt.
Absolutely. And glad you could take the time
to be with us. Before we dive into
everything we wanna talk with you about, can
you tell us a little bit more about
yourself, your background in health care, and what
it is that you're doing today at Vanderbilt?
Absolutely.
I in addition to
having a role in population health as you,
alluded to, I also have an active clinical
practice. I am a urologic oncologist
here at Vanderbilt Health.
I see patients I I do predominantly
cancer surgery for
prostate cancer, bladder cancer,
and kidney cancer.
In addition to that, my background,
especially during my training, was in health policy
research.
So my role at Vanderbilt is sort of
a natural fit,
that bridges both of those worlds. I get
to treat patients with urologic cancers. And at
the same time, in my role within episodes
of care under our population health umbrella,
I get to rethink how we deliver,
pay for, and experience
specialty care in our health care ecosystem.
Part of my role as medical director within
episodes of care
is to,
help operationalize,
lead, and support
the MyHealth bundles program, which I'm sure we'll
be talking more about in just a few
minutes.
But more broadly, I, essentially, am the medical
director for all of specialty value based care,
which includes some of the Medicare models that
are set to go into effect as of,
July first of twenty twenty five in addition
to January first of twenty twenty six. So
it's it's been a really fun ride here
at Vanderbilt getting to,
you know, sort of bridge both of my
worlds and both of my interests.
Fantastic. Well, like I said, we appreciate you
taking the time to be with us. And
you work for one of the country's leading
health systems, but you're here with us on
our insurance podcast to talk about how
employers nowadays are really seeking new and innovative
ways to manage their health care expenses
for their employees.
As you know, we're seeing on our end
that health care costs for employers
are set to rise by nearly 8%
this year alone. So maybe you could start
us off by explaining what provider led bundle
programs are,
how they offer a new model for addressing
high cost health conditions within the employer sponsored
health care space?
And why is Vanderbilt's,
interested in this kind of thing?
Sure. Sure.
You know, I think,
understanding,
exactly the point you just alluded to is
critical to understand why Vanderbilt wants to disrupt
this space.
You know, you alluded to this. Health care
costs for employers continue to rise. And as
we know, if we look at the proportion
of employers who provide,
employer sponsored insurance,
more and more of them are becoming fully
self self insured.
And and so they are very engaged
and very in tune with understanding,
their employees' health care related needs.
To that end, they're very astute in noticing
where their spend is particularly high. And here
at Vanderbilt, we have incredible
partnerships with our employers.
We ourselves are self insured, you know, the
medical center. And we have a a great
relationship with Metro Nashville Public School System, another
local self insured employer.
And
it was this partnership that really,
you know, served as the foundation
for our
now
wildly successful,
provider led bundle programs.
What we did was we looked at the
areas that were the biggest pain points for
them,
both as it relates to increased spend, but
also
predictability of spend
or their employees' experience
in getting care related to that condition.
And we,
you know, partnered with our
leading clinical teams here. You you said it
yourself. We're one of the nation's leading health
care systems.
And we said to our providers,
okay. This is an area,
of increased spend and and significant, you know,
pain for our employers that are in our
Nashville area, the ones that we have great
relationships with.
Tell me, what in a perfect world, in
a perfect scenario,
if we didn't have the burdens of prior
authorization,
utilization
management,
worrying about,
patient facing cost or out of pocket costs,
put together
an algorithm that lets you take the best
possible care of the patient and sets us
up to get the best possible outcomes.
And so we really centered our bundled payment
programs
on the patient. The patient is first. The
patient is front and center.
By doing so, we were able to
ensure that we're providing optimal outcomes. But, you
know, as a as a clinician myself, I
wanna call out the fact that we were
also able to make sure our provider teams
didn't have to deal with their own pain
points, such as prior authorization,
burdens, things like that.
For our employers,
we have packaged all of these services
at a single price
that allows them to achieve all of the
care related to that condition,
one single price. You know, it it accomplishes
that predictability
that people value.
And we take risk on our own outcomes.
So I'll I'll give you a couple examples.
Our oldest and most popular
bundle right now is the my maternity health
bundle. And we start the clock,
the day the patient has their first dating
ultrasound.
We cover all care related to the pregnancy,
throughout
the the the patient's pregnancy related journey.
And then we also cover
care related to the pregnancy up to ninety
days postpartum.
We do all of this as at one
single cost for our employers,
And we take risk. We take risk on
things like our c section rate. And that
has paid off because our c section rate
is lower than market, and our patient experience
is off the charts.
Our NPS scores, our net promoter scores are
often in the high eighties to to even
nineties for some of our programs when we
all know the average in health care is
is often in the 30 to 40 range.
Understood. And I I appreciate those real world
examples, doctor Tawar, and and clearly very beneficial
model for for the employer, for the provider,
and and the patients, of course.
For our listeners who might be unfamiliar with
these kind of programs, can you break down
for us how a bundled payment model differs
from that traditional fee for service arrangement
and what you're hearing from employers on the
ground in terms of why they they might
prefer something like this?
Yeah. Absolutely.
I I mentioned this, but let's dig in
a bit more. So first of all, our
bundled payment models,
have one single price.
And so I I alluded to this, but,
you know, our employers really appreciate the predictability.
When you're a self insured employer and you're
carrying a lot of that financial risk for
health care costs,
particularly
in the,
financial environment
and economic environment that we're in now,
predictability is key, and it allows you to
plan for the future and understand where your
spend is gonna go.
And and we cover again, the the way
that this is different from fee for service
is our bundled price
covers all of the care
related to that patient's condition.
Fee for service arrangements
require clinicians
to bill for specific services that are provided.
I gave an example of maternity care. Within
a woman's pregnancy journey,
you know, she may require
several ultrasounds
or
perhaps genetic testing,
or perhaps other sorts of tests that blood
tests, things like that, imaging,
outside of ultrasound.
All of that is covered in our single
price. Whereas in a traditional fee for service
arrangement, that would be billed product by or
service by service rather.
Similarly,
she may
be required to pay a co pay at
each specific visit.
Our program,
one of the big perks and one of
the the big patient satisfiers is the fact
that if you enroll in our program, we
waive all co pays. So for many patients,
that significantly
reduces
the out of pocket cost burden and financial
toxicity associated with getting care.
You know, I use the pregnancy model, but
to address why these,
sorts of programs are becoming increasingly popular with
employers,
I'm gonna use another example.
We have a program
that we offer to our employers that centers
around osteoarthritis
care.
And it's one of the only programs of
its kind that actually allows
employees who enroll
to opt for medical management
of osteoarthritis.
So what that means is we are,
taking risk on our rates of surgery
and and making sure that those are
done only when clinically appropriate and allowing patients
to have access
to non operative options,
such as injections, for example. Those injections can
otherwise be pretty costly.
But employers love the fact that they can
keep their workforce healthy
and, you know, avoid a major surgery by
getting them access to these sorts of injections,
for osteoarthritis
care. That keeps
employees healthy. It keeps them out of the
hospital. It keeps them at work functional,
and they love the fact that they can
have quality of life improvements
that don't require an invasive procedure.
So that's just one example of why these
sorts of programs are becoming really popular with
our employers.
You know, I think the mindset around health
care spending,
is is shifting a bit, and people are
realizing
with time that in general, health care spending,
you know, continues to trend upward, and it
is becoming unsustainable.
And so what I find really rewarding and
what I know our our employers really appreciate
is the opportunity
to work with with really a a center
of excellence in town
and and and to to ensure that their
patients are getting excellent care.
But removing some of the hassles as it
relates
to making sure that that clinician is in
network
or,
you know, again, I'll I'll refer to those
co pays. Some of our programs have enhanced
telehealth services. So, again, it may not require
someone to take an entire day off of
work and drive downtown
just for a doctor's appointment.
So we we really try to try to
address some of those specific
areas of of annoyance and and,
you know, the areas that can be really
inconvenient
for our patients, for our employers.
Absolutely. And from your clinical perspective, doctor Tauro,
what what are some of the long term
implications
of these models for both the employer
and and for the provider in terms of
improving care efficiency and health outcomes
for the employees under under a program like
the My Health bundles.
Yeah. And and, again, my lens as a
clinician, this is this is really what I
love most about this program.
So, you know, I'll go over some of
our recent results that we've seen and analyses
that we've done.
You know, for patients who enrolled in our
My Weight Loss Health program, which is a
bariatric
surgery
bundled payment,
we had over,
640
bariatric procedures
with over 40,000
pounds lost. And and what I love about
that is, you know,
wildly successful, but we actually had less than
a one percent reoperation rate. Again, we guarantee
high quality care.
Patients who un who enrolled in our MySpine
Health
program, who underwent surgery,
eighty six percent of them returned to work
within ninety days.
Across all of our surgical programs, we had
an average of a one percent surgical site
infection rate.
And that just, again, goes to show the
the excellent outcomes that we're able to ensure
here.
And,
you know, I again, my lens tends to
be clinical there, but I can tell you
that there's been,
incredible
financial impact too. I mentioned that we partnered
with one of our,
local
employers, Metro Nashville Public Schools.
And, you know, through participating in our my
maternity health bundle, we were able to significantly
cut the amount of money that they spent
on neonatal care. In fact, an analysis done
in 2024
actually showed
a $1,000,000,
reduction
in,
NICU spending and 50 NICU admissions that were,
avoided. So really a clinical success that translates
into a financial success.
So in my opinion, that's truly, you know,
a a win win win, I like to
call it. It's a win for for patients
first and foremost. It's a win for our
employers,
and it's a win for Vanderbilt because we
we we're doing what we know best, and
that's providing really high quality care.
You know, if you look at all of
our employers that participate in this program in
aggregate,
they've saved about 16%
on health care spend.
And tying that back into my clinical lens,
we've been able to avoid,
variations
in care and and improve the quality of
care
that our community gets. And that that is
really what I find
most rewarding.
Absolutely. And those are certainly some impressive statistics
that that you've accomplished through this program, doctor
Talwar.
Before we go, anything else that we're missing?
Any final thoughts you wanna share with our
audience, while you have the ears of a
lot of other health system and health plan
leaders around the country?
Yeah. Absolutely.
You know, I think that this program really
demonstrates
the ability to innovate,
to disrupt, and to improve the quality
of care
while reducing the costs of care for our
local communities. And so when people think about
value based care or bundled payments, I think
a lot of times,
we can we we we
think about the national level initiatives such as
some of those Medicare models,
some of which have been really successful and
others, you know, we're still trying to understand
the the success and financial implications of of
some of those Medicare innovations.
But that doesn't mean that we can't work
right at home,
in our backyards to partner with our own
employers
to,
implement some of these programs.
And so I'd encourage all of the payer
leaders on this on this podcast who are
listening and a lot of the health system
leaders
to take a look and see if some
of these innovations
are applicable
within your,
within your communities.
Because I think it's really it's really incredible,
to see how local partnerships
can improve the health of our patients
and also,
you know,
pave the way for innovations in specialty
value based care, you know, especially especially in
specialty care, which has been a a source
of
a lot of health care spending.
And and, you know, Vanderbilt's just one of
many systems
who are thinking about these kinds of problems,
but I I really think that,
our My Health Bundles program
provides a lens
for specialists
to take an active role in these sorts
of, value based care initiatives.
Fantastic. Well, thank you so much for taking
the time to sit down with us and
for sharing your insights with our audience. We
really appreciate it.
No problem. I appreciate the the,
opportunity to chat with you today. Thanks so
much.
Of course. And for our audience, if you'd
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