1 00:00:00,080 --> 00:00:02,159 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,159 --> 00:00:04,099 Becker's Payor Issues podcast. 3 00:00:04,480 --> 00:00:06,960 Thrilled today to be joined by doctor Sameer 4 00:00:06,960 --> 00:00:09,839 Amin, who serves as chief medical officer at 5 00:00:09,839 --> 00:00:12,080 LA Care Health Plan. Doctor Amin, thank you 6 00:00:12,080 --> 00:00:13,599 so much for taking the time to be 7 00:00:13,599 --> 00:00:15,434 with me on the podcast today. Thank you 8 00:00:15,434 --> 00:00:17,355 very much for the invite. Always happy to 9 00:00:17,355 --> 00:00:18,475 talk about these very, 10 00:00:18,954 --> 00:00:20,954 complicated issues and get some education out to 11 00:00:20,954 --> 00:00:21,855 the public and 12 00:00:22,475 --> 00:00:24,094 strike up a a good conversation. 13 00:00:24,714 --> 00:00:26,394 Absolutely. We're excited to have you here with 14 00:00:26,394 --> 00:00:27,675 us and and like you said, to talk 15 00:00:27,675 --> 00:00:30,239 about a really important topic. But before we 16 00:00:30,239 --> 00:00:32,079 dive into that, can you first tell us 17 00:00:32,079 --> 00:00:34,479 a little bit more about yourself, your background 18 00:00:34,479 --> 00:00:36,159 in health care, and then what it is 19 00:00:36,159 --> 00:00:38,020 that you do today at LA Care? 20 00:00:38,719 --> 00:00:41,200 Happy to. So my name is Sameer Amin. 21 00:00:41,200 --> 00:00:43,454 I'm the chief medical officer of LA Care. 22 00:00:43,615 --> 00:00:45,535 I've been at LA Care for about three, 23 00:00:45,535 --> 00:00:46,594 three and a half years. 24 00:00:47,054 --> 00:00:49,615 I'm an interventional cardiologist by training. I got 25 00:00:49,615 --> 00:00:51,535 into clinical leadership very early on in a 26 00:00:51,535 --> 00:00:52,594 value based care, 27 00:00:53,454 --> 00:00:55,695 delegated provider group and sort of grew into 28 00:00:55,695 --> 00:00:57,475 the health plan space over time. 29 00:00:58,090 --> 00:00:59,729 I've been doing this for for quite some 30 00:00:59,729 --> 00:01:02,530 time. I've worked in the Medicare line of 31 00:01:02,530 --> 00:01:04,930 business, the Medicaid line of business, and the 32 00:01:04,930 --> 00:01:06,950 exchange line of business. Also worked on the 33 00:01:07,090 --> 00:01:09,489 the start up space and have worked in 34 00:01:09,489 --> 00:01:09,989 technology, 35 00:01:10,689 --> 00:01:11,989 but now find myself 36 00:01:12,385 --> 00:01:13,604 very deeply rooted, 37 00:01:13,905 --> 00:01:15,765 in the community here in LA County, 38 00:01:16,224 --> 00:01:18,384 working in a in a health plan that 39 00:01:18,384 --> 00:01:20,325 has a publicly operated status. 40 00:01:20,944 --> 00:01:23,665 We have about 2,700,000 41 00:01:23,665 --> 00:01:24,165 members, 42 00:01:24,670 --> 00:01:26,829 largely in the medical space, but also with 43 00:01:26,829 --> 00:01:28,530 a Medicare Advantage line of business, 44 00:01:28,909 --> 00:01:30,450 and an exchange line of business. 45 00:01:31,229 --> 00:01:31,729 Understood. 46 00:01:32,030 --> 00:01:34,530 Well, Samir, let's, let's talk about 47 00:01:34,989 --> 00:01:37,789 Medicaid plans and what we've heard from them 48 00:01:37,789 --> 00:01:39,375 over the years in terms of 49 00:01:40,495 --> 00:01:43,375 investments for a long time now in social 50 00:01:43,375 --> 00:01:45,314 determinants programming and initiatives, 51 00:01:46,174 --> 00:01:48,174 a a a really diverse array of different 52 00:01:48,174 --> 00:01:50,174 kinds of programs and initiatives all over the 53 00:01:50,174 --> 00:01:50,674 country. 54 00:01:51,694 --> 00:01:53,250 But I think when those investments 55 00:01:53,629 --> 00:01:55,650 are made, have been made in the past, 56 00:01:55,870 --> 00:01:58,430 they assume a stable member population, and and 57 00:01:58,430 --> 00:01:59,170 they've been, 58 00:01:59,629 --> 00:02:02,510 under a period where there's been more stability 59 00:02:02,510 --> 00:02:04,829 than there is now. And I, I know 60 00:02:04,829 --> 00:02:06,109 you know what I'm talking about. I know 61 00:02:06,109 --> 00:02:07,090 our audience knows, 62 00:02:07,685 --> 00:02:09,444 in terms of the context of HR one 63 00:02:09,444 --> 00:02:11,145 and what's coming down the pipeline 64 00:02:11,444 --> 00:02:13,064 next year all over the country, 65 00:02:13,604 --> 00:02:15,044 all over the country and for Medi Cal, 66 00:02:15,044 --> 00:02:16,405 of course, as well. A lot of big 67 00:02:16,405 --> 00:02:17,224 changes there. 68 00:02:17,604 --> 00:02:19,604 So talk to us a little bit about 69 00:02:19,604 --> 00:02:21,145 how you main continuity 70 00:02:22,030 --> 00:02:23,330 for SDOH interventions 71 00:02:23,950 --> 00:02:26,530 when when you're facing large scale disenrollments, 72 00:02:26,830 --> 00:02:27,889 when you know that, 73 00:02:28,349 --> 00:02:31,010 there could be member major membership declines, 74 00:02:31,550 --> 00:02:34,030 and these programs might not have had time 75 00:02:34,030 --> 00:02:35,950 to work because, of course, you know, these 76 00:02:35,950 --> 00:02:38,275 things, they take time. They're they are social 77 00:02:38,275 --> 00:02:38,775 programs. 78 00:02:39,395 --> 00:02:41,555 Some take decades. So talk to us about 79 00:02:41,555 --> 00:02:43,655 how you're thinking about all of that. 80 00:02:44,435 --> 00:02:45,254 Yeah. I mean, 81 00:02:45,715 --> 00:02:47,254 clearly, there are unprecedented 82 00:02:47,715 --> 00:02:48,215 challenges 83 00:02:49,199 --> 00:02:51,039 to the safety net right now. There's a 84 00:02:51,039 --> 00:02:53,120 lot of movement in the member populations, people 85 00:02:53,120 --> 00:02:54,979 coming in and out of medical plans. 86 00:02:55,599 --> 00:02:57,120 But I'll just take a step back and 87 00:02:57,120 --> 00:02:59,620 say that, you know, though these may be 88 00:02:59,919 --> 00:03:02,145 more challenges than we've seen in the past, 89 00:03:02,385 --> 00:03:04,784 though there may be more memberships than we 90 00:03:04,784 --> 00:03:07,105 are we are used to, in the Medi 91 00:03:07,105 --> 00:03:08,645 Cal space, there's always, 92 00:03:08,944 --> 00:03:11,025 you know, an in out for members. You 93 00:03:11,025 --> 00:03:12,705 know, some members come in for a short 94 00:03:12,705 --> 00:03:13,605 period of time, 95 00:03:14,224 --> 00:03:15,480 and, you know, 96 00:03:15,780 --> 00:03:19,060 they change locations, they change jobs, and they're 97 00:03:19,060 --> 00:03:20,740 able to get their insurance in a different 98 00:03:20,740 --> 00:03:22,659 way. And so there's always that ebb and 99 00:03:22,659 --> 00:03:23,159 flow. 100 00:03:23,780 --> 00:03:24,439 I think 101 00:03:24,819 --> 00:03:26,420 taking out some of the noise of all 102 00:03:26,420 --> 00:03:28,659 the the challenges on the horizon, whether they're 103 00:03:28,659 --> 00:03:30,120 federal or state based, 104 00:03:30,615 --> 00:03:31,974 And just coming back to the fact that 105 00:03:31,974 --> 00:03:34,155 Medi Cal is always a population that 106 00:03:35,814 --> 00:03:37,754 that has a lot of transitions in it. 107 00:03:38,375 --> 00:03:40,694 We have to think about our social determinants 108 00:03:40,694 --> 00:03:43,014 of health pop our social determinants of health 109 00:03:43,014 --> 00:03:43,514 programs 110 00:03:44,189 --> 00:03:46,689 as being more about building an infrastructure 111 00:03:47,789 --> 00:03:48,289 than 112 00:03:48,909 --> 00:03:51,650 individual programs for individual people. 113 00:03:51,949 --> 00:03:53,409 So what do I mean by that? 114 00:03:54,509 --> 00:03:55,009 Well, 115 00:03:55,389 --> 00:03:56,289 we've utilized 116 00:03:56,590 --> 00:03:57,090 our 117 00:03:57,875 --> 00:04:00,694 population health pro our population health programming 118 00:04:01,155 --> 00:04:03,334 and our community strategic investments, 119 00:04:03,634 --> 00:04:05,094 the grants that we give, 120 00:04:05,555 --> 00:04:07,555 the the model of care that we put 121 00:04:07,555 --> 00:04:09,254 out through our community resource centers 122 00:04:09,715 --> 00:04:10,775 to really build 123 00:04:11,849 --> 00:04:12,909 stable programs 124 00:04:13,769 --> 00:04:15,229 for whoever may need them. 125 00:04:15,930 --> 00:04:17,389 And by doing that, 126 00:04:17,769 --> 00:04:20,729 we gather the benefit for members, whether they're 127 00:04:20,729 --> 00:04:22,970 in our programs for six months or they're 128 00:04:22,970 --> 00:04:25,185 in our programs for twelve months or they're 129 00:04:25,745 --> 00:04:27,604 they've been in Medi Cal for years. 130 00:04:28,384 --> 00:04:31,104 And by building that infrastructure, we can actually 131 00:04:31,104 --> 00:04:32,644 bolster the safety net, 132 00:04:33,264 --> 00:04:35,185 in a way that's what I would call 133 00:04:35,185 --> 00:04:35,685 durable. 134 00:04:36,949 --> 00:04:38,970 And it also allows for us to maintain 135 00:04:39,350 --> 00:04:41,610 an equity framework such that, 136 00:04:41,990 --> 00:04:43,209 those who are disadvantaged 137 00:04:44,229 --> 00:04:47,350 and are from a particular cultural or ethnic 138 00:04:47,350 --> 00:04:49,350 background are seeing care in a way that 139 00:04:49,350 --> 00:04:51,930 they can that they can, get more fluidly. 140 00:04:52,735 --> 00:04:55,154 And so it's really, again, about building infrastructure 141 00:04:55,295 --> 00:04:58,254 rather than targeted programs. It's also about collaborating 142 00:04:58,254 --> 00:05:00,654 with local partners who are critical for the 143 00:05:00,654 --> 00:05:01,154 community. 144 00:05:01,774 --> 00:05:03,555 We work in tandem with them, 145 00:05:04,254 --> 00:05:07,199 and allied groups to really drive efficiencies and 146 00:05:07,279 --> 00:05:09,220 help prevent any confusion and, 147 00:05:09,680 --> 00:05:12,020 allow for coordination of care in the community. 148 00:05:12,639 --> 00:05:14,720 And when we do this, we're, again, able 149 00:05:14,720 --> 00:05:15,379 to build, 150 00:05:16,000 --> 00:05:18,500 an infrastructure for care, a health care ecosystem 151 00:05:19,199 --> 00:05:19,699 that, 152 00:05:20,204 --> 00:05:21,185 you know, will 153 00:05:21,725 --> 00:05:23,964 last for years and not really be about 154 00:05:23,964 --> 00:05:25,564 an individual member coming in and out of 155 00:05:25,564 --> 00:05:27,425 the system. I hope that makes sense. 156 00:05:27,725 --> 00:05:29,404 It does make sense. And I I I 157 00:05:29,404 --> 00:05:31,725 think my natural follow-up to that, Sameer, would 158 00:05:31,725 --> 00:05:33,644 be, you know, when you're building, when you're 159 00:05:33,644 --> 00:05:35,185 investing in that infrastructure, 160 00:05:36,019 --> 00:05:38,120 how are you making the case internally, 161 00:05:38,899 --> 00:05:42,100 to to stakeholders within the health plan that 162 00:05:42,100 --> 00:05:44,600 that's spending on SDOH on this infrastructure? 163 00:05:46,019 --> 00:05:47,779 Is is how do you defend it? How 164 00:05:47,779 --> 00:05:49,540 do you make sure that this is the 165 00:05:49,540 --> 00:05:50,040 direction 166 00:05:50,420 --> 00:05:52,975 you wanna keep going? And are there metrics 167 00:05:52,975 --> 00:05:55,775 that you're using that demonstrate a return on 168 00:05:55,775 --> 00:05:56,514 those investments, 169 00:05:57,055 --> 00:05:59,475 to your internal stakeholders, to your board, 170 00:05:59,855 --> 00:06:01,154 to whoever whoever else, 171 00:06:01,455 --> 00:06:03,775 might need to know that these investments are 172 00:06:03,775 --> 00:06:04,275 worthwhile? 173 00:06:05,519 --> 00:06:07,919 I think, you know, at our plan, we're 174 00:06:07,919 --> 00:06:10,800 perhaps slightly different because we are coming from 175 00:06:10,800 --> 00:06:11,779 a public space. 176 00:06:12,240 --> 00:06:14,560 And social determinants of health are core to 177 00:06:14,560 --> 00:06:16,879 the safety net and to equity. They're they're 178 00:06:16,879 --> 00:06:17,475 not really 179 00:06:18,514 --> 00:06:20,915 discretionary things that we go after. We're a 180 00:06:20,915 --> 00:06:23,634 public plan. We have no shareholders. Our return 181 00:06:23,634 --> 00:06:25,095 on investment is measured 182 00:06:25,395 --> 00:06:28,194 in our community thriving in developing better health 183 00:06:28,194 --> 00:06:29,654 outcomes, reducing hospitalization. 184 00:06:30,269 --> 00:06:31,949 These are all things that are, you know, 185 00:06:31,949 --> 00:06:32,449 quantifiably 186 00:06:32,750 --> 00:06:35,149 critical to showing a return on the dollars 187 00:06:35,149 --> 00:06:36,930 we are, you know, sort of mindfully investing 188 00:06:37,149 --> 00:06:39,069 as fiduciaries of the funds entrusted to us. 189 00:06:39,069 --> 00:06:42,524 And so I think one is just the 190 00:06:42,524 --> 00:06:43,805 fact that we're looking at it from a 191 00:06:43,805 --> 00:06:45,665 lens as a as a public plan. 192 00:06:46,204 --> 00:06:47,964 But I think to the other point, you 193 00:06:47,964 --> 00:06:48,944 know, people oftentimes 194 00:06:49,324 --> 00:06:51,185 look at returns on investment 195 00:06:52,204 --> 00:06:55,024 as something that has a very long, 196 00:06:55,920 --> 00:06:58,279 a very long bend to it. So, you 197 00:06:58,279 --> 00:07:00,839 know, hey. You're gonna deliver on a heart 198 00:07:00,839 --> 00:07:03,160 failure program. You're gonna deliver on an asthma 199 00:07:03,160 --> 00:07:03,660 program. 200 00:07:04,279 --> 00:07:07,560 Those decrease in readmissions or those that decrease 201 00:07:07,560 --> 00:07:09,985 in cost of care is gonna potentially hit 202 00:07:09,985 --> 00:07:11,365 for years down the line. 203 00:07:11,745 --> 00:07:13,285 But some of the real 204 00:07:13,824 --> 00:07:16,305 thorny social determinants of health that we're investing 205 00:07:16,305 --> 00:07:18,865 in, that we're building that infrastructure that I 206 00:07:18,865 --> 00:07:20,485 talked about, actually, 207 00:07:21,149 --> 00:07:22,990 that's gonna make a measurable difference in a 208 00:07:22,990 --> 00:07:25,550 much shorter period of time. Let's take housing, 209 00:07:25,550 --> 00:07:27,410 for example, or food insecurity. 210 00:07:28,350 --> 00:07:29,649 Those issues are 211 00:07:30,269 --> 00:07:33,170 short term. If you can get somebody housed 212 00:07:33,425 --> 00:07:35,584 and you can you can more easily get 213 00:07:35,584 --> 00:07:36,644 them into care, 214 00:07:37,024 --> 00:07:39,764 the benefit of that is actually going to 215 00:07:40,064 --> 00:07:42,064 to accrue at a much earlier time. Same 216 00:07:42,064 --> 00:07:44,064 thing with food insecurity. When somebody doesn't have 217 00:07:44,064 --> 00:07:45,824 any food to eat, it's very hard to 218 00:07:45,824 --> 00:07:47,985 get them to concentrate on closing care gaps 219 00:07:47,985 --> 00:07:50,660 like getting their mammogram done or or getting 220 00:07:50,660 --> 00:07:53,160 their colonoscopy done. And so 221 00:07:53,540 --> 00:07:55,480 when when I look at the social determinants 222 00:07:55,540 --> 00:07:58,439 of health that we're investing in, building infrastructure 223 00:07:58,580 --> 00:08:01,540 on, creating durable process processes with our safety 224 00:08:01,540 --> 00:08:03,480 net and with our community partners, 225 00:08:04,415 --> 00:08:06,735 I'm thinking about things that, you know, actually 226 00:08:06,735 --> 00:08:09,694 will have KPI or key performance index that's 227 00:08:09,694 --> 00:08:11,775 gonna that's gonna shift in a very short 228 00:08:11,775 --> 00:08:13,775 period of time. And so we've been able 229 00:08:13,775 --> 00:08:16,035 to make a lot of those ROI calculations 230 00:08:16,740 --> 00:08:19,540 and investments, understanding that whether a member is 231 00:08:19,540 --> 00:08:22,019 with us for six months or a year 232 00:08:22,019 --> 00:08:23,240 or five years, 233 00:08:24,019 --> 00:08:24,920 that ultimately, 234 00:08:25,620 --> 00:08:27,319 we will get back our investment, 235 00:08:28,339 --> 00:08:30,615 in spades because there we're gonna be able 236 00:08:30,615 --> 00:08:32,375 to bend that cost curve of health care 237 00:08:32,375 --> 00:08:34,955 over time, and it won't take very long. 238 00:08:35,735 --> 00:08:38,714 I'll also just point out that whether there 239 00:08:38,855 --> 00:08:41,254 are quality care gaps that we're closing by 240 00:08:41,254 --> 00:08:42,315 way of creating these 241 00:08:42,629 --> 00:08:44,090 or putting in these investments 242 00:08:44,549 --> 00:08:47,190 or it's decrease in emergency room usage or 243 00:08:47,190 --> 00:08:48,009 inpatient usage 244 00:08:48,389 --> 00:08:50,410 or it's just strain on our network. 245 00:08:51,110 --> 00:08:52,870 We have to be holistic in how we 246 00:08:52,870 --> 00:08:56,070 actually look at the metrics that we're looking 247 00:08:56,070 --> 00:08:56,730 to improve, 248 00:08:58,105 --> 00:09:00,424 because it's not necessarily gonna be the cost 249 00:09:00,424 --> 00:09:02,704 of an admission always. It may be that, 250 00:09:02,704 --> 00:09:04,365 you know, you improve quality, 251 00:09:05,065 --> 00:09:06,125 and, you know, 252 00:09:06,825 --> 00:09:08,764 you get better remuneration 253 00:09:09,144 --> 00:09:10,764 from the government based on 254 00:09:11,740 --> 00:09:14,379 improved performance in their quality based programs or 255 00:09:14,379 --> 00:09:15,600 with their quality withhold. 256 00:09:16,220 --> 00:09:17,980 Same thing with network that, you know, hey. 257 00:09:17,980 --> 00:09:20,059 Listen. You know, we expand the network. We're 258 00:09:20,059 --> 00:09:22,059 able to get people into care, in a 259 00:09:22,059 --> 00:09:24,379 culturally competent way at a at a better 260 00:09:24,379 --> 00:09:26,754 clip. It's gonna reduce all the grievances and 261 00:09:26,754 --> 00:09:28,934 calls that we get, from members, 262 00:09:29,315 --> 00:09:31,235 and we can have more efficient and more 263 00:09:31,235 --> 00:09:33,954 productive staffing that way. And so it it's 264 00:09:33,954 --> 00:09:35,095 really also about 265 00:09:35,634 --> 00:09:36,855 finding the right metric 266 00:09:37,169 --> 00:09:39,570 that actually shows the benefit of the good 267 00:09:39,570 --> 00:09:41,269 investments that we want to make. 268 00:09:43,169 --> 00:09:45,330 I'll also just, you know, in closing, point 269 00:09:45,330 --> 00:09:47,570 out the fact that, you know, again, as 270 00:09:47,570 --> 00:09:48,149 a public 271 00:09:48,769 --> 00:09:52,129 plan that's holding the public trust, we also 272 00:09:52,129 --> 00:09:54,815 have a very unique ROI. 273 00:09:55,355 --> 00:09:55,855 Our, 274 00:09:56,475 --> 00:09:59,134 board is made up of member representatives, 275 00:10:00,315 --> 00:10:01,455 and member advocates, 276 00:10:02,154 --> 00:10:04,735 and, you know, they hold us accountable for 277 00:10:04,875 --> 00:10:07,309 not just the actual dollar amount that we 278 00:10:07,309 --> 00:10:09,409 may be saving on total cost of care, 279 00:10:09,470 --> 00:10:11,730 but also improvement on the community itself. 280 00:10:12,269 --> 00:10:14,429 So as a plan as as, you know, 281 00:10:14,429 --> 00:10:17,149 that publicly operated plan, it's on us. It's 282 00:10:17,149 --> 00:10:18,929 our responsibility. It's our accountability 283 00:10:19,389 --> 00:10:21,730 to be something more than an insurance company. 284 00:10:22,644 --> 00:10:24,565 Absolutely. And I and I do appreciate that 285 00:10:24,565 --> 00:10:26,965 clarification there, Sameer, for our audience in terms 286 00:10:26,965 --> 00:10:28,725 of how this is all a bit different 287 00:10:28,725 --> 00:10:31,045 for LA Care given that you are a 288 00:10:31,045 --> 00:10:32,424 a publicly funded entity, 289 00:10:32,804 --> 00:10:34,404 and how that kind of shakes out with 290 00:10:34,404 --> 00:10:36,665 ROI and how you track all of this. 291 00:10:36,860 --> 00:10:39,680 I think for our other health plan executives 292 00:10:39,740 --> 00:10:40,879 listening in right 293 00:10:41,180 --> 00:10:44,000 now, you know, many are not coming from 294 00:10:44,220 --> 00:10:46,879 a public funding source, but they are still 295 00:10:47,019 --> 00:10:48,240 as managed care organizations. 296 00:10:49,019 --> 00:10:51,100 They are still stewards of a lot of 297 00:10:51,100 --> 00:10:53,475 taxpayer dollars. And so I wonder what you 298 00:10:53,475 --> 00:10:56,035 would say to them in terms of they 299 00:10:56,035 --> 00:10:58,375 they might be tempted to deprioritize 300 00:10:59,075 --> 00:11:00,054 social determinants, 301 00:11:00,595 --> 00:11:01,575 programs entirely, 302 00:11:02,434 --> 00:11:04,914 as they see their Medicaid budgets tighten either 303 00:11:04,914 --> 00:11:06,835 within their state or because of what we're 304 00:11:06,835 --> 00:11:09,509 seeing at the federal level. So what would 305 00:11:09,509 --> 00:11:11,830 you say to a peer CMO who is 306 00:11:11,830 --> 00:11:13,690 weighing these decisions right now, 307 00:11:14,309 --> 00:11:17,769 either at an organization similarly structured as yours 308 00:11:17,830 --> 00:11:19,529 or at at some of the larger, 309 00:11:20,815 --> 00:11:23,375 nonprofits, publicly traded, just the the the gamut 310 00:11:23,375 --> 00:11:25,134 of the different kinds of insurers that are 311 00:11:25,134 --> 00:11:27,134 out there. Yeah. And I think whether you're 312 00:11:27,134 --> 00:11:29,074 at a for profit health plan, 313 00:11:29,375 --> 00:11:32,115 you're at a, you know, publicly traded one, 314 00:11:32,414 --> 00:11:34,735 or you're at one that's government associated like 315 00:11:34,735 --> 00:11:35,235 ours, 316 00:11:35,720 --> 00:11:37,480 I think that the challenge is still the 317 00:11:37,480 --> 00:11:37,980 same. 318 00:11:38,679 --> 00:11:41,160 And that challenge is really to identify what 319 00:11:41,160 --> 00:11:42,620 matters most to members. 320 00:11:43,399 --> 00:11:45,580 What is really going to change the trajectory 321 00:11:45,720 --> 00:11:48,840 of their care? And whether that person, again, 322 00:11:48,840 --> 00:11:50,379 is in your program for 323 00:11:50,694 --> 00:11:51,514 six months 324 00:11:51,815 --> 00:11:53,595 or two years, that doesn't change 325 00:11:54,134 --> 00:11:56,074 the value of the program that you're delivering. 326 00:11:56,375 --> 00:11:58,134 And so I don't think that we can 327 00:11:58,134 --> 00:12:00,774 be shortsighted to suggest, hey. Listen. There's a 328 00:12:00,774 --> 00:12:02,634 lot of budgetary pressure right now. 329 00:12:03,095 --> 00:12:05,115 And therefore, we're going to, 330 00:12:05,480 --> 00:12:07,980 you know, abandon some of these long term 331 00:12:08,840 --> 00:12:11,960 programs that actually deliver on better cost of 332 00:12:11,960 --> 00:12:14,560 care for membership down the line. And so 333 00:12:14,560 --> 00:12:16,759 I think it's less about, hey. We're gonna 334 00:12:16,759 --> 00:12:19,080 abandon ship on these things that are gonna 335 00:12:19,080 --> 00:12:21,735 bend that cost curve and more about finding 336 00:12:21,735 --> 00:12:24,134 the highest yield programs that we can actually 337 00:12:24,134 --> 00:12:26,214 invest in. And, you know, again, I'm I'm 338 00:12:26,214 --> 00:12:29,014 a very practical person. For me, it's, you 339 00:12:29,014 --> 00:12:30,774 know, I have a general sense as to, 340 00:12:30,774 --> 00:12:33,575 like, what what we should actually be investing 341 00:12:33,575 --> 00:12:35,789 in. You know, food is health. Housing is 342 00:12:35,789 --> 00:12:38,909 health. You know, there's a number of very 343 00:12:38,909 --> 00:12:41,250 important places where we can put our money 344 00:12:41,389 --> 00:12:42,929 that are gonna make a very 345 00:12:43,549 --> 00:12:44,049 quick, 346 00:12:45,149 --> 00:12:46,829 change in the trajectory of the care for 347 00:12:46,829 --> 00:12:48,644 our members. And I think it a lot 348 00:12:48,644 --> 00:12:50,264 of it is about having the right analytics 349 00:12:50,325 --> 00:12:51,684 to find the right folks who are gonna 350 00:12:51,684 --> 00:12:52,184 benefit. 351 00:12:52,565 --> 00:12:53,845 A lot of it is setting up the 352 00:12:53,845 --> 00:12:54,325 right, 353 00:12:54,644 --> 00:12:57,684 key performance indexes, the right metrics so that 354 00:12:57,684 --> 00:12:59,304 you can actually watch the improvement. 355 00:12:59,730 --> 00:13:01,490 And the third thing is just really being 356 00:13:01,490 --> 00:13:03,990 very practical about what you're gonna invest in. 357 00:13:04,129 --> 00:13:06,049 I would say that, you know, programs that 358 00:13:06,049 --> 00:13:09,730 are disease management programs, oftentimes building a population 359 00:13:09,730 --> 00:13:10,549 health infrastructure, 360 00:13:11,009 --> 00:13:12,690 those things do take a ton of time 361 00:13:12,690 --> 00:13:13,889 and the met you do need to have 362 00:13:13,889 --> 00:13:15,509 some consistency with your membership 363 00:13:15,884 --> 00:13:18,545 for those really to start benefiting members. 364 00:13:19,565 --> 00:13:21,725 But if you're gonna just build build a 365 00:13:21,725 --> 00:13:23,884 better community, if you're gonna invest in these 366 00:13:23,884 --> 00:13:24,384 things, 367 00:13:24,845 --> 00:13:28,205 that are very social determinant heavy, you're actually 368 00:13:28,205 --> 00:13:30,524 gonna build a health a healthier health care 369 00:13:30,524 --> 00:13:31,024 ecosystem 370 00:13:31,940 --> 00:13:34,740 for the membership to reside in. And when 371 00:13:34,740 --> 00:13:35,399 that happens, 372 00:13:35,860 --> 00:13:36,759 there's benefit. 373 00:13:37,220 --> 00:13:39,139 And, again, it can be very short term 374 00:13:39,139 --> 00:13:41,159 in terms of the benefit that you're getting. 375 00:13:41,379 --> 00:13:42,980 And even if and I I would also 376 00:13:42,980 --> 00:13:44,980 encourage other CMOs to really look at, like, 377 00:13:44,980 --> 00:13:46,600 what is the full gamut 378 00:13:47,945 --> 00:13:49,404 of benefit that you're deriving? 379 00:13:49,785 --> 00:13:51,865 Because it's not just, hey. Listen. There's gonna 380 00:13:51,865 --> 00:13:52,685 be less hospitalizations. 381 00:13:53,305 --> 00:13:55,465 It's a commitment to saying, hey. Listen. You 382 00:13:55,465 --> 00:13:58,185 know, we are gonna actually reduce the vicious 383 00:13:58,185 --> 00:14:00,685 cycle of having an inadequate network, 384 00:14:01,000 --> 00:14:04,300 of having difficult access to care, of having, 385 00:14:04,440 --> 00:14:06,519 you know, folks not being able to actually 386 00:14:06,519 --> 00:14:08,840 access the care because they don't have a 387 00:14:08,840 --> 00:14:09,899 home to live in. 388 00:14:10,279 --> 00:14:10,779 And 389 00:14:11,399 --> 00:14:13,019 having all those members 390 00:14:13,559 --> 00:14:15,554 reach out to us by way of the 391 00:14:15,554 --> 00:14:16,294 call center, 392 00:14:16,674 --> 00:14:17,174 grievances, 393 00:14:17,634 --> 00:14:18,134 appeals, 394 00:14:18,835 --> 00:14:21,075 all the angry like, all that stuff is 395 00:14:21,075 --> 00:14:22,215 a bunch of burden 396 00:14:22,835 --> 00:14:24,595 administrative burden on the plan. It's not good 397 00:14:24,595 --> 00:14:26,434 for members, not good for the plan. And 398 00:14:26,434 --> 00:14:28,355 if you can cut that vicious cycle off 399 00:14:28,355 --> 00:14:31,139 by creating that health, healthier health care ecosystem, 400 00:14:31,759 --> 00:14:32,580 you can actually 401 00:14:33,360 --> 00:14:36,000 have more efficiency and productivity at your actual 402 00:14:36,000 --> 00:14:37,920 plan. So you have to wrap some of 403 00:14:37,920 --> 00:14:39,920 those costs in to, hey. Listen. We're gonna 404 00:14:39,920 --> 00:14:41,920 actually reduce complaints on our line for the 405 00:14:41,920 --> 00:14:44,514 call center. We're gonna reduce appeals and grievances 406 00:14:44,514 --> 00:14:46,595 that come in through the door. We're gonna 407 00:14:46,595 --> 00:14:49,235 create, you know, a healthier flywheel here, and 408 00:14:49,235 --> 00:14:51,495 we're gonna do that by way of significant 409 00:14:51,554 --> 00:14:53,975 investments in network and social determinants of health. 410 00:14:54,115 --> 00:14:56,115 And so you take that ROI into account 411 00:14:56,115 --> 00:14:58,470 as well so that we're not just putting 412 00:14:58,470 --> 00:15:00,549 Band Aids on problems and spending money on 413 00:15:00,549 --> 00:15:03,929 administrative burden, but actually, again, making members healthier. 414 00:15:04,470 --> 00:15:06,709 Nobody wants to spend their life in a 415 00:15:06,709 --> 00:15:09,190 hospital or in a skilled nursing facility. They'd 416 00:15:09,190 --> 00:15:12,009 rather get their their care earlier and upfront, 417 00:15:12,774 --> 00:15:15,014 in a less expensive way. It's good for 418 00:15:15,014 --> 00:15:16,475 members. It's good for the plan. 419 00:15:16,934 --> 00:15:19,115 And when you can do that effectively 420 00:15:19,894 --> 00:15:22,134 by making the right investments, the right time, 421 00:15:22,134 --> 00:15:23,595 targeted to the right folks, 422 00:15:24,294 --> 00:15:25,115 you can actually 423 00:15:25,575 --> 00:15:27,115 significantly reduce costs 424 00:15:27,720 --> 00:15:29,480 on the administrative side as well as on 425 00:15:29,480 --> 00:15:31,179 the health care medical expense side. 426 00:15:31,879 --> 00:15:33,959 Fantastic. Well, I think that's a great place 427 00:15:33,959 --> 00:15:36,759 to leave things, Sameer. Some great bits of 428 00:15:36,759 --> 00:15:38,220 advice there for our audience, 429 00:15:39,079 --> 00:15:41,740 who are, you know, of course, facing similar, 430 00:15:42,544 --> 00:15:44,544 challenges as you and, 431 00:15:45,024 --> 00:15:45,764 a a lot 432 00:15:46,304 --> 00:15:48,245 of a lot of, I think tough conversations 433 00:15:48,384 --> 00:15:50,225 to come for plans all over the country. 434 00:15:50,225 --> 00:15:51,764 So I wanna thank you for, 435 00:15:52,384 --> 00:15:53,904 taking the time to chat with us about 436 00:15:53,904 --> 00:15:56,485 this and offering some some really good strategies 437 00:15:56,625 --> 00:15:57,684 on how to navigate, 438 00:15:58,360 --> 00:16:00,600 how to navigate this industry over the the 439 00:16:00,600 --> 00:16:02,759 coming year. Thank you very much. Appreciate it. 440 00:16:02,759 --> 00:16:05,000 It's been a great conversation. I really appreciate 441 00:16:05,000 --> 00:16:05,660 the time. 442 00:16:06,120 --> 00:16:08,200 Absolutely. And to our listeners, if you'd like 443 00:16:08,200 --> 00:16:10,540 to listen to more podcasts from Becker's Healthcare, 444 00:16:10,679 --> 00:16:13,580 you can visit beckershospitalreview.com.