1 00:00:00,410 --> 00:00:02,215 - Welcome to the Becker's Healthcare Podcast, made 2 00:00:02,215 --> 00:00:03,695 for the people who power healthcare. 3 00:00:03,975 --> 00:00:05,375 I am Molly PLE Becker's, 4 00:00:05,375 --> 00:00:06,735 and today delighted to have the chance 5 00:00:06,735 --> 00:00:08,175 to catch up with Steven Carson. 6 00:00:08,225 --> 00:00:11,335 Steve is the Senior Vice President for Population Health 7 00:00:11,365 --> 00:00:13,415 with Temple University Health System. 8 00:00:13,865 --> 00:00:15,295 Steve, welcome back to the podcast. 9 00:00:15,465 --> 00:00:17,655 Thank you so much for being my returning guest today. 10 00:00:18,275 --> 00:00:20,655 How are you doing? And, and where does the podcast find you? 11 00:00:22,035 --> 00:00:23,255 - Uh, thanks for having me back. 12 00:00:23,275 --> 00:00:25,935 Uh, the podcast finds me in a very busy place. 13 00:00:26,005 --> 00:00:28,815 This is an extraordinarily busy time of the year, preparing 14 00:00:28,815 --> 00:00:30,935 for next year taking a look how successful. 15 00:00:31,345 --> 00:00:33,535 We're not successful, we were in the prior year. 16 00:00:33,535 --> 00:00:35,295 Everything in my world is in calendar year, 17 00:00:35,295 --> 00:00:38,255 so we're going back retrospectively looking at calendar year 18 00:00:38,255 --> 00:00:41,455 23 and how we can improve it for 2024. 19 00:00:41,795 --> 00:00:43,215 So it's just a busy time for us. 20 00:00:43,475 --> 00:00:46,335 Um, and, um, thank you for, uh, inviting me back again. 21 00:00:46,885 --> 00:00:49,095 - Well, all the more grateful for you making time to, 22 00:00:49,095 --> 00:00:50,455 to do the podcast and be our guest. 23 00:00:50,455 --> 00:00:52,095 Steve, you know, for listeners 24 00:00:52,115 --> 00:00:54,935 who need a refresher on Temple University Health System 25 00:00:55,475 --> 00:00:57,415 and its Center for Population Health 26 00:00:57,555 --> 00:01:00,535 and your role within it, can, can you share an overview, uh, 27 00:01:00,535 --> 00:01:02,295 of both the center and and your work? 28 00:01:03,825 --> 00:01:05,565 - Uh, certainly. So, uh, the Center 29 00:01:05,585 --> 00:01:08,725 for Population Health has been a strategic asset 30 00:01:08,745 --> 00:01:10,565 for Temple Health, uh, related 31 00:01:10,665 --> 00:01:12,205 to our value-based care agreements. 32 00:01:12,545 --> 00:01:15,565 So we focus on, uh, several different, um, processes. 33 00:01:15,865 --> 00:01:18,765 We look at, um, how we manage our value-based care 34 00:01:18,765 --> 00:01:21,845 agreements, and we have a whole, um, uh, 35 00:01:22,485 --> 00:01:23,565 strategic asset group 36 00:01:23,945 --> 00:01:25,445 and in, in that management, 37 00:01:25,455 --> 00:01:27,325 which includes our primary care network, 38 00:01:27,545 --> 00:01:29,725 our care management programs, our hospital 39 00:01:29,785 --> 00:01:31,645 and skilled, um, facility networks, 40 00:01:31,865 --> 00:01:33,405 and also our quality programs. 41 00:01:33,405 --> 00:01:35,325 Because all those things tied together 42 00:01:35,665 --> 00:01:39,965 to really help manage our population health, um, uh, 43 00:01:39,965 --> 00:01:41,285 value-based care agreements. 44 00:01:41,285 --> 00:01:42,925 Because technically when we look at 45 00:01:42,925 --> 00:01:44,485 what we do within the center, 46 00:01:44,585 --> 00:01:46,445 we do population health management. 47 00:01:46,705 --> 00:01:49,885 How do we apply those tools that really focus on, uh, 48 00:01:49,885 --> 00:01:52,765 performance improvement within that group from both a, 49 00:01:53,165 --> 00:01:54,765 a quality and cost perspective? 50 00:01:55,825 --> 00:01:59,285 So the asset also focuses on, um, community 51 00:01:59,385 --> 00:02:01,125 and community resources and outreach. 52 00:02:01,125 --> 00:02:03,405 We spend a great deal of our work focused on social 53 00:02:03,765 --> 00:02:07,045 determinants of health and helping support our patients not 54 00:02:07,045 --> 00:02:08,405 only in our value-based care agreements, 55 00:02:08,425 --> 00:02:11,125 but our patients globally for Temple Health around food, 56 00:02:11,325 --> 00:02:13,405 housing, medical-legal partnerships, 57 00:02:13,585 --> 00:02:16,725 and, um, other resources that we can help patients 58 00:02:16,725 --> 00:02:18,805 to be successful once they're discharged 59 00:02:18,805 --> 00:02:19,805 or in the care of one 60 00:02:19,805 --> 00:02:22,565 of our primary care specialty physicians. 61 00:02:24,445 --> 00:02:26,505 - And Ste you mentioned this is a busy time. 62 00:02:26,505 --> 00:02:28,065 This is also a time for listeners, 63 00:02:28,125 --> 00:02:30,505 as I'm sure they're seeing that we're starting to get, 64 00:02:30,565 --> 00:02:33,185 and we're, we're continuing to get more data about 65 00:02:33,245 --> 00:02:35,985 how health systems fared throughout Covid to 19 66 00:02:36,085 --> 00:02:39,585 as it relates to a number of metrics around care, quality, 67 00:02:39,615 --> 00:02:41,665 patient safety, even the workforce. 68 00:02:42,365 --> 00:02:44,065 Um, and I, I, I wanted to spend some time there 69 00:02:44,185 --> 00:02:45,185 'cause you mentioned care quality 70 00:02:45,885 --> 00:02:47,745 and just to get a sense of your priorities right now 71 00:02:48,165 --> 00:02:49,745 or in those improvement efforts. 72 00:02:50,265 --> 00:02:53,505 I know last month CMS released a report finding some 73 00:02:53,505 --> 00:02:56,865 disparities in care quality in the hospitals, you know, pre 74 00:02:56,925 --> 00:02:59,165 and during pandemic finding a number 75 00:02:59,165 --> 00:03:01,805 of measures had worse than expected performance. 76 00:03:02,625 --> 00:03:03,885 We knew these hits were coming. 77 00:03:03,915 --> 00:03:05,085 This was not an easy time 78 00:03:05,085 --> 00:03:06,765 for health systems to be operating. 79 00:03:07,355 --> 00:03:09,605 What have been some of your biggest takeaways about quality 80 00:03:09,675 --> 00:03:12,245 improvement efforts pre and post pandemic? 81 00:03:12,255 --> 00:03:14,285 Where have you been focusing most of your time as of late? 82 00:03:15,545 --> 00:03:18,085 - Uh, great question and thank you lots to unpack there. 83 00:03:18,145 --> 00:03:20,725 So when you looked at the CMS report, you know, 84 00:03:20,725 --> 00:03:24,325 things were really focused on the inpatient networks, 85 00:03:24,435 --> 00:03:27,685 inpatient care delivery metrics, infection prevention, 86 00:03:28,245 --> 00:03:29,965 readmissions, things of that nature. 87 00:03:30,425 --> 00:03:32,725 And I think from a temple perspective, we have led 88 00:03:32,725 --> 00:03:34,685 with quality pre and post covid. 89 00:03:34,825 --> 00:03:36,845 It has been our primary rubric 90 00:03:37,505 --> 00:03:39,085 and we've been fortunate in 91 00:03:39,085 --> 00:03:43,165 that we have been very successful before, during, and even 92 00:03:43,215 --> 00:03:44,765 after, um, covid. 93 00:03:44,935 --> 00:03:48,565 We've seen, um, uh, we've seen, um, our, um, 94 00:03:48,675 --> 00:03:51,605 quality metrics actually improve over the course 95 00:03:51,625 --> 00:03:53,045 of the last four to five years. 96 00:03:53,385 --> 00:03:54,685 And that's really been a focus. 97 00:03:54,825 --> 00:03:57,765 We have an a rating, if you will, uh, for health grades. 98 00:03:58,045 --> 00:03:59,045 I think that's really important. 99 00:03:59,095 --> 00:04:00,165 We've been identified 100 00:04:00,265 --> 00:04:04,405 as a 2024 patient safety excellence top performer. 101 00:04:04,825 --> 00:04:06,645 So we have always led with quality, 102 00:04:06,695 --> 00:04:08,565 which is really important to understand. 103 00:04:08,825 --> 00:04:11,605 But really to go back to your question where those areas 104 00:04:11,605 --> 00:04:13,805 that slid somewhat during covid 105 00:04:14,265 --> 00:04:16,685 and that you really saw a lot of that during the period 106 00:04:16,685 --> 00:04:19,285 of time where offices from an ambulatory care perspective 107 00:04:19,305 --> 00:04:20,405 really closed down. 108 00:04:20,865 --> 00:04:25,205 And then as a result of that, the pivot to, uh, telehealth 109 00:04:25,905 --> 00:04:29,085 and also the, the, um, measures related to 110 00:04:29,665 --> 00:04:33,285 health screenings really declined mammography, 111 00:04:33,455 --> 00:04:35,485 colorectal screening, you know, 112 00:04:35,485 --> 00:04:38,605 those measures were required, the in-person touching. 113 00:04:38,985 --> 00:04:40,005 So you saw some of 114 00:04:40,005 --> 00:04:42,045 that backslide over the course of the year. 115 00:04:42,145 --> 00:04:45,725 And we've really seen in our quality improvement efforts 116 00:04:45,745 --> 00:04:47,205 and building our quality infrastructure, 117 00:04:47,215 --> 00:04:51,685 we've seen our most improvement in those areas over the, um, 118 00:04:51,865 --> 00:04:53,765 the past two years, to be honest with you. 119 00:04:54,265 --> 00:04:57,365 And today in some of our larger payers, we have finally 120 00:04:57,975 --> 00:04:59,085 moved the needle 121 00:04:59,425 --> 00:05:03,845 and really, um, helping us to be a four star, um, you know, 122 00:05:04,065 --> 00:05:06,525 uh, star measure from a Medicare perspective. 123 00:05:06,525 --> 00:05:08,485 We've seen our HEDIS scores go up 124 00:05:08,725 --> 00:05:10,885 and improve over the last several years 125 00:05:10,955 --> 00:05:12,725 because offices are back open. 126 00:05:12,745 --> 00:05:15,325 People are, feel comfortable going back into the practice 127 00:05:15,335 --> 00:05:17,645 again, and then actually feel comfortable going 128 00:05:17,705 --> 00:05:20,885 to radiology departments to get their mammographies into, 129 00:05:21,145 --> 00:05:23,125 you know, get, get the colorectal screening, 130 00:05:23,125 --> 00:05:25,245 whether it's in the office, pick up a fit kit, 131 00:05:25,245 --> 00:05:28,245 or actually having the colonoscopy, um, itself, 132 00:05:28,345 --> 00:05:30,285 so people are feeling more confident in 133 00:05:30,285 --> 00:05:31,365 going back into the office. 134 00:05:31,825 --> 00:05:34,685 So I think that that's where you saw some backsliding in the 135 00:05:34,685 --> 00:05:36,565 ambulatory care environment, um, 136 00:05:36,565 --> 00:05:38,205 because it was difficult to do some 137 00:05:38,205 --> 00:05:39,925 of this work without the inpatient touch. 138 00:05:39,925 --> 00:05:41,645 Telehealth took us to a certain degree 139 00:05:41,645 --> 00:05:43,805 but didn't really, you know, help in, um, 140 00:05:43,815 --> 00:05:46,885 other areas which required the, the high level of touch. 141 00:05:47,385 --> 00:05:49,445 So when you ask where our priorities were, 142 00:05:49,585 --> 00:05:51,645 mm-hmm , I think our priorities over the last 143 00:05:51,665 --> 00:05:54,405 two years has really been building that infrastructure. 144 00:05:54,535 --> 00:05:55,725 We've always had a core 145 00:05:56,185 --> 00:05:58,405 of quality on the ambulatory care side. 146 00:05:58,625 --> 00:06:00,925 And what we've done is expanded that core, 147 00:06:01,525 --> 00:06:03,805 expanded the cadence of the work that we're doing 148 00:06:03,835 --> 00:06:07,285 with our providers and how we actually engage our providers. 149 00:06:07,625 --> 00:06:09,285 And I think that that's really important, 150 00:06:09,285 --> 00:06:11,885 providing them the data they needed to be able to understand 151 00:06:12,105 --> 00:06:13,645 how to close those gaps in care 152 00:06:13,785 --> 00:06:18,765 and hey, help them be able to be successful in, um, in 153 00:06:18,765 --> 00:06:19,845 that quality outcome. 154 00:06:20,265 --> 00:06:22,205 And as we have continued to do that, 155 00:06:22,205 --> 00:06:24,605 we've added a chief medical officer to our programming, 156 00:06:24,605 --> 00:06:26,045 which is really critically important. 157 00:06:26,425 --> 00:06:27,805 You know, sometimes that physician 158 00:06:27,805 --> 00:06:30,125 to physician communication is much different than a 159 00:06:30,125 --> 00:06:31,645 physician to a nurse 160 00:06:31,645 --> 00:06:34,765 or even a physician to a, a quality project manager. 161 00:06:35,105 --> 00:06:38,405 So that has been really helpful for us to be able to build 162 00:06:38,435 --> 00:06:41,525 that, um, engagement with our providers as well. 163 00:06:41,785 --> 00:06:43,405 So we've seen improvement there. 164 00:06:43,425 --> 00:06:46,445 So our investments have really been how to explain, expand 165 00:06:46,445 --> 00:06:49,215 that quality management infrastructure. 166 00:06:49,275 --> 00:06:50,935 Mm-Hmm. . So we've spent a, we've spent a lot 167 00:06:50,935 --> 00:06:52,055 of time there around it 168 00:06:52,075 --> 00:06:54,815 and focused on what we need to do to be able to, 169 00:06:55,075 --> 00:06:56,495 uh, manage our work. 170 00:06:56,995 --> 00:06:59,715 - Mm-Hmm. , I'm remembering from our last 171 00:06:59,715 --> 00:07:01,555 conversation when we last connected for the podcast. 172 00:07:01,945 --> 00:07:03,115 There's a through line here 173 00:07:03,115 --> 00:07:04,555 because we spent some time in 174 00:07:04,555 --> 00:07:08,035 that conversation talking about tele visits as a tool 175 00:07:08,035 --> 00:07:10,915 and technology enabled care as a tool. 176 00:07:11,455 --> 00:07:12,795 But really how much of your work 177 00:07:12,795 --> 00:07:14,515 and strategy rests upon, like you said, 178 00:07:14,515 --> 00:07:16,555 that primary care touchstone 179 00:07:16,615 --> 00:07:19,475 and those in in-person care appointments. 180 00:07:19,935 --> 00:07:22,595 Um, can, can you share any success stories or, 181 00:07:22,615 --> 00:07:25,995 or case studies with us, Steve, where embedding caregivers 182 00:07:26,575 --> 00:07:29,035 has really resulted in some notable improvements, 183 00:07:29,035 --> 00:07:31,475 either in patient outcomes or experiences? 184 00:07:32,455 --> 00:07:34,955 We spoke about embedding caregivers last time, 185 00:07:35,055 --> 00:07:37,435 and I'm just curious if there was a, a story you could share 186 00:07:37,435 --> 00:07:38,835 with us in greater detail about that. 187 00:07:40,185 --> 00:07:41,435 - Yeah, I think that that's a, 188 00:07:41,435 --> 00:07:42,715 thank you for asking that question. 189 00:07:42,795 --> 00:07:45,115 I think that's really a good point about the embedding 190 00:07:45,115 --> 00:07:46,155 of our nurse navigators. 191 00:07:46,155 --> 00:07:49,355 That has been really a critical tool for us, um, 192 00:07:49,505 --> 00:07:52,755 that the nurse navigator has been the person who's been 193 00:07:52,755 --> 00:07:55,435 that connection point between the provider and the patient 194 00:07:55,975 --> 00:07:59,795 and really driving many of the care management 195 00:08:00,525 --> 00:08:02,635 strategies, um, with the patient 196 00:08:02,855 --> 00:08:04,795 and following up on the care that they may need, 197 00:08:04,795 --> 00:08:05,875 whether it's a resource 198 00:08:05,935 --> 00:08:08,275 or whether it's they need a community health worker 199 00:08:08,375 --> 00:08:12,395 to help follow through on a particular, um, application 200 00:08:12,655 --> 00:08:14,315 for a service that they may need. 201 00:08:14,735 --> 00:08:17,555 So we've been seeing a tremendous amount of success 202 00:08:18,095 --> 00:08:20,595 around the use of these embedded care managers. 203 00:08:20,815 --> 00:08:22,755 And what you see with this group over time, 204 00:08:22,755 --> 00:08:24,915 you've seen improvement of our readmission rates. 205 00:08:25,615 --> 00:08:28,835 Um, you've seen a reduction in, you know, um, 206 00:08:29,145 --> 00:08:30,475 unplanned admissions 207 00:08:30,475 --> 00:08:33,115 because there's that open line of communication 208 00:08:33,385 --> 00:08:36,915 between the provider, the member, the patient, and the, 209 00:08:36,915 --> 00:08:38,875 and the nurse navigator that's working in concert 210 00:08:38,875 --> 00:08:40,915 with the physician in the office, uh, 211 00:08:40,915 --> 00:08:43,955 and working in concert with the patient from a, you know, 212 00:08:44,055 --> 00:08:45,475 telecommunication standpoint. 213 00:08:45,695 --> 00:08:46,875 The patient's more engaged 214 00:08:46,875 --> 00:08:48,275 because they now know that person 215 00:08:48,365 --> 00:08:49,715 who's on the other end of the phone. 216 00:08:50,255 --> 00:08:53,715 Um, it's not just a random, you know, anonymous voice making 217 00:08:53,715 --> 00:08:55,440 that phone call that they've met 218 00:08:55,440 --> 00:08:57,365 that person in the office at some point in time. 219 00:08:57,465 --> 00:09:00,365 So there's a connection. So I think that we've seen that, 220 00:09:00,425 --> 00:09:02,525 and that was a strategic change for us. 221 00:09:02,825 --> 00:09:06,205 We had a a hundred percent telehealth model when it 222 00:09:06,205 --> 00:09:07,285 came to nurse navigation. 223 00:09:07,665 --> 00:09:11,125 So when we flipped that last year, it was really, we did it 224 00:09:11,125 --> 00:09:13,205 with the knowledge that we wanted 225 00:09:13,365 --> 00:09:16,125 to engage both our physicians as well 226 00:09:16,125 --> 00:09:17,285 as the patients differently. 227 00:09:17,705 --> 00:09:21,885 And I see that playing out in our overall outcomes when it 228 00:09:21,885 --> 00:09:23,765 look, when we look at patient 229 00:09:23,815 --> 00:09:25,925 experience, are they satisfied? 230 00:09:26,305 --> 00:09:27,885 You know, are they, you know, are they following 231 00:09:27,885 --> 00:09:29,605 through on their, um, transition of care? 232 00:09:29,945 --> 00:09:32,365 So we're seeing lots of improvement around that. 233 00:09:32,585 --> 00:09:35,005 And we've seen nice, um, uh, 234 00:09:35,465 --> 00:09:37,765 member satisfaction scores as a result of it. 235 00:09:37,765 --> 00:09:38,765 - Mm-Hmm. . Mm-Hmm. . 236 00:09:39,765 --> 00:09:41,245 I mean, I think that's a pretty remarkable shift 237 00:09:41,245 --> 00:09:43,925 to go from 100% telehealth model 238 00:09:43,945 --> 00:09:45,885 for nurse navigation to now the in-person. 239 00:09:46,025 --> 00:09:48,725 And then reaching those results that you just shared 240 00:09:48,725 --> 00:09:50,045 with us about readmissions 241 00:09:50,065 --> 00:09:52,045 and unplanned admissions going down 242 00:09:52,505 --> 00:09:53,925 and just the utilization rates, 243 00:09:53,945 --> 00:09:57,125 the fact those relationships are things something that pe pa 244 00:09:58,215 --> 00:09:59,985 something that patients are returning to. 245 00:10:02,125 --> 00:10:04,345 - No, agreed. And I think that that's been really a, 246 00:10:04,425 --> 00:10:06,185 a nice transition back into the practice 247 00:10:06,185 --> 00:10:08,385 because now there's something, they now have something 248 00:10:08,385 --> 00:10:09,985 different to look forward to. 249 00:10:10,205 --> 00:10:11,105 Mm-Hmm. to look forward to, to have a 250 00:10:11,105 --> 00:10:12,385 different relationship in the office. 251 00:10:12,645 --> 00:10:14,385 And, and we've spent a lot of time 252 00:10:14,905 --> 00:10:16,665 engaging like all levels of the office. 253 00:10:16,805 --> 00:10:18,985 So it's that experience, just not the navigator, 254 00:10:19,015 --> 00:10:20,225 it's the person at the front desk. 255 00:10:20,335 --> 00:10:23,305 It's the person who's rooming the, um, rooting the patient 256 00:10:23,565 --> 00:10:24,705 and, you know, engaging them. 257 00:10:25,625 --> 00:10:29,985 I think the one thing that I wanted to add, when we look at, 258 00:10:30,165 --> 00:10:34,845 um, um, projects, I wanted to go back on something 259 00:10:35,005 --> 00:10:37,045 'cause I think this all ties in together 260 00:10:37,195 --> 00:10:40,645 with this in-person navigator in the office, is 261 00:10:40,645 --> 00:10:42,445 that we have been tremendously focused 262 00:10:42,445 --> 00:10:43,885 around the social determinants of health. 263 00:10:44,505 --> 00:10:47,125 We have been screening patients for a long time 264 00:10:47,205 --> 00:10:48,925 around their social determinants, 265 00:10:49,115 --> 00:10:53,525 looking at things like housing and food, um, transportation. 266 00:10:54,145 --> 00:10:56,725 Um, because they're the things that people struggle with 267 00:10:56,825 --> 00:10:58,045 to come back into the office. 268 00:10:58,785 --> 00:11:02,405 And our, um, program for um, screening 269 00:11:02,955 --> 00:11:05,485 also has led us to focus on different areas 270 00:11:05,825 --> 00:11:07,085 of health disparities. 271 00:11:07,545 --> 00:11:09,525 Not only from a social determinant perspective, 272 00:11:09,625 --> 00:11:11,325 but also from an access perspective. 273 00:11:11,745 --> 00:11:15,765 You know, focus, we are part of the A CO reach, uh, 274 00:11:15,895 --> 00:11:17,245 pilot with CMS. 275 00:11:17,785 --> 00:11:19,725 In a CO reach, you have a health, you know, 276 00:11:19,725 --> 00:11:20,885 you have a health equity plan 277 00:11:20,885 --> 00:11:21,965 that you have to be able to develop. 278 00:11:21,965 --> 00:11:25,485 And we've chosen hypertension about how our black 279 00:11:25,485 --> 00:11:30,085 and brown communities access, um, services for hypertension 280 00:11:30,465 --> 00:11:32,765 and being able to give them resources, um, 281 00:11:32,765 --> 00:11:35,925 within our hypertensive group from a, um, 282 00:11:35,925 --> 00:11:37,045 telehealth perspective. 283 00:11:37,445 --> 00:11:38,485 'cause we are using remote patient 284 00:11:38,485 --> 00:11:40,325 monitoring in those cases. 285 00:11:40,825 --> 00:11:42,445 And that's been also successful. 286 00:11:42,505 --> 00:11:44,605 So now you have, you've tied together 287 00:11:44,605 --> 00:11:46,045 that nurse navigator in the office, 288 00:11:46,145 --> 00:11:47,805 you've addressed social determinants, 289 00:11:47,805 --> 00:11:49,325 you're looking at a health disparity 290 00:11:49,665 --> 00:11:51,765 and you're now continuing to engage 291 00:11:52,305 --> 00:11:54,045 the physician and the patient. 292 00:11:54,705 --> 00:11:56,205 So I think that all those things kind 293 00:11:56,205 --> 00:11:57,445 of tied together in the end. 294 00:11:57,445 --> 00:11:58,965 So I think there, you know, when you look at 295 00:11:58,965 --> 00:12:01,485 where we spend our time quality 296 00:12:01,625 --> 00:12:04,165 and that level of engagement with our, um, 297 00:12:04,315 --> 00:12:05,725 patient membership has really 298 00:12:05,725 --> 00:12:07,005 been critically important for us. 299 00:12:07,185 --> 00:12:09,445 And that change with the nurse navigators has been 300 00:12:09,445 --> 00:12:11,165 extraordinarily beneficial. Mm-Hmm. 301 00:12:11,205 --> 00:12:13,675 - and social determinants of health. 302 00:12:13,675 --> 00:12:16,355 You, you mentioned housing, food, transportation, I mean, 303 00:12:16,405 --> 00:12:19,435 these require partnerships at the Temple Center 304 00:12:19,495 --> 00:12:20,515 for Population Health. 305 00:12:21,175 --> 00:12:23,235 Can you highlight one partner relationship 306 00:12:23,305 --> 00:12:26,115 that you found particularly effective, Steve, 307 00:12:26,115 --> 00:12:27,195 and, and tell us why that is. 308 00:12:28,605 --> 00:12:31,065 - Um, um, and thinking about it, 309 00:12:31,145 --> 00:12:33,505 there's a couple partnerships I'm gonna outline 310 00:12:33,505 --> 00:12:34,785 for you briefly because I think 311 00:12:34,785 --> 00:12:36,905 that those will really help you understand 312 00:12:37,155 --> 00:12:39,345 where we are organizationally. 313 00:12:40,085 --> 00:12:42,545 And I think that, you know, we're in north Philadelphia 314 00:12:42,675 --> 00:12:45,425 where, um, temple main campuses 315 00:12:45,425 --> 00:12:47,225 and where our Episcopal campuses, 316 00:12:47,225 --> 00:12:49,025 which is a behavioral health location, 317 00:12:49,695 --> 00:12:52,745 there's a strong homelessness patient population. 318 00:12:52,845 --> 00:12:55,225 And there's also a high, you know, like all 319 00:12:55,225 --> 00:12:59,265 of us in in the country are experiencing, um, you know, 320 00:12:59,265 --> 00:13:02,225 high opioid use disorders, individuals. 321 00:13:02,485 --> 00:13:03,745 So between homelessness and epi 322 00:13:03,885 --> 00:13:08,065 and uh, uh, opioid use disorder patients, there's really, 323 00:13:08,405 --> 00:13:09,425 you know, they're complex. 324 00:13:09,425 --> 00:13:11,225 They're complex 'cause they may have wounds. 325 00:13:11,225 --> 00:13:12,545 They're complex because they're, 326 00:13:12,575 --> 00:13:14,065 there's nowhere to place them. 327 00:13:14,125 --> 00:13:16,065 And often, um, our, you know, 328 00:13:16,275 --> 00:13:18,705 acute care hospital leadership are always struggling with, 329 00:13:18,805 --> 00:13:22,105 you know, how to move the, um, patient along a continuum 330 00:13:22,105 --> 00:13:24,585 of care when their continuum doesn't really exist. 331 00:13:25,325 --> 00:13:27,145 So, you know, we have partnered 332 00:13:27,175 --> 00:13:29,305 with a group called Project Home in Philadelphia. 333 00:13:29,845 --> 00:13:34,265 Um, they've been in the homelessness, um, arena 334 00:13:34,565 --> 00:13:37,745 for over 30 years, creating respites and housing. 335 00:13:37,965 --> 00:13:42,065 And, and those, um, programs have really been helpful 336 00:13:42,085 --> 00:13:43,825 to place patients in the community. 337 00:13:44,325 --> 00:13:46,665 So we are working with Project Home 338 00:13:46,885 --> 00:13:50,945 and we're also working as part of a project with them, with, 339 00:13:51,005 --> 00:13:53,945 um, other health systems in the Philadelphia marketplace, 340 00:13:54,135 --> 00:13:55,265 Penn and Jefferson. 341 00:13:55,725 --> 00:13:59,185 Um, in a gift that was provided by, um, hemostat 342 00:13:59,185 --> 00:14:03,255 and Iron Lubert to help us design a program 343 00:14:03,595 --> 00:14:07,335 and a process in which we address opioid use disorder 344 00:14:07,485 --> 00:14:11,055 through, um, substance use, um, programming as well 345 00:14:11,055 --> 00:14:12,095 as identifying 346 00:14:12,715 --> 00:14:16,615 and building, if you will, respite to, um, temporary housing 347 00:14:16,685 --> 00:14:18,095 that will lead to permanent housing. 348 00:14:18,235 --> 00:14:19,535 Mm-Hmm. . So that's a fairly 349 00:14:19,535 --> 00:14:20,615 significant project. 350 00:14:20,715 --> 00:14:21,975 And that really started with us 351 00:14:22,045 --> 00:14:24,535 with a project we called Housing Smart, 352 00:14:24,745 --> 00:14:26,975 where we took a small group of patients 353 00:14:26,995 --> 00:14:29,215 who were homeless substance use disorder, 354 00:14:29,235 --> 00:14:30,295 placed them in housing. 355 00:14:30,675 --> 00:14:34,535 And we were able to identify that by stabilizing housing, 356 00:14:35,095 --> 00:14:37,895 stabilizing medical care, you saw a reduction in 357 00:14:37,895 --> 00:14:42,615 inappropriate utilization of the, of the emergency room. 358 00:14:42,875 --> 00:14:45,295 You saw a slight reduction around, um, 359 00:14:45,355 --> 00:14:46,695 in acute care admissions 360 00:14:46,695 --> 00:14:48,735 because some of those acute care admissions were social, 361 00:14:48,805 --> 00:14:50,655 some of them were actually, um, 362 00:14:51,645 --> 00:14:53,245 required based on clinical conditioning. 363 00:14:53,245 --> 00:14:56,085 So when I say you saw a slight reduction, maybe it was 10% 364 00:14:56,105 --> 00:15:00,605 as compared to ed, you saw a 75% reduction in utilization. 365 00:15:01,065 --> 00:15:03,405 So we knew that the process was worked and when, 366 00:15:03,705 --> 00:15:05,925 and we collaborated with Project Home 367 00:15:05,925 --> 00:15:07,085 to be able to begin this process. 368 00:15:07,185 --> 00:15:10,605 So we're very early in that journey in order to be able 369 00:15:10,605 --> 00:15:14,285 to create access to a very complex patient population 370 00:15:14,285 --> 00:15:15,445 who has complex needs 371 00:15:15,705 --> 00:15:18,205 and housing is a key part of that programming. 372 00:15:19,135 --> 00:15:20,195 And so I think that, you know, 373 00:15:20,195 --> 00:15:23,115 that's a huge effort on our part at this point in time. 374 00:15:23,615 --> 00:15:25,315 And the other area that's unique 375 00:15:25,315 --> 00:15:28,675 and innovative, um, that we're doing is really 376 00:15:28,675 --> 00:15:29,915 around a health hub. 377 00:15:30,335 --> 00:15:32,595 We have collaborated with a local supermarket, 378 00:15:32,795 --> 00:15:34,155 ShopRite in our community, 379 00:15:34,455 --> 00:15:37,395 and we've placed a health screening hub in the 380 00:15:37,395 --> 00:15:38,915 supermarket near the entrance. 381 00:15:39,255 --> 00:15:40,555 We walk into the supermarket. 382 00:15:41,015 --> 00:15:43,795 So we have the ability to screen patients for hypertension. 383 00:15:44,615 --> 00:15:48,675 Um, we have the, uh, stroke awareness, um, brain health. 384 00:15:49,255 --> 00:15:51,155 We have pharmacists there who are doing 385 00:15:51,685 --> 00:15:53,155 medication education. 386 00:15:53,375 --> 00:15:54,715 We have a diabetes program 387 00:15:55,135 --> 00:15:58,555 and we put that programming all around that health hub, 388 00:15:58,565 --> 00:16:01,235 which is linked to a mobile health vehicle 389 00:16:01,235 --> 00:16:02,875 that actually goes out to the community. 390 00:16:03,175 --> 00:16:05,635 So that programming that we're offering in the hub 391 00:16:06,155 --> 00:16:07,435 actually goes out into the community. 392 00:16:07,815 --> 00:16:11,355 And the sole purpose is really about, you know, helping, 393 00:16:11,655 --> 00:16:13,555 you know, hypertension, as I mentioned earlier, 394 00:16:13,615 --> 00:16:17,035 is such a huge condition in our community. 395 00:16:17,375 --> 00:16:18,955 And when you tie that to diabetes 396 00:16:19,055 --> 00:16:21,995 and smoking, it also ties a high risk of stroke. 397 00:16:22,815 --> 00:16:24,875 And when you look at all those pieces together, 398 00:16:24,975 --> 00:16:26,635 our job here is really to help screen 399 00:16:26,735 --> 00:16:29,355 and help people get into care, um, 400 00:16:29,615 --> 00:16:32,515 before they're in the condition of having a stroke. 401 00:16:32,615 --> 00:16:34,075 So how to manage it Mm-Hmm. . 402 00:16:34,075 --> 00:16:36,715 So we're using that health hub, our mobile health 403 00:16:36,935 --> 00:16:40,995 as another way to be able to screen create access 404 00:16:41,655 --> 00:16:44,075 and, um, create an ability to follow up care. 405 00:16:44,615 --> 00:16:46,155 So when I look at, you know, so I see 406 00:16:46,155 --> 00:16:48,635 that is pretty innovative as far as how we're creating 407 00:16:48,635 --> 00:16:50,075 that level of access, um, 408 00:16:50,095 --> 00:16:52,315 for our community here in North Philadelphia. 409 00:16:52,895 --> 00:16:57,355 So combined with the two of those, um, the a critical 410 00:16:58,115 --> 00:16:59,315 clinical need in our community 411 00:16:59,415 --> 00:17:03,275 and being innovative around access are probably some 412 00:17:03,275 --> 00:17:05,915 of the two biggest projects when I look at partnerships 413 00:17:05,935 --> 00:17:09,435 and relationships, um, in the work that we do. Mm-Hmm. 414 00:17:09,475 --> 00:17:11,995 - , I think too, you, you just illustrated 415 00:17:12,055 --> 00:17:14,355 so wonderfully, Steve, how interconnected so many 416 00:17:14,355 --> 00:17:16,675 of these health outcomes and behaviors are. 417 00:17:17,215 --> 00:17:20,395 And so this work, it's, it's difficult and it's challenging, 418 00:17:20,415 --> 00:17:23,715 but such meaningful work to be able to meet patients 419 00:17:23,715 --> 00:17:25,075 and then also hit the levers 420 00:17:25,075 --> 00:17:26,635 and meet their needs in different ways 421 00:17:26,635 --> 00:17:28,675 that can contribute upstream, uh, 422 00:17:28,695 --> 00:17:30,835 to the downstream health effects 423 00:17:30,835 --> 00:17:32,115 that would bring them into the ED 424 00:17:32,115 --> 00:17:33,675 or other care settings like that. 425 00:17:33,855 --> 00:17:35,315 So thank you so much for sharing 426 00:17:35,315 --> 00:17:36,515 that in greater detail with us. 427 00:17:37,385 --> 00:17:39,635 It's been so great catching up with you today, Steve. 428 00:17:39,655 --> 00:17:41,915 Is is there anything you'd like to close with, uh, 429 00:17:42,015 --> 00:17:44,235 our listeners or share with them in, in closing? 430 00:17:45,075 --> 00:17:46,805 - Yeah. I think as we think about the work 431 00:17:46,805 --> 00:17:49,165 that we're doing from a population health management 432 00:17:49,400 --> 00:17:52,005 perspective, I really think that combination 433 00:17:52,625 --> 00:17:54,485 of quality care management 434 00:17:54,585 --> 00:17:58,285 and access to community resources have really been a vital 435 00:17:58,765 --> 00:18:01,405 function and also vital to our success 436 00:18:01,465 --> 00:18:03,605 and helping our patients achieve their goals. 437 00:18:04,265 --> 00:18:06,325 So when I look at that and I look at the, the, 438 00:18:06,385 --> 00:18:09,685 the world in which we, um, uh, live in, I think there, 439 00:18:09,685 --> 00:18:11,685 those are really three key areas that 440 00:18:11,745 --> 00:18:13,365 as people look at population health 441 00:18:13,365 --> 00:18:16,205 and population health management strategies, they're areas 442 00:18:16,205 --> 00:18:17,845 that they could be successful in. 443 00:18:20,175 --> 00:18:22,645 - Steve Carson, senior Vice President for Population health 444 00:18:22,675 --> 00:18:24,405 with Temple University Health System. 445 00:18:24,455 --> 00:18:26,245 Thank you again, Steve for returning 446 00:18:26,245 --> 00:18:27,885 to the podcast and being my guest today. 447 00:18:29,675 --> 00:18:30,625 - Thank you for having me.