- Welcome to the Becker's Healthcare Podcast, made
for the people who power healthcare.
I am Molly PLE Becker's,
and today delighted to have the chance
to catch up with Steven Carson.
Steve is the Senior Vice President for Population Health
with Temple University Health System.
Steve, welcome back to the podcast.
Thank you so much for being my returning guest today.
How are you doing? And, and where does the podcast find you?
- Uh, thanks for having me back.
Uh, the podcast finds me in a very busy place.
This is an extraordinarily busy time of the year, preparing
for next year taking a look how successful.
We're not successful, we were in the prior year.
Everything in my world is in calendar year,
so we're going back retrospectively looking at calendar year
23 and how we can improve it for 2024.
So it's just a busy time for us.
Um, and, um, thank you for, uh, inviting me back again.
- Well, all the more grateful for you making time to,
to do the podcast and be our guest.
Steve, you know, for listeners
who need a refresher on Temple University Health System
and its Center for Population Health
and your role within it, can, can you share an overview, uh,
of both the center and and your work?
- Uh, certainly. So, uh, the Center
for Population Health has been a strategic asset
for Temple Health, uh, related
to our value-based care agreements.
So we focus on, uh, several different, um, processes.
We look at, um, how we manage our value-based care
agreements, and we have a whole, um, uh,
strategic asset group
and in, in that management,
which includes our primary care network,
our care management programs, our hospital
and skilled, um, facility networks,
and also our quality programs.
Because all those things tied together
to really help manage our population health, um, uh,
value-based care agreements.
Because technically when we look at
what we do within the center,
we do population health management.
How do we apply those tools that really focus on, uh,
performance improvement within that group from both a,
a quality and cost perspective?
So the asset also focuses on, um, community
and community resources and outreach.
We spend a great deal of our work focused on social
determinants of health and helping support our patients not
only in our value-based care agreements,
but our patients globally for Temple Health around food,
housing, medical-legal partnerships,
and, um, other resources that we can help patients
to be successful once they're discharged
or in the care of one
of our primary care specialty physicians.
- And Ste you mentioned this is a busy time.
This is also a time for listeners,
as I'm sure they're seeing that we're starting to get,
and we're, we're continuing to get more data about
how health systems fared throughout Covid to 19
as it relates to a number of metrics around care, quality,
patient safety, even the workforce.
Um, and I, I, I wanted to spend some time there
'cause you mentioned care quality
and just to get a sense of your priorities right now
or in those improvement efforts.
I know last month CMS released a report finding some
disparities in care quality in the hospitals, you know, pre
and during pandemic finding a number
of measures had worse than expected performance.
We knew these hits were coming.
This was not an easy time
for health systems to be operating.
What have been some of your biggest takeaways about quality
improvement efforts pre and post pandemic?
Where have you been focusing most of your time as of late?
- Uh, great question and thank you lots to unpack there.
So when you looked at the CMS report, you know,
things were really focused on the inpatient networks,
inpatient care delivery metrics, infection prevention,
readmissions, things of that nature.
And I think from a temple perspective, we have led
with quality pre and post covid.
It has been our primary rubric
and we've been fortunate in
that we have been very successful before, during, and even
after, um, covid.
We've seen, um, uh, we've seen, um, our, um,
quality metrics actually improve over the course
of the last four to five years.
And that's really been a focus.
We have an a rating, if you will, uh, for health grades.
I think that's really important.
We've been identified
as a 2024 patient safety excellence top performer.
So we have always led with quality,
which is really important to understand.
But really to go back to your question where those areas
that slid somewhat during covid
and that you really saw a lot of that during the period
of time where offices from an ambulatory care perspective
really closed down.
And then as a result of that, the pivot to, uh, telehealth
and also the, the, um, measures related to
health screenings really declined mammography,
colorectal screening, you know,
those measures were required, the in-person touching.
So you saw some of
that backslide over the course of the year.
And we've really seen in our quality improvement efforts
and building our quality infrastructure,
we've seen our most improvement in those areas over the, um,
the past two years, to be honest with you.
And today in some of our larger payers, we have finally
moved the needle
and really, um, helping us to be a four star, um, you know,
uh, star measure from a Medicare perspective.
We've seen our HEDIS scores go up
and improve over the last several years
because offices are back open.
People are, feel comfortable going back into the practice
again, and then actually feel comfortable going
to radiology departments to get their mammographies into,
you know, get, get the colorectal screening,
whether it's in the office, pick up a fit kit,
or actually having the colonoscopy, um, itself,
so people are feeling more confident in
going back into the office.
So I think that that's where you saw some backsliding in the
ambulatory care environment, um,
because it was difficult to do some
of this work without the inpatient touch.
Telehealth took us to a certain degree
but didn't really, you know, help in, um,
other areas which required the, the high level of touch.
So when you ask where our priorities were,
mm-hmm , I think our priorities over the last
two years has really been building that infrastructure.
We've always had a core
of quality on the ambulatory care side.
And what we've done is expanded that core,
expanded the cadence of the work that we're doing
with our providers and how we actually engage our providers.
And I think that that's really important,
providing them the data they needed to be able to understand
how to close those gaps in care
and hey, help them be able to be successful in, um, in
that quality outcome.
And as we have continued to do that,
we've added a chief medical officer to our programming,
which is really critically important.
You know, sometimes that physician
to physician communication is much different than a
physician to a nurse
or even a physician to a, a quality project manager.
So that has been really helpful for us to be able to build
that, um, engagement with our providers as well.
So we've seen improvement there.
So our investments have really been how to explain, expand
that quality management infrastructure.
Mm-Hmm. . So we've spent a, we've spent a lot
of time there around it
and focused on what we need to do to be able to,
uh, manage our work.
- Mm-Hmm. , I'm remembering from our last
conversation when we last connected for the podcast.
There's a through line here
because we spent some time in
that conversation talking about tele visits as a tool
and technology enabled care as a tool.
But really how much of your work
and strategy rests upon, like you said,
that primary care touchstone
and those in in-person care appointments.
Um, can, can you share any success stories or,
or case studies with us, Steve, where embedding caregivers
has really resulted in some notable improvements,
either in patient outcomes or experiences?
We spoke about embedding caregivers last time,
and I'm just curious if there was a, a story you could share
with us in greater detail about that.
- Yeah, I think that that's a,
thank you for asking that question.
I think that's really a good point about the embedding
of our nurse navigators.
That has been really a critical tool for us, um,
that the nurse navigator has been the person who's been
that connection point between the provider and the patient
and really driving many of the care management
strategies, um, with the patient
and following up on the care that they may need,
whether it's a resource
or whether it's they need a community health worker
to help follow through on a particular, um, application
for a service that they may need.
So we've been seeing a tremendous amount of success
around the use of these embedded care managers.
And what you see with this group over time,
you've seen improvement of our readmission rates.
Um, you've seen a reduction in, you know, um,
unplanned admissions
because there's that open line of communication
between the provider, the member, the patient, and the,
and the nurse navigator that's working in concert
with the physician in the office, uh,
and working in concert with the patient from a, you know,
telecommunication standpoint.
The patient's more engaged
because they now know that person
who's on the other end of the phone.
Um, it's not just a random, you know, anonymous voice making
that phone call that they've met
that person in the office at some point in time.
So there's a connection. So I think that we've seen that,
and that was a strategic change for us.
We had a a hundred percent telehealth model when it
came to nurse navigation.
So when we flipped that last year, it was really, we did it
with the knowledge that we wanted
to engage both our physicians as well
as the patients differently.
And I see that playing out in our overall outcomes when it
look, when we look at patient
experience, are they satisfied?
You know, are they, you know, are they following
through on their, um, transition of care?
So we're seeing lots of improvement around that.
And we've seen nice, um, uh,
member satisfaction scores as a result of it.
- Mm-Hmm. . Mm-Hmm. .
I mean, I think that's a pretty remarkable shift
to go from 100% telehealth model
for nurse navigation to now the in-person.
And then reaching those results that you just shared
with us about readmissions
and unplanned admissions going down
and just the utilization rates,
the fact those relationships are things something that pe pa
something that patients are returning to.
- No, agreed. And I think that that's been really a,
a nice transition back into the practice
because now there's something, they now have something
different to look forward to.
Mm-Hmm. to look forward to, to have a
different relationship in the office.
And, and we've spent a lot of time
engaging like all levels of the office.
So it's that experience, just not the navigator,
it's the person at the front desk.
It's the person who's rooming the, um, rooting the patient
and, you know, engaging them.
I think the one thing that I wanted to add, when we look at,
um, um, projects, I wanted to go back on something
'cause I think this all ties in together
with this in-person navigator in the office, is
that we have been tremendously focused
around the social determinants of health.
We have been screening patients for a long time
around their social determinants,
looking at things like housing and food, um, transportation.
Um, because they're the things that people struggle with
to come back into the office.
And our, um, program for um, screening
also has led us to focus on different areas
of health disparities.
Not only from a social determinant perspective,
but also from an access perspective.
You know, focus, we are part of the A CO reach, uh,
pilot with CMS.
In a CO reach, you have a health, you know,
you have a health equity plan
that you have to be able to develop.
And we've chosen hypertension about how our black
and brown communities access, um, services for hypertension
and being able to give them resources, um,
within our hypertensive group from a, um,
telehealth perspective.
'cause we are using remote patient
monitoring in those cases.
And that's been also successful.
So now you have, you've tied together
that nurse navigator in the office,
you've addressed social determinants,
you're looking at a health disparity
and you're now continuing to engage
the physician and the patient.
So I think that all those things kind
of tied together in the end.
So I think there, you know, when you look at
where we spend our time quality
and that level of engagement with our, um,
patient membership has really
been critically important for us.
And that change with the nurse navigators has been
extraordinarily beneficial. Mm-Hmm.
- and social determinants of health.
You, you mentioned housing, food, transportation, I mean,
these require partnerships at the Temple Center
for Population Health.
Can you highlight one partner relationship
that you found particularly effective, Steve,
and, and tell us why that is.
- Um, um, and thinking about it,
there's a couple partnerships I'm gonna outline
for you briefly because I think
that those will really help you understand
where we are organizationally.
And I think that, you know, we're in north Philadelphia
where, um, temple main campuses
and where our Episcopal campuses,
which is a behavioral health location,
there's a strong homelessness patient population.
And there's also a high, you know, like all
of us in in the country are experiencing, um, you know,
high opioid use disorders, individuals.
So between homelessness and epi
and uh, uh, opioid use disorder patients, there's really,
you know, they're complex.
They're complex 'cause they may have wounds.
They're complex because they're,
there's nowhere to place them.
And often, um, our, you know,
acute care hospital leadership are always struggling with,
you know, how to move the, um, patient along a continuum
of care when their continuum doesn't really exist.
So, you know, we have partnered
with a group called Project Home in Philadelphia.
Um, they've been in the homelessness, um, arena
for over 30 years, creating respites and housing.
And, and those, um, programs have really been helpful
to place patients in the community.
So we are working with Project Home
and we're also working as part of a project with them, with,
um, other health systems in the Philadelphia marketplace,
Penn and Jefferson.
Um, in a gift that was provided by, um, hemostat
and Iron Lubert to help us design a program
and a process in which we address opioid use disorder
through, um, substance use, um, programming as well
as identifying
and building, if you will, respite to, um, temporary housing
that will lead to permanent housing.
Mm-Hmm. . So that's a fairly
significant project.
And that really started with us
with a project we called Housing Smart,
where we took a small group of patients
who were homeless substance use disorder,
placed them in housing.
And we were able to identify that by stabilizing housing,
stabilizing medical care, you saw a reduction in
inappropriate utilization of the, of the emergency room.
You saw a slight reduction around, um,
in acute care admissions
because some of those acute care admissions were social,
some of them were actually, um,
required based on clinical conditioning.
So when I say you saw a slight reduction, maybe it was 10%
as compared to ed, you saw a 75% reduction in utilization.
So we knew that the process was worked and when,
and we collaborated with Project Home
to be able to begin this process.
So we're very early in that journey in order to be able
to create access to a very complex patient population
who has complex needs
and housing is a key part of that programming.
And so I think that, you know,
that's a huge effort on our part at this point in time.
And the other area that's unique
and innovative, um, that we're doing is really
around a health hub.
We have collaborated with a local supermarket,
ShopRite in our community,
and we've placed a health screening hub in the
supermarket near the entrance.
We walk into the supermarket.
So we have the ability to screen patients for hypertension.
Um, we have the, uh, stroke awareness, um, brain health.
We have pharmacists there who are doing
medication education.
We have a diabetes program
and we put that programming all around that health hub,
which is linked to a mobile health vehicle
that actually goes out to the community.
So that programming that we're offering in the hub
actually goes out into the community.
And the sole purpose is really about, you know, helping,
you know, hypertension, as I mentioned earlier,
is such a huge condition in our community.
And when you tie that to diabetes
and smoking, it also ties a high risk of stroke.
And when you look at all those pieces together,
our job here is really to help screen
and help people get into care, um,
before they're in the condition of having a stroke.
So how to manage it Mm-Hmm. .
So we're using that health hub, our mobile health
as another way to be able to screen create access
and, um, create an ability to follow up care.
So when I look at, you know, so I see
that is pretty innovative as far as how we're creating
that level of access, um,
for our community here in North Philadelphia.
So combined with the two of those, um, the a critical
clinical need in our community
and being innovative around access are probably some
of the two biggest projects when I look at partnerships
and relationships, um, in the work that we do. Mm-Hmm.
- , I think too, you, you just illustrated
so wonderfully, Steve, how interconnected so many
of these health outcomes and behaviors are.
And so this work, it's, it's difficult and it's challenging,
but such meaningful work to be able to meet patients
and then also hit the levers
and meet their needs in different ways
that can contribute upstream, uh,
to the downstream health effects
that would bring them into the ED
or other care settings like that.
So thank you so much for sharing
that in greater detail with us.
It's been so great catching up with you today, Steve.
Is is there anything you'd like to close with, uh,
our listeners or share with them in, in closing?
- Yeah. I think as we think about the work
that we're doing from a population health management
perspective, I really think that combination
of quality care management
and access to community resources have really been a vital
function and also vital to our success
and helping our patients achieve their goals.
So when I look at that and I look at the, the,
the world in which we, um, uh, live in, I think there,
those are really three key areas that
as people look at population health
and population health management strategies, they're areas
that they could be successful in.
- Steve Carson, senior Vice President for Population health
with Temple University Health System.
Thank you again, Steve for returning
to the podcast and being my guest today.
- Thank you for having me.