This is Laura Dierdahl with the Becker's Healthcare
Podcast. I'm thrilled today to be joined by
doctor Bill Raymond, chief medical officer at Ochsner
Health Network. Doctor Raymond, it's a pleasure to
have you on the podcast today. Pleasure being
here. Thanks for having me.
Absolutely. Now I'm excited for our conversation because
I know you are doing some very innovative
things at Ochsner, and, it's certainly exciting to
think about, you know, what the future may
hold. But before we dive in, can you
tell me a little bit more about yourself
and Ochsner Health Network?
Sure.
So first of all, I'm the chief medical
officer for Ochsner Health Network.
In that role,
my job is to
oversee the population health management for as as
a physician leader on that group. Our group
manages, like, all the value based contracts that
we have,
the MA capitation,
at risk MA, our enhanced tracked ACO. We
even have an an upside only ACO,
as well as commercial,
and MA shared savings and a commercial p
for p contract.
Together, all that's roughly about 600,000
lives.
OHN, Oshunov Network, that's our CIN that has
about, over 3,500
MDs in it,
and over 2,600 APPs.
Ocean, which is our enhanced tracked ACO, includes
nearly 5,000
MDs and APPs.
And taking a step back, so Ochsner is,
you know, based in New Orleans,
over 40 hospitals,
manage over a million patients throughout Louisiana, Mississippi.
And when we include
OHN, which includes partners and the like,
as well as within Ocean, which are the
Enhanced Right KCO I mentioned, we then go
even more geographically to parts of Texas and
even into Alabama a bit within those groups.
So we have a significant impact on the
communities that we take care of through those
different, arrangements that we have in place.
That's great to hear. And I know being
able to have all those different,
contracts and arrangements
really
pulls through a lot of the principles and
values when you're thinking about value based care
and and how to really make the most
of the quality,
care you're able to provide as well as,
the dollar. And so it seems like, you
know, having all of those different,
plans in place in different things that you're
doing really gives the health system a great,
window into, you know, how they can control
more of that quality as well as cost
of care.
Yeah. Real quickly on that. It's interesting because,
you know, you bring up a a a
part about us having the value based contracts.
The reality of what we have to do
more so nowadays is is think about how
we're taking care of patients that even aren't
in those contracts because, you know, looking at
how total cost of care is provided,
how how we're getting reimbursed as a health
system and everything else, it kinda changes dynamic
a good bit from just being looking at
a contract side of things and how we
can, you know, do things across a more
a broader population.
For example, if you think about it, you
know, within the hospital system, when somebody gets
admitted and it's a preventable illness, I mean,
that's that's sort of us missing an opportunity
to try to keep people healthier and keeping
them well and keeping them out of the
hospital.
One is the right thing to do. And
so that's what the interesting thing is value
based care has kinda gotten a little bit
about what does value mean and everything else.
And so it's more of, you know, let's
do the right thing for for people.
And if you have people who are getting
into your hospital facilities because
you could have done something differently to take
care of them differently and help prevent that
illness, prevent that condition, whatever else, We need
to be more proactive about how we do
that. And so I think
that's kinda where we need to be going
more and more is not looking specifically at
the contract aspect of it, but what are
we doing
from a holistic aspect of how we're managing
patients regardless of who their payer is and
how we're doing thing things right across the
board to help prevent those sorts of things
from happening.
I love it. That makes a lot of
sense. And, you know, it's really helpful to
understand about your mindset and mind frame going
into,
those types of arrangements and and thinking through,
you know, quality care for all patients.
Now what are some of the trends that
you're watching most closely currently?
Trends currently would be whatever CMMI is pushing
out this week. It feels like it happens
a lot right now.
I mean, if you think about it, at
the end of the year,
LEED, ACCESS, Maha Elevate,
all those were pushed out as well
as looking at payment aspects for Medicaid and
pharmacy.
They're even still talking about expanding the ahead
programs. So there's a lot coming out of
CMMI. So I feel like a good part
of my job and other people who are
similar to me is
trying to keep pace with that and understand
exactly what those different models mean and how
we can try to participate in them and
try to improve,
the health care of the community that we
serve using these different models that are out
there.
I think everything that CMMI is putting out
right now is very innovative.
I'm very encouraged by it because it looks
like they're trying to change
how
health care is paid and including
new innovative care models as well.
So it's not just gonna be
regular fee for service
medicine
where the more you do, the more you
get paid.
It's it aligns very much with, you know,
our core values here, which is, you know,
trying to make sure that we're doing the
right things for patient and how do we
help manage them outside the walls of our
institution so they're not having to come in.
So I think it's great where they're going.
I think it's gonna be interesting when we
find out more details,
but, certainly, that is a lot of our
time, effort, and energy right now is trying
to understand exactly what those opportunities are.
That makes a lot of sense. And, you
know, it's just, it seems like a lot
as you mentioned. It's coming out of the
government policy changes and thinking through, you know,
how you're, going to transform the health system,
alongside many of these change changes are important
too. And so when you look at, you
know, the teams that you're building, whether it's
clinical, administrative, across the board,
how do you make sure that, you know,
the the team culture is so flexible that
you're able to,
you know, be nimble and make changes as
they come and really not only be thinking
about, you know, the near term, but as
far term as well,
in, you know, your broader mission and vision
for the future.
Yeah. So I think if you keep in
mind that you're,
you know, taking care of patients is number
one. Right? So patients come first. That is
our our first
objective and and keeping them at the center
of what we do.
And so if you think about that,
these are opportunities for us to help align
with how we want to manage patients,
and how we wanna help the communities that
we serve.
And so
just keeping focus on that aspect of it,
that end goal of trying to actually improve
the health of the community,
that aligns with a lot of what's going
on right now and
allows for trying to do things differently and
be innovative in how you manage patients.
If you're currently focused on
the regular fee for service payment model, for
example, then, you know, you are driven to
make people come in and see you within
your four walls and everything else.
Well, access
is a challenge,
as well as, you know, our system
the hospitals,
we have lots of people in the ED,
people that are waiting for beds, there's demand
for transfers, all these things. So if we're
able to help manage patients and keep them
healthier and keep them out of the hospital,
that means the people that actually need to
be in the
costliest
aspect of our system inside the hospital can
get that access,
and get that great care that they need
when they need it. So let's do what
we can to try to
manage patients in very different ways, think about
things differently, have the right mindset about
what does the patient want. Does the patient
really wanna be in the hospital? Probably not,
unless they actually need the care that's there.
Right? So let's focus on how we can
take care of patients in different ways to
meet their needs and the way that they
wanna be met.
I love that. I think it's so critical
to have that type of framing when you're
looking at, you know, what is the day
to day? What what do we need to
do differently, and how do we,
evolve is to just have that patient
mindset and centric
view. You know? It seems like it would
make things a lot, more provide more clarity,
amid amid some of the chaos. So,
I I'm curious. Could you tell us a
little bit about something you're most proud of
from the last six to eighteen months or
so?
Yeah. So I'll I'll I'll break out a
few things.
So last year,
is actually
we we we're still waiting right now for
last year. So let's go back to '24.
For '24,
our group, the employee group at here at
Ochsner
within the Blue Cross Blue Shield contract, there's
a a primary care pay for performance contract,
and we got four diamonds out of four
diamonds. In that contract, there are
20 different measures,
and so you have to do well across
the board on all those. And I'll just
hit some highlights. I mean, this is 80,000
people we're talking about that are attributing this
contract.
So ninety three percent of the patients got
their breast cancer screening.
There are fifteen percent fewer emergency department visits
than were expected,
and eighty seven percent of the patients had
their a one c under control. Like, those
are just highlights from that one contract.
And then on the
on the Enhanced Track ACO side of things,
we actually ended up being the number three
in the country for care coordination,
based on patient surveys. And
I was astounded when that came out because
these are what patients are saying. So that
is huge accolades for our group and and
part of what our my team has to
help manage,
making sure that people are getting the right
care at the right place, and they're getting
the coordination that we're looking for.
And
being touted as number three in the nation
was a little humbling and but I think
that goes a long way to talk about,
you know, what we're doing, try to make
sure people are take well taken care of.
So there's there's a couple on that side
of things. But I think that's really based
on you know, it comes down to doing
the right blocking and tackling,
on a regular basis. And so within our
system,
we have if you attribute to one of
our primary care physicians, we're looking at certain
types of measures and seeing how we're doing
performance wise regardless of what the payer is.
So going back to what I was talking
to before. And within that, you know, 85
of the people with hypertension have their blood
pressure controlled. Eighty two percent of diabetic diabetics
have their a one c controlled. Ninety percent
of people got their breast cancer screenings. Eighty
seven percent had their cervical cancer screens. And
eighty four got their co operative cancer screenings
as recommended. So those are all basically what
you need to be doing on a regular
basis to help manage patients,
which then helps out with further downstream things
that you're trying to prevent from a chronic
condition standpoint.
So, you know, at this moment, we're trying
to like I said, we're gonna go beyond
just our value based care agreements
because it's the right thing to do as
to how we manage patients.
So
the more we do about taking care of
patients, doing it in innovative ways, I mean,
and taking care of people outside the walls,
this involves, like, care model redesign,
constantly looking where you can do things differently,
as well as, you know, I have I've
waited all the way till now to mention
it, how you use AI to help enable
those sorts of things,
because that is a way for us to
try to do things a little bit differently
too. So
a lot of that about some of the
things that we've we've done lately,
I will say
we have a huge focus right now on
care model redesign,
and the goal of that is to decrease
variation of care. And, again, with the end
goal of being preventing
people from having complications and even preventing people
from getting chronic conditions in the first place.
So if
we have a focus right now on CKD
and CHF.
So both of those, the big drivers are
diabetes, hypertension, obesity. So the more we can
do to keep people under control,
then the less people end up getting CKD.
But then also once they get it, what
what are we doing to prevent that progression?
Because the slow the slower they are progression
wise, that means the likelihood of getting dialysis
or needing transplant, I think that is greatly
diminished.
So let's just do those things right and
do that across the board, and let's make
sure that we're doing everything we can.
So that's a lot that we're doing right
now regarding the care model. There's some other
aspects of that. We're making sure everybody gets
all the right things,
as a patient.
And so a lot of things being done
that way.
Fantastic. I mean, I think that's so helpful
to understand and being grounded in,
you know, what that care model redesign looks
like. And and I I love the idea
of going back to more prevention,
how you work within the community and, reaching
patients in different ways than ever thought possible.
Is there any kind of partnerships or,
you know, things that you've been doing recently
on that side, on the care model redesign
side and the preventative care,
that have really,
shown through that you're really excited about?
So
I will say a lot of this is
is looking
inward as to how we can do things
differently. So the things that we're building inside
Epic to ensure that and we'll we'll I'll
pick on patients with diabetes.
How are we making sure that their blood
pressure is controlled, their diabetes controlled, that they're
a nonsmoker,
that they,
are on the right statin, that their that
their LDLs echo all those things? How can
we make sure that's happening across the board?
And so we're looking at that. So we're
actually in a transition,
not this year, but next year. We're in
transition from just what what is our control
rate for diabetes to what's our percentage of
patients that are getting all these things done.
And so that's a lot of where our
focus is. We do work with some others,
regarding helping take care of people outside the
four walls.
We we've been working with a company called
MyLaurel, which has
paramedics go and check on patients so we
can, make sure that they're doing well and
help prevent those readmissions.
We have our own program regarding nurse practitioners
that go to that home as well for
those that need to have a nurse practitioner
go to their home. We have our own
digital medicine company, so that's,
how we manage patients with hypertension, diabetes, and
even chronic kidney disease,
where basically they're sending readings to us, and
we make adjustments without them having to come
in. So there's a lot that we're doing
ourselves. A lot some things are certainly with
partners. But the goal is, like I said,
how do we how do we make sure
people are getting everything that they need and
preventing those later complications?
That makes a lot of sense. Thank you
for, sharing a little bit deeper there. Now
before we wrap up our conversation,
what advice would you give to evolving and
emerging leaders today in the health care space,
especially given all of the changes that are
occurring and, you know, what's gonna be critical
to caring for communities in the future?
Yeah. So
advice that I would give is, number one,
listen.
You have a
lot of smart people around you.
You also should be listening to patients, listening
to other people in your community to understand
what the needs are and how you can
try to better serve them.
I that's also you should surround yourself with
good people. So
don't feel like you need to be the
one who comes up with all the solutions.
It's better for you to sit there and
listen and hear what's happening and engage other
leaders,
frontline folks, patients, all those people. And then
your job should be helping connect the dots,
seeing where those opportunities are.
And then from there, you facilitate collaboration.
So
you can't feel like it's all on
an individual to make this happen. Health care
is a highly complex,
system,
and so you cannot be working on an
island. You have to learn from others. You
have to engage with others.
And your job as a leader should really
be, let's figure out what we can do
differently. What are the opportunities? How do you
identify those opportunities? And then how do you
get the right team engaged to make a
difference and take it and
address those opportunities that you find?
I love that. It it makes so much
sense. Doctor Raymond, thank you so much for
joining us on the podcast today. This has
been such a fun conversation and a window
into some of the things you're doing at
Ochsner Health Network. And, you know, I'm looking
forward to seeing you as well at our
annual meeting. I know you'll be speaking on
a panel, and we'll dig deeper into many
of these themes as well as, you know,
share additional perspective about going forward. So it'll
be great to connect and see you there.
That was great. Appreciate the opportunity. Thanks so
much.