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Session overview

The OptumLabs Leadership Learning Series features unique, speaker-led talks and Q&A on key research and translation topics. These discussions facilitate the exchange of diverse perspectives as we tackle health care's biggest challenges.

The COVID-19 pandemic caused disruption and is sparking rapid innovation in how and where care is delivered. The future of care must recognize what patients want and how they are willing to receive care.

At-home screenings, virtual monitoring and better transition models can help us prevent, detect and intercept disease. They can also cut down on waste in the system and improve health equity.


More care in the home

In this talk, Drs. Deneen Vojta and Jay LaBine discuss some of the latest care delivery innovations coming out of OptumLabs and naviHealth. We also discuss how technology and service can combine to improve and personalize care.

Video Component

Speaker 1 (00:05):

Hello everyone. And thank you for joining us in the latest of the OptumLabs leadership Learning Series work here in the home innovations in self-service care and home support. I'm Kevin Larson, senior vice president for clinical innovation and translation at Optum labs. And I'll be your host where we begin. I'd like to cover a few quick housekeeping items. This presentation uses streaming audio and video to ensure the best possible system performance. Please be sure to shut down any VPN connections and connect directly you to the internet. You have any questions for the speakers during the webcast. You can submit it then by the Q and a feature in the webcast window. We'll try to answer these at the end of the live presentations, you can use the same Q and a feature to reach out if you experience any technical difference. [inaudible]

Speaker 1 (00:53):

today's today's webinar will be recorded and will be made available in the coming weeks. I'm now pleased to announce our speakers. Dr. Deneen Vojta is the executor, the vice president for global research and development at United health group and chief physician executive at Optum labs with 25 years of experience, as a researcher, entrepreneur health system, executive and board member, she developed strategies for growth through innovation investment. She has spent much of her career focused on accelerating the design execution and scaling of disruptive programs, leveraging general purpose technologies. And she has a strong history of building mutually beneficial partnerships with academics, government, and entrepreneurs to achieve the larger goals of improving health quality, reducing costs, and more effectively engaging consumers in their health. As a pediatrician, she began her career at the children's hospital of Philadelphia, uh, where she was a resident fellow in hematology and oncology subsequently.

Speaker 1 (01:52):

She launched chops pediatric hospitalist program that first in Delaware valley and became the COO of health partners and the Frankford health system leaving and founding my Medico, a disease management company acquired by United health in 2006 since joining United health part of the leadership team and has built multiple businesses, but successful. She serves on the board and the board of the children. It was Minnesota and the advisory to the center for health incentives and behavioral economics and Penn. Interestingly, she was an Emmy award winner in 2013 and at CES innovation design and in an engineering innovation honoree. Our second speaker today is Dr. Jay LaBine. He's the chief medical officer at naviHealth in this role. He focuses on delivering best in country post-acute care management and advances in value based care initiatives by overseeing clinical strategies, health service operations, and physician leadership is more than 20 years of leadership experience includes a clinical practice as a trauma in general and renal transplant surgeon at St.

Speaker 1 (02:56):

Mary's medical, the center, uh, Trinity health hospital, and serving as a us army surgeon during operation enduring freedom. Most recently, Dr. LaBine served as senior vice president and associate chief medical officer at spectrum health in grand rapids, Michigan. And prior to that chief medical officer at priority health spectrum health largest insurance plan during his time at spectrum, Dr. LaBine developed a 3,500 provider clinically integrated network implemented a system sponsored telehealth program implemented in scale, the physician house calls model for high acuity seniors. He's passionate about population health and regularly speaks on the topic at conferences around the country. Not at work. Dr. LaBine enjoys time with family boating in lake Michigan, and engaging in discussions with the book club that has been part of for more than 20 years. Welcome to both of you. This is a really terrific panel. I'm very excited. So we will start with, um, Deneen and I will be advancing your slides Deneen. And so let me pull them up to be sure that we have them here. Um, and I will let you go

Speaker 2 (04:08):

So good morning, everybody. Um, as Kevin said, I'm Deneen Vojta and I, um, work in United health groups, research and development arm called Optum labs, and I've been in R and D for about 15 years after, uh, the company I found it was acquired. And, uh, I actually thought I'd stay about three years, but I ended up staying 15 years because it's just an amazing platform. And, um, and when you think about it, United health care as the insurance entity of United health group really is, um, very much aligned with patients. And that is, you know, we really wanna, you know, historically we're trying to figure out together what's the best care out there. And we would use the, you know, the benefit platform to drive patients and members to the best care out there. And over the last couple years, we've actually reframed the conversation to figuring out what the best care possible is.

Speaker 2 (05:04):

And when you think about that, it actually completely changes, uh, what, you know, what, um, what your orientation is, what you invest in, what you think about from a research perspective. And so, um, our mission again, is to find the figure out what is the best care possible? And there's, there's two major tenants. One is this whole notion of, you know, the current care system really was designed to treat acute, you know, car accidents on the cat catastrophic. Um, and yet a lot of the care that we deliver now is chronic care management and in chronic care management, sadly, a lot of the, if you look at guidelines, et cetera, a lot of it's driven towards end stage disease, the medications, surgery, et cetera. And when you think about what do we really all want, I suppose, as providers and as payers is that we want to prevent disease, Sigley chronic disease.

Speaker 2 (06:03):

And we want to figure out what signals when a disease is worsening. Um, and how do we intercept that disease? So we know what can we do about it much earlier? I mean, just ask yourself all of you on the call, if you, um, are going to develop colon cancer, for example, would you like to have stage one colon cancer or stage four colon cancer? I'll give you a minute to think that through. Um, and so, so that's, um, so it's the whole notion of best care possible. And then the notion of prevention signal detection for early interception. And the last tenant of our work is facilitated self care. This coin, this term was coined by my friend and colleague, Dr. David Ash at Penn who, um, you know, nicely articulated, I think it was published in the new England journal of medicine. It's just a couple of pages.

Speaker 2 (06:56):

Um, next slide please. Um, and it really articulate how, and almost every other part of our lives, we facilitate our own action with the world. So for example, banking, I'm old enough to remember that, um, when I would go with my father to the bank on Friday evenings with his paper check, they deposit it to get a little money back and then, you know, live our week, um, from a financial perspective. And now we do all of our banking at our fingertips and without professional guidance, fascinating, that being said, if we're being honest, when there is a problem, we're darn glad that there's a branch in our neighborhood. And, um, some of them are still around so that we can go in and, um, get help from a professional. And, and David articulates this nicely, that healthcare is the one field that, you know, self service just, it just rarely happens.

Speaker 2 (07:52):

There's a lot of reasons for that. Um, but they're not all technology. Some of them are, are very I'll call social or, you know, the way it's been. Um, so, so we are, we have spent a lot of time and certainly I would argue that the pandemic, what it did for us, it actually rapidly escalated adoption of, uh, facilitated self care, um, both particularly in chronic disease, but also in some areas of acute disease, um, because we had no other choice. And so, and the good news is that the reality is we don't need to develop new technologies. We actually can leverage existing general purpose technologies. And let me give you an example, as we know, telehealth has been around for a long time. Certainly there was some payment issues, et cetera, and social issues. So neither physicians care, uh, the actual practice flow nor patients really wanted adopt that.

Speaker 2 (08:56):

But the reality was that a lot of telehealth uses the same general purpose technologies as FaceTime. And I'll use my mother as an example of what happened last year, she's 80, and she has never used FaceTime, even though she does have a smartphone. And, but all of a sudden, when she was stuck in her apartment alone and wanted to have more contact with her grandchildren or children or friends, all of a sudden FaceTime on this device became very appealing and she learned how to do it successfully. So then the transition of using a technology, this video conferencing, you know, um, live stream on my phone for social reasons is now we can translate that to the patient doctor relationship. And in fact, we, if we, when we looked at United health care, the number of visits in December, 2019 versus April of 2020, it was a hundred fold increase.

Speaker 2 (10:03):

And, um, kudos during that, that time on the United healthcare side, um, you know, health care was the first payer to come out and say, we will pay for these services, you know, um, and on the OptumCare side, again, kudos to an organization that worked with 60,000 clinicians. How do you on a dime turn, turn on these tele-health and workflow to be able to serve members and, and patients? Well, good news. Again, the general purpose technologies are already there. They're already used in other parts of our life. And we were, we were able to do that and as were others. So I'm looking forward to this conversation. Can I see the next line, have a bit of a delay?

Speaker 2 (10:57):

Okay. I'm just going to talk because there's a delay. So I will tell you that we started during the pandemic. Oh, by the way, what I just said was actually our pre pandemic mission and asset development and product development and technology, et cetera, next slide. But during the pandemic, nothing changed except we were very focused on what we w what the content was, if you will. So, one of the next slide, one of the next, uh, that one of the first projects we did is I got a call early in the pandemic from, um, one of our, uh, care delivery organizations out in Seattle, Washington called the Everett clinic. And basically they, they let us know that they were going through 2.2 sets of PPE per swab for testing, because I, as a physician would jam this thing, practically, doing a brain biopsy up your nose.

Speaker 2 (11:48):

You would either vomit seize on me or throw up on me, or, um, you vomit or throw up or sorry, throw up on me or sneeze on me or cough on me. And so, and they kept having to change and we were running out of PPE. And, um, many of you, I don't know if you know this, but that, that kind of instruction is actually regulated by the FDA and what it said on this wall. But it was that it had to be a physician or clinician jamming it into your nose, et cetera. And where in the nose is all actually spelled out? Well, we said, why? So we actually worked 24, 7 for two weeks with the, um, investigators out in the Everett clinic and the FDA to say, we're going to prove that that doing it yourself, you can put it into your own nose, you can switch it around and we did it.

Speaker 2 (12:32):

So you didn't even have to do it so far, you know, would, um, just the nasal swab work. And we were able to show and MGC, it was published in the new England journal of medicine. Um, I think it was new England journal of medicine. We published it somewhere high end and, um, showing that in fact patients can do it themselves thus saving the healthcare system, time, harm and PPE. And then we went on to, we sort of took that learning to say, how else we haven't. We have a, we have a blank sheet here. What else can we do to help people get the care they need during a time when we saw, uh, we saw cancer screening drop by 85%, particularly colorectal cancer screening and cervical cancer. Um, and so what can we do then? So then we said, well, that's sort of interesting.

Speaker 2 (13:20):

Although we all think colorectal cancer screening is synonymous with colonoscopy. The reality is there's two home-based tests that you pretty much can do yourself and Malin. And yet, if we look there, our care delivery organization and Optum care, it was about 80 20, 80% of the offerings were colonoscopy, pre pandemic, and 20% were home-based tests. So we created a shared decision-making tool, and we, we identified all these people who needed a colorectal cancer screening. And we, you know, we asked them, do you want to do your home test? Again, most people, all three save lives. Most people were unaware of the other options, and we completely reversed it. So 85% of people then, and still now choose home-based testing just fascinating. And I remember there's a whole industry dedicated and designed for colonoscopies among all Americans. I think we're going to see that change going forward.

Speaker 2 (14:15):

And I see Jay Jay laughing, um, and, and, and, and, and you see on this slide level two is basically, this is the diabetes business that we created, and it uses CGMs, continuous glucose monitor to help people manage their own condition for the, for the 365 days 24 7 that you are doing. You know, as you know, when you have type two diabetes, what you eat, how much you sleep exercise near max, all matters on your glucose levels and your wellbeing. And so, and again, why do I think I, as a physician should tell you and give you some free advice. It's actually not so free, huh? Uh, when I see you two or three times a year, and instead I can give you a, a, a signal detector and a continuous glucose monitor that gives you 288 readings a day. I'll tell you I wore one, although I don't have dysglycemia, um, I did learn what, what food, how sleep affects my sugar levels, fascinating and giving people these tools actually allows us to help people figure it out.

Speaker 2 (15:18):

You can actually get off your insulin. You can actually reduce your medications. You can actually facilitate your own care. And the last, um, next, and one of my favorite next slide please is we were very worried last fall about co-infection of flu and, and, uh, SARS cov two. And because the British experience let us know that there was about a 55, 0% mortality among people were coinfected who were over age 65. So we said, well, we know at least with the flu part of there's two things. When we got to get people diagnosed early and we got to get them treatment, at least on the flu side. And so what we put together, these kits and actually offered our highest risk Medicare members, um, would they want to participate with this study? Would you want to participate this and what we sent in the weld home box?

Speaker 2 (16:07):

And you can see it right. There is a Tamiflu, an actual box of Tamiflu or generic, uh, a thermometer, a one 800 number for a telehealth visit and a COVID collection kit. And what we said to people is basically, if you start feeling unwell, call us, call the telehealth provider and he, or she will decide, well, we'll want your temperature. We'll want to know your symptoms. But if we think it's flu, we will actually ask you to start the Tamiflu cause as you know, every hour matters. And then also we want to click that, uh, uh, sorry, it's going to be two question kit so that we have the full picture, which, you know, the results are at least under our contract came back within 24 hours and we will, um, be able to help you facilitate care in your home. And the final, my final data point about this was at the time when the COVID, uh, positivity rate was about 11% nationally among this program, 35%. And that allowed us to put on COVID watch like programs in your home. Kevin, I'll turn it back to you.

Speaker 1 (17:12):

Thank you. Deneen this is really exciting. I love this transition and the creativity of thinking about how to, um, empower people to care for their own. I want to now turn it over to Dr. Jay LaBine. Can you tell us about how they do innovation even having health? Yeah,

Speaker 3 (17:32):

Thanks for that, Kevin. And, uh, uh, Deneen. I, I, I think this is fascinating, um, and what, uh, what a great, uh, area to be in at this time. Um, and I also, as a former surgeon, I love your characterization of a COVID nasal swab as a brain biopsy using surgical literature. Um, so what I'd like to do is, um, first started with describing naviHealth the naviHealth model. And then also talk about how naviHealth is moving closer to the patient closer to, to the home environment as, as an extension of its core model. Uh, so Kevin, why don't you go ahead and put on the next slide? Um, really this is what is, what is naviHealth or who is naviHealth. Um, and this slide is just there to demonstrate that we're why we're in all 50 states. We're rolling out our core model, which I'll describe in just a minute, um, around post acute care management and in post acute care management, the members that we're managing are seniors it's really, we're really focused on senior care.

Speaker 3 (18:46):

And our mission is to improve the healthcare experience for seniors so that they can live a better life and have more days at home. And that's, um, part of the, I would say the trouble well, aim, um, mission of, of naviHealth. So why don't you go to the next slide? And I'll just briefly describe our core model, our core model around post-acute care management, what is post-acute care? So it's patients that are doing the care transition from the hospital into inpatient post-acute care. So that would be the skilled nursing facilities. Now in skilled nursing facilities, we all know that there's mixed model, meaning there's short-term rehab, and then there's long-term care naviHealth works with the short-term rehabilitation. So that, that part of that transition is to get them through the nursing home. And then back into home, as you can imagine with COVID, this was a major challenge.

Speaker 3 (19:49):

It was a major the challenge for the entire healthcare system, but certainly naviHealth. And what we were doing in the skilled nursing facility was, um, was, uh, quite a challenge with COVID. Um, the other areas, the settings of care that naviHealth manages is, uh, acute inpatient rehabilitation, and then long-term acute care. So this is our PAC model, it's our core model. And, you know, as physicians know that it's that handoff, it's that transition where things can get, um, missed or there can be miss, uh, communication. And so what we try to do a smooth out seamlessly that transition from hospital post acute care facility, and then to home, why is it that we, um, are focusing on post acute care? The data shows that there's tremendous value ability in the outcomes, the quality of the care delivered, and also the experience and efficiency of care in post-acute care.

Speaker 3 (21:00):

It's highly, highly variable. There are some facilities, there are some, uh, care delivery that's extremely well done. And then there are others that, um, are, are not so well done. And with our model, which is a combination of, of, um, clinical, um, care coordinators based in the skilled nursing facility. And they work with patients, families, they've actually worked with the skilled nursing facility staff so that we can, can, uh, efficiently move people through and give them more days at home. When they're ready, it's all about creating a safe discharge and returning people to optimal function. When it comes to gauging that function. This is where the high-tech part of naviHealth comes in is that we have a, a, a tool, a technology that will benchmark best practice for an individual it's individualized. So that, that, and personalized care plan for that person. And we with onsite care coordinators, guide them through to reach to the best practice, um, setting for functional gain.

Speaker 3 (22:18):

So the rehabilitation goals are all, um, known by the facility, the staff and the naviHealth care coordinator, there's patients and families. And then we also ensure that they're getting this optimal functional gain during a best practice, uh, length of stay. That's really the naviHealth core model. So now let's go to the next slide, so that as we were so Navajo has been doing this for over 10 years, and we do it with major health plans and at risk providers, ACO, CO's a physician groups, and it's always been our goal to do more in the home, right? So as we were growing and developing and say, can't, we come up with some new solutions that would enhance our model or expand our model. And these new solutions really had to follow some of the principles that I just described, which would be personalized care, also care that is, um, supported by the best data and striving for the best outcomes.

Speaker 3 (23:29):

So when you look at the home health model that we are expanding to the home health model is around not only home health utilization management, we aim to have a low for that initial admission to home health home health can be very important for seniors who are transitioning from hospital to home, but they can also be very important for seniors who are transitioning from that post acute care setting into the home. And so we make it very low barrier to get that initial home health visit. We ensure timeliness of care. The start of care is quite important in order to provide the best quality. And then also collecting data on the outcomes of that home health episode, so that we can do our next value proposition for home health, which is all about identifying and optimizing the network in the same way that skilled nursing facilities had great variability in care delivery.

Speaker 3 (24:37):

There's great variability and quite a bit of fragmentation in the home health care agency market. So that's the identification of the high performing home health providers, and then ensuring that their service delivery, as well as the outcomes are optimized. Um, once you enhance that service delivery, you're providing a significant value when it comes to, um, the home health, you have management, then the last two things are interrelated, but, um, combining this high performing network with additional care coordination, for those that are, have prolonged stay in home health episode, this is where we can mitigate, mitigate low value home health, um, uh, service delivery. There are times where the person really needs another solution and another like a care management solution, or even the transition to, uh, other, um, support services. If they're identified as a high need, chronically ill complex patient, we can help navigate them to a, um, service like Prospero or landmark they can longitudinally provide for their needs.

Speaker 3 (26:00):

So that part of the home health, he goes station management model as well. Now I'm going to turn our attention to patient navigation, which is also the next solution that naviHealth is actually implementing right now. We implemented for the primary goal of patient navigation is to address the non-clinical factors that lead to readmissions. So naviHealth is a fully at risk, um, um, entity. And so when we're, uh, providing, uh, post acute care management, uh, and we have length of stay reductions were at risk for that readmission, but it's also that the, you know, nobody wants somebody to, um, have to return to the hospital if it's not needed. And so patient navigation uses nonclinical, um, community health care workers who actually engage with the patient post discharge from the hospital, or post discharged from the skilled nursing facility and in their home. And what they do is they address those social determinants.

Speaker 3 (27:18):

There are a number of things that are, um, I would say differentiators for the patient navigation solution. And number one is engagement. Um, this solution today has a very high engagement because they're nonclinical and they're addressing, um, in a engaging way with patients and family, the, um, the issues that are nonmedical, um, and this, they form a bond that can help get them into, um, the needs to be addressed by potentially other services. If there, if there are clinical needs and they escalate those. Um, so there's an up to 70% engagement rate with the patient navigation, nonclinical community health workers. The other differentiator is that the people who undertake patient navigation and do this for their job, they are tenacious advocates for the patient tenacious around. What else do you need? How can we make sure that you have meals on wheels? There was a recent case where, uh, this was in Atlanta, an elderly man came home from the hospital, uh, was expecting meals on wheels, but he was put on a waiting list.

Speaker 3 (28:40):

They literally called around to other services to get him the meals that he needed, which helped keep him at home and safe. Um, they identify people who live alone and connect them to other community-based organizations. And probably most importantly is that they ensure that there's no, um, um, continuation of care issues, meaning when you're discharged and you need to see your PCP, these advocates really help make those post discharge appointments. This is all designed to have the primary outcome of reducing readmissions and ensuring that when people are home, that they're stabilized in their care journey. So Kevin, these are the two areas where naviHealth is moving closer to patients and members higher engagement. And then also, um, ensuring that we're doing more in the home.

Speaker 1 (29:45):

Thank you, Jay. It just took me a minute to unmute there. Um, it's this was terrific. And both of you are describing such wonderful programs. Uh, and I'm really curious about the innovation approach that you take to get there, uh, to reminder to the audience. Um, please submit any questions you have through the chat and those we will feed up. Uh, but I will take the speaker prerogative and ask the first few questions. Um, so, uh, question number one is for Deneen. Uh, your, you talked about, uh, David ashes paper that was published in the new England journal a couple of years ago in facilitated care. Uh, how do we get there? What are, what are the things that we need to do? What are the, so you mentioned the social constructs that need to change. What are those and how are we going to overcome them?

Speaker 2 (30:40):

So, great question, Kevin, in that, um, I'd say everything we do prevent it. So it really is identifying, uh, sort of the stakeholders in why don't we have more facilitated self care. First of all, I say on the physician part, you know, we take our oath not to do, to do no harm seriously as we should, but sometimes we also use it as an excuse. Well, I can't let you do that yourself, uh, because you know, you're not really qualified. And yet we know if you look at the history of, uh, uh, glucose checking, I mean, there was a time early in the days of insulin that you had to go into your doctor's office every day to get your glucose checked. And now, I mean, do you just can't even imagine it, women used to have to go to the doctor's office to get pregnancy tests.

Speaker 2 (31:22):

Now you just go to the pharmacy and pick up a home-based test. So, um, and then of course there are the reimbursement parts of, of these kinds of services. Um, and I think with the, um, market increase in value based care, I think we're going to see some changing there. And then of course there's the consumer adoption, right? So we're so used to the notion that every single interaction between in healthcare has to be between a doctor and a patient is healthcare's choke point. And guess who coined that one? Kevin, you got it, David Ash, the guy's on a tear. Um, but, um, I'm Abby, uh, to, um, to borrow other people's great ideas. He's just very good at articulating them. And so, um, I do, and I'm going to give you one example of particularly at Fort with, well at home. Well, at home was specifically, we were solving one problem co-infection with flu and COVID during a pandemic, but you can use the same framework for any problem in healthcare, right?

Speaker 2 (32:20):

So I would imagine you can imagine a well at home box that you have for expecting parents. I can imagine, or young children I could go on and on, right. We're listening. We're all physicians, at least three of us presenting. How many of you I have, I have a drawer at home with my own facilitated self service, so I don't have to run to the pharmacy. I can, I can do pretty much anything at home, right. And so I think we will have to address the payment. And, and, but I do think that the provider community and the, um, the consumer community, uh, also will need some good old fashioned behavioral economics. I do want to give you one data point. And that is when we originally made the well box weld home box, because it was a study and we made 200,000 boxes. We said, okay, you know, let's see how many seniors say yes.

Speaker 2 (33:11):

Eight days later, we had an order, an additional 200,000. That's the evidence you need that this is a good idea. Um, I think we're going to see some of our competitors jump on this. Now I did have somebody, an old friend now who's at a health plan competitor who wrote, he said, the mic wants to know, should we do this? I let them know that it was all marketing. And I, uh, wrote when I wrote him back the publication saying, here's your marketing? You know? So, cause we did of course publishes in the peer review literature.

Speaker 1 (33:44):

Yeah. It reminds me of a really cool innovation. I saw at the Alaska native health service where on the Aleutian islands, where they didn't have pre health providers, it's all telehealth. And they actually have prescription drug vending machines that are controlled by a pharmacist in the mainland. And you have a telehealth visit. And if you need a prescription drug, the pharmacist releases it to the vending machine and you pick it up on the island. And I thought, gee, that's super cool. Why don't we do that in other places? And to your point, I think it's, it's people that have to respond to a new creative in a new environment with a new stressors that build these new solutions that, um, I really serve people where they're at. So Jay, how does your innovation model work? How do you guys decide to do something and how do you test and try a new thing before you build a whole, uh, a whole model around it, a whole new, um, uh, programming around it? Yeah,

Speaker 3 (34:41):

I mean, um, we, we actually do have model design, you know, around, um, basically some of the tripling principles, cause it really has to be balanced. Right. Um, there is certainly a cost conundrum that, you know, value based care is, um, is very much in tune to, but the cost conundrum camp, you know, overshare all the balance of experience and also making sure that you have quality outcomes. So that's the first thing. The other thing I'll just say is that in population health, it's also about, um, understand that you can understand your population, but it's to individually like care for a person better. Right. And so one of the mantras that we have as we're developing our solutions is patients being patient centered is all about, but no me tell me, help me. Right. And Deneen, I really think that that's a lot of what I'm hearing you say when you, when you have these solutions that you're pushing out is that they're individualized for people who they know themselves.

Speaker 3 (35:53):

And they know that, Hey, I can handle this. And so part of our strategy is number one, let's personalize the care. And so when we go and roll out foam health care, right, we want to make sure that we understand the needs of that patient and that we're personalizing. We're not putting up any barriers for the, um, the provider, but we're also understanding them better. So that at the tail end of that home healthcare episode, we can personalize what happens next to them, link them to other needs other care services to address their needs. And then when it comes to the patient navigation, that is all about engagement and knowing who that person is. And it's interesting because I think now we're hearing more and more about the nonmedical factors that relate to health. But back when patient navigation started a number of like almost 10 years ago, that wasn't on the radar as much as now.

Speaker 3 (37:02):

And so when it comes to personalizing, I think there's a lot more we can do. Um, and then the second principle, I think that helps with solutioning is the combination of, um, clinical service or services, like smart touch, ensuring that you're, you have a relationship, you have some engagement. I think the pandemic really demonstrated that when you can't interact with a person, it really does affect the person, right. And that patient needs interaction. And I think they look to the healthcare system in some ways to interact with them, to build that trust. Right? So interaction and engagement and touch combined with tech. So this smart tech and that's, that's where our tool with the naviHealth model is all about benchmarking to the best practice and ensuring that we have a technology that's going to ensure best outcomes and that we're striving for those best outcomes. So that's how we, we do this and we actually developed a new solutions group that is under our growth, uh, and, uh, growth and development area. Very cool,

Speaker 2 (38:28):

Actually. So I appreciate your comments, Jay. And it makes me realize when you think about from a product mindset, um, a it's clear, you had a good understanding of what problem you're trying to solve, you know, and it's amazing how many people don't when they start, you know, creating new solutions, they want to create a solution and then go find a problem. You, you had problem, you were trying to solve. Number one. Number two is you. I would imagine when you did your, a lot of people call it minimum, minimally viable product. I would call it the minimally lovable product, right? So you figure out what, what will work for what you want, what problem you're trying to solve, what will work for consumers and the physicians whoever's involved, whatever. And actually the, the least amount of technology, because technology to me is just an escalator and it's, it makes things easier, more efficient and automated, but the route has to be the baseline or the has the, the foundation has to be grounded in solid clinical, clinical and solid consumerism and so distribution. And then of course you put light it on fire, uh, with, uh, technology. But, um, so I appreciate those comments from you. Well, Denise,

Speaker 3 (39:42):

I was curious like just how high a hurdle you think right now we have with consumerism, because it's been talked about a lot that, you know, more and more a, you know, like a, patient's going to be coming more of a consumer. And, but I'll tell you, I'll give you one quick story. Like we developed when I was in a different job at the health plan, a cost calculator, it would basically calculate cost of service. So if they went here for an ultrasound, it cost them this much out of pocket versus over here. And we thought there'd be like widespread adoption because they would save money with this cost calculator. It was a struggle. It was such a struggle because people just defaulted to what they knew or to their doctor. And I'm just curious if you think we still have a big hurdle to get more consumerism in, in healthcare.

Speaker 2 (40:42):

So I'd say I've come over the years when I've been on the same journey you have. And I've come to realize that I think about myself as the consumer, even though we're physicians and you know, what is it that we want? The reality is I love my doctors. I love them. And you know, when my children were sick or my mother said, oh, I'll pick up my app. I call my trusted David Ash. So, um, and you get some advice where I think that the consumer is in part comes in, is both for physicians or consumers too. Right? We're human. So maybe we stop calling consumer, we call people humans and saying, okay, what do humans need to actually better navigate this system? The reality is if we work closer with our providers and help them understand in a way they've found acceptable, but you know, what the need your patients are like in debt now, you know, their eyeballs because you keep, you know, going to Mr.

Speaker 2 (41:40):

Expensive MRI down the street, I would be, I'd say, oh my heavens. You know, so I gotta fix that. So sometimes you'll also, again, what problem are you trying to solve? Where, um, uh, and who w where's the best lever to solve that problem? Right. Instead of saying, we've got it. It was, you know, we had a cost calculator to, I gotta get my patients. They don't want to use it. So I would argue that none of us use design principles and the patients, they weren't saying this was, I mean, they just weren't, especially in the heat of the moment. Right. So, um, so I just think the word consumers, and we're still not selling toilets, you know, we're not selling, which is not, I think about product development and healthcare. It's still is different. It's very complicated and it's complicated on the buyer and the seller side. So that's the additional complexity. But I, you know, when I think about, um, my little drawer at home with all my stuff, my, so I can facilitate my own care for my own care at home. Um, then why can't I let you do that to my patient? I, there might be an additional route, but the answer shouldn't be a, I love having my stuff. And once a year, I make sure it's all up to date. Yeah.

Speaker 3 (42:54):

Okay. I'll give you another insight. And, um, and again, this is linked to a little bit of a question around, um, how the payment model really impacts this, um, you know, new solution development and carrying the home. And as you know, Kevin, we're exploring like being able to do more, um, like skilled nursing facility or rehab at home. So that, cause right now COVID really people already with, that were in the hospital didn't want like, especially seniors, they don't want to go to a nursing home, but really they had to, right. There was no infrastructure to care for them at home. Right. So COVID many, many people said, absolutely not. Because as we all know, right. 40% of all deaths occurred in the nursing home. Right. And it was fearful. So people said no way and they were going to go home. Well, we don't have a strong infrastructure to care for more complex patients at home, but we actually have the capability to do it.

Speaker 3 (43:59):

Um, so we're exploring like rehab at home or sniffing at home. But the question around this as well, how does, how do you incentivize a payment model to support that? Is it actually going to save versus facility care? And then I think lastly, and very importantly is is that care going to be at the highest of quality and comparable outcomes is if they went to a, I'm struggling with this right now as to how to like move that new solution forward. I believe that say there's a, there's like a clear need for an option for seniors instead of like choosing, oh, I'm going to go home with minimal services or go into a facility where I'm going to have to stay for at least two weeks.

Speaker 1 (44:58):

Jay, what a terrific point, um, to your, to your point about the variability, both in a skilled nursing facility care and in home care. Part of the challenge in my time in government was how do we, how do we do comparisons across sites with the same risk adjustment and the same outcomes? Because the outcomes people really care about are their functional status and their wellbeing. And those to date have not been very well or very consistently measured. And they'd been very site-specific. So, so how to get, uh, site neutral, um, uh, uh, in can more conditions, centric measurement that is appropriately risk adjusted to my mind is a critical path here. Well, I agree

Speaker 3 (45:41):

With that. And the other piece that plays into this, like if we're going to do more at home, um, and Janina, I'd love your take on this, but like the whole field of remote patient monitoring, I think is, I mean, it's, it's fascinating how much we can monitor, but then you need the infrastructure like to support the monitoring. I know we have solutions, but that's also run up against, you know, payment model barriers and adherence barriers. And I mean, there's, there's a lot of promise for remote patient monitoring. Um, but to get it to scale, uh, I think there's, there's more work to be.

Speaker 2 (46:25):

Yeah. I think though, the notion is Jay, we all think the remote monitoring has to be continuous. It has to be. And in fact, I think the greatest example is showing that how that's a bad idea. It's the old apnea monitors. Remember those? You know, when I was in residency training, we sent everybody home on an apnea monitor, turns out the apnea monitor was developed in Philadelphia who knew, right? And so everybody went on. What, what, what, what a bad idea. It tortured. The children had tortured. The parents had tortured the doctors and we got no benefit. Now there are, of course, a few kids who needed that apnea monitor, but a few. And my, my aha was one of my, one of my dearest friends, went out to Michigan to do her pediatric work after residency. And she called me one day. She said, you're not even going to believe this.

Speaker 2 (47:06):

They don't send everyone home on an apnea monitor and they both survive. And so like how much is too much. And that's really where the implementation science and understanding what, how much do I need, right. Because too much information is a bad idea. Even like my example about CGMs and type twos, people living with type two diabetes, forget me. Um, you know, the, they, they don't, I actually, I mean, type one opposite, they need continuous glucose monitoring everyday L'Oreal type twos. What may be a couple of times a year when there's a med change or there's a lifestyle change or just in a feeling, well, that would make more sense to me to give me that snapshot and then take the darn thing off and pay for what we need. Yeah.

Speaker 1 (47:49):

To Jay's point. How are you guys thinking about this combination of payment model reform or health plan benefit or form at the same time as you're thinking of innovation, how do you innovate both on the payments side and the care delivery technical side? Yeah. So

Speaker 2 (48:09):

They are already at full risk for so much care, right? And so we have that latitude to try things because we already got the payment you're, I'm already being paid and charged with the responsibility of taking care of these folks. And, um, and what's nice. That's on the United healthcare side, only on the Optum care side, there's a lot of full risk contracts and value-based care arrangements, as you know. And so I find that there's an amazing willingness to try things. And, and as long as you're disciplined enough to follow the outcome, set this study up the right way and not always a randomized controlled trial, it can be AB testing. You know, if I have two standards, so they're both acceptable. Why can't I say, well, on Monday, Wednesday and Friday, all the patients are getting a and Tuesday, Thursday, Saturday, all the patients are getting B and I'm going to see which one actually works better.

Speaker 2 (48:54):

Both are standards of care. Both do not need consent right before the standard. I'm just evaluating what is better. What do people like? Did it work for certain groups? So that is another thing I think, um, as it relates to people are, so we got locked in our minds that somehow only randomized control trial for everything. And I'm going to argue for effectiveness because that's real world, it's probably the wrong study design. And as my son, the economist always beats in my head. Um, they use lots of non, these lots of different types of experimentation. Um, and he'd argued that sadly physicians were not well-trained like that, but we could probably partner more with those kinds of professionals to learn what would be the best designs.

Speaker 3 (49:41):

Yeah. I find the like payment reform quite fascinating. Um, so we're been to the, like an episode of payments. So we were full risk for the post acute episode. And through these, uh, other expansions, we'd like to expand the amount of risk in an episode. So that would mean not only inpatient PAC, right. But then you add on, well, you'll be at risk for that whole health, and then you're at risk for readmissions. And so pretty soon you have this very large care transition risk, which is still episodic. Right. Um, and then when it comes to longitudinal risk, I think, you know, more and more, we want to push to capitation and, you know, full longitudinal risk. But I would just say that there there's those that do it really, really well, and they know how to manage the risk and know the effectiveness of these solutions like the Nene you're talking about and how to iterate on the effectiveness. But I think there's a, a large, uh, amount of providers that are not skilled in managing full longitudinal risks. So it seems like episodic risk can help you learn more about managing a longitudinal risk. Um, but I do agree, I agree that it allows you to, uh, be innovative when you're in those types of payment models.

Speaker 1 (51:18):

So a couple of questions from the chat, um, are there two or three problem domains or clinical in clinical care delivery that are waiting for technology to catch up?

Speaker 3 (51:34):

Um, so I'll just, I'll just explain, uh, I'll just give you my 2 cents on that is that, um, clearly chronic disease, right. Is the driver of, you know, um, spend, right. So in chronic disease and chronic disease management, what are the things that we need more solutions for? Like in our bundles work, we know today that, um, CHF readmissions 90 day are still at the 40 to 50% range. We need a solution for that. That, that seems like completely unacceptable that if you have heart failure and leave the hospital, that in 90 days, you're going to be back. Right. So I think there's a lot of, uh, opportunity to combine, you know, these types of like really figure out these types of problems.

Speaker 2 (52:34):

Yeah. Kevin, I'll jump in here. And then I apologize. I, as you know, I have to leave five minutes early, so I'll make this my final comment that I'll say two words, mental health, um, and, and, and not only on the, what I'll call the more wellness part of mental health, but the care, the care part, and particularly as it relates to measurement.

Speaker 1 (52:53):

Fantastic. Thank you, Janine. This was terrific to have you, we'll get a few questions here. Thank you. And JL I'll pivot to a couple that are sort of directed dreaded naviHealth, uh, here's one does naviHealth evaluate the unpaire the unpaid caregiver status in the home setting and think about support for that caregiver or caregiver burden.

Speaker 3 (53:16):

That's a great question. Um, so we've evaluated, um, personalized care. So the, um, you know, like a personal services care, right, as a potential, um, expansion area and ambition, and we evaluated a number of, um, capabilities that are out there for care or support. Um, and so some of that was, um, evaluated. It did run into the, um, the payment model. She was like, how do you, how do you do that? But I think more and more support for family members or people who, who are, um, caring, personalized care for a member should get into more and more benefit designs so that there can be a support for that.

Speaker 1 (54:09):

Yeah. I certainly know from my time at the government, that Medicaid was focused very heavily on this in our long-term services and supports approach, they called us. Um, and so I think a lot of the challenge we've had is that each of the various federal payment programs, uh, really specific guard rails around them. And so in Medicare, as, you know, those things are paid for by Medicaid, that's some are. Um, and, and so it's a bit of a challenge to combine those models, to understand how to best solve problems for patients. When there are bright lines between how one type of insurance works and other types of insurance works

Speaker 3 (54:50):

Well. And Kevin, as you know, right, there's this huge workforce of unpaid, you know, um, that, you know, if it it's already, um, it's already being delivered because of the, the care of family and friends. Um, and then to put that into paid delivery would be quite a, um, a burden on the finances of the healthcare system.

Speaker 1 (55:18):

So here's a great question. What's the best way for clinicians at UHG and our various business to help with these ideas and innovations, what do you need from support from the rest of the company?

Speaker 3 (55:31):

Um, well with, uh, um, Patrick Conway's leadership in, um, care solutions there's, um, develop in development now, home and community, um, um, infrastructure. And I believe it'll be through like really through Patrick Conway's leadership, that they'll be more and more attention paid to new solutions in Pullman community. And this is combining naviHealth with sound physicians, uh, understanding how we can use our engagement platform of naviHealth to refer into Prospero or landmark or other care solution activities. Um, so I guess I would direct folks, um, you know, they can certainly come to me directly, but, um, Patrick Conway and his team, um, are definitely innovative.

Speaker 1 (56:34):

Thank you so much, Jay. Um, this concludes our webinar for today thing. Um, both of the speakers were fantastic, really interesting, innovative work that is also practical, which I think is the funnest part of innovation is when it is really helping and impacting people's lives. Um, we'd appreciate it if you, in the audience, but to complete a evaluation of today's webinar, clicking the link in the announcement section of your screen. And we'll also include the survey link and a follow up email, and we hope that you join us in the future from future leadership learning series events, and look for invitations to come again. Thank you very much. Thank you to Jay and thank you to Deneen and, uh, have a lovely afternoon.