Latest / Becker’s Payer Issues Podcast / Dr. Ken Cohen, Executive Director of Translational Research at Optum Health

Transcript

Dr. Ken Cohen, Executive Director of Translational Research at Optum Health · Becker’s Payer Issues Podcast

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Everyone. This is Jacob Emerson with the Becker's
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Health Care podcast. Thrilled today to be joined
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by a special guest. Doctor Ken Cohen is
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executive director of translational research at Optum Health,
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and he also leads the Optum Center for
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Research and Innovation.
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Doctor Cohen, thank you so much for taking
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the time to be with us on the
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podcast today.
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Happy to be here, Jacob.
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So, Ken, before we dive into everything we
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wanna talk with you about, can you tell
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us a little bit more about yourself, your
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background in health care, and what it is
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that you do today at Optum Health?
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Yeah. I'm happy to do that. So I'm
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an internist by training. I spent my first
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ten years at one of the academic,
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medical centers in Philadelphia.
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And then the next twenty five years as
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the chief medical officer of a large primary
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care group in Denver, known as New West
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Physicians.
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And while at New West, I built a
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care model that used level one and level
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two evidence at the point of care
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to drive improvements in patient outcomes as well
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as the elimination of wasted and harmful care.
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In 2,018,
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Optum became interested in that model, and they
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acquired our group, with the understanding that I
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would take that model
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and scale it across the rest of the
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Optum health practices
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nationally.
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So today, I have two fundamental roles. One
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is that role that I just described.
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And then additionally,
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I have a translational
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research team,
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and together, we do health outcomes research specifically
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focused on value based care.
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Fantastic. So decades at New West Physicians and
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now helping lead research at Optum Health.
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Ken, before we dive into your research that
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you've done for Optum,
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I wanted to level set for our audience
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and get your perspective on on a term
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that we, of course, hear often in the
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health care industry, and that's value based care.
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So we hear that from different stakeholders across
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the health care spectrum, and I'm wondering if
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you could,
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put it in simple terms for us how
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UnitedHealth Group and Optum specifically
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define value based care today.
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Certainly. So
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value based care is where physicians
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accept accountability
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for the care outcomes.
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And under value based care,
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primary care providers engage with patients,
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use high quality evidence based medicine combined with
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shared decision making
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to arrive at the decisions that align best
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with patients' values and preferences.
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There's a focus on prevention,
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early
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detection, and importantly,
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management of chronic diseases.
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And this approach emphasizes
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a proactive
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preventive care that looks at the patient's overall
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health.
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It increases the chances of early disease identification,
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and it ensures that patients receive optimal, particularly
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evidence based care.
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Primary care physicians receive financial incentive, hence the
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accountability,
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for effectively improving both health outcomes and costs
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by keeping their patients healthier and reducing their
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total cost of care.
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Wonderful. Appreciate that overview, Ken. And I wanted
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to specifically talk with you today about some
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of the research you've done into value based
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care for Optum.
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Actually, I wanna talk about two two of
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your most recent research projects that you coauthored,
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and that was in partnership with America's Physician
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Groups.
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And, ultimately, it validated the benefits of a
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value based care model.
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So your first study, it was peer reviewed
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research published within the JAMA network open, and
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that showed that Medicare Advantage members in value
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based arrangements
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receive better care compared to beneficiaries
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in traditional
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Medicare Advantage arrangements. So from from your perspective,
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Ken, what were some of the most significant
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takeaways
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from the JAMA research
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in terms of patient outcomes
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under value based care models?
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Importantly,
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what it really focused on
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is trying to isolate the impact
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of different Medicare Advantage payment models.
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So the study looked at 17 physician groups.
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All of these groups were part of America's
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Physician Groups, one of the large physician advocacy
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organizations
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that is really focused on,
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developing skill sets around value based care.
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In those 17 physician groups, we included over
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15,000
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primary care physicians,
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and it included over 5,000,000 patient years of
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data. So this was a very, very large
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dataset.
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And it compared two groups of Medicare Advantage
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enrollees.
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One was in value based care arrangements. So
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these were either fully accountable two sided risk
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arrangements
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or at a minimum full professional risk.
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And the other group that it compared to
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were standard fee for service Medicare Advantage contracts.
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And the unique feature of the study was
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that all of the patients were cared for
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by the same physicians and the same physician
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groups.
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So again, this allowed us to isolate and
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highlight
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the impact of the fully accountable value based
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care model since the physicians caring for patients
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were the same in both groups.
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And the findings
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highlight that Medicare Advantage
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value based care arrangements,
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which emphasize, as I mentioned, preventive screenings, integrated
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medical and behavioral care,
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care coordination,
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population risk stratification,
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embedded pharmacy services, so a whole range of
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infrastructure associated with value based care.
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But this model delivered higher
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quality clinical care and better health outcomes
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compared to the traditional
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Medicare Advantage models that were paid fee for
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service.
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And these arrangements resulted in fewer hospitalizations,
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fewer emergency visits, and safer medication use among
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others.
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Understood. So your study confirmed that these these
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patients, these Medicare Advantage patients in value based
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arrangements,
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they're they're getting better clinical care, and overall,
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they're seeing better health outcomes. It's it's, so
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fascinating that that's the conclusion that you you
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came to in your research.
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Let's talk about another study that you published
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in the American Journal of Managed Care recently,
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which showed that Medicare fee for service patients
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cared for by physician groups who also care
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for patients under at risk payment arrangements with
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Medicare Advantage Plans,
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they experienced better health outcomes.
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What that's that's fascinating, Ken. And what about
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individuals that were not engaged
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in value based care models? Can can you
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explain for our listeners,
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the spillover effect that that you highlighted
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in that most recent paper for AGMC?
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Yes. And and I agree with you, Jacob.
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I think this is an an absolutely
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fascinating finding, And I've been wanting to do
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this study for a very long time, but
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it wasn't until I had the data assets
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available that I could really study this in
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detail.
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So we examined care
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that was provided by nine large physician groups,
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again, part of APG.
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And in this case, these physician groups cared
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for over one point four million traditional
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Medicare patients.
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And this study occurred with data between 02/2016
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and 02/2019.
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So again, these were APG physicians highly experienced
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in value based care,
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but now we're examining their traditional Medicare patients
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who were not in value based care contracts.
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So that was the intervention group. And the
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control group is we compared outcomes
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for those traditional Medicare patients
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to the broader community of physicians caring for
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traditional Medicare patients. So, again, the entire population
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are traditional Medicare patients, but the intervention group
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being those with experience and value based care
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and the control group being the broader traditional
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Medicare population.
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And this study is the first to show
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that the benefits of value based care,
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including fewer hospitalizations for chronic illnesses, fewer emergency
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visits, more wellness visits, and better medication adherence,
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that these improvements in overall care quality and
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efficiency
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actually spill over from the Medicare Advantage patients
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onto the Medicare recipients when their physicians are
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skilled at value based care.
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And this has just an absolutely enormous impact
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on the traditional Medicare program.
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So you can imagine what those benefits might
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look like where the entire physician cohort taking
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care of traditional Medicare patients
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skilled in value based care arrangements.
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And on average, about seventy percent of these
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groups Medicare Advantage patients were under value based
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care,
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where the groups were responsible for the quality
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and the cost of care.
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And because these physician groups also treated many
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traditional Medicare patients using the same advanced care
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practices,
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it was these advanced care practices that led
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to the improved health outcomes,
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not only for their MA patients,
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but also meaningfully better care for their traditional
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Medicare patients.
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Wow. I mean, so just to confirm there,
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because that's an amazing statement, Ken, in conclusion
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from the study that that Medicare Advantage,
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members and these value based care models for
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physicians that participate in, that's spilling over to
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also positively
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impact
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fee for service Medicare patients. Is that correct?
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And that's correct. And and if you think
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about it, it makes sense because what we're
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talking about
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is that when physicians
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are skilled at a certain care model, so
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for example, engaging in preventive services,
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use of evidence based medicine,
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careful selection of specialist cohorts, so you're referring
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to the highest quality specialists,
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Careful selection of hospitals and ambulatory surgery centers,
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so you're using the highest quality and most
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efficient sites of service.
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All of these are not unique to a
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Medicare Advantage population.
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And once physicians learn that skill set and
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see the positive impact that it has on
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their MA population,
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it's only natural that they would use that
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same skill set when caring for their traditional
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Medicare patient.
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Absolutely. It makes complete sense. And and in
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that vein, Ken, we we have a lot
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of hospital and insurance leaders listening in right
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now.
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If we're considering both the pay papers that
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you just gave us an overview of, what's
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the most important point or takeaway that you
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wanna make sure our listeners remember?
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Well, let's talk about the JAMA network paper
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first.
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And recall that that paper examined two different
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Medicare payment arrangements. One, a fully accountable two
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sided risk and the other fee for service
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MA.
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And ultimately, the Medicare Advantage value based care
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arrangements delivered exceptional results for their patients.
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There's already a substantial literature showing that overall
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MA patients receive care of higher quality and
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efficiency compared to traditional Medicare.
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However, it's important to recognize that MA plans
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pay physicians differently and physician groups can either
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be paid in a fully accountable model or
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in a fee for service arrangement.
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What was different about this study is that
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it was one of the first and certainly
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the largest and most comprehensive study to date
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showing that within Medicare Advantage,
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when physicians are paid in accountable care arrangements,
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the care delivered to their patients is better
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than when they are paid in fee for
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service arrangements.
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And some of those key results
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included the patients in value based care arrangements
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were twenty two percent less likely to be
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admitted to the hospital for chronic chronic common
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conditions like COPD or asthma.
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They were fifteen percent less likely to use
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high risk medications that can cause serious side
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effects if used incorrectly.
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And overall, there are nine percent less likely
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to be admitted to the hospital
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and nine percent less likely to visit hospital
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emergency departments.
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So so these studies then and then data
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you just shared, Ken, they clearly validate the
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impactful and the innovative work happening
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at UnitedHealth and at Optum. If we were
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looking ahead, how do we move the broader
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transaction based health care
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system to these value based care models that
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you've been discussing with us today?
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Ultimately,
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how do we get these models moving forward,
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so that
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we're more proactive
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with people's health and and we're keeping patients
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and members healthy over the course of their
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lifetimes.
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I think that's the critical issue. And and
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before I get there, let me spend a
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little bit more time, just discussing the spillover
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paper and looking at the specific impacts of
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that paper.
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And here, there was a clear indication that
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the superior care outcomes achieved by physician groups
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that are participating in accountable value based care
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arrangements for quality and costs
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spill over to the traditional Medicare patients, as
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I just mentioned.
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And the results of that paper further validate
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that value based care models are improving health
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outcomes across different populations,
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including the traditional Medicare population.
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And in that study,
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what we showed is that the traditional Medicare
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patients who were being cared for by these
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physicians' skilled and value based care
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were ten percent less likely to have acute
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hospital admissions,
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twelve percent less likely to be readmitted within
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thirty days,
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twenty one percent less likely to use emergency
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departments,
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and eighty two percent more likely to have
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annual wellness visits.
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They were nine to thirteen percent more likely
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to adhere to medications for hypertension,
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diabetes,
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and hyperlipidemia,
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and they were five percent less likely to
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be prescribed high risk medications.
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So putting these two papers together,
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I think we can begin to answer the
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question that you're asking.
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And I think one point is that value
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based care arrangements are working,
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not only for Medicare Advantage patients, but across
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traditional Medicare patients as well. And, frankly, although
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we didn't study it, there's every reason to
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expect
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that these same skills would also spill over
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into a commercial or a Medicaid population.
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And the second critical point is that all
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Medicare beneficiaries
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are now benefiting from these advanced practices
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that prioritize
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whole person patient specific care.
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So clearly, the benefits of these models are
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are are known.
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It's been validated by this research, Ken.
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From your perspective, from where you're sitting at
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Optum,
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as a health care system,
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where where is the rest of the the
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the health care system on this journey of
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broad adoption
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of this model? Is it being widely accepted?
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And where are you seeing some of the
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hesitancies
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out there?
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Well, part of the problem is that
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the definition
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of value based care,
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varies depending on who is looking at it.
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So some folks will look at value based
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care and they'll think that fee for service
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with an upside bonus potential is value based
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care, and I wish push back on that.
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We've been studying this for a long period
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of time now, and, ours aren't the only
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studies that demonstrate this. But what moves the
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needle
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is that accountability
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for costs and outcomes.
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So, for example, there are studies that show
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that in a Medicare Advantage model that, pays
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physicians either by fee for service, fee for
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service with upside bonus, or in two sided
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risk fully accountable models.
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That the needle on outcomes doesn't really improve
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until you move to that accountable for two
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sided outcomes model.
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So it's really critical that we understand
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what is the definition of value based care
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that actually will drive
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improvements in health outcomes.
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And UnitedHealth Group through Optum and UnitedHealthcare
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really aims to lead the shift towards a
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health system
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where the needs of all patients, care providers,
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and payers are closely aligned
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to deliver coordinated and seamless care in a
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value based care model.
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For example, home care can play a vital
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role in this approach,
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ensuring patient centered, equitable, and accessible care that
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addresses complex conditions, medication adherence, social needs, and
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behavioral health challenges
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for patients that aren't able to reliably
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reach the office for their care.
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We have systems in place where patients' entire
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health care journey,
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takes place entirely in the home.
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Another important point is that the Medicare
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alternative payment models are also an important part
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of the strategy,
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driving value, improving quality, and lowering costs for
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original Medicare beneficiaries,
16:53
again, with the caveat
16:55
that there should be a component of two
16:57
sided risk to them. So ACO reach, for
17:00
example, is an excellent example of that, and
17:02
MSSP
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now has significant components of risk associated with
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it as well. So the expectation is that
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both of those models should also improve patient
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outcomes,
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reduce wasted and and harmful care, and overall
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reduce total cost of care.
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Certainly. Well, I know I speak for all
17:20
of us here at Becker's, Ken, when I
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say that we look forward to your further
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research into these important issues and and some
17:26
of those ones that you just mentioned. But
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before we go, is there anything else that
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we're missing? Any final thoughts or pieces of
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advice you wanna offer our listeners today?
17:36
In closing, Jacob, the last point I'd like
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to make is that our research and others
17:40
now have clearly shown that patients in value
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based care arrangements
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have better outcomes and overall efficiency of care
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has improved.
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For over two decades now, there has been
17:50
bipartisan agreement among healthcare experts and policy makers
17:54
that value based care outperforms fee for service
17:57
in terms of health outcomes, consumer experience, and
18:00
cost.
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Most value based care arrangements are currently within
18:04
Medicare Advantage, but CMS is targeting one hundred
18:07
percent of Medicare members to be in VBC
18:09
arrangements by 02/1930.
18:11
Additionally, the number of individuals in commercial value
18:14
based plans has grown by nearly fifty percent
18:16
over the past two years, and many patients
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are in Medicaid managed care as well.
18:21
We know that this is a better model.
18:23
The tipping point is almost upon us, but
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we're not there yet, and it is time
18:28
to push fully accountable
18:29
value based care models over the finish line.
18:33
Absolutely. It's a great piece of advice for
18:35
us to leave things at today. Doctor. Cohen,
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I want to thank you for taking the
18:38
time to sit down with us and for
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sharing your insights with our listeners. We truly
18:42
appreciate it.
18:44
I was happy to have the opportunity to
18:46
speak with you, Jacob.
18:48
And if you'd like to listen to more
18:50
podcasts from Becker's HealthCare, you can visit beckershospitalreview.com.