Latest / Becker’s Payer Issues Podcast / Dr. Ruchi Talwar, Medical Director of Episodes of Care Population Health at Vanderbilt Health

Transcript

Dr. Ruchi Talwar, Medical Director of Episodes of Care Population Health at Vanderbilt Health · Becker’s Payer Issues Podcast

0:00
Hello, everyone. This is Jacob Emerson with the
0:02
Becker's Payer Issues podcast. Thrilled today to be
0:04
joined by doctor Rishi Tawar, who is a
0:07
medical director in the office of episodes of
0:09
Care Population Health at Vanderbilt Health. Doctor Talwar,
0:13
thank you so much for taking the time
0:14
to be with me on the podcast today.
0:17
Thank you. I really appreciate the opportunity to
0:19
share a bit more about the work we're
0:21
doing here at Vanderbilt.
0:22
Absolutely. And glad you could take the time
0:24
to be with us. Before we dive into
0:26
everything we wanna talk with you about, can
0:27
you tell us a little bit more about
0:29
yourself, your background in health care, and what
0:31
it is that you're doing today at Vanderbilt?
0:34
Absolutely.
0:36
I in addition to
0:38
having a role in population health as you,
0:41
alluded to, I also have an active clinical
0:44
practice. I am a urologic oncologist
0:47
here at Vanderbilt Health.
0:49
I see patients I I do predominantly
0:51
cancer surgery for
0:53
prostate cancer, bladder cancer,
0:56
and kidney cancer.
0:58
In addition to that, my background,
1:01
especially during my training, was in health policy
1:04
research.
1:05
So my role at Vanderbilt is sort of
1:08
a natural fit,
1:10
that bridges both of those worlds. I get
1:12
to treat patients with urologic cancers. And at
1:16
the same time, in my role within episodes
1:19
of care under our population health umbrella,
1:22
I get to rethink how we deliver,
1:25
pay for, and experience
1:27
specialty care in our health care ecosystem.
1:32
Part of my role as medical director within
1:35
episodes of care
1:36
is to,
1:38
help operationalize,
1:40
lead, and support
1:41
the MyHealth bundles program, which I'm sure we'll
1:44
be talking more about in just a few
1:46
minutes.
1:47
But more broadly, I, essentially, am the medical
1:50
director for all of specialty value based care,
1:53
which includes some of the Medicare models that
1:56
are set to go into effect as of,
2:00
July first of twenty twenty five in addition
2:03
to January first of twenty twenty six. So
2:05
it's it's been a really fun ride here
2:07
at Vanderbilt getting to,
2:09
you know, sort of bridge both of my
2:11
worlds and both of my interests.
2:14
Fantastic. Well, like I said, we appreciate you
2:16
taking the time to be with us. And
2:18
you work for one of the country's leading
2:20
health systems, but you're here with us on
2:22
our insurance podcast to talk about how
2:25
employers nowadays are really seeking new and innovative
2:28
ways to manage their health care expenses
2:31
for their employees.
2:33
As you know, we're seeing on our end
2:35
that health care costs for employers
2:37
are set to rise by nearly 8%
2:40
this year alone. So maybe you could start
2:43
us off by explaining what provider led bundle
2:46
programs are,
2:47
how they offer a new model for addressing
2:50
high cost health conditions within the employer sponsored
2:53
health care space?
2:54
And why is Vanderbilt's,
2:56
interested in this kind of thing?
2:59
Sure. Sure.
3:01
You know, I think,
3:02
understanding,
3:04
exactly the point you just alluded to is
3:06
critical to understand why Vanderbilt wants to disrupt
3:09
this space.
3:11
You know, you alluded to this. Health care
3:12
costs for employers continue to rise. And as
3:15
we know, if we look at the proportion
3:17
of employers who provide,
3:20
employer sponsored insurance,
3:22
more and more of them are becoming fully
3:25
self self insured.
3:27
And and so they are very engaged
3:29
and very in tune with understanding,
3:32
their employees' health care related needs.
3:35
To that end, they're very astute in noticing
3:38
where their spend is particularly high. And here
3:41
at Vanderbilt, we have incredible
3:44
partnerships with our employers.
3:46
We ourselves are self insured, you know, the
3:49
medical center. And we have a a great
3:51
relationship with Metro Nashville Public School System, another
3:55
local self insured employer.
3:58
And
3:59
it was this partnership that really,
4:01
you know, served as the foundation
4:05
for our
4:06
now
4:07
wildly successful,
4:09
provider led bundle programs.
4:12
What we did was we looked at the
4:14
areas that were the biggest pain points for
4:16
them,
4:17
both as it relates to increased spend, but
4:20
also
4:21
predictability of spend
4:22
or their employees' experience
4:25
in getting care related to that condition.
4:28
And we,
4:30
you know, partnered with our
4:32
leading clinical teams here. You you said it
4:34
yourself. We're one of the nation's leading health
4:37
care systems.
4:38
And we said to our providers,
4:40
okay. This is an area,
4:43
of increased spend and and significant, you know,
4:45
pain for our employers that are in our
4:48
Nashville area, the ones that we have great
4:50
relationships with.
4:51
Tell me, what in a perfect world, in
4:54
a perfect scenario,
4:55
if we didn't have the burdens of prior
4:57
authorization,
4:58
utilization
4:59
management,
5:00
worrying about,
5:02
patient facing cost or out of pocket costs,
5:05
put together
5:06
an algorithm that lets you take the best
5:09
possible care of the patient and sets us
5:12
up to get the best possible outcomes.
5:15
And so we really centered our bundled payment
5:19
programs
5:20
on the patient. The patient is first. The
5:22
patient is front and center.
5:25
By doing so, we were able to
5:28
ensure that we're providing optimal outcomes. But, you
5:31
know, as a as a clinician myself, I
5:33
wanna call out the fact that we were
5:34
also able to make sure our provider teams
5:37
didn't have to deal with their own pain
5:39
points, such as prior authorization,
5:42
burdens, things like that.
5:45
For our employers,
5:46
we have packaged all of these services
5:49
at a single price
5:51
that allows them to achieve all of the
5:53
care related to that condition,
5:55
one single price. You know, it it accomplishes
5:58
that predictability
5:59
that people value.
6:01
And we take risk on our own outcomes.
6:04
So I'll I'll give you a couple examples.
6:06
Our oldest and most popular
6:09
bundle right now is the my maternity health
6:11
bundle. And we start the clock,
6:15
the day the patient has their first dating
6:17
ultrasound.
6:18
We cover all care related to the pregnancy,
6:21
throughout
6:22
the the the patient's pregnancy related journey.
6:26
And then we also cover
6:29
care related to the pregnancy up to ninety
6:31
days postpartum.
6:32
We do all of this as at one
6:34
single cost for our employers,
6:37
And we take risk. We take risk on
6:40
things like our c section rate. And that
6:42
has paid off because our c section rate
6:44
is lower than market, and our patient experience
6:47
is off the charts.
6:49
Our NPS scores, our net promoter scores are
6:51
often in the high eighties to to even
6:54
nineties for some of our programs when we
6:56
all know the average in health care is
6:58
is often in the 30 to 40 range.
7:02
Understood. And I I appreciate those real world
7:04
examples, doctor Tawar, and and clearly very beneficial
7:08
model for for the employer, for the provider,
7:11
and and the patients, of course.
7:13
For our listeners who might be unfamiliar with
7:16
these kind of programs, can you break down
7:18
for us how a bundled payment model differs
7:21
from that traditional fee for service arrangement
7:24
and what you're hearing from employers on the
7:25
ground in terms of why they they might
7:27
prefer something like this?
7:29
Yeah. Absolutely.
7:30
I I mentioned this, but let's dig in
7:32
a bit more. So first of all, our
7:34
bundled payment models,
7:36
have one single price.
7:38
And so I I alluded to this, but,
7:40
you know, our employers really appreciate the predictability.
7:43
When you're a self insured employer and you're
7:45
carrying a lot of that financial risk for
7:47
health care costs,
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particularly
7:49
in the,
7:51
financial environment
7:52
and economic environment that we're in now,
7:55
predictability is key, and it allows you to
7:57
plan for the future and understand where your
8:00
spend is gonna go.
8:02
And and we cover again, the the way
8:05
that this is different from fee for service
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is our bundled price
8:09
covers all of the care
8:11
related to that patient's condition.
8:14
Fee for service arrangements
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require clinicians
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to bill for specific services that are provided.
8:21
I gave an example of maternity care. Within
8:24
a woman's pregnancy journey,
8:27
you know, she may require
8:29
several ultrasounds
8:30
or
8:31
perhaps genetic testing,
8:34
or perhaps other sorts of tests that blood
8:37
tests, things like that, imaging,
8:40
outside of ultrasound.
8:42
All of that is covered in our single
8:45
price. Whereas in a traditional fee for service
8:47
arrangement, that would be billed product by or
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service by service rather.
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Similarly,
8:54
she may
8:55
be required to pay a co pay at
8:57
each specific visit.
8:59
Our program,
9:01
one of the big perks and one of
9:03
the the big patient satisfiers is the fact
9:05
that if you enroll in our program, we
9:08
waive all co pays. So for many patients,
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that significantly
9:12
reduces
9:13
the out of pocket cost burden and financial
9:15
toxicity associated with getting care.
9:19
You know, I use the pregnancy model, but
9:21
to address why these,
9:24
sorts of programs are becoming increasingly popular with
9:27
employers,
9:27
I'm gonna use another example.
9:30
We have a program
9:31
that we offer to our employers that centers
9:35
around osteoarthritis
9:36
care.
9:37
And it's one of the only programs of
9:39
its kind that actually allows
9:42
employees who enroll
9:44
to opt for medical management
9:47
of osteoarthritis.
9:49
So what that means is we are,
9:52
taking risk on our rates of surgery
9:55
and and making sure that those are
9:57
done only when clinically appropriate and allowing patients
10:00
to have access
10:02
to non operative options,
10:04
such as injections, for example. Those injections can
10:08
otherwise be pretty costly.
10:10
But employers love the fact that they can
10:13
keep their workforce healthy
10:15
and, you know, avoid a major surgery by
10:18
getting them access to these sorts of injections,
10:22
for osteoarthritis
10:23
care. That keeps
10:25
employees healthy. It keeps them out of the
10:28
hospital. It keeps them at work functional,
10:31
and they love the fact that they can
10:33
have quality of life improvements
10:36
that don't require an invasive procedure.
10:38
So that's just one example of why these
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sorts of programs are becoming really popular with
10:44
our employers.
10:45
You know, I think the mindset around health
10:47
care spending,
10:49
is is shifting a bit, and people are
10:51
realizing
10:52
with time that in general, health care spending,
10:55
you know, continues to trend upward, and it
10:57
is becoming unsustainable.
10:59
And so what I find really rewarding and
11:02
what I know our our employers really appreciate
11:05
is the opportunity
11:06
to work with with really a a center
11:08
of excellence in town
11:11
and and and to to ensure that their
11:13
patients are getting excellent care.
11:17
But removing some of the hassles as it
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relates
11:20
to making sure that that clinician is in
11:23
network
11:24
or,
11:25
you know, again, I'll I'll refer to those
11:27
co pays. Some of our programs have enhanced
11:30
telehealth services. So, again, it may not require
11:33
someone to take an entire day off of
11:35
work and drive downtown
11:37
just for a doctor's appointment.
11:38
So we we really try to try to
11:40
address some of those specific
11:42
areas of of annoyance and and,
11:45
you know, the areas that can be really
11:48
inconvenient
11:49
for our patients, for our employers.
11:53
Absolutely. And from your clinical perspective, doctor Tauro,
11:56
what what are some of the long term
11:58
implications
11:59
of these models for both the employer
12:01
and and for the provider in terms of
12:03
improving care efficiency and health outcomes
12:07
for the employees under under a program like
12:09
the My Health bundles.
12:11
Yeah. And and, again, my lens as a
12:14
clinician, this is this is really what I
12:16
love most about this program.
12:18
So, you know, I'll go over some of
12:19
our recent results that we've seen and analyses
12:22
that we've done.
12:24
You know, for patients who enrolled in our
12:26
My Weight Loss Health program, which is a
12:28
bariatric
12:29
surgery
12:30
bundled payment,
12:32
we had over,
12:34
640
12:35
bariatric procedures
12:37
with over 40,000
12:39
pounds lost. And and what I love about
12:42
that is, you know,
12:43
wildly successful, but we actually had less than
12:46
a one percent reoperation rate. Again, we guarantee
12:50
high quality care.
12:52
Patients who un who enrolled in our MySpine
12:55
Health
12:56
program, who underwent surgery,
12:58
eighty six percent of them returned to work
13:00
within ninety days.
13:02
Across all of our surgical programs, we had
13:06
an average of a one percent surgical site
13:08
infection rate.
13:09
And that just, again, goes to show the
13:11
the excellent outcomes that we're able to ensure
13:15
here.
13:16
And,
13:17
you know, I again, my lens tends to
13:19
be clinical there, but I can tell you
13:22
that there's been,
13:24
incredible
13:25
financial impact too. I mentioned that we partnered
13:28
with one of our,
13:30
local
13:31
employers, Metro Nashville Public Schools.
13:34
And, you know, through participating in our my
13:37
maternity health bundle, we were able to significantly
13:41
cut the amount of money that they spent
13:43
on neonatal care. In fact, an analysis done
13:46
in 2024
13:48
actually showed
13:49
a $1,000,000,
13:51
reduction
13:52
in,
13:53
NICU spending and 50 NICU admissions that were,
13:58
avoided. So really a clinical success that translates
14:02
into a financial success.
14:04
So in my opinion, that's truly, you know,
14:07
a a win win win, I like to
14:09
call it. It's a win for for patients
14:11
first and foremost. It's a win for our
14:13
employers,
14:14
and it's a win for Vanderbilt because we
14:16
we we're doing what we know best, and
14:19
that's providing really high quality care.
14:22
You know, if you look at all of
14:23
our employers that participate in this program in
14:26
aggregate,
14:27
they've saved about 16%
14:29
on health care spend.
14:32
And tying that back into my clinical lens,
14:34
we've been able to avoid,
14:37
variations
14:38
in care and and improve the quality of
14:40
care
14:41
that our community gets. And that that is
14:43
really what I find
14:45
most rewarding.
14:47
Absolutely. And those are certainly some impressive statistics
14:49
that that you've accomplished through this program, doctor
14:52
Talwar.
14:53
Before we go, anything else that we're missing?
14:55
Any final thoughts you wanna share with our
14:58
audience, while you have the ears of a
15:00
lot of other health system and health plan
15:02
leaders around the country?
15:04
Yeah. Absolutely.
15:06
You know, I think that this program really
15:08
demonstrates
15:09
the ability to innovate,
15:11
to disrupt, and to improve the quality
15:14
of care
15:15
while reducing the costs of care for our
15:18
local communities. And so when people think about
15:21
value based care or bundled payments, I think
15:24
a lot of times,
15:26
we can we we we
15:28
think about the national level initiatives such as
15:31
some of those Medicare models,
15:33
some of which have been really successful and
15:36
others, you know, we're still trying to understand
15:38
the the success and financial implications of of
15:41
some of those Medicare innovations.
15:43
But that doesn't mean that we can't work
15:45
right at home,
15:46
in our backyards to partner with our own
15:49
employers
15:50
to,
15:52
implement some of these programs.
15:53
And so I'd encourage all of the payer
15:57
leaders on this on this podcast who are
15:59
listening and a lot of the health system
16:02
leaders
16:03
to take a look and see if some
16:06
of these innovations
16:07
are applicable
16:08
within your,
16:10
within your communities.
16:12
Because I think it's really it's really incredible,
16:15
to see how local partnerships
16:18
can improve the health of our patients
16:21
and also,
16:22
you know,
16:24
pave the way for innovations in specialty
16:27
value based care, you know, especially especially in
16:30
specialty care, which has been a a source
16:32
of
16:33
a lot of health care spending.
16:35
And and, you know, Vanderbilt's just one of
16:38
many systems
16:39
who are thinking about these kinds of problems,
16:41
but I I really think that,
16:43
our My Health Bundles program
16:46
provides a lens
16:47
for specialists
16:48
to take an active role in these sorts
16:51
of, value based care initiatives.
16:54
Fantastic. Well, thank you so much for taking
16:56
the time to sit down with us and
16:58
for sharing your insights with our audience. We
17:00
really appreciate it.
17:02
No problem. I appreciate the the,
17:05
opportunity to chat with you today. Thanks so
17:07
much.
17:08
Of course. And for our audience, if you'd
17:10
like to listen to more podcasts from Becker's
17:12
Healthcare, you can visit beckershospitalreview.com.