Latest / Becker’s Payer Issues Podcast / Redesigning Autism and I/DD Care: Insights from Catalight’s Chief Health Officer

Transcript

Redesigning Autism and I/DD Care: Insights from Catalight’s Chief Health Officer · 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
• 0:05
  joined by doctor Tracy Gajewski, who's the chief
• 0:08
  health officer at Catalite. Tracy, thank you so
• 0:10
  much for taking the time to be with
• 0:12
  me on the podcast today.
• 0:14
  Thank you so much for having me. It's
• 0:15
  a pleasure to be here. Yeah. Absolutely. And
• 0:17
  before we dive into everything we wanna talk
• 0:19
  with you about, Tracy, can you talk to
• 0:21
  us a little bit more about your self,
• 0:24
  your background in health care, and what it
• 0:26
  is that you do today at Catalyte?
• 0:28
  Yeah. So I'm a licensed clinical neuropsychologist.
• 0:31
  I have more than twenty years of experience
• 0:34
  in the field of developmental disabilities,
• 0:36
  something I'm pretty proud of. I also have
• 0:39
  an MBA specializing in health care management.
• 0:41
  But as the
• 0:43
  chief health officer at Adelaide, I oversee day
• 0:46
  to day clinical operations, administrative,
• 0:49
  operations, also our provider network, which is a
• 0:51
  very large provider network,
• 0:54
  and then our research institute.
• 0:56
  So,
• 0:57
  we're we're pretty big. We have we serve
• 1:00
  more than 20,000
• 1:01
  families,
• 1:03
  a day. And so we have a sort
• 1:05
  of a scope and scale that I feel
• 1:07
  really excited about being a part of.
• 1:10
  What drives me and why I'm in the
• 1:12
  role that I'm in, I've been in this
• 1:13
  role at Catalite for for seven years. Prior
• 1:16
  to that, I was in large health care
• 1:18
  organizations.
• 1:20
  But what really drives me is creating systems
• 1:23
  of care that supports our clients and families
• 1:25
  in different ways. Right? And so
• 1:27
  really,
• 1:29
  understanding
• 1:30
  our industry of serving people with developmental
• 1:33
  disabilities, how we can how we can do
• 1:35
  this better, how we can make change in
• 1:37
  our industry to really have better outcomes and,
• 1:41
  support those families in different ways. So
• 1:43
  my passion and purpose,
• 1:45
  I I really are filled at Catalyte because
• 1:48
  we are paying such close attention
• 1:51
  to how we can focus on well-being of
• 1:54
  these clients and families,
• 1:56
  and really,
• 1:57
  you know, pay attention to how we break
• 1:59
  down barriers and biases for a more equitable
• 2:01
  world for people with developmental disabilities. So this
• 2:04
  is this is what I do and and
• 2:06
  what I'm passionate about and why I'm I'm
• 2:08
  really excited to be here talking with you
• 2:09
  all.
• 2:10
  Fantastic. Well, we're really looking forward to all
• 2:13
  the insights you're gonna tell us, especially for
• 2:15
  our audience listening in, Tracy.
• 2:18
  In that vein, you mentioned you've been in
• 2:20
  your role at Catalyte for seven years now.
• 2:23
  Talk to us about what you're seeing in
• 2:24
  terms of the major obstacles out there in
• 2:26
  providing care for individuals with autism and other
• 2:29
  intellectual and developmental disabilities.
• 2:33
  Yes. So, I really see three main obstacles
• 2:36
  that we are always looking at, always pagan
• 2:39
  paying attention to
• 2:40
  and trying to to bring down. So one
• 2:43
  is access. Right? Access to care, access to
• 2:45
  the diagnosis, and access to treatment once that
• 2:47
  diagnosis is made
• 2:49
  and, in a timely way. Right? So what
• 2:52
  we know is that I I'll say at
• 2:54
  Catalite,
• 2:54
  we pay very close attention to it, and
• 2:56
  our accesses is quite good. We have, clients
• 3:00
  that want when when they, come into our
• 3:02
  services,
• 3:03
  we see them with, you know, less than
• 3:05
  ten days, more like five to seven days.
• 3:08
  And we make sure that they're getting into
• 3:09
  services very quickly.
• 3:11
  But that is not the case for everywhere.
• 3:13
  You know, one area in Northern California, but
• 3:15
  then as we start looking at,
• 3:18
  The United States and then we look at
• 3:19
  the world, access really changes.
• 3:22
  I will say we we know that the
• 3:23
  the new CDC report just came out.
• 3:26
  So nationally, it's one in thirty one children
• 3:28
  are diagnosed with autism. In California, it's one
• 3:31
  in nineteen.
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  So we will continue,
• 3:34
  to see and and feel that that challenge
• 3:38
  with access.
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  And it's something I I think is really
• 3:41
  important to continue to pay attention to.
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  Second,
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  serious outcomes. So this is not something in
• 3:48
  our industry that we we, you know, we're
• 3:51
  still figuring out how to do.
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  What are we measuring in order to understand
• 3:56
  if a client or a family is making
• 3:58
  meaningful progress in their treatment? What does that
• 4:01
  look like? What are those outcomes? At Cadillac,
• 4:03
  we have very clear outcome measures that we
• 4:05
  look at and focus on. But as an
• 4:07
  industry, I think we
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  are challenged by aligning
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  to what those outcomes are,
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  and having, you know, a standardized way of
• 4:15
  looking at quality of care.
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  And then lastly,
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  I'm gonna talk a little bit about value
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  because you have to talk about value. Right?
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  We we need to pay attention to cost
• 4:24
  of services.
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  High hours, which translates into high cost, doesn't
• 4:29
  always mean better care, and so we need
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  to pay attention to that. So it's another,
• 4:33
  obstacle
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  think
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  can get in our way sometimes. Certainly. And
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  let's stay on that topic, Tracy, the the
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  second point that you mentioned,
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  how to measure success in this space. What
• 4:44
  are the most meaningful ways to measure success
• 4:46
  when it comes to autism and IDD care?
• 4:50
  Yeah. So
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  my focus, our focus,
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  everything rolls up to well-being. So well-being of
• 4:56
  the client and family.
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  I'll also put in there well-being of our
• 5:00
  industry, well-being of our providers who are,
• 5:03
  you know, serving our clients and our industry,
• 5:05
  but well-being in general. But specifically, when we
• 5:08
  look at measuring success
• 5:10
  of a treatment plan or a client in
• 5:12
  care,
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  looking at how they are doing
• 5:16
  in terms of their well-being scale, you know,
• 5:19
  score. So we have a scale, a well-being,
• 5:21
  scale that we utilize,
• 5:24
  and it's pretty important. But let me also
• 5:26
  pause and say, what is well-being? Right? Well-being
• 5:28
  could mean a lot of things to a
• 5:29
  lot of different people. But, ultimately, we we
• 5:32
  see this as the ultimate measure of success,
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  and it's it's different for every person. Right?
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  So every family, every client that comes into
• 5:40
  us, we need to sit down and understand
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  for that family what is well-being.
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  We have such a heterogeneous population
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  that we need to understand from an individual
• 5:50
  basis for that family, what does that mean?
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  Is it having greater independence? Is it having,
• 5:56
  you know, strengthening family relationships?
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  I'll give a very
• 6:01
  easy quick example,
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  which when we look at treatment plans, we
• 6:05
  look at lots of treatment plans, and we'll
• 6:06
  see a goal on that treatment plan
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  such as tying shoes.
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  And that goal stays on that treatment plan
• 6:13
  for a long time. And the question that
• 6:15
  we ask that our clinicians ask is, why
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  why are we focusing on tying shoes? Is
• 6:20
  is that
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  actually
• 6:22
  contributing to a better well-being in that for
• 6:24
  that client or family? Or should we just
• 6:26
  get some Velcro shoes or some slip on
• 6:28
  shoes and move on to something that will
• 6:29
  actually increase the well-being in that family, which
• 6:32
  might be better communication,
• 6:34
  lowering challenging behaviors. Right? So they can go
• 6:36
  out to a family dinner.
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  So, again, getting real focused on well-being and
• 6:41
  the measure of well-being
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  is important. And then the last piece I'll
• 6:44
  I'll add to the well-being piece is affordability.
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  So, looking at the we look at the
• 6:50
  whole family, right, holistically.
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  Cost share can be really challenging and debilitating
• 6:55
  for a family.
• 6:56
  So in my mind, we really need to
• 6:58
  pay attention to,
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  you know, what is the cost for this
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  family and how does that impact that whole
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  family,
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  and making sure that we have the right
• 7:07
  treatment,
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  so that they really can move through treatment
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  swiftly,
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  and have meaningful progress,
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  but also pay attention to the impact of
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  that entire family.
• 7:18
  Sure. And I I wanna come back to
• 7:20
  something you had said about serving a heterogeneous
• 7:23
  population.
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  Catalyte is a growing company. How do you
• 7:27
  ensure that the care you're providing
• 7:30
  remains deeply individualized while operating at scale across,
• 7:34
  the diverse populations that you serve?
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  Yes.
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  So what's really important here is having
• 7:42
  different treatment options. So, again, this is something
• 7:45
  that our our industry
• 7:47
  historically doesn't really do,
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  but,
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  one size truly does not fit all in
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  terms of treatment for autism,
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  or developmental disabilities for that matter.
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  So, again, in the past, we've had this
• 7:59
  sort of one form of treatment. We we
• 8:01
  do the same thing for all of our
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  families, and it just it doesn't it doesn't
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  make sense.
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  So at Catalyte, what what we do is
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  we've really expanded the treatment options.
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  You know, that that's how we can do
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  this at scale. So, individually,
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  we'll sit down with a family when they
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  first come into treatment. That first appointment is
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  really important
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  to understand
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  what that client needs, what that family needs,
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  and then ensure that as we build their
• 8:29
  their
• 8:30
  their care path,
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  that we're really paying attention to those individual
• 8:34
  needs and treatment and then have different treatment
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  options. Right? So for one family, it might
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  mean one thing. For another, it might mean
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  something else.
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  But having those options to care
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  at a large scale,
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  and ensuring that we have access to those
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  different options, treatment options,
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  is is, I think, what sort of the
• 8:55
  secret sauce is there. Right? It's it's really
• 8:57
  about driving individualized care and getting it right
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  right from the beginning of of treatment so
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  that that client can really,
• 9:05
  again, so we see meaningful progress.
• 9:09
  So, Tracy, I wanna ask you about something
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  that we're constantly hearing about from insurers, and
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  it's their their their want and their need
• 9:16
  to address better
• 9:18
  social determinants of health, among their membership.
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  Can you talk to us a little bit
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  about how Catalyte is designing care models to
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  address SDOH, and and how are you responsive
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  to individual emotional or geographic needs among among
• 9:33
  those that you're serving?
• 9:35
  Yeah. So
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  it's a great question and is absolutely one
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  that, gets, I think, asked often. So, again,
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  I'm gonna go back to this different options
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  of of care delivery that is so important.
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  So,
• 9:47
  understanding addressing
• 9:50
  those individual needs of our population
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  is really important. So what we do and
• 9:53
  what is, I think, really important is in
• 9:55
  that first meeting that I was just talking
• 9:56
  about in that last question,
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  we are looking we are asking questions
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  about what is needed for that holistic,
• 10:04
  you know, for the whole family. Right? So
• 10:06
  understanding those social determinants of health, understanding
• 10:09
  access for transportation,
• 10:11
  food insecurity, economic stability.
• 10:14
  All of these things will impact care and
• 10:16
  impact how
• 10:17
  the best delivery for care for that family
• 10:20
  will be. So, again, now let's talk about,
• 10:23
  you know, is it having telehealth? Is telehealth
• 10:25
  actually just a much,
• 10:27
  better care delivery for a family or coming
• 10:29
  into a clinic or
• 10:31
  having a mixture of that or having,
• 10:34
  the the treatment team going into the home.
• 10:36
  Again, going back to what are those individual
• 10:39
  needs,
• 10:40
  and then designing the care path around those
• 10:43
  needs,
• 10:45
  and ensuring that we're paying attention to to
• 10:47
  what they are for that that family. It's
• 10:49
  a crucial step in the beginning of treatment
• 10:52
  that so then we can design that care
• 10:54
  path with the treatment options and all and
• 10:56
  service delivery options
• 10:58
  that will really help tailor it to that
• 11:01
  family.
• 11:02
  So, Tracy, earlier in our conversation, you were
• 11:04
  talking about how affordability
• 11:06
  often remains a a key challenge for patients
• 11:09
  in this space. And, you know, I think
• 11:11
  affordability often gets framed as cost cutting. So
• 11:16
  how how are you defining affordability in a
• 11:18
  way that supports both sustainable and high quality
• 11:22
  care for your patients with autism or or
• 11:25
  other intellectual and developmental disabilities?
• 11:29
  Yes. So, when I think about affordability
• 11:33
  or defining affordability,
• 11:35
  with high quality care for clients, really, what
• 11:38
  what we're talking about in my mind is
• 11:40
  value based care. We at Catalyte believe and
• 11:42
  operate under a large valley based care model,
• 11:45
  and,
• 11:46
  it's it's quite important. In fact, I
• 11:49
  I believe that high quality care, which is,
• 11:53
  you know, a part of this,
• 11:54
  you know, valley based care, actually
• 11:57
  drives lower costs,
• 11:59
  and it opens up access. So those three
• 12:02
  things, as we talked about in the beginning
• 12:04
  of this podcast, are really,
• 12:07
  really important to pay attention to. So high
• 12:10
  quality care is really about that client,
• 12:13
  you know, being able to achieve their goals,
• 12:17
  and,
• 12:17
  have meaningful progress in their treatment. In order
• 12:21
  to do this, we have to get it
• 12:22
  right from the beginning. So we've talked about
• 12:24
  that. Right? It's really important to understand what
• 12:26
  the right care path is and the right
• 12:29
  recommendations for that family.
• 12:31
  And in doing that,
• 12:33
  what we'll see
• 12:35
  is we'll see a client attaining their goals
• 12:38
  and treatment. So then we'll see this engagement
• 12:41
  in front of the caregiver.
• 12:43
  Caregiver engagement is really important. When a caregiver
• 12:47
  is truly engaged in in the treatment, what
• 12:49
  we'll see is we'll see stress levels come
• 12:52
  down in the family.
• 12:53
  We'll see confidence levels go up in the
• 12:56
  family in terms of caring for that that
• 12:59
  client, and then we'll see,
• 13:01
  goal attainment. We'll see goals really, being achieved.
• 13:05
  And then we'll see, you know, ending of
• 13:07
  an episode of care,
• 13:09
  because,
• 13:10
  that family that, has integrated
• 13:13
  those parenting strategies,
• 13:15
  those interventions in their everyday life. And so
• 13:18
  we'll see all of these things working together,
• 13:20
  and and then we can end the episode
• 13:22
  of care.
• 13:24
  What that translates
• 13:25
  into is
• 13:27
  lower cost.
• 13:28
  Right?
• 13:29
  And so that first pillar of of a
• 13:32
  value based, you know,
• 13:34
  care is high quality,
• 13:37
  meaningful outcomes happening quickly,
• 13:40
  which then, will translate into
• 13:42
  lower costs.
• 13:44
  So it's important to get it right right
• 13:46
  from the beginning to be able to do
• 13:47
  that, but I think it's it's really the
• 13:50
  way that we should be caring for our
• 13:51
  clients and families.
• 13:53
  Absolutely. It's such a good point that providing
• 13:56
  this high quality care isn't just good for
• 13:58
  the patient. It's good for their families, those
• 14:00
  around them, and that trickles down to affecting
• 14:03
  the the entire system.
• 14:05
  I think that's that kind of leads me
• 14:07
  to ask more of a philosophical question here,
• 14:09
  Tracy.
• 14:10
  You've been in this space, for so long.
• 14:12
  You have so much expertise here. If you
• 14:14
  could redesign this system and and how we
• 14:17
  care for individuals with autism and other IDDs
• 14:20
  from the ground up.
• 14:22
  What are some of the first things that
• 14:23
  you would build differently?
• 14:26
  Yes. So I'm gonna tell you four things.
• 14:28
  These are four things that I feel pretty
• 14:30
  passionately about, and you've heard me mention some
• 14:33
  of these. So one is different treatment options.
• 14:35
  Right? So, again, one size does not fit
• 14:37
  all. We have to have different treatment options
• 14:39
  for our clients and families
• 14:41
  that can,
• 14:43
  you know, really help them be able to
• 14:45
  tailor
• 14:46
  the needs to that family. So that's the
• 14:48
  first one. Number two
• 14:50
  is,
• 14:51
  supporting caregivers
• 14:53
  in different ways so that they really feel
• 14:55
  empowered
• 14:56
  and their their active
• 14:58
  role in supporting their child
• 15:00
  rather than this emphasis on a professional or
• 15:03
  a paraprofessional
• 15:04
  coming in and being the agent and change.
• 15:06
  The caregiver, they they they know their child
• 15:09
  best,
• 15:10
  and helping them feel empowered and lowering their
• 15:13
  stress, increasing their their confidence,
• 15:16
  is really important.
• 15:18
  Third,
• 15:19
  respite services. So this is something that we
• 15:22
  don't I don't think do enough of. So
• 15:25
  a family does need a break. A caregiver
• 15:27
  does need a break.
• 15:29
  Sometimes we'll see treatment plans that honestly are
• 15:32
  very, very high hours. And really what I'm
• 15:34
  looking at is not necessarily the medical need
• 15:36
  there, but, a caregiver needing a break. And
• 15:39
  so I think that it what's really important
• 15:42
  is weaving into
• 15:43
  the care for this family
• 15:45
  are more respite services
• 15:48
  and fun respite services. Right? Ones that the
• 15:51
  the client is really out there having fun
• 15:53
  and the caregiver can relax and say, I'm
• 15:56
  gonna actually take care of myself today.
• 15:59
  While I know my my child is in
• 16:01
  really good hands and actually having a good
• 16:04
  experience themselves.
• 16:05
  And then lastly,
• 16:07
  and, again, I've talked about this throughout this
• 16:09
  podcast, but I'm gonna say it again because
• 16:11
  it's really important,
• 16:12
  is our industry focusing on the well-being of
• 16:14
  the client and the family.
• 16:16
  I think we can sometimes overlook that.
• 16:18
  And I think if we get back down
• 16:20
  to the basics of asking ourselves what is
• 16:22
  the best thing, what is increasing the well-being
• 16:24
  of that client and family, I think that
• 16:26
  a lot of the puzzle pieces fall into
• 16:28
  place.
• 16:30
  Understood. It's it's great list. And let me
• 16:32
  just recap there for our audience, Tracy. You're
• 16:35
  you're really recommending
• 16:36
  different treatment options, better caregiver support, more respite
• 16:40
  services, and,
• 16:41
  just a reimagined
• 16:43
  industry focus on the patient
• 16:45
  and their family.
• 16:46
  I I also wanna ask you something that,
• 16:47
  you know, we hear about constantly from health
• 16:49
  care leaders, and I I'd be remiss if
• 16:51
  I didn't ask you as well.
• 16:53
  How are you using artificial intelligence today, And
• 16:56
  and what do you think that this will
• 16:57
  continue to look like in this space,
• 16:59
  two years from now?
• 17:01
  Yes. I had so much fun at the
• 17:03
  Becker's conference
• 17:04
  hearing about and talking about AI. I think
• 17:07
  every presentation had an element of AI in
• 17:10
  it, and as it should because this is
• 17:12
  this is something that we need to pay
• 17:14
  very close attention to. It's something that I'm
• 17:15
  wildly excited about, to be quite honest with
• 17:17
  you, about client care, patient care because,
• 17:20
  I I think
• 17:22
  three things. It's gonna expand access. Right? Really
• 17:24
  important. It's gonna enhance our care, and it's
• 17:27
  gonna drive efficiency.
• 17:28
  So, ultimately,
• 17:30
  what we care about is more time using
• 17:33
  AI, leveraging AI to have more
• 17:36
  direct time with clients and families.
• 17:39
  So a clinician does not come into this
• 17:41
  field,
• 17:42
  you know, to do chart notes, right, and
• 17:45
  to do a lot of administrative tasks. Yet
• 17:47
  that is a big piece of their day.
• 17:50
  AI is something that we can leverage,
• 17:52
  that we are leveraging, and I'll tell you
• 17:53
  about that in a second. But to be
• 17:55
  able to reduce
• 17:56
  those administrative tasks and really for clinician
• 17:59
  to spend that direct time with a client
• 18:01
  and family, which is, you know, really where
• 18:03
  their skill set is and really what what,
• 18:06
  is is wonderful for them,
• 18:08
  and for the client and family. So right
• 18:11
  now at Adelaide,
• 18:12
  last year, we rolled out, an Ambient AI
• 18:15
  tool that is reduced note taking. It's, Nabla.
• 18:19
  And so it reduced the note taking and
• 18:21
  increases
• 18:22
  rapport and connection with the clients. It reduces
• 18:25
  burnout of our clinicians.
• 18:27
  We also have a shortage of clinicians in
• 18:29
  the industry, right, overall. And so taking care
• 18:32
  of those clinicians and helping them really do
• 18:34
  what why they're there, what, you know, what
• 18:37
  what they're in the field for
• 18:39
  is really important. So this is an, Ambien
• 18:42
  AI documentation tool, and it transcribes the the
• 18:44
  notes in real time and then really cuts
• 18:46
  down on,
• 18:48
  their them having to do that note taking
• 18:50
  afterward that everyone sort of dreads.
• 18:52
  So that is in full flight at Catalite,
• 18:55
  which is is really wonderful, and we're seeing
• 18:56
  a lot of the benefits there. But when
• 18:59
  we talk about because because I think the
• 19:00
  question, yep, was really around also looking forward.
• 19:03
  What is it gonna look like in in
• 19:05
  a couple of years? What are we gonna
• 19:06
  you know, I think there's there's two other
• 19:08
  areas that I'm pretty excited about. One is
• 19:11
  really looking at how we can do assessments
• 19:13
  and diagnostics in a different way that, again,
• 19:16
  takes out
• 19:17
  the administrative pieces of writing big long reports,
• 19:20
  and helps to streamline that. So,
• 19:23
  we can, have some more standardization
• 19:26
  and, report writing that is more efficient. So
• 19:29
  we're excited about this, ability to
• 19:32
  really look at how we do assessments differently.
• 19:35
  And then lastly,
• 19:36
  using generative AI.
• 19:38
  What we're what we're starting to really look
• 19:41
  at and focus on is how do we,
• 19:44
  optimize,
• 19:45
  clinical recommendations
• 19:47
  and outcomes
• 19:48
  as well as looking at stratified risks enable,
• 19:51
  proactive support. So
• 19:54
  understand
• 19:55
  from from the very beginning what this client
• 19:57
  might need,
• 19:59
  what the most optimal
• 20:01
  recommendation is going to be that will bring
• 20:03
  them to the most optimal outcomes,
• 20:05
  and using generative
• 20:07
  AI to do that. This is a really
• 20:09
  sort of scalable, repeatable model of tech enabled
• 20:12
  value based care is how how how we
• 20:14
  see it, and I'm really excited about
• 20:16
  it. Wow. I mean, clearly, really exciting things
• 20:19
  to come in this space, Tracy, and and
• 20:21
  from Catalite,
• 20:23
  certainly as well.
• 20:24
  Before we go, we've got a lot of
• 20:26
  health plan and other health care leaders listening
• 20:29
  in today from all over the country.
• 20:31
  What else are we missing, Tracy? What do
• 20:33
  you wanna tell them?
• 20:34
  Yeah.
• 20:35
  I think we covered a lot, but I
• 20:37
  will just go back and say
• 20:39
  caregiver
• 20:40
  involvement,
• 20:42
  treatment options,
• 20:44
  individualized
• 20:45
  care, looking at the whole family, and
• 20:48
  system of that family
• 20:50
  drives better outcomes and value.
• 20:53
  So again, bottom line, everything rolls up to
• 20:55
  well-being.
• 20:56
  And if we can stay focused on
• 20:59
  what matters to our clients and families, I
• 21:01
  think we will
• 21:03
  be able to,
• 21:04
  sort of hit the mark and change our
• 21:06
  industry.
• 21:08
  Wonderful. Well, I think that's a great place
• 21:10
  to leave things. Tracy, I wanna thank you
• 21:12
  for taking the time to sit down with
• 21:14
  us and for sharing your insights with our
• 21:16
  listeners. We really appreciate it. Thank you so
• 21:19
  much. It was a pleasure being here.
• 21:21
  I'd also like to thank our podcast sponsor,
• 21:24
  Catalite.
• 21:25
  You can tune in to more podcasts from
• 21:26
  Becker's Healthcare by visiting our podcast page at
• 21:29
  beckershospitalreview.com.