Latest / Becker’s Healthcare Podcast / How Value-Based Care Delivers Better Outcomes for Medicare Members with Dr. Ali Khan

Transcript

How Value-Based Care Delivers Better Outcomes for Medicare Members with Dr. Ali Khan · Becker’s Healthcare Podcast

• 0:01
  - The payer provider relationship has never been simple,
• 0:04
  - but what's happening now is something different.
• 0:07
  - Value based models are maturing unevenly,
• 0:10
  - prior authorization
• 0:11
  - reform is reshaping workflows on both sides, and
• 0:14
  - affordability pressure is intensifying.
• 0:17
  - The organizations that figure out how to collaborate
• 0:19
  - genuinely, not just contractually,
• 0:21
  - are the ones that will set the terms
• 0:23
  - for what comes next.
• 0:24
  - Becker's fifth annual fall payer issues round table
• 0:27
  - brings together more than 500 executive level attendees
• 0:30
  - and 70 plus speakers for two days of
• 0:32
  - focused senior level conversation
• 0:35
  - on benefit design, network strategy, transparency,
• 0:38
  - and the financial and regulatory dynamics that are
• 0:41
  - redefining how care gets paid for. Join us
• 0:44
  - November second and third at the Swiss Hotel
• 0:46
  - Chicago.
• 0:47
  - For the agenda and event details, visit beckerspayer.com
• 0:51
  - and click on the events tab in the
• 0:52
  - upper right.
• 0:54
  - Hi, everyone. My name is Elizabeth Cassello with
• 0:57
  - the Becker's Payer Issues podcast.
• 0:59
  - I'm thrilled today to be joined by doctor
• 1:01
  - Ali Khan, Aetna Medicare chief medical officer. Doctor
• 1:05
  - Khan, thank you so much for chatting with
• 1:06
  - us today. It's such a pleasure to be
• 1:08
  - here. Thanks for having me. Of course. So
• 1:10
  - before we jump in, I would love for
• 1:12
  - you to fill us in a bit more
• 1:13
  - about your health care career backgrounds and your
• 1:15
  - role at Aetna.
• 1:17
  - Happy to. So, Elizabeth, I am coming to
• 1:19
  - you from Becker's hometown of Chicago, Illinois, where
• 1:22
  - I both live and practice still as a
• 1:24
  - practicing primary care physician in the South And
• 1:25
  - West Sides Of Chicago.
• 1:27
  - I, you know, have the incredible good fortune
• 1:29
  - to serve Aetna and CVS Health as the
• 1:31
  - chief medical officer
• 1:33
  - for our Medicare and, duly eligible members around
• 1:35
  - the country.
• 1:37
  - Really, you know, partnering closely with with our
• 1:39
  - business partners and with everybody else in the
• 1:41
  - Medicare team
• 1:42
  - to try to drive, you know, superior clinical
• 1:45
  - outcomes
• 1:45
  - and fantastic population health for for folks who
• 1:49
  - we're lucky enough to serve. I'm also really
• 1:52
  - excited to talk to you today, in the
• 1:53
  - context of value based care because I'm a
• 1:55
  - bit of a one trick pony having spent
• 1:57
  - almost my entire career in value based care
• 1:59
  - delivery.
• 2:00
  - Prior to Aetna, I served, you know, six
• 2:03
  - and a half years at Oak Street Health,
• 2:04
  - the last three as chief medical officer, building
• 2:06
  - that national network of value based care clinics
• 2:09
  - for seniors and other Medicare enrollees.
• 2:11
  - Prior to that, a number of years of
• 2:13
  - CareMore Health Plan, part of Anthem,
• 2:15
  - also focused as a health plan and as
• 2:17
  - a clinical organization
• 2:18
  - on the needs of highly vulnerable, complex seniors
• 2:20
  - who are Medicare Advantage members with our health
• 2:22
  - plan. And then before that, part of the
• 2:25
  - early team at Iora Health, in their in
• 2:28
  - what feels like the early days of value
• 2:29
  - based care in the twenty teens, really trying
• 2:32
  - to figure out how to build, you know,
• 2:34
  - again,
• 2:35
  - clinics that are driving phenomenal clinical outcomes and
• 2:38
  - highly differentiated patient experiences
• 2:40
  - for folks who really need that and work
• 2:42
  - and deserve that kind of care. So
• 2:45
  - the opportunity to come to talk today about
• 2:46
  - value based care and what we see from
• 2:47
  - the NETA landscape, particularly from a research standpoint,
• 2:50
  - is just super exciting.
• 2:51
  - We're looking forward to diving into this white
• 2:54
  - paper that your team shared with me. So
• 2:56
  - there are some new data points coming out
• 2:58
  - regarding
• 2:58
  - value based care and fee for service Medicare
• 3:01
  - models. So can you give a high level
• 3:03
  - overview of some of the key takeaways from
• 3:05
  - those findings? And maybe even before you get
• 3:07
  - into that, sometimes value based care can be
• 3:10
  - kind of like an amorphous term. So what
• 3:12
  - specifically are y'all referring to with this specific
• 3:15
  - white paper? That's a great question.
• 3:18
  - Good. That's the right frame.
• 3:20
  - And I think look. When we talk about
• 3:22
  - value based care in the country of this
• 3:23
  - paper,
• 3:24
  - we are talking about
• 3:27
  - anything on the spectrum
• 3:29
  - of
• 3:30
  - arrangements
• 3:32
  - that our network partners, providers around the country
• 3:34
  - are partnering with us
• 3:37
  - in any sort of fashion from,
• 3:39
  - you know, quality bonus programs to shared savings
• 3:42
  - programs, all the way through the full risk
• 3:44
  - value based care arrangements, right, where those practices,
• 3:47
  - those providers are taking on total responsibility for
• 3:50
  - everything that happens to the patients under their
• 3:52
  - care that are Aetna members.
• 3:53
  - And so we are looking at the entire
• 3:55
  - spectrum of value based care arrangements, and there
• 3:57
  - there's a lot of them. Right? To say,
• 4:00
  - what happens
• 4:01
  - once somebody's in these kinds of arrangements? Right?
• 4:04
  - We've heard a lot about value based care
• 4:06
  - in the past ten years and particularly last
• 4:08
  - couple years. Right? There's been a lot of
• 4:09
  - questions about value based care. What does it
• 4:12
  - do? Who is it good for? What kinds
• 4:14
  - of outcomes is it is it driving?
• 4:16
  - Is it worth the hype?
• 4:18
  - And what we have found in this paper,
• 4:21
  - Elizabeth, is that the hype is actually
• 4:24
  - deserved in the context
• 4:26
  - of clinical outcomes and clinical quality, which at
• 4:30
  - its core are where value based care has
• 4:33
  - always, you know, positive to focus on in
• 4:35
  - terms of what it's able to drive.
• 4:37
  - So we looked at 2,000,000 members around the
• 4:39
  - country in our both
• 4:42
  - within Aetna value based care arrangements of any
• 4:44
  - sort from, you
• 4:45
  - know, shared savings all the way into full
• 4:47
  - risk
• 4:48
  - and against a cohort
• 4:50
  - of our fee for service members around the
• 4:52
  - country.
• 4:53
  - And
• 4:54
  - what we did was to look at those
• 4:57
  - numbers
• 4:57
  - and to say, hey. How do those numbers
• 5:00
  - do
• 5:01
  - on the elements
• 5:04
  - of actual clinical outcomes? Right? There are a
• 5:06
  - lot of quality measures in in the Medicare
• 5:08
  - Advantage world. We've got a lot of different
• 5:10
  - things. But foundationally,
• 5:13
  - the things that are hardest to influence
• 5:15
  - are the things that are very clinical. Right?
• 5:17
  - And in our data, we saw the value
• 5:20
  - our our members in value based care arrangements
• 5:23
  - receive better care for their diabetes. Right? Forty
• 5:25
  - three percent more members in our value based
• 5:27
  - care arrangements
• 5:29
  - got their hemoglobin a one c, their marker
• 5:31
  - of diabetes management under control
• 5:34
  - relative to our fee for service members. When
• 5:36
  - it came to blood pressure control, not an
• 5:37
  - easy thing for anyone,
• 5:39
  - thirty four percent more members in our value
• 5:41
  - based care arrangements, again, of any type,
• 5:44
  - achieve blood pressure control
• 5:45
  - relative to national standards versus our fee for
• 5:48
  - service population.
• 5:49
  - When it comes to prevention, our value based
• 5:51
  - care members are much more likely, a ten
• 5:54
  - percent or more more likely, actually, to get
• 5:56
  - their recommended mammograms,
• 5:58
  - their recommended colorectal cancer screenings, like colonoscopies and
• 6:01
  - fit tests, or to be screened for diabetic,
• 6:03
  - you know, kidney disease on at least an
• 6:06
  - annual basis as is the recommendation.
• 6:08
  - Elizabeth, you and I both know that, like,
• 6:10
  - the challenge in American medicine is not
• 6:13
  - the amount of recommendations, the amount of things
• 6:15
  - that we're supposed to do. It's about whether
• 6:17
  - those things actually happen. Right?
• 6:19
  - And our data really suggests that in our
• 6:22
  - value based care partnerships,
• 6:23
  - we are seeing the right things happen at
• 6:26
  - a far greater frequency.
• 6:28
  - And when those things come together,
• 6:30
  - the payoff
• 6:31
  - is in actually better care. And we see
• 6:34
  - this, again, when we're looking at this at
• 6:35
  - the millions of members level,
• 6:37
  - our members in value based care arrangements
• 6:40
  - were admitted to the hospital 7% less often
• 6:43
  - than those in fee for service arrangements.
• 6:46
  - So and, like, that made that that's a
• 6:48
  - huge number when we think about how many
• 6:50
  - people we're talking about here. Right? That's potentially
• 6:53
  - thousands of hospital admissions avoided
• 6:55
  - because
• 6:56
  - we did the right things up front. And
• 6:58
  - I think that's the real the the real,
• 7:00
  - you know, spotlight here is that when we
• 7:03
  - get this right, we actually can fulfill the
• 7:06
  - promise of what value based care is supposed
• 7:07
  - to deliver.
• 7:09
  - And can you fill us in on any
• 7:10
  - sort of relevant
• 7:12
  - context when it comes to value based care
• 7:14
  - and the Medicare Advantage population and any big
• 7:17
  - trends in terms of utilization
• 7:19
  - and funding pressures? I know CMS also has
• 7:23
  - some initiatives relating to value based care programs
• 7:26
  - in this area. So
• 7:28
  - what is it like operationalizing
• 7:29
  - these arrangements when it comes to the Medicare
• 7:32
  - Advantage population
• 7:33
  - specifically?
• 7:34
  - It's such a great question, Elizabeth. I think
• 7:36
  - both from my own lived experience having, you
• 7:38
  - know, run and operated these models and practicing
• 7:40
  - these models for years, but also now from
• 7:42
  - the vantage point of Aetna seeing the whole
• 7:44
  - field.
• 7:44
  - What we see over and over again is
• 7:46
  - that it is
• 7:49
  - the players
• 7:50
  - who
• 7:52
  - take the time
• 7:53
  - to change
• 7:55
  - how they are delivering care, to change the
• 7:58
  - operations of what they're doing day in and
• 7:59
  - day out so that they're not trying to
• 8:01
  - run
• 8:03
  - a 30 person fee for service schedule every
• 8:05
  - ten minutes in one half of the clinic
• 8:06
  - and then doing something else in the other
• 8:08
  - half. But they've said, hey.
• 8:10
  - We have the financial resources from value based
• 8:12
  - care payment. We have the incentive
• 8:15
  - from, you know, the quality program and from
• 8:16
  - the outcomes, that we run. And in many
• 8:19
  - cases, we are assuming full risk or significant
• 8:21
  - level of risk on these patients that we
• 8:23
  - change the time. Right? We see patients for
• 8:26
  - longer. We see them more frequently.
• 8:28
  - The average Medicare beneficiary
• 8:30
  - sees a primary care physician 1.3 times a
• 8:33
  - year for about seventeen minutes total.
• 8:35
  - In these models, people are being seen upwards
• 8:39
  - eight, twelve, fourteen, fifteen times a year, often
• 8:41
  - for twenty, thirty, sixty minutes at a time.
• 8:44
  - Right? They get resources. These teams are often
• 8:47
  - larger staffed. They have not just physicians and
• 8:50
  - and nurse practitioners and PAs, but they also
• 8:52
  - have, you know, medical assistants, nurses, behavioralists, podiatrists,
• 8:55
  - pharmacists, social worker, and behavioralists, all coming together
• 8:59
  - to support these patients.
• 9:01
  - And then third, they get follow through. Right?
• 9:03
  - Systems are designed as actually particularly from a
• 9:05
  - technology perspective
• 9:06
  - to ensure that members are being
• 9:09
  - worked on proactively,
• 9:10
  - engaged when when things could be getting worrisome,
• 9:13
  - and that they don't fall through the cracks.
• 9:15
  - Right? That operationalization is very different than what
• 9:18
  - we see in fee for service medicine because
• 9:20
  - it's a matter of incentive alignment.
• 9:22
  - And our paper bears that out in showing
• 9:25
  - that the bulk of the value that we
• 9:27
  - saw,
• 9:28
  - in terms of those better clinical outcomes, those
• 9:30
  - lower readmissions,
• 9:31
  - the concentration was highest in our members
• 9:34
  - who were in full those kinds of full
• 9:35
  - risk arrangements. Right? Be those brick and mortar
• 9:38
  - relationships like Oak Street Health, ChenMed, CenterWell, you
• 9:41
  - know, and others, or our national partners who
• 9:44
  - are working with independent practices across the country
• 9:46
  - like Aladaid, Agilon, and others
• 9:48
  - to support them in that journey of getting
• 9:51
  - operations right, bringing in those resources, enabling that
• 9:54
  - kind of time, and then getting that kind
• 9:55
  - of execution.
• 9:57
  - So I think when we think about this
• 9:58
  - in the context of everything going on Medicare
• 10:00
  - Advantage
• 10:01
  - in the last few years,
• 10:03
  - where there has been a renewed emphasis on
• 10:06
  - what are we doing to manage total cost
• 10:08
  - of care trends that continue to rise,
• 10:11
  - And what is CMS signaling, the innovation center
• 10:14
  - from other places in terms of from the
• 10:16
  - Biden administration through the second Trump administration
• 10:19
  - of emphasizing that not only is it the
• 10:21
  - goal to get everybody in an accountable care
• 10:23
  - arrangement, but that they are you know, as
• 10:25
  - with this most recent position fee schedule notice
• 10:28
  - in Medicare,
• 10:29
  - that they're not gonna pay differentially
• 10:31
  - for folks who are in an ACO in
• 10:33
  - order to continue to incentivize that journey.
• 10:35
  - We are seeing real momentum around putting our
• 10:38
  - dollars
• 10:39
  - into the places that can fund this kind
• 10:42
  - of reop re rejiggering of operations. And I
• 10:44
  - think that's incredibly gratifying for where we're headed.
• 10:47
  - So you mentioned Oak Street Health, and I
• 10:49
  - do wanna follow-up a little bit on that,
• 10:51
  - you know, given your background there.
• 10:53
  - How is that relationship
• 10:55
  - with Oak Street Health and between Aetna,
• 10:58
  - shaping these findings,
• 11:00
  - ultimately given how Oak Street Health focuses on
• 11:02
  - value based primary care centers for older adults?
• 11:06
  - It's a great question, Elizabeth. You know, Oak
• 11:08
  - Street Health is obviously one of our eyes
• 11:10
  - partners in the value based care space,
• 11:12
  - one of our largest partners, but not the
• 11:14
  - largest. Right? We work with value based care
• 11:16
  - groups across the country, including many of Oak
• 11:19
  - Street's competitors,
• 11:20
  - ChenMed,
• 11:21
  - CenterWell,
• 11:22
  - Alidaide,
• 11:23
  - Agiline, and, you know, many others. We work
• 11:25
  - with also a number of specialty value based
• 11:27
  - care partners around the country
• 11:28
  - and, who are focusing on, you know, from
• 11:31
  - the context of, you know, chronic kidney disease
• 11:33
  - or cancer care or heart disease or other,
• 11:35
  - you know, other sort of, you know, foci.
• 11:39
  - And so I would say that, like, in
• 11:41
  - the in the context of Oak Street shaping
• 11:44
  - these results,
• 11:45
  - no one player is sort of driving any
• 11:47
  - of these results or others. But I would
• 11:49
  - say the what's been most obvious is that
• 11:52
  - we also have a number of relationships around
• 11:53
  - the country with large health systems and other
• 11:55
  - provider groups and other, you know, small independent
• 11:57
  - practices
• 11:58
  - who may be earlier on that value based
• 12:00
  - care or that risk journey.
• 12:02
  - And so what we've realized is that, like,
• 12:03
  - when we see that the results are so
• 12:05
  - concentrated
• 12:06
  - in terms of the the biggest benefits are
• 12:08
  - happening in folks who are in full risk,
• 12:10
  - then what we are saying is actually, it's
• 12:13
  - we will always support the Oak Streets of
• 12:15
  - the world, but we also need to be
• 12:16
  - doing more to support everybody else as they
• 12:19
  - are on that path
• 12:21
  - towards, you know, that end state of of
• 12:23
  - ideally more risk, more accountability,
• 12:26
  - and whatever critical mass is needed to get
• 12:28
  - to that that kind of substantive operational change.
• 12:32
  - So I know the white paper talks a
• 12:33
  - little bit about the one and two sided
• 12:35
  - risk arrangements.
• 12:36
  - Can you tell us in a bit more
• 12:37
  - about what you're seeing with providers' risk appetites
• 12:40
  - right now?
• 12:41
  - Yeah. It's always a fun always
• 12:44
  - a always a, a joy to dig into
• 12:46
  - this question, because I think
• 12:49
  - we see some providers
• 12:51
  - who look at the last couple years, particularly
• 12:53
  - in and around shifts in
• 12:56
  - Medicare Advantage and and managed Medicaid enrollment.
• 12:59
  - Right? Shifts in some of the how program
• 13:02
  - design in some of those places with OB
• 13:04
  - three and others,
• 13:05
  - and where
• 13:07
  - with more of an emphasis
• 13:09
  - on needing to
• 13:11
  - really drive key results on clinical quality, clinical
• 13:14
  - outcomes, and therefore total cost of care. And
• 13:17
  - they've said, hey. We're not ready to do
• 13:18
  - this. Right? Right? So we may be in
• 13:20
  - a one-sided risk relationship right now, but we
• 13:22
  - shouldn't do that.
• 13:23
  - And, you know, glad that's disappointing to hear,
• 13:26
  - but that's okay. Right? Because then we we
• 13:28
  - say, okay. You're not there yet. But then
• 13:30
  - we need to figure out what to do
• 13:32
  - to make sure that the patients who are
• 13:33
  - seeing you are getting the support that they
• 13:35
  - need. Right? And what do we what do
• 13:37
  - we offer as a health plan from our
• 13:38
  - own care management,
• 13:40
  - enablement and our own kinda set of programs?
• 13:43
  - What are we doing to partner with you
• 13:45
  - to make sure we can add layers of
• 13:47
  - support, be that
• 13:48
  - support from nurses coming at the nurses coming
• 13:51
  - to the hospital to help with discharge planning
• 13:52
  - and cross the t's and dot the i's
• 13:53
  - to make sure people get home safely, not
• 13:55
  - that they just get home quickly. Right?
• 13:57
  - Whether it's or whether it's working on interoperability
• 13:59
  - to make sure that we are presenting as
• 14:01
  - many real time signals as possible for people
• 14:03
  - to act on to do the right thing
• 14:05
  - of heading off an ER visit or getting
• 14:08
  - somebody enrolled in a hospital at home program
• 14:10
  - or, you know, making sure that they transition
• 14:13
  - from a skilled nursing facility back home in
• 14:15
  - a safe manner.
• 14:16
  - Those are the kinds of places where we
• 14:18
  - all too often see so much
• 14:20
  - room for error in American medicine.
• 14:23
  - Right, Elizabeth? And so we are saying no
• 14:25
  - matter where anyone is on that journey, we
• 14:27
  - have a suite of services that we're ready
• 14:28
  - to deploy
• 14:30
  - to try to drive more coordinated,
• 14:32
  - higher quality, and ideally better outcome focused care.
• 14:37
  - And if that's the, you know, connective tissue
• 14:40
  - that we think will help give our partners
• 14:42
  - no matter where they are on that risk
• 14:44
  - journey, one-sided, two sided, or not not none,
• 14:48
  - the confidence and the trust that they need
• 14:51
  - to go down that path with us into
• 14:54
  - taking on more risk.
• 14:55
  - I think, you know, it's been a lot
• 14:57
  - of ups and downs the last few years.
• 14:59
  - And so we're hoping that with this kind
• 15:01
  - of evidence in hand, we can really point
• 15:03
  - to the fact of of a strong clinical
• 15:05
  - North Star
• 15:06
  - and then as and use that as justification
• 15:08
  - for the investments that we're making
• 15:10
  - to rebuild that trust and to advance, you
• 15:12
  - know, better clinical care for everyone.
• 15:15
  - And looking at the white paper, you know,
• 15:17
  - if there was a critic in the room,
• 15:19
  - what would they ask about your findings? I
• 15:21
  - mean, what other room for inquiry
• 15:24
  - is still left that you're hoping to explore?
• 15:27
  - I mean, I think a critic
• 15:28
  - who probably have a lot of things. Right?
• 15:29
  - I'm not a health services researcher. I just
• 15:31
  - like to pretend to be one on TV.
• 15:33
  - So there's always that.
• 15:36
  - But I think that
• 15:37
  - what folks would look at is that especially
• 15:40
  - looking at our data, is that it's easy
• 15:42
  - to sort of dismiss, like, oh, it's only
• 15:43
  - 7% reduction in hospital admissions.
• 15:46
  - And, again, I think the size of this
• 15:48
  - study is really critical,
• 15:50
  - Elizabeth, because at the millions of members level,
• 15:53
  - this shows that it's that these are statistically
• 15:55
  - significant results and it wasn't just by accident.
• 15:58
  - It is not a sample bias question, right,
• 16:00
  - or issue.
• 16:01
  - This is real
• 16:03
  - And
• 16:04
  - critics will argue that it's not enough, that
• 16:06
  - we have further to go, that there's far
• 16:08
  - more left on the table.
• 16:09
  - And we would agree with that. I think
• 16:11
  - all of us know that there is more
• 16:13
  - that we can do substantively
• 16:15
  - to drive better clinical outcomes, to drive a
• 16:17
  - better patient experience,
• 16:19
  - to reduce misery,
• 16:20
  - and to ensure that everyone is getting the
• 16:23
  - kind of care that we want for our
• 16:24
  - parents and grandparents.
• 16:25
  - And that's a long journey ahead. Right? And
• 16:28
  - then at the dawn of the AI era
• 16:29
  - that we're in right now, you know, my
• 16:31
  - hope is that we will be able to
• 16:33
  - use AgenTech technologies and others to be able
• 16:36
  - to advance all those core points I just
• 16:37
  - mentioned.
• 16:38
  - But right now, you know, we may be
• 16:40
  - focusing on other things in the AI world.
• 16:42
  - And so
• 16:44
  - I think this kind of paper offers an
• 16:46
  - opportunity to reset,
• 16:47
  - to say, hey. Where are we supposed to
• 16:49
  - be going?
• 16:50
  - The and where have we been supposed to
• 16:52
  - be going this whole time? To use this
• 16:54
  - as validation to say, yes, we've been on
• 16:56
  - the right path.
• 16:57
  - And then hopefully take that as jet fuel
• 16:59
  - to say, and as we think about what
• 17:01
  - more we can do,
• 17:02
  - here's what we now know about what's needed
• 17:04
  - from an infrastructure perspective, what's needed from an
• 17:06
  - operation standpoint, what's needed from a financing perspective,
• 17:10
  - and what's needed from a, like, a just
• 17:12
  - intangible support standpoint?
• 17:14
  - And how can we as payers come together
• 17:16
  - with providers
• 17:17
  - meaningfully to actually provide that, not just get
• 17:19
  - lip service? I think that's the challenge ahead
• 17:21
  - of us, and that's where I can imagine
• 17:23
  - a lot of my critics heads would be
• 17:24
  - as well.
• 17:25
  - So with the white paper, what do you
• 17:27
  - think is changing operationally at Aetna with these
• 17:31
  - findings?
• 17:32
  - Is this going to influence how y'all communicate
• 17:34
  - with providers who might be on the fence
• 17:36
  - with taking on more risk? What could that
• 17:38
  - look like in practice?
• 17:40
  - So I think very tactically, Elizabeth, what we're
• 17:42
  - spending time on is, like, how are we
• 17:43
  - giving people the tools they need to succeed?
• 17:47
  - We think interoperability is a big part of
• 17:48
  - this. Right?
• 17:50
  - The best groups out there are relentless on
• 17:53
  - pursuing real time data exchange,
• 17:56
  - responding to ADT feeds like admission discharge and
• 17:58
  - transfer notifications from hospitals and ERs in real
• 18:01
  - time,
• 18:02
  - and using claims based, you know, analytics
• 18:05
  - to try to identify folks who they're who
• 18:07
  - they should be worried about, who may be
• 18:09
  - at risk of of a a new event,
• 18:11
  - and then pushing forward.
• 18:13
  - And so we are spending an enormous amount
• 18:15
  - of resources
• 18:17
  - in bringing interoperability
• 18:19
  - into, like, as frontier of a capability as
• 18:21
  - possible for us at Aetna to be able
• 18:23
  - to use, you know, whether it's Epic payer
• 18:25
  - platform, Athena, Care Connect, whatever,
• 18:28
  - to make it easier for providers to really
• 18:30
  - access and share more clinical data so that
• 18:32
  - bidirectionally,
• 18:33
  - they see what care gaps emerge, they see
• 18:35
  - what opportunities
• 18:36
  - emerge, and we and they can reach out
• 18:38
  - for help or we reach out to them
• 18:40
  - to offer support when we identify those kinds
• 18:42
  - of opportunities together. Right? I think that's that's
• 18:45
  - job one.
• 18:46
  - Job two is to also say, like, engagement
• 18:49
  - is
• 18:50
  - it's very sexy to talk about engagement in
• 18:52
  - a digital and agentic form today, but engagement
• 18:55
  - is also shoe leather and analog.
• 18:57
  - Right? And so how do we use all
• 18:59
  - the tools in our tool in our toolkit
• 19:02
  - to get folks engaged with the providers who
• 19:05
  - are taking care of them, who are their
• 19:06
  - primary care physicians or their specialists?
• 19:08
  - So, you know, we our partnership with Signify,
• 19:11
  - you know, another CVS Health cousin of ours,
• 19:13
  - suggests when the mill the millions of members
• 19:15
  - that get a Signify home visit,
• 19:17
  - from us who are Aetna members every year,
• 19:19
  - when we go into their homes when Signify
• 19:21
  - goes into their homes rather and sees that
• 19:24
  - this is a member who is eligible for
• 19:25
  - an advanced care coordination or care management program
• 19:28
  - through Aetna or when they see that this
• 19:30
  - is a member who hasn't seen their primary
• 19:31
  - care position in some time,
• 19:33
  - We are able to flag then that number
• 19:36
  - one concern for that member.
• 19:38
  - And then in use, like, the Signify
• 19:41
  - clinician working with the patient,
• 19:44
  - taking the patient's phone from them, with permission,
• 19:46
  - of course, dialing a number with a fifteen
• 19:49
  - with a fifteen second pickup time, service level
• 19:51
  - agreement with a clear requirement. And on the
• 19:54
  - spot, get somebody enrolled in that care management
• 19:56
  - program or get somebody engaged with that provider
• 19:58
  - who they've been try who that provider has
• 20:00
  - been trying to get a hold of them
• 20:00
  - they haven't been able to. Right? We are
• 20:02
  - doing the work
• 20:04
  - not only at a digital level, but also
• 20:06
  - at that shoe leather level
• 20:08
  - of ensuring connectivity,
• 20:10
  - making things simple when they're often all too
• 20:13
  - complex, and trying to drive people into the
• 20:15
  - kind of care
• 20:16
  - that can be stabilizing and ultimately humanizing.
• 20:19
  - And so that's where we're really focused on,
• 20:21
  - again, being that connective tissue
• 20:23
  - and pushing as much as we can
• 20:25
  - to be supportive
• 20:27
  - but not abrasive in the journey towards better
• 20:29
  - health.
• 20:30
  - Well, doctor Khan, as we wrap up, do
• 20:32
  - you have any sorts of final words of
• 20:35
  - wisdom, advice for other Medicare leaders?
• 20:39
  - I would say this. And, again, I'm very
• 20:40
  - biased just given, you know, where I've spent
• 20:42
  - my whole career. But we see this at
• 20:44
  - Aetna as a very clear sign, Elizabeth,
• 20:47
  - that value based care arrangements work. Right?
• 20:50
  - When we create that kind of shared focus
• 20:52
  - between health plans and providers and we get
• 20:54
  - the rewards right, and then we see this
• 20:55
  - obviously particularly in the two sided risk and
• 20:57
  - full risk domains,
• 20:59
  - We can actually fulfill the promise of value
• 21:01
  - based care in delivering
• 21:04
  - better quality, better value, and lower cost.
• 21:07
  - And so this isn't the first study to
• 21:09
  - support this conclusion, but the size of this
• 21:11
  - study and the the power it holds, I
• 21:13
  - think, is a
• 21:14
  - important reminder of where we where we need
• 21:17
  - to be going from a North Star perspective
• 21:19
  - as we head into this next era of
• 21:20
  - innovation.
• 21:21
  - Well, doctor Khan, thank you so much for
• 21:23
  - taking the time to chat with us today.
• 21:25
  - Elizabeth, it's such a pleasure, and, you know,
• 21:27
  - always love interacting with the Becker's crew and
• 21:30
  - looking forward to more. And to our listeners,
• 21:32
  - if you'd like to hear more podcasts from
• 21:34
  - Becker's Health Care, you can visit beckershospitalreview.com.
• 21:38
  - Thank you.