Latest / Becker’s Payer Issues Podcast / Breaking Barriers in Home-Based Healthcare

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Breaking Barriers in Home-Based Healthcare · Becker’s Payer Issues Podcast

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  Evernorth brings the power of wonder and relentless
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  innovation to create world class pharmacy care and
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  benefit solutions. Our connected health services make the
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  treatment, prediction, and prevention of health care's most
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  complex conditions
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  easier and more accessible as we drive organizations
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  and people forward. Ever North Home Based Care
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  provides value based care that helps patients with
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  multiple chronic conditions
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  and social determinant of health barriers get the
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  care they need and the personalized experience they
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  deserve. We serve patients who struggle to navigate
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  the health care system by bringing high quality
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  primary
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  and preventative care services to the home. By
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  providing clinical care and support services that provide
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  whole person care, we improve health equity, access,
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  and outcomes for the populations we serve.
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  Hello, and welcome to the Becker's Healthcare podcast.
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  My name is Chanel Bunger. And right now,
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  I'm thrilled to be joined by doctor Yvette
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  Lefebvre,
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  the chief medical officer, home based care, Ever
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  North Health Services.
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  Thank you so much for joining me today.
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  Thank you. Thanks for having me. Perfect. Well,
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  to get us started, could you please tell
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  us a little bit about your background? Sure.
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  So I'm an emergency medicine physician by background.
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  And as you said, I'm I'm currently the
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  chief medical officer for home based care at
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  EverNorth.
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  And so kind of an interesting,
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  I'd say circuitous route to get here. Started
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  off my career in emergency medicine and have
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  now transitioned into home based care. And it's
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  kind of a a great full circle experience,
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  if you will, because I feel like now
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  so at EverNorth home based care, we provide
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  in home care in a few different programs.
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  We have an in home primary care program.
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  We have a health risk solutions program, and
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  we have a post acute care and transitions
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  of care program. And so if I think
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  back to my days in the emergency room
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  where I
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  struggled with giving the time and attention to
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  patients with a lot of chronic conditions who
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  would come into the emergency room for care,
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  usually in the middle of the night when
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  there was a lot going on because they
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  weren't getting the primary care that they needed,
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  That was a stressful time for me. And
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  so now I feel like working at EverNorth
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  home based care, I'm actually starting to
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  address the root causes of the problems that
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  those patients were having. And so it's it's
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  a great program and happy to talk more
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  about that offline at some time. Perfect. And
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  speaking of problems,
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  from a clinical perspective,
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  how would you describe the biggest barriers to
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  effectively serving and engaging members? And what opportunities
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  do you have for large scale improvements?
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  And how are you applying this in your
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  current strategies?
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  That's a lot, and probably more than we
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  can cover in a 15 minute podcast. But
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  so high level, I think some of the
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  biggest challenges that we're facing together when we're
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  looking at health care across the country right
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  now, we're looking at an aging population. The
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  population reference bureau is telling us that by
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  the year 2050, we're going to have
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  85,000,000
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  people who are aged 65 or over. That's
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  a 47%
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  increase over what we saw in 2022. Wow.
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  Yeah. So that's a lot of aging patients
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  that we need to be prepared to take
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  care of.
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  And then coupled with that, we're actually seeing
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  a sicker younger generation, if you will. So
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  when you look at patients who are under
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  45,
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  we're seeing
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  an increase in obesity. We're seeing an increase
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  in cancers. We're seeing an increased risk of
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  death from heart failure, and that's patients under
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  45.
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  So we've got sicker patients, and we've got
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  patients who are aging.
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  So we've got a lot of challenges in
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  how we're going to deliver the care that
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  those patients need.
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  And then coupled with that, there's 2 other
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  things that I think it's worth addressing or
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  trying to address. We're not gonna fix it
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  again in 15 minutes, but we need to
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  acknowledge that there's been an erosion of trust
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  of the health care system.
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  I think it's been happening gradually over time,
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  but I think over the last 5 to
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  10 years, we've really seen a lot of
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  erosion of trust in the traditional health care
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  relationships
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  with our patients.
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  And then last but not least, I would
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  call out the fact that we've got a
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  a provider shortage in our country, and that's
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  only going to get worse. First of all,
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  providers are not immune to aging. Right? So
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  we're gonna see more and more providers getting
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  ready to retire in the coming years. And
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  we've also got providers who are burning out.
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  Right? Probably as a result of all those
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  other challenges that we've been facing.
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  So those are what I would highlight as
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  kind of my my hit list, my top
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  five challenges.
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  And then as far as opportunities and how
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  we're addressing that from home based care, I
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  would say,
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  flip those on their head. Right? So if
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  we look at those challenges as as opportunities,
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  at Evernorth home based care, we're doubling down
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  on population health. And so if you think
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  about population health as the health outcomes for
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  a group of individuals,
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  including the spectrum of
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  outcomes for those patients across the group. Okay?
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  By identifying the patients who are at highest
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  risk or rising risk, like the ones I
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  just outlined. Right? The patients who are aging,
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  the patients who are younger and sicker,
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  patients who are disenfranchised for one reason or
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  another from the health care system, patients who
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  don't have access to providers because they're leaving
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  health care,
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  standing up population health. First of all, identifying
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  where they are, who they are, and having
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  the data to show us where we need
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  to focus our efforts,
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  and then working to stand up programs to
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  help specifically
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  assist those patient populations.
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  That's how we're starting to tackle some of
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  those challenges,
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  and I think it's a great opportunity for
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  us to meet those patients where they are
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  and to start addressing kind of the challenges
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  that they're facing.
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  Got it. Thank you so much for walking
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  us through that. Now kind of switching gears
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  here. In an ever evolving regulatory environment, what
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  tools or key strategies have helped your organization
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  improve quality
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  and clinical outcomes for members while staying compliant?
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  Yeah. So, that's another big one to tackle
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  in few minutes. But,
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  at Evernorth, I would say actually that home
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  based care is a live living, breathing example
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  of one way that that larger
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  organizations are starting to address that challenge.
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  By leaning into care delivery, and that's what
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  home based care is, we are we are
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  actually providing care to these patients. We're sending
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  our in home primary care providers and our
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  nurses and our social workers into the home
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  to take care of patients, to touch them,
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  and to help them through their care journey.
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  That's a great way that a lot of
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  larger organizations
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  are really
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  leaning in to drive quality outcomes
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  for their membership as a whole.
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  I would also say that for our health
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  plan clients,
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  taking advantage of the of the drive towards
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  value based care is is a great opportunity.
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  And, actually, it's a great opportunity for both
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  providers and the health plan clients. Right? Because
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  the health plan clients have the opportunity
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  to support providers in those value based care
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  arrangements.
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  The value based care arrangements enable these providers
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  to provide the care that they always wanna
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  deliver in order to drive great outcomes. And
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  so I think, obviously, we've been talking about
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  value based care for, what, at least a
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  decade? Probably more now. And so
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  it's definitely going to happen. We're definitely going
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  in that direction. And then so I see
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  that as another great opportunity for organizations
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  to drive quality outcomes
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  even though we're seeing more and more regulation
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  around
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  how health plans can interact with providers and
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  with patients.
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  That makes sense. Absolutely. And you spoke on
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  a panel focused on fostering health equity.
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  How do you define what health equity truly
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  means in practice?
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  And how would how should health plans redefine
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  strategies to ensure
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  equitable outcomes across diverse patient populations?
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  That's another good one. So if we think
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  about health equity as a state in which
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  everyone has a fair and just opportunity to
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  be as healthy as possible,
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  And then we recognize
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  that
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  equity and equality are 2 different things. Right?
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  So health care
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  equality
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  is,
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  unfortunately, what we've seen in the past in
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  this country, right, where we build a care
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  model, we build a health care system delivery,
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  and we try to spread it peanut butter
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  across the country.
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  And then we wonder why wait. These patients
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  are doing well with that, but these patients
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  aren't. Right?
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  Equity says, you know what? We need to
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  look at those patients who aren't doing as
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  well and figure out what additional resources, what
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  different care models they need because they're starting
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  from an uneven starting point. Right? They're it's
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  not even playing ground, so to speak. So
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  they're starting from a different place. And so
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  there are populations who need different programs. There
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  are populations who need additional resources in order
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  to attain the same outcomes. Right? So we
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  can't just say, here's how we treat CHF
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  across the country. We need to figure out
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  what each population needs. Equity, not equality. Exactly.
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  Exactly.
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  And so how do we do that and
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  how do health plans do that? I would
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  I would come back to where I started,
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  which is with population health. Right? So coming
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  back to the idea that population health is
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  looking at the outcomes of a group of
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  patients,
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  but also looking at the individuals across that
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  continuum to see how they're responding to programs.
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  Another way to think about population health is
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  how do we treat individuals at scale?
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  And so
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  population health, I started earlier saying that we
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  need data. Right? So we can identify the
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  populations who need different programs that need additional
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  resources to obtain health care equity.
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  But I would also submit that once we
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  have that data, we also need to spend
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  time with the individuals. And we need to
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  spend time with the caregivers, and we need
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  to spend time in the communities because I
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  can't
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  I shouldn't. Sitting in my office, look at
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  data and say, okay. Here's a population that
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  needs a a different program. I'm gonna design
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  it in my program and and send it
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  in my office and send it out to
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  be, you know, implemented. Right? We need to
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  spend time with those communities
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  so that we can hear from them what
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  they need. Because I don't know what they
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  need. They know what they need. So so
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  getting back to the root of where health
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  care started. Right? Spending time with our patients,
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  hearing from them, hearing from what they need,
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  and then taking that back and saying, okay.
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  This is how now we can operationalize that
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  at scale.
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  I think that's how we're going to start
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  to really address health equity
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  within our care models, and then that can
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  spread right across the country as far as
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  our health care system goes. Got it. Got
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  it. Well, Yvette, I wanna thank you for
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  sharing your insights today on the Becker's healthcare
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  podcast. And to our listeners, thank you for
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  joining us, and please be sure to check
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  out other Becker's podcast. Have a wonderful rest
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  of your day. Thanks so much for having
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  me.