Latest / CareTalk: Healthcare. Unfiltered. / Empowering Patients Through Whole Person Care w/ Dr. Michael Cantor & Catherine Tabaka | Executive Feature

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Empowering Patients Through Whole Person Care w/ Dr. Michael Cantor & Catherine Tabaka | Executive Feature · CareTalk: Healthcare. Unfiltered.

• 0:00
  As the U.
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  S.
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  population ages, Medicare is consuming more and more of the federal budget.
• 0:05
  At some point, those costs will become unsustainable, which is why we need innovations that save money and improve outcomes.
• 0:13
  Whole person care and care at home are two promising approaches that are already being implemented.
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  Matrix Medical Network is at the forefront of this movement.
• 0:21
  So I'm very pleased to host today, CEO, Catherine Tabaka and Chief Medical Officer, Dr.
• 0:27
  Michael Cantor.
• 0:34
  Welcome to CareTalk Executive Features, a series where we spotlight innovative companies and leaders working to advance the healthcare field.
• 0:41
  I'm your host, David Williams, president of Health Business Group.
• 0:45
  Catherine and Michael.
• 0:47
  Welcome to CareTalk.
• 0:48
  Thank you.
• 0:49
  Thank you.
• 0:50
  So, Medicare is a big deal, but just to give people a sense of it, I mean, how big of a deal is Medicare spending?
• 0:58
  And how did we get to this place where it's so dominant?
• 1:01
  So I can I can start , and Mike, feel free to add to this.
• 1:04
  If you think about the recent report that was released by CMS by recently to release the 2021, 2030 national health expenditure, the NHE report.
• 1:17
  They're projecting that the total health care spending David will reach nearly 7 trillion by 2030 and Medicare continues to grow at an average of 77 percent rate because of an aging population and increased utilization.
• 1:38
  So if you're thinking to your point about the cost of health care and the size of the numbers that we're talking here.
• 1:46
  The population will continue to grow and age health expenditures continue to rise.
• 1:52
  We're nearly under, I mean, just under 20 percent of GDP.
• 1:57
  Healthcare represents just under 20 percent of GDP from an expenditure perspective.
• 2:02
  So, the government is unlikely to spend more on healthcare.
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  We're right up there and really high up there compared to other nations globally.
• 2:11
  We're I think it's fair to say we're at an inflection point might have been for a little while, but we certainly are in an inflection point and need to face reality as an industry that there is no more money coming into health care change is not an option at this time and we'll have to see and develop those alternative models of care to improve access to improve quality and the care outcomes at a much lower overall cost to society.
• 2:39
  Catherine, you know, they sometimes try to get your arms around these numbers, like 7 trillion dollars, and I remember, they used to have these things, they'd say, like, if I stacked Dollar bills, like up to the, the moon, you know, now it's like up to the sun.
• 2:52
  Now of course it's gonna, you consume all the forests of the, of the, of the world and also probably burn it up as it gets to the sun.
• 2:58
  But I mean, it's very hard to actually get your arms around it, but it is just gigantic.
• 3:02
  I think it's, it's fair to say, and Mike, you've been, your physician, you've probably been helping to, to get, drive the costs up there.
• 3:07
  I mean, Medicare wasn't always meant like this.
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  It was, it, it, that's not how it started.
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  So that's true.
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  Medicare started as a very simple health plan for older adults that was going to focus on taking care of people who need to be hospitalized.
• 3:20
  That's why Medicare still has these two structures where there's a hospital fund and a non hospital fund, which is what doctors get paid out of, and now there's a medication fund called Part D, and all of those parts of the funds are growing, and they're growing because of success.
• 3:35
  We've successfully aged as a society, as a world, so people are living longer and the longer you live, the more health care resources you tend to use, because the prevalence of chronic illnesses goes up.
• 3:46
  Usually, we say about three quarters of health care expenditures are related to chronic illnesses.
• 3:50
  And in the United States, we don't do a great job of managing chronic illness, and so Those costs continue to grow.
• 3:56
  And so not only are we the victims of our success, that we've got more older people as percentage of the population, we also have better treatments and more expensive care to offer them.
• 4:06
  And we've learned recently that, not surprisingly, that it isn't just the medications we take or, or not take that our health is actually influenced by other factors.
• 4:16
  In fact, genetics only accounts for about 25 percent of our longevity.
• 4:21
  Most of what affects our health is our behaviors, what we eat, how much we sleep, what kind of What we, whether or not we exercise on a regular basis, how social we are, whether we're connected to the community those things, but also what's our community like?
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  What's the environment like?
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  Do I live in a toxic, you know, waste dump neighborhood or am I in a cleaner, less polluted neighborhood?
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  All of these social, so called social determinants of health.
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  As distinguished from sort of the physical determinants of health and the genetic determinants of health, these SDOH factors as they're called are being recognized as being really important in terms of the quality of life we have and the quality of health we have.
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  And in the U.
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  S.
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  we've built a really good sick care system in the sense that we focus on diagnosis and treatment.
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  What we haven't done is built a really good holistic health care system which focuses on health, which is more than just the absence of disease.
• 5:12
  Alright, so, we talked about, Medicare started pretty simply, as you know, insurance for older people as one of these great society programs.
• 5:20
  We had Medicare for the old and Medicaid for the poor.
• 5:24
  But now I hear this concept of dual eligibles, meaning that the older people are not just using Medicare, but also a lot of the Medicaid spending is coming there as well.
• 5:32
  What, what does this dual eligibles and how does this fit in with with Medicare overall?
• 5:36
  So dual eligibles are people who are eligible for both Medicare and Medicaid.
• 5:41
  There are a couple of ways you get there.
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  The majority, like you said, is the eligibility for Medicare is that you You pay taxes into the Medicare costs and you're eligible for parts A and B, the hospital part is A, the doctor part, I'm grossly oversimplifying, is B, and then the drug part is part D.
• 5:57
  So you do that, you live long enough, you get to age 65, you elect Medicare coverage, then you're in the Medicare program.
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  There are lots of choices now between Medicare, traditional Medicare, Medicare Advantage, etc.
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  For Medicaid, it's usually based on income.
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  So if you spend if you have a certain amount of income or if you have a certain amount of assets, you qualify.
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  Medicaid is a combined federal and state program.
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  So states set their own rules in terms of the, what level of poverty you have to be at to qualify for Medicaid.
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  And what we're seeing is, and what's traditionally happened is, unlike Medicare, which focuses on the hospitals and the doctors and the medicines, Medicaid pays for everything.
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  And what I mean by everything is not just acute care, and physician care, and medications.
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  But also long term care.
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  So nursing home care, care in the community, what I call long term support services.
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  That could be home healthy, and it could be meals on wheels or nutrition.
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  It pays for lots of things that Medicare doesn't.
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  The people who are dually eligible, therefore, tend to be both older, which I qualify for Medicare, And they tend to be poorer, which I qualify for Medicaid, and many of them have multiple chronic illnesses because of their being older and because of being poor and living in those neighborhoods, like I talked about a second ago, that happen to have less education, more pollution, more stress in their lives, all of these things add up to the fact that now when we think about those who have both Medicare and Medicaid 40 percent of them are in only fair or poor health compared to a much higher percentage of people who only have Medicare.
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  40 percent of people in Medicare and Medicaid, the duals, have at least two limitations in activities of daily living.
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  In other words, they can't take care of themselves in terms of dressing, eating, bathing, paying the bills, those kinds of things.
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  And a surprising number, 26 percent of them, have five or more chronic conditions.
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  And in general, the duly eligible population accounts for less than 10 percent of the Medicare population, but over 30 percent of Medicare expenditures.
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  And many of these people are living in nursing homes, two thirds of the Medicaid budget in the United States is going to pay for long term care.
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  Less in nursing homes than it used to be, but still, that's overwhelmingly nursing home care.
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  So it's not surprising when you think about what it's like, how sick you have to be and how much function you have to have lost to get into a nursing home, that when you think Medicaid is the primary payment source for nursing homes, which it is in the U.
• 8:26
  S., That's why when you look at these dually eligible folks that have both Medicare and Medicaid, they tend to be very sick.
• 8:33
  The other way, by the way, that you can get to be on both Medicare and Medicaid is you don't have to be older to qualify for Medicare.
• 8:40
  If you are disabled, you can qualify for Medicare.
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  And so there are lots of people who are disabled and are on Medicare because of that, who may qualify for Medicaid because they need the long term support services.
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  So you've enriched both the older population has a larger number of chronic illnesses and medications and all the rest of it.
• 8:58
  But even the younger Medicare population, they tend to have more disabilities, more behavioral, behavioral health problems, more substance use disorder and in combinations of physical and behavioral health challenges.
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  So, when you think about why would we focus.
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  Why would we focus on duly eligibles?
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  The answer is that they are where the action is from a health perspective and where they need more help and more support than typical Medicare beneficiaries.
• 9:27
  So Catherine, if we think about these, you know, these dual eligibles, on the one hand, it sounds great.
• 9:31
  You've got Medicaid, which pays for everything.
• 9:33
  You've got Medicare and you've got these two programs.
• 9:37
  But on the other hand, They weren't designed necessarily to work together, and are they, you know, who decides what goes where, and are these people actually benefiting from having both coverages, or does that also start to introduce some new challenges?
• 9:52
  I think that the eligibility, as Mike described, right, think of it as the, The culmination of circumstances, both physical health issues as well as social health or social and environmental issues.
• 10:08
  And the fact that we're recognizing them today, David is.
• 10:12
  Is good because these are individuals that from a health literacy access, understanding, knowledge on how to navigate the system are not in even sometimes a physical condition to get themselves to a clinic or to a doctor, let alone trust potentially.
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  The system.
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  So one, we've identified them.
• 10:40
  The second piece is, and if you think about what matrix does, and you mentioned, you know, being at the forefront as an organization for nearly now, a quarter of a century, matrix has been meeting people where they are and where they are is in the home and particularly for those dual eligible and I will share this much my first ride along with a clinician with this organization three years ago, when I joined was actually a dual eligible 50 years old.
• 11:07
  Disabled, to your point, Mike, right, wouldn't be eligible to Medicare just by age, but that first visit, David, really brought home for me the value of that in home visit and home care that can be delivered to somebody that literally had issues that were much bigger than just the health and physical issues, but questions that are Asked to our clinicians who spend as long as they will, as long as they need to spend in the home to really help answer educate not only on the condition, but the living life choices that they make that these individuals may make the.
• 11:51
  Compatibility between their lifestyle and the medication that they take or the medication regimen that they that they are under that they may or may not understand the time of day that they take it get disoriented questions such as can you help me file my taxes or how do I access access a food bank right so it's it's that that first visit again three years ago was like okay now I understand and I really fully grasp what the benefit is because that person is on Medicare and Medicaid to your point.
• 12:21
  So they supposedly have access to resources, but with the question that that gentleman was asking us, there is no way that he was accessing those benefits, and he was not mobile to actually get himself to visit a PCP or get it.
• 12:40
  Himself to a clinic or to a specialist to address his conditions.
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  The only way you get to see that person in 360 head to toe toe to head in their environment with their anxieties and after a solid hour of conversation, frankly, you get to build a rapport where they open up and share with you everything that we need to know.
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  To better architect that bubble wrap, the way I like to call it, right?
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  Wrap the bubble around them and bring the village to actually come to them so that they stay on their care journey, rather than likely, if nothing happens after we leave the home and close the door, they're going to float.
• 13:20
  They're going to float again.
• 13:21
  You know, you use this term I've seen in your literature, whole person care, and I'm getting a bit of a sense of it from your description there.
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  I mean, filing the taxes, I don't think was intended originally for you know, Medicaid or or Medicare.
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  And yet, if someone is going to be able to live their life and not have anxiety, these, these are the things that have to be.
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  Dealt with.
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  So I'm wondering if you can, you've kind of described it, but define a little bit what whole person care is and then how much of a difference can it make?
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  I mean, you actually go after it and you say, wow, it's an hour.
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  I spent an hour here and I just see that I've got more problems than solutions and it is kind of hopeless.
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  Or what kind of, what do you actually do with that?
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  How do you make a difference in the whole person care?
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  I've been lucky as a geriatrician to make house calls throughout my career.
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  So I've had a lot of experience with those kinds of visits.
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  Like Catherine described, I've, I've made house calls to people who live in mansions, I've made house calls.
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  More commonly to people who don't live in mansions and what you see is the whole spectrum of, of human success and human challenges.
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  And when you begin to understand that health is more than a diagnosis and a treatment, that it's really understanding the totality of that person, what we used to call in medical school, the biopsychosocial model.
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  So.
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  What's driving their, their medical illness?
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  What's the psychological piece?
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  Where are the social aspects of their lives?
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  And that, by the way, isn't just housing and transportation.
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  It's who's in their neighborhood, who's helping them.
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  All of these folks by the time, many of them, by the time they get to be older and duly eligible, especially they do need help.
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  And they need help in an ongoing, chronic way that Medicare doesn't pay for, but Medicaid can.
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  But even Medicaid is limited.
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  Many states don't have the budget to actually pay for all the home health aides and the home care that their Medicaid populations need.
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  So there's a, a real challenge these days.
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  And what happens is family caregivers, neighbors, friends other people in the community tend to pick up the slack.
• 15:22
  And so understanding the totality of that person.
• 15:25
  And then recognizing whether or not they're on Medicaid, even Medicare members, you know, qualify for a variety of different services from what we call community based organizations, access to transportation, socialization, nutrition.
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  These can all be arranged, but it takes work, and it takes understanding and insight into the systems, which are very complicated and hard to navigate.
• 15:46
  And so, If you don't get into the home or if you don't ask the right questions, you don't ever understand that the reason the person isn't taking their medicine isn't because they don't want to take it.
• 15:55
  It's because they can't afford the copay or they didn't like the side effect it had, but they didn't feel comfortable telling their doctor that when you're in their home, you're a guest there.
• 16:04
  They'll tell you a lot of things.
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  Like Catherine said, you would establish this rapport.
• 16:08
  You learn a lot by walking into someone's home from the trust that you can establish and then what they'll tell you.
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  And to be honest, you learn a lot by literally.
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  Seeing and smelling what's going on in that home.
• 16:19
  You open up the refrigerator, you open up the medicine cabinet in the bathroom, you just see things and you smell things and you hear things like the neighbors or what's going on with the kids and all of that that you just don't get during a traditional office visit.
• 16:33
  That holistic assessment can actually lead to great care planning, great support, much better interventions.
• 16:39
  That's really what we've been working towards, to be able to identify what are those challenges.
• 16:44
  The diagnosis and treatment, of course, but also the social determinant needs and then connecting people to the resources that they need to be healthy and to stay healthy.
• 16:53
  I think that the 360 I was referring to earlier, David, right?
• 16:56
  Because, because we're in the home, we are.
• 17:00
  And we are able to see things that others might not see or might not be able to see.
• 17:06
  We can be the eyes and ears for other actors in the ecosystem of care and for the care team of that person.
• 17:18
  To Mike's point, things that will not be revealed, not because we don't want to The person may not be comfortable necessarily, they may forget, they may not think of it.
• 17:28
  So, we are able to actually, 360, head to toe, toe to head, see, hear, and smell things that, that you will not have the ability to see, hear, and smell by the time I've made the effort to shower, dress and get myself to a doctor's office.
• 17:47
  The conversation short as it is, and we know that, you know, the, the, the, the time that a PCP gets to spend with their, with their patients is not quite as much as what we spend.
• 17:59
  There's a whole lot that we can context, right?
• 18:02
  The whole person cares about the context and what is not Typically shared or declared that allows us to connect the dots and connect the dots in a different way, David, and hopefully a more streamline effective way to for this journey to actually be be followed and for the patient to stay on that journey, rather than likely falling off at some point, which is, which is, which is a point.
• 18:29
  Dramatic.
• 18:31
  Dramatic conditions ends up in ER visits and additional costs.
• 18:36
  Right.
• 18:37
  To get the quality of life of that person altogether.
• 18:39
  So, starting with that, but also the costs and adverse events, more adverse events that could be avoided.
• 18:45
  Now, CMS, which administers both Medicare and Medicaid, has these newly announced health equity initiatives.
• 18:53
  And I'm wondering, what is their motivation for doing them?
• 18:57
  What's the potential, potential?
• 18:59
  We hear sometimes people talking about things like equity, and it can be kind of a throwaway words that are nice to have.
• 19:05
  Maybe something people, there's even a backlash against why is CMS health, these health equity initiatives and, you know, where do they go with them?
• 19:12
  I think, as we said, I think there's an increasing recognition and there's even like data and enough reports that are showing that.
• 19:21
  People will get different levels of access to care, quality of care, David, based on some of those factors that we talked about, right?
• 19:31
  Sometimes even their race, where they live, and if you think of it at the core, healthcare treats everybody the same way.
• 19:38
  Those are things that should not impact.
• 19:40
  The ability for an individual to access care or the quality impact, the quality of the care that they receive.
• 19:47
  So I think you're seeing the regulators to try to course correct those aspects by putting emphasis on them.
• 19:54
  And that's how you hear about those health equity initiatives.
• 19:58
  And then the most recent one is this health equity index that is really.
• 20:04
  Taking trying to level set those known disparities because, again, those factors are known, but they're not necessarily addressed.
• 20:13
  So how do you level set and try to erase some of those disparities between members with social risk factors and those that do not suffer the same social risk factors?
• 20:25
  So that's that's how again that latest health equity indexes as come as a storm measure for, so that that I think is a it's not a new concept again.
• 20:36
  I don't think that we're but but there's a continued push.
• 20:39
  I think David for more those inequities to be taken seriously because to Mike's point earlier by the time you're dual eligible by the time you've piled up basically.
• 20:51
  Right.
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  The conditions or barriers that make you want to consume and access care in the appropriate way to take care of yourself.
• 21:00
  You've created a whole series of side effects thinking about your individual contribution to society at this point.
• 21:09
  You cost more than you contribute, right?
• 21:11
  It's I often like to think the health of the population is a reflection of the health of the Society itself in the country.
• 21:20
  We can do a better job.
• 21:21
  And I think that's where we're being pushed as an industry to think a little bit differently and not apply the common and systematic model to those that actually need a bit more help.
• 21:32
  And what we know is that if you're different.
• 21:35
  And the average middle class white male, because women actually face disparities based on gender.
• 21:43
  If you have heart disease, it shouldn't matter whether you're male or female, right?
• 21:46
  But the physiology is the same.
• 21:48
  The outcomes, the outcomes for women are worse.
• 21:50
  And there.
• 21:52
  Their expression of cardiovascular symptoms aren't taken as seriously as they are of a man.
• 21:56
  There are a whole bunch of, and that's just one example, many, many disease states are affected by things that should not affect, should not impact access to care.
• 22:05
  It's simply unfair and not the way that we would ever design a health care system.
• 22:09
  Despite that, despite mountains of data showing this we still have these challenges in 2024.
• 22:16
  And so CMS, in order to force the system to begin to respond to this, has put in place rules that impact the income to Medicare Advantage plans.
• 22:26
  The health equity index is basically a way of measuring how much of a problem is health equity for the population being managed by a plan.
• 22:35
  And one of the ways that they measure The disparity, not measuring the disparities, but measuring the complexity of that population is they look at the percentage of people who are dually eligible, who have both Medicare and Medicaid.
• 22:47
  They look at people who have low income subsidies, which are special payments that people can get for their medications, reduces the cost of prescription drugs, for example, for Medicare Advantage beneficiaries who are not eligible for Medicaid.
• 23:00
  but are still not able to afford the cost of many medications.
• 23:04
  So that's why health plans really need to understand, if they're working in Medicare Advantage, that some of the bonuses they may have gotten in the past, for example, for improving quality measures, those bonuses are not going to be directed towards improving equity measures.
• 23:17
  So, the first step is showing that you have a population that's diverse, that has duly eligible folks, that has low income subsidy members.
• 23:26
  Because if you don't, you may not even qualify.
• 23:28
  The plan may not qualify for any of the bonuses related to improving health care equity.
• 23:34
  And Of course, we'd like to live in a world where that wouldn't matter, that all health plans would be doing the right things for the right reasons, just the same way all health systems should be responding the same way, but the money does matter, so it's getting more attention now in our industry.
• 23:49
  And we believe, obviously, overdue attention.
• 23:52
  And we've, we know that if you meet people where they are, both literally and figuratively, in a culturally competent way which isn't just language, but understanding the health beliefs from the culture of that person, and you do it in the home, and you connect with people as individuals, that you can address some of these health equity issues and improve them.
• 24:11
  And so that's why Matrix Medical in particular is really interested in health equity because we know that by going into the home and the, the, the, the story that Catherine shared earlier about her ride along, very first one, being with someone who's really struggling despite having access theoretically to great health care resources, unfortunately, was a good example of even with access, you can't get there unless you have help to know how to work the system.
• 24:37
  And for people who are duals, they often don't get that help.
• 24:40
  Yeah, we can help with we know we can help them because that's what we do think that the way I like to think about those initiatives, David is is the regulators incentivizing the industry to think differently, right?
• 24:53
  And the actors are here.
• 24:55
  It's not that we need more.
• 24:57
  Of anything.
• 24:57
  What we need is we need more.
• 24:59
  Something is more coordination, more hand holding and wrapping that bubble right around that member or that patient holding hands, making sure that for those more vulnerable members or patients, we ensure that the actions that we take.
• 25:18
  Right in the home, from a care team perspective, and from a health plan perspective, are coordinated.
• 25:24
  Coordinated and better coordinated, ensuring that the left hand knows what the right hand is doing.
• 25:29
  Does Right at any point in time so that that care journey is coordinated.
• 25:34
  It's made as easy as possible for patients that, as we've said, many times, are unlikely to by themselves activate because they may not be able to feel that they're, it is safe, that they want to trust it, that, that, that coordination and that very specific action.
• 25:52
  Starting in the home is how we diagnose early is how we empower individuals to get their best life, no matter what their conditions and social risk factors.
• 26:02
  Maybe that's how you catch things earlier.
• 26:04
  And you prevent, as I said earlier, that the more serious and higher cost health events in overall, reduce the burden of care costs to the society.
• 26:13
  So it's a win, win, win, win, win.
• 26:15
  And I'm not sure where it would start, because it's different is what I think to do.
• 26:19
  I've gotten from this conversation that, you know, the health.
• 26:21
  Disparities are quite significant if you look overall, and Mike, you've been mentioning you're doing the house calls either, you know, to a mansion or, you know, to less than a mansion and, you know, hearing about the kind of challenges people have.
• 26:33
  Do we know whether the disparities have been increasing over time or decreasing over time?
• 26:38
  I mean, certainly anecdotally you see things that would say they're increasing, but is that just a matter of we're looking at them and we know that they matter?
• 26:46
  Or has there actually been an increase or has there been a decrease?
• 26:49
  The answer is usually it depends, right?
• 26:51
  So it depends on what specific disparities you're looking at.
• 26:54
  And I think it also depends on we're still emerging from COVID and COVID the pandemic tend to make everything worse because of reduced access to care.
• 27:03
  People were discouraged internally or externally from seeking care.
• 27:07
  And so if you already had a problem with access, it made it worse.
• 27:11
  If you are already being discriminated against or being treated differently because of what you look like, or who you were, that got worse because inevitably the.
• 27:20
  There are now there are now long lines, for example.
• 27:23
  So before COVID, if you needed to have an elective procedure, say you want to have your knee replaced, you can get in relatively quickly post COVID.
• 27:30
  Now we know things are harder.
• 27:33
  The weights are there.
• 27:34
  Wait times are longer.
• 27:35
  The staffing levels are lower.
• 27:37
  So, if you already started out behind before COVID, now you're even more behind.
• 27:41
  And so I think it's gotten worse especially for some elective procedure access and things like that.
• 27:46
  And because people have delayed access to care, which means when they show up, they're sicker.
• 27:50
  And that makes it harder for them to get the care they need.
• 27:52
  I think the way to put this all together is that we know that our costs are going up as a system.
• 27:58
  Medicare is growing.
• 27:59
  We have people in that program who have health care disparities and challenges with access and the approach that's going to work is whole person care because whole person care is the only way that you capture the functional status, the disease status, the environment, the caregivers, and you help people do what Catherine said is so important is navigate that.
• 28:20
  Sounds very simple.
• 28:21
  Navigating the health care system.
• 28:22
  If you have ever, it doesn't matter who you are, if you've ever had to deal with the health care system in the United States in the last three years, it is not easy.
• 28:32
  It doesn't even matter.
• 28:33
  A simple picking up a prescription turns out to be a whole day event.
• 28:36
  In some cases, they're fighting with the, you know, getting the pharmacy to fill the right one at the right time and not too soon and not too late.
• 28:44
  Everything is very, very complicated and we need to go back to the first principles, which is.
• 28:50
  Let's do a comprehensive assessment.
• 28:52
  Let's bring care to the patient instead of bringing the patients into care.
• 28:55
  And let's ensure that we're giving everybody all the care that they're entitled to and that they need.
• 28:59
  Not extra care, but not less care either.
• 29:02
  So I like this idea of whole person care because it takes into account all the different factors.
• 29:09
  But on the other hand, if I think about going back to where we started with, you know, Medicare being a simple program, Medicaid being a fairly simple program, and I sort of say, well, because all of these things matter to health, we have to kind of encompass them all there, whether it's food, housing you know, all these different pieces.
• 29:25
  And is there something weird about using you know, government sponsored medical insurance?
• 29:30
  As like a social welfare system overall, it's I'm trying to get my heads around whether is that done elsewhere in the world?
• 29:37
  Does it end up making sense, or should we step back into it in some other manner?
• 29:41
  This is a very challenging area that a lot of people have started to debate as we move towards whole person care.
• 29:48
  And I think there are a couple ways to think about it.
• 29:50
  One, in terms of the U.
• 29:52
  S.
• 29:52
  system, you have federal, state, and local resources that people can access, often don't know about, and that navigation help they can't get.
• 30:01
  With that navigation, they're just getting what they're entitled to.
• 30:04
  And in many cases, If you're qualifying for Medicaid, you're also qualifying for housing benefits.
• 30:09
  And so, theoretically, you should be able to access all of them.
• 30:12
  And transportation benefits are included within Medicaid.
• 30:15
  There are a lot of people who fall off the Medicaid rolls, not because their income has gone up, but because they're not documenting and getting the paperwork to prove that their income has not gone up, right?
• 30:24
  So a lot of this is our own sort of systems complexity in the fragmentation, not just within the health care system, but across the health care system and the social welfare system that you mentioned.
• 30:36
  The second thing to think about is comparing us to other countries.
• 30:39
  How you allocate expenditures as health related is a question of policy.
• 30:45
  There is no specific definition.
• 30:47
  So if you're sick and you come home from the hospital and we deliver meals to you for a week to keep you healthy during that week because nutrition is so important to recovery, is that a social expense or is that a medical expense?
• 30:59
  Depending on the country or the jurisdiction, you may have very different answers.
• 31:02
  And Catherine, I mean, you grew up in the French system.
• 31:05
  You've experienced firsthand how countries allocate their resources differently, how they think about health differently.
• 31:12
  Yeah, absolutely.
• 31:12
  And, and probably a, a system, to your point, you refer to a sick care system in the us or at least in the or most traditional design of it.
• 31:21
  I would say I grew up in a healthcare system where preventative health is much more the forefront education around the, the, the, the role of nutrition towards health activity, exercise.
• 31:33
  So it's, it's.
• 31:33
  It is a, it is a, an approach, a different approach to health from that perspective.
• 31:39
  So you're right.
• 31:40
  I mean, difficult to answer the question, David, in terms of, you know, whether it's a medical or social, but at the end of the day, it will be a cost.
• 31:48
  That's the one thing I can guarantee you.
• 31:49
  So the question is whether you actually invest upfront or you pay the bill later.
• 31:54
  I am on Mike's side in the sense that I'd rather invest a bit more upfront.
• 31:59
  Thanks.
• 32:01
  Intuitively, you're doing the right thing and preventing more adverse outcomes.
• 32:05
  You know that the cost of the back end is going to be a lot, lot higher.
• 32:10
  And again, think of the quality of life, the events that could have been avoided for that person, right, for that individual.
• 32:18
  Their lack of ability to contribute to society, which typically causes more behavioral mental health issues.
• 32:24
  So it is a downward spiral when, I'm not going to say that.
• 32:28
  Other systems globally are more trying to create an upward.
• 32:33
  The future cycle, but if I were to really sort of draw a black and white picture, that's probably the difference that I would make.
• 32:40
  Focus on the preventative, it will help downwards and, and, and keep, and keep people healthier.
• 32:48
  Clearly this whole person care and the in home, you, you, you really got your, your finger on something, but you've also recently published a white paper, you know, to get into some of the depths about that.
• 32:58
  What, what was the inspiration to do the white paper in the first place and what approach have you, have you taken to it?
• 33:03
  But very high level, and Mike, you can, you co authored it, so you definitely can talk, talk, talk a lot more, but to your point, David, it's, it's difficult to be holistic, no pun intended, right, but to be holistic about a concept that is as fast.
• 33:20
  And and complex in many ways.
• 33:22
  So there is a lot of education that needs to happen.
• 33:25
  There is a lot of perceptions around the different actors in the ecosystem of the health care industry, and it will only work if we all come together.
• 33:35
  So it's it's probably trying to rise the level of understanding put a.
• 33:42
  Definition out there to sort of get people to sort of rally and respond and and get and bring the village together so that we can make this work.
• 33:51
  Because again, it's not 1 entity of matrix starting in the home unless we can rally.
• 33:56
  The pharmacy, the care team, the health plan, and make sure, as I said, that communication, if you think about the visually, the member in the middle of the patient in the middle, and everybody else around and rallying around them.
• 34:09
  So that they stay within the parameters of what the health journey will help them get better, or at least prevent a rapid progression of their conditions.
• 34:21
  It's the coming together that makes it work.
• 34:24
  So, how do we elevate the understanding, put a definition out there?
• 34:29
  So, that's why Mike, yeah, has worked with us in really helping, trying to ignite something, ignite a movement, David, so that we're not by ourselves tooting our own horn, basically, but really trying to bring the village together around the concept so that we can make progress faster.
• 34:50
  I think it's just, we, what we try to do in the white paper is connect the dots between increasing scarcity of health care resources.
• 34:57
  The challenges of, of inequitable access to care, which aggravate the costs problem you face.
• 35:04
  And again, the only real solution is whole person care.
• 35:06
  Understanding the biopsychosocial model and the comprehensive needs of that person, and then helping them navigate and connect into the various systems, some healthcare related, some non healthcare related, to ensure that they can become healthy and stay healthy.
• 35:20
  There are a lot more statistics, there are a lot more detail, obviously in the white paper.
• 35:23
  So I highly encourage people to take a look at it, but that's really what it's about.
• 35:26
  And it's in service to what Catherine just said, which is really getting our disparate, complicated, fragmented healthcare system to actually work better together for our patients to make sure that they get what they need.
• 35:37
  Well, it's I'm excited for the white paper.
• 35:39
  We have a link to it in the description below.
• 35:41
  You can download it.
• 35:42
  And I'm sure the the the authors would welcome your comments.
• 35:46
  And I'll say that's it for the latest episode of the care talk executive feature series.
• 35:50
  My guests today have been Catherine Tabaka, CEO and Dr.
• 35:54
  Michael Cantor, Chief Medical Officer at Matrix Medical network.
• 35:57
  I'm David Williams, president of health business group.
• 36:00
  If you've enjoyed this show, please leave a rating and subscribe on your favorite service.
• 36:05
  Catherine and Mike, thank you so much for joining me today.