Latest / Becker’s Payer Issues Podcast / Using Evidence Based Prevention to Improve Outcomes and Control Costs with Dr. Alice Chen

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Using Evidence Based Prevention to Improve Outcomes and Control Costs with Dr. Alice Chen · Becker’s Payer Issues Podcast

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  - The payer provider relationship has never been simple,
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  - but what's happening now is something different.
• 0:07
  - Value based models are maturing unevenly,
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  - prior authorization reform is reshaping workflows on both
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  - sides, and affordability
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  - pressure is intensifying.
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  - The organizations that figure out how to collaborate
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  - genuinely, not just contractually,
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  - are the ones that will set the terms
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  - for what comes next.
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  - Becker's fifth annual fall payer issues roundtable brings
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  - together more than 500 executive level attendees
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  - and 70 plus speakers for two days of
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  - focused senior level conversation on benefit design, network
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  - strategy, transparency,
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  - and the financial
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  - Hotel Chicago. For the agenda and event details,
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  - visit beckerspayer.com
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  - and click on the events tab in the
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  - upper right.
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  - Hi, everyone. This is Elizabeth Casselow with the
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  - Becker's Payer Issues podcast.
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  - I'm excited today to be joined by doctor
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  - Alice Chen, chief health officer at Centene.
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  - Doctor Chen, thank you so much for taking
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  - the time and joining us today.
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  - Thanks so much for having me, Liz. I'm
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  - delighted to be here.
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  - Of course. And so before we jump in,
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  - can you just tell us a little bit
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  - more about yourself, your career background, and your
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  - current role at Centene?
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  - Absolutely.
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  - So I have been chief health officer here
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  - at Centene,
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  - for the last almost four years
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  - and would say,
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  - it is a really unique health plan. I
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  - know we all think we're unique, but Centene
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  - really is. It is the largest
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  - government payer,
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  - with currently about 12,000,000 Medicaid members,
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  - three and a half million marketplace members,
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  - and a little less than a million Medicare
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  - members,
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  - with a through line of low income Americans.
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  - So we really focus on,
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  - government programs,
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  - and in particular, underserved
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  - Americans.
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  - As for me, the reason I ended up
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  - here is because my entire career has been
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  - focused on,
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  - improving access quality,
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  - of care to... For underserved populations. So whether
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  - that's in the delivery system,
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  - as a primary
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  - care physician, I still volunteer at a free
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  - clinic in San Francisco,
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  - in public health, community health centers, public hospitals,
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  - philanthropy, government, purchasers.
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  - That's been the through line for me. So,
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  - Centene
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  - is a place that I think has special
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  - resonance
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  - for
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  - anyone who cares about the
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  - quality and outcomes for for underserved populations.
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  - Well, thank you for giving us that overview.
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  - I know today we were gonna talk a
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  - little bit about an article that you published
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  - in health affairs recently
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  - on the evidence based prevention continuum. So can
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  - you fill in our audience about what that
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  - is and how it's differentiated from other frameworks?
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  - Absolutely.
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  - So the Centers for Medicare and Medicaid Innovation,
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  - almost a little bit more than fifteen years
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  - ago in 2015,
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  - established the health care payment learning action network.
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  - That is quite a mouthful. We oftentimes call
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  - it the HCP LAN or LAN for short.
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  - And,
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  - the LAN
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  - is a collaborative
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  - of public and private health care leaders
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  - that collectively believe
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  - in alternative payment models and accountable care and
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  - really thinking about, how do we align all
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  - the stakeholders,
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  - providers to,
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  - payers to purchasers to policymakers
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  - around creating more value in healthcare
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  - through aligning incentives.
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  - Most recently,
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  - the LAN stood up, a series of work
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  - groups including this work group around evidence based
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  - prevention
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  - with the idea that particularly now when there
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  - is a
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  - real focus on,
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  - both affordability
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  - and outcomes
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  - and the need for prevention,
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  - there have been a lot of,
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  - new ideas bubbling up around what constitutes,
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  - effective prevention.
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  - And so in that,
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  - context,
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  - we thought it was important to create a
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  - framework
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  - in order for all the different stakeholders to
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  - have a common
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  - understanding,
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  - common language, common reference point around
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  - what constitutes evidence based prevention versus
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  - a good idea or maybe not even a...
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  - Maybe not a good idea in order to
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  - more effectively,
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  - have a societal discussion about what,
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  - merits investment
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  - and scaling.
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  - Can you talk a little bit more about
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  - what a good idea might look like and
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  - how
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  - this framework would help a health plan understand
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  - if that would scale?
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  - I'm gonna give you a little bit of
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  - a preview because one of the use cases
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  - that the evidence based work group decided to
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  - take on is the idea of nutritional interventions.
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  - This idea of food is medicine is very
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  - compelling because it just makes intuitive sense to
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  - people that what you eat affects your health.
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  - When I first got to Centene, what I
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  - would say is there was a lot of
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  - interest in this, but it really was a
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  - thousand flowers blooming. A lot of people had
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  - lots of different
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  - ideas and pilots and programs,
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  - that were not necessarily evidence based.
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  - And so the idea
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  - of food as medicine is one that I
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  - think has intuitive validity,
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  - and
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  - when you delve into it, the evidence base,
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  - helps you differentiate between things that are more
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  - opinion of... Informed or emerging evidence versus things
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  - that are more evidence based and ready for
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  - scaling.
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  - And so along that continuum are things like
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  - just sending people food boxes versus
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  - very
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  - targeted
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  - interventions around
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  - post hospitalization,
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  - medically tailored meals for people with diabetes or
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  - congestive heart failure. So, again, taking a concept
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  - that's that's a good idea
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  - and then
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  - having the rigor
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  - to look at the evidence to say which
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  - populations
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  - and what specific interventions are likely going to
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  - get you
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  - outcomes
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  - both in terms of potentially cost savings and
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  - improved,
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  - health.
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  - So what are some next steps for health
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  - plans that are looking at this framework and
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  - are curious and wanna dive into this more?
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  - We would love it,
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  - at Evidence based... And I... I'm saying we,
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  - the royal the royal we for, the work
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  - group because I know we've had a lot
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  - of conversations about this. If payers and purchasers
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  - would use this framework
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  - before they
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  - decided to invest
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  - significantly in a given intervention in part because
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  - it's not to say that things that are
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  - on the emergence...
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  - Emerging evidence
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  - or evidence informed side of things don't deserve
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  - investment.
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  - It's that they deserve investment in a different
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  - way, which is if you're going to do
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  - something, make sure that you set it up
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  - in a way where you can rigorously evaluate
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  - it and add to the literature and add
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  - to our our collective knowledge
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  - about work, what works for whom in what
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  - settings.
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  - And again, I think
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  - for Centene in particular as a government payer,
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  - we have a very strong ethos that,
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  - we are stewards of taxpayer dollars.
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  - So every dollar needs to go to its
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  - highest and best use, and if it's not
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  - evidence based, if it's not something that has
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  - a emerging evidence that we can then add
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  - to and then decide
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  - whether to continue down this path, or
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  - if it doesn't work, stop doing it,
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  - then we're not doing our our our duty.
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  - What other advice do you have for industry
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  - leaders as they think about this framework,
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  - and what are you excited about as a
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  - team right now more generally?
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  - I would say, I would encourage,
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  - my peers
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  - to have frank conversations
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  - with companies that come to solicit,
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  - business and partnerships. And for us at Centene,
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  - we typically have three
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  - out of the gate criteria. One is particular
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  - to us because of our size and scale
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  - that we don't wanna be any company's first
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  - relationship. We want an established
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  - organization that's kinda worked out the kinks already.
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  - That may not be true for a small
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  - plan or a regional plan, but we really
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  - want to be able to identify things that
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  - work in scale.
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  - Secondly is develop your intervention
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  - for our population.
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  - Nothing
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  - is more disappointing than an,
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  - an intervention that's been developed for a commercial
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  - population with a lot more resources, with different
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  - barriers to care, and then the group wanting
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  - to pivot and looking at the TAM and
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  - Medicaid and saying, oh, this is a great
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  - population to go after,
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  - without accounting for,
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  - issues of literacy and language. Some of the,
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  - constraints that our members may deal with that
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  - aren't true for potentially you and me.
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  - And then lastly... And this tags back to
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  - the evidence based prevention framework, which
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  - is, have real data. I can't tell you
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  - how many decks they've seen where, there's this
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  - just straight line of, like, benefit,
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  - going right up to the upper right corner.
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  - And
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  - when you dig into it, it's, you know,
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  - 50 people with no comparison cohort. And so
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  - it's really hard to hang your hat on
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  - that. So in terms
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  - of payers, particularly in the government space, really
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  - looking
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  - rigorously at the level of evidence,
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  - making sure that the interventions are for your
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  - population,
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  - and have,
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  - been actually implemented in real life before taking
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  - it on.
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  - Do you have any advice for vendors on
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  - the flip side of things that might be
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  - eyeing Centene but are still in those, like,
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  - early stages? I know our audience is mostly
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  - payer executives, but there are some vendors who
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  - listen too. So I'm curious.
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  - Those would be my three,
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  - recommendations. Like, no...
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  - Before you approach a payer, understand who they're
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  - serving.
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  - Make sure that you're solving a problem that
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  - they actually have because I think the health
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  - care system all too often
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  - has solutions in search of problems.
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  - And in order to do that, you have
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  - to deeply understand again both who the plan
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  - is serving, what problems those populations have,
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  - and, ideally,
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  - have some proof points.
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  - I love the solutions in search of problems
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  - point. I feel like I see that across
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  - industries.
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  - And they're so shiny. They're so tempting.
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  - Absolutely. No. I totally get that. Do you
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  - have any final thoughts as we wrap up,
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  - doctor Chen?
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  - I would say,
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  - my hope is
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  - this continuum
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  - sparks a conversation about the importance of prevention,
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  - because it is something
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  - that
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  - is being rightfully raised to something we under
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  - invest in. And the way I think we
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  - get to it is by being rigorous about
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  - what level of evidence there is, but also
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  - not stopping just because it isn't on the
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  - far side of the continuum. But again, being
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  - clear eyed
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  - and frankly collaborative
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  - in terms of
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  - sharing the data that each of us actually
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  - generates when we when we pilot something that's
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  - more on the evidence informed or, emerging evidence
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  - side so that we can inform the field
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  - so we can move forward collectively.
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  - Doctor Chen, thank you so much for taking
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  - the time to chat with us today.
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  - You're so welcome. Thank you for having me.
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  - Of course. And to our listeners, if you'd
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  - like to hear more podcasts from Becker's Healthcare,
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  - you can visit beckershospitalreview.com.
• 11:24
  - Thank you.