Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Sidney H. Raymond on Scaling Value Based Care at Ochsner Health Network

Transcript

Dr. Sidney H. Raymond on Scaling Value Based Care at Ochsner Health Network · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  This is Laura Dierdahl with the Becker's Healthcare
• 0:02
  Podcast. I'm thrilled today to be joined by
• 0:04
  doctor Bill Raymond, chief medical officer at Ochsner
• 0:06
  Health Network. Doctor Raymond, it's a pleasure to
• 0:08
  have you on the podcast today. Pleasure being
• 0:10
  here. Thanks for having me.
• 0:12
  Absolutely. Now I'm excited for our conversation because
• 0:15
  I know you are doing some very innovative
• 0:17
  things at Ochsner, and, it's certainly exciting to
• 0:19
  think about, you know, what the future may
• 0:21
  hold. But before we dive in, can you
• 0:23
  tell me a little bit more about yourself
• 0:25
  and Ochsner Health Network?
• 0:27
  Sure.
• 0:28
  So first of all, I'm the chief medical
• 0:30
  officer for Ochsner Health Network.
• 0:32
  In that role,
• 0:33
  my job is to
• 0:35
  oversee the population health management for as as
• 0:38
  a physician leader on that group. Our group
• 0:40
  manages, like, all the value based contracts that
• 0:42
  we have,
• 0:43
  the MA capitation,
• 0:45
  at risk MA, our enhanced tracked ACO. We
• 0:47
  even have an an upside only ACO,
• 0:50
  as well as commercial,
• 0:52
  and MA shared savings and a commercial p
• 0:54
  for p contract.
• 0:56
  Together, all that's roughly about 600,000
• 0:58
  lives.
• 0:59
  OHN, Oshunov Network, that's our CIN that has
• 1:02
  about, over 3,500
• 1:04
  MDs in it,
• 1:05
  and over 2,600 APPs.
• 1:08
  Ocean, which is our enhanced tracked ACO, includes
• 1:11
  nearly 5,000
• 1:12
  MDs and APPs.
• 1:14
  And taking a step back, so Ochsner is,
• 1:16
  you know, based in New Orleans,
• 1:18
  over 40 hospitals,
• 1:20
  manage over a million patients throughout Louisiana, Mississippi.
• 1:24
  And when we include
• 1:26
  OHN, which includes partners and the like,
• 1:29
  as well as within Ocean, which are the
• 1:31
  Enhanced Right KCO I mentioned, we then go
• 1:34
  even more geographically to parts of Texas and
• 1:37
  even into Alabama a bit within those groups.
• 1:39
  So we have a significant impact on the
• 1:41
  communities that we take care of through those
• 1:43
  different, arrangements that we have in place.
• 1:46
  That's great to hear. And I know being
• 1:47
  able to have all those different,
• 1:49
  contracts and arrangements
• 1:50
  really
• 1:51
  pulls through a lot of the principles and
• 1:54
  values when you're thinking about value based care
• 1:56
  and and how to really make the most
• 1:58
  of the quality,
• 1:59
  care you're able to provide as well as,
• 2:01
  the dollar. And so it seems like, you
• 2:03
  know, having all of those different,
• 2:05
  plans in place in different things that you're
• 2:07
  doing really gives the health system a great,
• 2:10
  window into, you know, how they can control
• 2:12
  more of that quality as well as cost
• 2:14
  of care.
• 2:16
  Yeah. Real quickly on that. It's interesting because,
• 2:19
  you know, you bring up a a a
• 2:20
  part about us having the value based contracts.
• 2:23
  The reality of what we have to do
• 2:24
  more so nowadays is is think about how
• 2:27
  we're taking care of patients that even aren't
• 2:29
  in those contracts because, you know, looking at
• 2:32
  how total cost of care is provided,
• 2:34
  how how we're getting reimbursed as a health
• 2:36
  system and everything else, it kinda changes dynamic
• 2:39
  a good bit from just being looking at
• 2:42
  a contract side of things and how we
• 2:43
  can, you know, do things across a more
• 2:45
  a broader population.
• 2:48
  For example, if you think about it, you
• 2:49
  know, within the hospital system, when somebody gets
• 2:52
  admitted and it's a preventable illness, I mean,
• 2:54
  that's that's sort of us missing an opportunity
• 2:57
  to try to keep people healthier and keeping
• 2:59
  them well and keeping them out of the
• 3:01
  hospital.
• 3:02
  One is the right thing to do. And
• 3:03
  so that's what the interesting thing is value
• 3:05
  based care has kinda gotten a little bit
• 3:06
  about what does value mean and everything else.
• 3:09
  And so it's more of, you know, let's
• 3:10
  do the right thing for for people.
• 3:13
  And if you have people who are getting
• 3:15
  into your hospital facilities because
• 3:17
  you could have done something differently to take
• 3:19
  care of them differently and help prevent that
• 3:21
  illness, prevent that condition, whatever else, We need
• 3:23
  to be more proactive about how we do
• 3:25
  that. And so I think
• 3:27
  that's kinda where we need to be going
• 3:28
  more and more is not looking specifically at
• 3:30
  the contract aspect of it, but what are
• 3:32
  we doing
• 3:33
  from a holistic aspect of how we're managing
• 3:35
  patients regardless of who their payer is and
• 3:38
  how we're doing thing things right across the
• 3:40
  board to help prevent those sorts of things
• 3:42
  from happening.
• 3:44
  I love it. That makes a lot of
• 3:46
  sense. And, you know, it's really helpful to
• 3:47
  understand about your mindset and mind frame going
• 3:49
  into,
• 3:50
  those types of arrangements and and thinking through,
• 3:52
  you know, quality care for all patients.
• 3:55
  Now what are some of the trends that
• 3:56
  you're watching most closely currently?
• 4:00
  Trends currently would be whatever CMMI is pushing
• 4:03
  out this week. It feels like it happens
• 4:06
  a lot right now.
• 4:07
  I mean, if you think about it, at
• 4:09
  the end of the year,
• 4:11
  LEED, ACCESS, Maha Elevate,
• 4:14
  all those were pushed out as well
• 4:16
  as looking at payment aspects for Medicaid and
• 4:19
  pharmacy.
• 4:20
  They're even still talking about expanding the ahead
• 4:22
  programs. So there's a lot coming out of
• 4:24
  CMMI. So I feel like a good part
• 4:27
  of my job and other people who are
• 4:29
  similar to me is
• 4:30
  trying to keep pace with that and understand
• 4:32
  exactly what those different models mean and how
• 4:35
  we can try to participate in them and
• 4:37
  try to improve,
• 4:38
  the health care of the community that we
• 4:40
  serve using these different models that are out
• 4:42
  there.
• 4:43
  I think everything that CMMI is putting out
• 4:45
  right now is very innovative.
• 4:47
  I'm very encouraged by it because it looks
• 4:50
  like they're trying to change
• 4:52
  how
• 4:54
  health care is paid and including
• 4:56
  new innovative care models as well.
• 4:59
  So it's not just gonna be
• 5:01
  regular fee for service
• 5:03
  medicine
• 5:04
  where the more you do, the more you
• 5:06
  get paid.
• 5:07
  It's it aligns very much with, you know,
• 5:09
  our core values here, which is, you know,
• 5:12
  trying to make sure that we're doing the
• 5:14
  right things for patient and how do we
• 5:15
  help manage them outside the walls of our
• 5:18
  institution so they're not having to come in.
• 5:20
  So I think it's great where they're going.
• 5:22
  I think it's gonna be interesting when we
• 5:24
  find out more details,
• 5:26
  but, certainly, that is a lot of our
• 5:28
  time, effort, and energy right now is trying
• 5:30
  to understand exactly what those opportunities are.
• 5:34
  That makes a lot of sense. And, you
• 5:35
  know, it's just, it seems like a lot
• 5:37
  as you mentioned. It's coming out of the
• 5:40
  government policy changes and thinking through, you know,
• 5:43
  how you're, going to transform the health system,
• 5:46
  alongside many of these change changes are important
• 5:49
  too. And so when you look at, you
• 5:51
  know, the teams that you're building, whether it's
• 5:53
  clinical, administrative, across the board,
• 5:56
  how do you make sure that, you know,
• 5:57
  the the team culture is so flexible that
• 6:00
  you're able to,
• 6:02
  you know, be nimble and make changes as
• 6:04
  they come and really not only be thinking
• 6:06
  about, you know, the near term, but as
• 6:08
  far term as well,
• 6:10
  in, you know, your broader mission and vision
• 6:12
  for the future.
• 6:14
  Yeah. So I think if you keep in
• 6:16
  mind that you're,
• 6:17
  you know, taking care of patients is number
• 6:19
  one. Right? So patients come first. That is
• 6:21
  our our first
• 6:23
  objective and and keeping them at the center
• 6:25
  of what we do.
• 6:26
  And so if you think about that,
• 6:29
  these are opportunities for us to help align
• 6:31
  with how we want to manage patients,
• 6:34
  and how we wanna help the communities that
• 6:36
  we serve.
• 6:37
  And so
• 6:38
  just keeping focus on that aspect of it,
• 6:41
  that end goal of trying to actually improve
• 6:43
  the health of the community,
• 6:45
  that aligns with a lot of what's going
• 6:47
  on right now and
• 6:49
  allows for trying to do things differently and
• 6:52
  be innovative in how you manage patients.
• 6:55
  If you're currently focused on
• 6:57
  the regular fee for service payment model, for
• 6:59
  example, then, you know, you are driven to
• 7:02
  make people come in and see you within
• 7:04
  your four walls and everything else.
• 7:06
  Well, access
• 7:08
  is a challenge,
• 7:10
  as well as, you know, our system
• 7:13
  the hospitals,
• 7:14
  we have lots of people in the ED,
• 7:16
  people that are waiting for beds, there's demand
• 7:18
  for transfers, all these things. So if we're
• 7:20
  able to help manage patients and keep them
• 7:23
  healthier and keep them out of the hospital,
• 7:24
  that means the people that actually need to
• 7:26
  be in the
• 7:27
  costliest
• 7:28
  aspect of our system inside the hospital can
• 7:31
  get that access,
• 7:33
  and get that great care that they need
• 7:35
  when they need it. So let's do what
• 7:37
  we can to try to
• 7:38
  manage patients in very different ways, think about
• 7:41
  things differently, have the right mindset about
• 7:44
  what does the patient want. Does the patient
• 7:46
  really wanna be in the hospital? Probably not,
• 7:48
  unless they actually need the care that's there.
• 7:50
  Right? So let's focus on how we can
• 7:52
  take care of patients in different ways to
• 7:54
  meet their needs and the way that they
• 7:55
  wanna be met.
• 7:57
  I love that. I think it's so critical
• 7:59
  to have that type of framing when you're
• 8:01
  looking at, you know, what is the day
• 8:03
  to day? What what do we need to
• 8:04
  do differently, and how do we,
• 8:06
  evolve is to just have that patient
• 8:08
  mindset and centric
• 8:10
  view. You know? It seems like it would
• 8:12
  make things a lot, more provide more clarity,
• 8:15
  amid amid some of the chaos. So,
• 8:18
  I I'm curious. Could you tell us a
• 8:19
  little bit about something you're most proud of
• 8:21
  from the last six to eighteen months or
• 8:23
  so?
• 8:24
  Yeah. So I'll I'll I'll break out a
• 8:26
  few things.
• 8:27
  So last year,
• 8:29
  is actually
• 8:30
  we we we're still waiting right now for
• 8:32
  last year. So let's go back to '24.
• 8:34
  For '24,
• 8:35
  our group, the employee group at here at
• 8:38
  Ochsner
• 8:39
  within the Blue Cross Blue Shield contract, there's
• 8:41
  a a primary care pay for performance contract,
• 8:45
  and we got four diamonds out of four
• 8:46
  diamonds. In that contract, there are
• 8:49
  20 different measures,
• 8:51
  and so you have to do well across
• 8:53
  the board on all those. And I'll just
• 8:55
  hit some highlights. I mean, this is 80,000
• 8:57
  people we're talking about that are attributing this
• 8:59
  contract.
• 9:00
  So ninety three percent of the patients got
• 9:02
  their breast cancer screening.
• 9:04
  There are fifteen percent fewer emergency department visits
• 9:06
  than were expected,
• 9:07
  and eighty seven percent of the patients had
• 9:09
  their a one c under control. Like, those
• 9:11
  are just highlights from that one contract.
• 9:13
  And then on the
• 9:16
  on the Enhanced Track ACO side of things,
• 9:18
  we actually ended up being the number three
• 9:21
  in the country for care coordination,
• 9:23
  based on patient surveys. And
• 9:26
  I was astounded when that came out because
• 9:29
  these are what patients are saying. So that
• 9:32
  is huge accolades for our group and and
• 9:35
  part of what our my team has to
• 9:37
  help manage,
• 9:39
  making sure that people are getting the right
• 9:40
  care at the right place, and they're getting
• 9:42
  the coordination that we're looking for.
• 9:44
  And
• 9:45
  being touted as number three in the nation
• 9:47
  was a little humbling and but I think
• 9:49
  that goes a long way to talk about,
• 9:50
  you know, what we're doing, try to make
• 9:52
  sure people are take well taken care of.
• 9:54
  So there's there's a couple on that side
• 9:57
  of things. But I think that's really based
• 9:59
  on you know, it comes down to doing
• 10:01
  the right blocking and tackling,
• 10:03
  on a regular basis. And so within our
• 10:05
  system,
• 10:06
  we have if you attribute to one of
• 10:08
  our primary care physicians, we're looking at certain
• 10:11
  types of measures and seeing how we're doing
• 10:12
  performance wise regardless of what the payer is.
• 10:15
  So going back to what I was talking
• 10:16
  to before. And within that, you know, 85
• 10:19
  of the people with hypertension have their blood
• 10:20
  pressure controlled. Eighty two percent of diabetic diabetics
• 10:23
  have their a one c controlled. Ninety percent
• 10:25
  of people got their breast cancer screenings. Eighty
• 10:27
  seven percent had their cervical cancer screens. And
• 10:30
  eighty four got their co operative cancer screenings
• 10:32
  as recommended. So those are all basically what
• 10:35
  you need to be doing on a regular
• 10:36
  basis to help manage patients,
• 10:38
  which then helps out with further downstream things
• 10:40
  that you're trying to prevent from a chronic
• 10:42
  condition standpoint.
• 10:44
  So, you know, at this moment, we're trying
• 10:46
  to like I said, we're gonna go beyond
• 10:49
  just our value based care agreements
• 10:51
  because it's the right thing to do as
• 10:53
  to how we manage patients.
• 10:55
  So
• 10:56
  the more we do about taking care of
• 10:58
  patients, doing it in innovative ways, I mean,
• 11:00
  and taking care of people outside the walls,
• 11:02
  this involves, like, care model redesign,
• 11:04
  constantly looking where you can do things differently,
• 11:08
  as well as, you know, I have I've
• 11:10
  waited all the way till now to mention
• 11:11
  it, how you use AI to help enable
• 11:13
  those sorts of things,
• 11:15
  because that is a way for us to
• 11:17
  try to do things a little bit differently
• 11:18
  too. So
• 11:19
  a lot of that about some of the
• 11:20
  things that we've we've done lately,
• 11:23
  I will say
• 11:25
  we have a huge focus right now on
• 11:27
  care model redesign,
• 11:28
  and the goal of that is to decrease
• 11:30
  variation of care. And, again, with the end
• 11:33
  goal of being preventing
• 11:35
  people from having complications and even preventing people
• 11:38
  from getting chronic conditions in the first place.
• 11:40
  So if
• 11:41
  we have a focus right now on CKD
• 11:43
  and CHF.
• 11:44
  So both of those, the big drivers are
• 11:47
  diabetes, hypertension, obesity. So the more we can
• 11:49
  do to keep people under control,
• 11:52
  then the less people end up getting CKD.
• 11:54
  But then also once they get it, what
• 11:56
  what are we doing to prevent that progression?
• 11:58
  Because the slow the slower they are progression
• 12:01
  wise, that means the likelihood of getting dialysis
• 12:04
  or needing transplant, I think that is greatly
• 12:06
  diminished.
• 12:07
  So let's just do those things right and
• 12:09
  do that across the board, and let's make
• 12:11
  sure that we're doing everything we can.
• 12:13
  So that's a lot that we're doing right
• 12:14
  now regarding the care model. There's some other
• 12:17
  aspects of that. We're making sure everybody gets
• 12:19
  all the right things,
• 12:20
  as a patient.
• 12:22
  And so a lot of things being done
• 12:23
  that way.
• 12:25
  Fantastic. I mean, I think that's so helpful
• 12:27
  to understand and being grounded in,
• 12:29
  you know, what that care model redesign looks
• 12:31
  like. And and I I love the idea
• 12:33
  of going back to more prevention,
• 12:35
  how you work within the community and, reaching
• 12:38
  patients in different ways than ever thought possible.
• 12:41
  Is there any kind of partnerships or,
• 12:43
  you know, things that you've been doing recently
• 12:45
  on that side, on the care model redesign
• 12:48
  side and the preventative care,
• 12:50
  that have really,
• 12:51
  shown through that you're really excited about?
• 12:54
  So
• 12:55
  I will say a lot of this is
• 12:57
  is looking
• 12:58
  inward as to how we can do things
• 13:00
  differently. So the things that we're building inside
• 13:02
  Epic to ensure that and we'll we'll I'll
• 13:06
  pick on patients with diabetes.
• 13:08
  How are we making sure that their blood
• 13:10
  pressure is controlled, their diabetes controlled, that they're
• 13:12
  a nonsmoker,
• 13:13
  that they,
• 13:15
  are on the right statin, that their that
• 13:17
  their LDLs echo all those things? How can
• 13:19
  we make sure that's happening across the board?
• 13:21
  And so we're looking at that. So we're
• 13:23
  actually in a transition,
• 13:25
  not this year, but next year. We're in
• 13:26
  transition from just what what is our control
• 13:30
  rate for diabetes to what's our percentage of
• 13:32
  patients that are getting all these things done.
• 13:34
  And so that's a lot of where our
• 13:36
  focus is. We do work with some others,
• 13:40
  regarding helping take care of people outside the
• 13:42
  four walls.
• 13:43
  We we've been working with a company called
• 13:45
  MyLaurel, which has
• 13:47
  paramedics go and check on patients so we
• 13:49
  can, make sure that they're doing well and
• 13:52
  help prevent those readmissions.
• 13:53
  We have our own program regarding nurse practitioners
• 13:56
  that go to that home as well for
• 13:57
  those that need to have a nurse practitioner
• 13:59
  go to their home. We have our own
• 14:02
  digital medicine company, so that's,
• 14:04
  how we manage patients with hypertension, diabetes, and
• 14:07
  even chronic kidney disease,
• 14:10
  where basically they're sending readings to us, and
• 14:12
  we make adjustments without them having to come
• 14:14
  in. So there's a lot that we're doing
• 14:16
  ourselves. A lot some things are certainly with
• 14:19
  partners. But the goal is, like I said,
• 14:21
  how do we how do we make sure
• 14:23
  people are getting everything that they need and
• 14:25
  preventing those later complications?
• 14:28
  That makes a lot of sense. Thank you
• 14:30
  for, sharing a little bit deeper there. Now
• 14:32
  before we wrap up our conversation,
• 14:35
  what advice would you give to evolving and
• 14:37
  emerging leaders today in the health care space,
• 14:39
  especially given all of the changes that are
• 14:41
  occurring and, you know, what's gonna be critical
• 14:44
  to caring for communities in the future?
• 14:46
  Yeah. So
• 14:48
  advice that I would give is, number one,
• 14:50
  listen.
• 14:51
  You have a
• 14:53
  lot of smart people around you.
• 14:56
  You also should be listening to patients, listening
• 14:59
  to other people in your community to understand
• 15:00
  what the needs are and how you can
• 15:03
  try to better serve them.
• 15:05
  I that's also you should surround yourself with
• 15:08
  good people. So
• 15:10
  don't feel like you need to be the
• 15:12
  one who comes up with all the solutions.
• 15:15
  It's better for you to sit there and
• 15:16
  listen and hear what's happening and engage other
• 15:19
  leaders,
• 15:20
  frontline folks, patients, all those people. And then
• 15:23
  your job should be helping connect the dots,
• 15:26
  seeing where those opportunities are.
• 15:28
  And then from there, you facilitate collaboration.
• 15:32
  So
• 15:33
  you can't feel like it's all on
• 15:35
  an individual to make this happen. Health care
• 15:37
  is a highly complex,
• 15:40
  system,
• 15:41
  and so you cannot be working on an
• 15:43
  island. You have to learn from others. You
• 15:45
  have to engage with others.
• 15:47
  And your job as a leader should really
• 15:49
  be, let's figure out what we can do
• 15:51
  differently. What are the opportunities? How do you
• 15:54
  identify those opportunities? And then how do you
• 15:56
  get the right team engaged to make a
• 15:57
  difference and take it and
• 16:00
  address those opportunities that you find?
• 16:03
  I love that. It it makes so much
• 16:04
  sense. Doctor Raymond, thank you so much for
• 16:06
  joining us on the podcast today. This has
• 16:08
  been such a fun conversation and a window
• 16:10
  into some of the things you're doing at
• 16:12
  Ochsner Health Network. And, you know, I'm looking
• 16:14
  forward to seeing you as well at our
• 16:15
  annual meeting. I know you'll be speaking on
• 16:17
  a panel, and we'll dig deeper into many
• 16:18
  of these themes as well as, you know,
• 16:21
  share additional perspective about going forward. So it'll
• 16:23
  be great to connect and see you there.
• 16:26
  That was great. Appreciate the opportunity. Thanks so
• 16:28
  much.