Latest / Becker’s Healthcare - Clinical Leadership Podcast / Steven Carson, Vice President of Population Health at Temple Center for Population Health, Temple University Health System

Transcript

Steven Carson, Vice President of Population Health at Temple Center for Population Health, Temple University Health System · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - Welcome to the Becker's Healthcare Podcast, made
• 0:02
  for the people who power healthcare.
• 0:03
  I am Molly PLE Becker's,
• 0:05
  and today delighted to have the chance
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  to catch up with Steven Carson.
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  Steve is the Senior Vice President for Population Health
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  with Temple University Health System.
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  Steve, welcome back to the podcast.
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  Thank you so much for being my returning guest today.
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  How are you doing? And, and where does the podcast find you?
• 0:22
  - Uh, thanks for having me back.
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  Uh, the podcast finds me in a very busy place.
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  This is an extraordinarily busy time of the year, preparing
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  for next year taking a look how successful.
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  We're not successful, we were in the prior year.
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  Everything in my world is in calendar year,
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  so we're going back retrospectively looking at calendar year
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  23 and how we can improve it for 2024.
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  So it's just a busy time for us.
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  Um, and, um, thank you for, uh, inviting me back again.
• 0:46
  - Well, all the more grateful for you making time to,
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  to do the podcast and be our guest.
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  Steve, you know, for listeners
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  who need a refresher on Temple University Health System
• 0:55
  and its Center for Population Health
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  and your role within it, can, can you share an overview, uh,
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  of both the center and and your work?
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  - Uh, certainly. So, uh, the Center
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  for Population Health has been a strategic asset
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  for Temple Health, uh, related
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  to our value-based care agreements.
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  So we focus on, uh, several different, um, processes.
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  We look at, um, how we manage our value-based care
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  agreements, and we have a whole, um, uh,
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  strategic asset group
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  and in, in that management,
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  which includes our primary care network,
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  our care management programs, our hospital
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  and skilled, um, facility networks,
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  and also our quality programs.
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  Because all those things tied together
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  to really help manage our population health, um, uh,
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  value-based care agreements.
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  Because technically when we look at
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  what we do within the center,
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  we do population health management.
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  How do we apply those tools that really focus on, uh,
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  performance improvement within that group from both a,
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  a quality and cost perspective?
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  So the asset also focuses on, um, community
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  and community resources and outreach.
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  We spend a great deal of our work focused on social
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  determinants of health and helping support our patients not
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  only in our value-based care agreements,
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  but our patients globally for Temple Health around food,
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  housing, medical-legal partnerships,
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  and, um, other resources that we can help patients
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  to be successful once they're discharged
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  or in the care of one
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  of our primary care specialty physicians.
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  - And Ste you mentioned this is a busy time.
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  This is also a time for listeners,
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  as I'm sure they're seeing that we're starting to get,
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  and we're, we're continuing to get more data about
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  how health systems fared throughout Covid to 19
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  as it relates to a number of metrics around care, quality,
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  patient safety, even the workforce.
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  Um, and I, I, I wanted to spend some time there
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  'cause you mentioned care quality
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  and just to get a sense of your priorities right now
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  or in those improvement efforts.
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  I know last month CMS released a report finding some
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  disparities in care quality in the hospitals, you know, pre
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  and during pandemic finding a number
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  of measures had worse than expected performance.
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  We knew these hits were coming.
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  This was not an easy time
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  for health systems to be operating.
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  What have been some of your biggest takeaways about quality
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  improvement efforts pre and post pandemic?
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  Where have you been focusing most of your time as of late?
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  - Uh, great question and thank you lots to unpack there.
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  So when you looked at the CMS report, you know,
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  things were really focused on the inpatient networks,
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  inpatient care delivery metrics, infection prevention,
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  readmissions, things of that nature.
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  And I think from a temple perspective, we have led
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  with quality pre and post covid.
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  It has been our primary rubric
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  and we've been fortunate in
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  that we have been very successful before, during, and even
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  after, um, covid.
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  We've seen, um, uh, we've seen, um, our, um,
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  quality metrics actually improve over the course
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  of the last four to five years.
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  And that's really been a focus.
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  We have an a rating, if you will, uh, for health grades.
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  I think that's really important.
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  We've been identified
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  as a 2024 patient safety excellence top performer.
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  So we have always led with quality,
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  which is really important to understand.
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  But really to go back to your question where those areas
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  that slid somewhat during covid
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  and that you really saw a lot of that during the period
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  of time where offices from an ambulatory care perspective
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  really closed down.
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  And then as a result of that, the pivot to, uh, telehealth
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  and also the, the, um, measures related to
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  health screenings really declined mammography,
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  colorectal screening, you know,
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  those measures were required, the in-person touching.
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  So you saw some of
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  that backslide over the course of the year.
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  And we've really seen in our quality improvement efforts
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  and building our quality infrastructure,
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  we've seen our most improvement in those areas over the, um,
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  the past two years, to be honest with you.
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  And today in some of our larger payers, we have finally
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  moved the needle
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  and really, um, helping us to be a four star, um, you know,
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  uh, star measure from a Medicare perspective.
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  We've seen our HEDIS scores go up
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  and improve over the last several years
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  because offices are back open.
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  People are, feel comfortable going back into the practice
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  again, and then actually feel comfortable going
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  to radiology departments to get their mammographies into,
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  you know, get, get the colorectal screening,
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  whether it's in the office, pick up a fit kit,
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  or actually having the colonoscopy, um, itself,
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  so people are feeling more confident in
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  going back into the office.
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  So I think that that's where you saw some backsliding in the
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  ambulatory care environment, um,
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  because it was difficult to do some
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  of this work without the inpatient touch.
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  Telehealth took us to a certain degree
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  but didn't really, you know, help in, um,
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  other areas which required the, the high level of touch.
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  So when you ask where our priorities were,
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  mm-hmm , I think our priorities over the last
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  two years has really been building that infrastructure.
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  We've always had a core
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  of quality on the ambulatory care side.
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  And what we've done is expanded that core,
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  expanded the cadence of the work that we're doing
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  with our providers and how we actually engage our providers.
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  And I think that that's really important,
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  providing them the data they needed to be able to understand
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  how to close those gaps in care
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  and hey, help them be able to be successful in, um, in
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  that quality outcome.
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  And as we have continued to do that,
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  we've added a chief medical officer to our programming,
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  which is really critically important.
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  You know, sometimes that physician
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  to physician communication is much different than a
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  physician to a nurse
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  or even a physician to a, a quality project manager.
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  So that has been really helpful for us to be able to build
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  that, um, engagement with our providers as well.
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  So we've seen improvement there.
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  So our investments have really been how to explain, expand
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  that quality management infrastructure.
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  Mm-Hmm. . So we've spent a, we've spent a lot
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  of time there around it
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  and focused on what we need to do to be able to,
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  uh, manage our work.
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  - Mm-Hmm. , I'm remembering from our last
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  conversation when we last connected for the podcast.
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  There's a through line here
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  because we spent some time in
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  that conversation talking about tele visits as a tool
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  and technology enabled care as a tool.
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  But really how much of your work
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  and strategy rests upon, like you said,
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  that primary care touchstone
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  and those in in-person care appointments.
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  Um, can, can you share any success stories or,
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  or case studies with us, Steve, where embedding caregivers
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  has really resulted in some notable improvements,
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  either in patient outcomes or experiences?
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  We spoke about embedding caregivers last time,
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  and I'm just curious if there was a, a story you could share
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  with us in greater detail about that.
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  - Yeah, I think that that's a,
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  thank you for asking that question.
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  I think that's really a good point about the embedding
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  of our nurse navigators.
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  That has been really a critical tool for us, um,
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  that the nurse navigator has been the person who's been
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  that connection point between the provider and the patient
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  and really driving many of the care management
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  strategies, um, with the patient
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  and following up on the care that they may need,
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  whether it's a resource
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  or whether it's they need a community health worker
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  to help follow through on a particular, um, application
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  for a service that they may need.
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  So we've been seeing a tremendous amount of success
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  around the use of these embedded care managers.
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  And what you see with this group over time,
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  you've seen improvement of our readmission rates.
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  Um, you've seen a reduction in, you know, um,
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  unplanned admissions
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  because there's that open line of communication
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  between the provider, the member, the patient, and the,
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  and the nurse navigator that's working in concert
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  with the physician in the office, uh,
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  and working in concert with the patient from a, you know,
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  telecommunication standpoint.
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  The patient's more engaged
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  because they now know that person
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  who's on the other end of the phone.
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  Um, it's not just a random, you know, anonymous voice making
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  that phone call that they've met
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  that person in the office at some point in time.
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  So there's a connection. So I think that we've seen that,
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  and that was a strategic change for us.
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  We had a a hundred percent telehealth model when it
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  came to nurse navigation.
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  So when we flipped that last year, it was really, we did it
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  with the knowledge that we wanted
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  to engage both our physicians as well
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  as the patients differently.
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  And I see that playing out in our overall outcomes when it
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  look, when we look at patient
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  experience, are they satisfied?
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  You know, are they, you know, are they following
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  through on their, um, transition of care?
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  So we're seeing lots of improvement around that.
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  And we've seen nice, um, uh,
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  member satisfaction scores as a result of it.
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  - Mm-Hmm. . Mm-Hmm. .
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  I mean, I think that's a pretty remarkable shift
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  to go from 100% telehealth model
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  for nurse navigation to now the in-person.
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  And then reaching those results that you just shared
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  with us about readmissions
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  and unplanned admissions going down
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  and just the utilization rates,
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  the fact those relationships are things something that pe pa
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  something that patients are returning to.
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  - No, agreed. And I think that that's been really a,
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  a nice transition back into the practice
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  because now there's something, they now have something
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  different to look forward to.
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  Mm-Hmm. to look forward to, to have a
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  different relationship in the office.
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  And, and we've spent a lot of time
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  engaging like all levels of the office.
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  So it's that experience, just not the navigator,
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  it's the person at the front desk.
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  It's the person who's rooming the, um, rooting the patient
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  and, you know, engaging them.
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  I think the one thing that I wanted to add, when we look at,
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  um, um, projects, I wanted to go back on something
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  'cause I think this all ties in together
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  with this in-person navigator in the office, is
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  that we have been tremendously focused
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  around the social determinants of health.
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  We have been screening patients for a long time
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  around their social determinants,
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  looking at things like housing and food, um, transportation.
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  Um, because they're the things that people struggle with
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  to come back into the office.
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  And our, um, program for um, screening
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  also has led us to focus on different areas
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  of health disparities.
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  Not only from a social determinant perspective,
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  but also from an access perspective.
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  You know, focus, we are part of the A CO reach, uh,
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  pilot with CMS.
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  In a CO reach, you have a health, you know,
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  you have a health equity plan
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  that you have to be able to develop.
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  And we've chosen hypertension about how our black
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  and brown communities access, um, services for hypertension
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  and being able to give them resources, um,
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  within our hypertensive group from a, um,
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  telehealth perspective.
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  'cause we are using remote patient
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  monitoring in those cases.
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  And that's been also successful.
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  So now you have, you've tied together
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  that nurse navigator in the office,
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  you've addressed social determinants,
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  you're looking at a health disparity
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  and you're now continuing to engage
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  the physician and the patient.
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  So I think that all those things kind
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  of tied together in the end.
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  So I think there, you know, when you look at
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  where we spend our time quality
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  and that level of engagement with our, um,
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  patient membership has really
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  been critically important for us.
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  And that change with the nurse navigators has been
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  extraordinarily beneficial. Mm-Hmm.
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  - and social determinants of health.
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  You, you mentioned housing, food, transportation, I mean,
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  these require partnerships at the Temple Center
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  for Population Health.
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  Can you highlight one partner relationship
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  that you found particularly effective, Steve,
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  and, and tell us why that is.
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  - Um, um, and thinking about it,
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  there's a couple partnerships I'm gonna outline
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  for you briefly because I think
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  that those will really help you understand
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  where we are organizationally.
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  And I think that, you know, we're in north Philadelphia
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  where, um, temple main campuses
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  and where our Episcopal campuses,
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  which is a behavioral health location,
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  there's a strong homelessness patient population.
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  And there's also a high, you know, like all
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  of us in in the country are experiencing, um, you know,
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  high opioid use disorders, individuals.
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  So between homelessness and epi
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  and uh, uh, opioid use disorder patients, there's really,
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  you know, they're complex.
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  They're complex 'cause they may have wounds.
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  They're complex because they're,
• 13:12
  there's nowhere to place them.
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  And often, um, our, you know,
• 13:16
  acute care hospital leadership are always struggling with,
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  you know, how to move the, um, patient along a continuum
• 13:22
  of care when their continuum doesn't really exist.
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  So, you know, we have partnered
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  with a group called Project Home in Philadelphia.
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  Um, they've been in the homelessness, um, arena
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  for over 30 years, creating respites and housing.
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  And, and those, um, programs have really been helpful
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  to place patients in the community.
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  So we are working with Project Home
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  and we're also working as part of a project with them, with,
• 13:51
  um, other health systems in the Philadelphia marketplace,
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  Penn and Jefferson.
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  Um, in a gift that was provided by, um, hemostat
• 13:59
  and Iron Lubert to help us design a program
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  and a process in which we address opioid use disorder
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  through, um, substance use, um, programming as well
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  as identifying
• 14:12
  and building, if you will, respite to, um, temporary housing
• 14:16
  that will lead to permanent housing.
• 14:18
  Mm-Hmm. . So that's a fairly
• 14:19
  significant project.
• 14:20
  And that really started with us
• 14:22
  with a project we called Housing Smart,
• 14:24
  where we took a small group of patients
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  who were homeless substance use disorder,
• 14:29
  placed them in housing.
• 14:30
  And we were able to identify that by stabilizing housing,
• 14:35
  stabilizing medical care, you saw a reduction in
• 14:37
  inappropriate utilization of the, of the emergency room.
• 14:42
  You saw a slight reduction around, um,
• 14:45
  in acute care admissions
• 14:46
  because some of those acute care admissions were social,
• 14:48
  some of them were actually, um,
• 14:51
  required based on clinical conditioning.
• 14:53
  So when I say you saw a slight reduction, maybe it was 10%
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  as compared to ed, you saw a 75% reduction in utilization.
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  So we knew that the process was worked and when,
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  and we collaborated with Project Home
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  to be able to begin this process.
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  So we're very early in that journey in order to be able
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  to create access to a very complex patient population
• 15:14
  who has complex needs
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  and housing is a key part of that programming.
• 15:19
  And so I think that, you know,
• 15:20
  that's a huge effort on our part at this point in time.
• 15:23
  And the other area that's unique
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  and innovative, um, that we're doing is really
• 15:28
  around a health hub.
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  We have collaborated with a local supermarket,
• 15:32
  ShopRite in our community,
• 15:34
  and we've placed a health screening hub in the
• 15:37
  supermarket near the entrance.
• 15:39
  We walk into the supermarket.
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  So we have the ability to screen patients for hypertension.
• 15:44
  Um, we have the, uh, stroke awareness, um, brain health.
• 15:49
  We have pharmacists there who are doing
• 15:51
  medication education.
• 15:53
  We have a diabetes program
• 15:55
  and we put that programming all around that health hub,
• 15:58
  which is linked to a mobile health vehicle
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  that actually goes out to the community.
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  So that programming that we're offering in the hub
• 16:06
  actually goes out into the community.
• 16:07
  And the sole purpose is really about, you know, helping,
• 16:11
  you know, hypertension, as I mentioned earlier,
• 16:13
  is such a huge condition in our community.
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  And when you tie that to diabetes
• 16:19
  and smoking, it also ties a high risk of stroke.
• 16:22
  And when you look at all those pieces together,
• 16:24
  our job here is really to help screen
• 16:26
  and help people get into care, um,
• 16:29
  before they're in the condition of having a stroke.
• 16:32
  So how to manage it Mm-Hmm. .
• 16:34
  So we're using that health hub, our mobile health
• 16:36
  as another way to be able to screen create access
• 16:41
  and, um, create an ability to follow up care.
• 16:44
  So when I look at, you know, so I see
• 16:46
  that is pretty innovative as far as how we're creating
• 16:48
  that level of access, um,
• 16:50
  for our community here in North Philadelphia.
• 16:52
  So combined with the two of those, um, the a critical
• 16:58
  clinical need in our community
• 16:59
  and being innovative around access are probably some
• 17:03
  of the two biggest projects when I look at partnerships
• 17:05
  and relationships, um, in the work that we do. Mm-Hmm.
• 17:09
  - , I think too, you, you just illustrated
• 17:12
  so wonderfully, Steve, how interconnected so many
• 17:14
  of these health outcomes and behaviors are.
• 17:17
  And so this work, it's, it's difficult and it's challenging,
• 17:20
  but such meaningful work to be able to meet patients
• 17:23
  and then also hit the levers
• 17:25
  and meet their needs in different ways
• 17:26
  that can contribute upstream, uh,
• 17:28
  to the downstream health effects
• 17:30
  that would bring them into the ED
• 17:32
  or other care settings like that.
• 17:33
  So thank you so much for sharing
• 17:35
  that in greater detail with us.
• 17:37
  It's been so great catching up with you today, Steve.
• 17:39
  Is is there anything you'd like to close with, uh,
• 17:42
  our listeners or share with them in, in closing?
• 17:45
  - Yeah. I think as we think about the work
• 17:46
  that we're doing from a population health management
• 17:49
  perspective, I really think that combination
• 17:52
  of quality care management
• 17:54
  and access to community resources have really been a vital
• 17:58
  function and also vital to our success
• 18:01
  and helping our patients achieve their goals.
• 18:04
  So when I look at that and I look at the, the,
• 18:06
  the world in which we, um, uh, live in, I think there,
• 18:09
  those are really three key areas that
• 18:11
  as people look at population health
• 18:13
  and population health management strategies, they're areas
• 18:16
  that they could be successful in.
• 18:20
  - Steve Carson, senior Vice President for Population health
• 18:22
  with Temple University Health System.
• 18:24
  Thank you again, Steve for returning
• 18:26
  to the podcast and being my guest today.
• 18:29
  - Thank you for having me.