Latest / Becker’s Payer Issues Podcast / Dr. Todd May, Vice President and Medical Director at Health Net

Transcript

Dr. Todd May, Vice President and Medical Director at Health Net · Becker’s Payer Issues Podcast

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Hello, everyone. This is Jacob Emerson with the
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Becker's Payer Issues podcast. Thrilled today to be
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joined by a special guest. Doctor Todd May
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is vice president and medical director at Health
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Net. Doctor May, thank you so much for
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taking the time to be with me on
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the podcast today.
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Jacob, thank you for having me. I'm I'm
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very pleased to be here.
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I'll just mention,
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importantly that I am a practicing family physician,
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and I've been practicing
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primary care for over thirty years. So I
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I have deep, deep experience in the in
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this area and, a lot of interest. Fantastic.
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And I appreciate you you diving in,
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to your career background, Todd. And before we
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get started with everything you want we wanna
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talk with you about, can you tell us
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a little bit more about your current role
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at Health Net and what you do?
0:48
Sure. Sure. I,
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I am the executive representing the commercial line
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of business. I am involved in in all
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things,
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clinical, sup supporting supporting the business.
1:00
I'm very deeply involved in population health management,
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which is our,
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approach to optimizing the care for,
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all of our members, across all lines of
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business,
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deeply involved in quality improvement,
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health equity,
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looking at,
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member engagement platforms, digital tools,
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that kind of thing to to
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maximize engagement
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of our members in their in their own
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health care.
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Fantastic. So, Todd, we're we're here today to
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talk with you about a really big and
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special initiative.
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If multiple insurers are are coming together to
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or or have. They've launched a shared value
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based payment model for reimbursing primary care physicians
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in California.
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That initiative includes collaboration from Aetna, Blue Shield
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of California,
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and, of course, HealthNets
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along with 11 providers
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across the state.
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So talk to us a little bit about
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this. What what does this mean? What were
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some of the key factors in bringing all
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these stakeholders together?
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Well, Jacob, first, thank you for recognizing how
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big of a deal this is. This is
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unique, innovative,
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groundbreaking work.
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And and, you know, there's been we have
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a we have a fragmented health care system.
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Right, and there's been realization for the health
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plans
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for some time that to have a real
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impact on broad systems like health care delivery
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and primary care specifically
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that we can work together to align with
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a cohesive multi plan strategy.
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And and this demonstration project
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stems from a partnership,
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agreement that we made, in July 2022
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with HealthEd and, and, and several other payer
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organizations.
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And we've all been deeply engaged, in this
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work,
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from the very beginning.
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It was
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California
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Quality Collaborative, the CQC,
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and Integrated Healthcare Association, IHA,
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who brought us together. They were the conveners,
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of this group, and they can continue to
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facilitate
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the project.
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And,
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you know, there's real value,
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in this approach when
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offering provider organizations a cohesive, aligned strategy
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that really helps them transform
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into becoming higher functioning
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advanced primary care practices.
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And and a high functioning primary care
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is is a foundation for a high quality
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and cost effective health care system.
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And when this happens, we're better able to
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meet the needs of patients and improve health
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outcomes
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that really matter. For for example,
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you know, the sweet spot for for primary
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care
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are are managing chronic conditions like
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diabetes and and high blood pressure. And,
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you know, why are these important? Well, these
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are
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two of the most prevalent conditions in The
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United States and their
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underlying causes of cardiovascular
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disease, which is the primary,
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cause of,
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death in our country. And we also focus
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on
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prevention, like cancer screening vaccinations,
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that kind of thing that really impacts impacts
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health.
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Absolutely. And and, Todd, let's dive into this
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a little bit more because this new model
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is shifting
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individual payment systems to a single shared system
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that rewards
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high quality care.
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How does that approach differ from the traditional
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fee for service models we all know,
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and what are some of the specific metrics
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or outcomes that are being used to measure
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and reward,
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physicians' performances?
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Yeah. You know, value based care differs from
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traditional health care by prior prioritizing patient outcomes
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and the quality of care over the volume
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of services provided. And that and that means,
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our providers are financially rewarded for achieving positive
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health results for their patients
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rather than the number of services delivered.
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In the traditional long standing fee for service
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models,
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providers are paid for the volume of preserve
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services they provide. And, you know, that that's
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irrespective of the impact
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on or or outcomes that they achieve. I
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mean, whether they do any good or not
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doesn't actually factor into the equation. They get
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paid for
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doing things.
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So this shift,
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really encourages a more holistic and proactive
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approach to patient care. We're focusing on preventioning,
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prevention, mind managing chronic conditions,
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and really looking at the overall overall health
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status of patients
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rather than just treating acute issues or or
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whatever they, happen to come in with that
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day.
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And, you know, HealthNet and other health plans
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have been engaged in
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in this value based purchasing,
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arrangement for some time. This is not a
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new concept.
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But we we all did as individual plans
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with individual models and priorities,
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you know, so help, you know, provider groups
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just have,
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a bunch of different health plans,
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providing different incentives and that kind of thing.
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So so what we're doing here with this
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demonstration project
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that's that's really revolutionary
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is this multi plan alignment.
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We're all rowing in the same direction, and
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the practices know,
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what's expected. And we're we're really amplifying the
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impact,
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that we have in producing high quality,
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high value results.
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And, you know, the the health plans all
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came together with CQC, NIAJ.
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We developed this together from the very beginning
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from the conception design payment models.
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We developed the metrics, which I'll get to
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in a moment.
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We got the implementation plan, then we're gonna
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assess the outcomes.
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Now in terms of metrics,
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we jointly developed key performance metrics that reflect,
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high quality and high value member outcomes.
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And these metrics this is really important. These
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are closely aligned with the priority metrics
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that our major purchasers
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have identified
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as well as key leaders in the industry.
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So at a high level, these metrics include
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health outcomes and prevention.
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Talked about diabetes, high blood pressure,
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immunizations, and cancer screenings.
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We're looking at patient reported outcomes and focusing
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on
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depression status.
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We're looking at patient safety,
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looking at minimizing high risk drug combinations.
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We're looking at patient experience using industry standard
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surveys.
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That's really key. We really hope to move
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the dial, the the needle there,
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and also high value care, which is, you
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know, minimizing you know, with with really strong,
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primary care, we hope to minimize
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emergency departments and, inpatient hospital utilization.
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Those are the those are the key metrics
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that we are targeting and that we are
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rewarding
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the practices
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for achieving.
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Absolutely. And going off of that, Todd, with
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everything you just said and and these and
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how these metrics were developed,
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why were small
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independent practices chosen as the starting point for
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this new model?
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And have you learned any lessons so far,
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being only just a short amount of time,
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since implementation?
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Yeah. That that's a really great question. So
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so like I said, primary care is the
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foundation of a high functioning
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health system.
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And we have while while we have
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growing
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consolidation in in health care delivery,
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we still have, you know, a vast, vast
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number of small independent practices out there providing
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a substantial portion of primary care.
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Now this advanced primary care model is an
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integrated, comprehensive,
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patient centered, team based care model, and we're
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supporting these practices
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in in adopting
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this broader,
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broader approach to care. It's not just contingent
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on that doctor in the room,
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but it's more of a team approach. So
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everybody in the office,
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can contribute
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to, this population health,
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management approach. And together, they look at all
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the patients,
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use data,
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identify their needs, and then proactively
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reach out to to their patients and close
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their care care gaps.
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Now we've we've focused on these small independent
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practices because they're they're largely under resourced,
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and they they lack the size and infrastructure
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to implement these changes on their own. I
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mean, it takes work. It takes effort to
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do this, to to change your,
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your, you know, standard way of doing things.
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Now larger provider groups tend to be better
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resourced,
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to enact these kinds of changes. So,
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with the with the, demonstration project, we're excited,
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with where we're, where we're at and what
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we're seeing.
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I'll just mention we're calling this a demonstration
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project instead of a pilot, and there's a
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reason for that.
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Pilots are, like, initial attempts to just test
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out a new idea,
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But this this project is based on science
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and experience, and this methodology has been proven.
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We we know that advanced primary care works,
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so we we are we're moving ahead beyond
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just a a test pilot.
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And so far, we've,
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we've learned that health plans can indeed come
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together collaboratively,
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get in the same room, elbow to elbow,
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align around key innovations and operational interventions,
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and, we've been able to successfully
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engage targeted practices,
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to commit to practice transformation
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in in adopting this advanced primary care model.
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And we're also finding high interest from these
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practices. They're eager to receive support. They wanna
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be helped. They wanna do better.
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They know it's hard work and and that
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they can't do it on their own. So
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they really appreciate,
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both the financial resources, but also
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the the training and coaching,
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that we're providing,
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to to make this transition.
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Yeah. And, Todd, let me follow-up with a
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point, one of those last points you just
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made that this is really bringing together a
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lot of organizations that in the past may
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have been directly competing
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with one another. So how do you see
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this demonstration
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project setting a precedent for for other insurers,
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for other providers throughout the country?
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Well, like I say I mean, this is
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what's groundbreaking.
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Right? I mean, who would imagine,
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the health plans
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competitors, yes, getting together literally in the same
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room
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and talking this all through, working this all
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out, coming to
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common
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agreements,
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with a focus on
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you know, we we we keep we keep
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the business separate. Right? This is this is
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really about
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quality. When you get down to it, we're
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all it's all about quality, improving outcomes, improving
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the care, improving the value of care that
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the people of California receive.
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And we can all agree on that. Right?
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I mean, there there's
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we we should we should be
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all,
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promoting that across the board for all Californians,
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and that's what we're doing here. And we
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found that through this alignment,
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we can really amplify our impact and make
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a difference, and it just makes a lot
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of sense. Now what we what we hope
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to do with this demonstration
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project is,
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show that, yes, indeed, health plans can do
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this. They can align. They can come together
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with strength in numbers
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and the and the amplification
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that we can,
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really help practices,
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adopt this model and provide,
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higher value care
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with it. Obviously,
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the long term goal here, demonstrate this works,
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and then scale it. Scale it across the
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across the state, maybe across the country,
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get other plans to to come on board
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and
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and really, really move the dial.
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Yeah. I mean, it's really exciting to to
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think about the potentials here, Todd. But let
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me ask you one last question about some
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of the technical
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aspects of this model,
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because as you've said throughout our our conversation
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today, you're really looking to address reimbursement challenges,
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improve health equity, and boost health outcomes among
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your your members,
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particularly those who may have been underserved
13:17
in the past. So
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how are you specifically addressing some of those
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disparities in care, and how does a tool
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like the like the Coziva platform play in
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ensuring that those goals can be met?
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Great.
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So
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the the key here,
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is data.
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Timely, accurate, and actionable data is the key
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to all performance improvement efforts across the board,
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and that's especially,
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true with health equity. And so we're making
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it easier for the provider organizations to access
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their patient data.
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You know, we we like I mentioned, we
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have a fragmented system.
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Our data, our information, our medical records
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is equally
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fragmented, and that makes it really difficult to
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get a comprehensive view
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of the care that patients have had and
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identify their needs.
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So
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with this demonstration project,
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the three plans together
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are providing access to a uniform data platform,
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a single source of data, a single source
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of information
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where the pro practices can view key patient
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clinical information for our members
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for all of the plans
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in one place, on one dashboard.
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And
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access to and use of accurate data foundation
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of health equity work, and the way that
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that works is we stratify
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data. So we have a you know, look
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at a practice. They have their full panel
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patients. It's a diverse,
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array of folks in in any given practice.
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What you do in health equity is you
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take that data and then stratify
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by race, ethnicity,
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language,
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and other parameters,
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and then you compare the groups. And that
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reveals
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disparities
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in the services that that are provided.
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It uncovers
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things that you would not see unless you
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look at the data and stratify the data.
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So then we can identify those gaps in
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care,
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and then practices
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can proactively,
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address those gaps to mitigate health, health disparities.
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So the, you know, the goal here is
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visibility,
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see where the gaps of care are,
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take action,
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proactively
15:35
outreach to specific especially
15:38
underserved members. Now these are folks who may
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have fewer resources
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and fewer opportunities to access this care on
15:45
their own. So
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by reaching out, bringing them in, or delivering
15:50
the services to them, we can promote health
15:52
equity.
15:54
Fantastic. Well, Todd, we've got a lot of
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other health plan and health system leaders listening
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in right now. Any other final thoughts or
16:03
final bits of advice you wanna offer them
16:05
based off of everything we've just chatted about?
16:08
Yeah. Well, first of all,
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watch this. Pay attention to what we're doing
16:12
here. We follow this along. We'll we'll obviously,
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give status reports as we go, and,
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and we'll,
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share the results, that we demonstrate. We hope
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to show very positive results.
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So that's one, keep a close eye on
16:27
this.
16:28
And two,
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don't be afraid to jump in. Don't you
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know, it's it I know it seems foreign,
16:34
sounds,
16:36
sounds counterintuitive
16:37
for competitors
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to get together
16:40
and do good work together,
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but it makes sense. Okay. Then we're not,
16:45
violating any
16:46
any business comp competition practices or
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sharing proprietary information. There's none of that. We
16:53
are focused on
16:55
improving the health outcomes of all Californians, and
16:58
everybody can get behind that.
17:01
Wonderful. Well, doctor May, thank you so much
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for taking the time to sit down with
17:05
us and for sharing your insights with our
17:07
listeners. We really appreciate it.
17:10
Jacob, thank you very much for having me
17:11
today.
17:12
If you'd like to listen to more podcasts
17:14
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