Latest / Becker’s Payer Issues Podcast / Aric Sharp, CEO of Value-Based Care at Clover Health

Transcript

Aric Sharp, CEO of Value-Based Care at Clover Health · Becker’s Payer Issues Podcast

• 0:00
  Evernorth brings the power of wonder and relentless
• 0:02
  innovation to create world class pharmacy care and
• 0:05
  benefit solutions. Our connected health services make the
• 0:09
  treatment, prediction, and prevention of health care's most
• 0:12
  complex conditions
• 0:13
  easier and more accessible as we drive organizations
• 0:16
  and people forward. Ever North Home Based Care
• 0:19
  provides value based care that helps patients with
• 0:22
  multiple chronic conditions
• 0:23
  and social determinant of health barriers get the
• 0:26
  care they need and the personalized experience they
• 0:28
  deserve. We serve patients who struggle to navigate
• 0:31
  the health care system by bringing high quality
• 0:34
  primary
• 0:34
  and preventative care services to the home. By
• 0:37
  providing clinical care and support services that provide
• 0:40
  whole person care, we improve health equity, access,
• 0:44
  and outcomes for the populations we serve.
• 0:47
  This is Gracelyn Keller with the Becker's Health
• 0:49
  Care podcast, and we are recording live at
• 0:51
  the 2024
• 0:52
  fall payer issues roundtable.
• 0:55
  I'm joined right now by Eric Sharp, who's
• 0:56
  the CEO of value based care at Clover
• 0:58
  Health. So, Eric, thank you for being here
• 1:00
  today. We'd love to have you start off
• 1:02
  by introducing yourself and telling us a little
• 1:04
  bit more about your role.
• 1:05
  Sure. It's great to be here.
• 1:07
  In my role as CEO of value based
• 1:10
  care with Clover Health,
• 1:12
  I'm really charged with
• 1:14
  driving value based care for payers and providers
• 1:17
  out in the industry. So at Clover,
• 1:20
  we're very technology centric
• 1:23
  and have developed our own
• 1:25
  technology stack that we use to drive value
• 1:27
  based care.
• 1:29
  Again, my challenge is to help others outside
• 1:32
  of Clover Markets
• 1:33
  do that very same thing.
• 1:35
  So it's been a, a fun role. I've
• 1:37
  been here for about 3 years now.
• 1:39
  Wonderful. Well, thank you for taking the time
• 1:40
  to sit down with me today.
• 1:42
  And let's start our conversation talking about,
• 1:45
  at an industry level, what opportunities are you
• 1:48
  seeing for large scale improvements?
• 1:51
  Sure. So one of the things that that
• 1:53
  I've observed
• 1:54
  from my experience in being involved in value
• 1:57
  based care for the past,
• 1:59
  decade, really, probably closer to 12, 13 years
• 2:02
  now,
• 2:03
  is that while there's a lot of approaches
• 2:05
  to try to drive performance improvement,
• 2:08
  as an industry, we're actually making that pretty
• 2:10
  difficult on physicians.
• 2:12
  So if you think of that about that
• 2:14
  from the payer lens,
• 2:16
  we have a lot of different insurance companies
• 2:18
  action asking physicians to do a lot of
• 2:21
  additional work
• 2:23
  and do it in a lot of different
• 2:24
  ways. So,
• 2:26
  forms are different, processes are different,
• 2:29
  websites are different. And it creates,
• 2:32
  a lot of chaos, a lot of administrative
• 2:35
  burden.
• 2:36
  And I think that there's opportunity to try
• 2:38
  to streamline that,
• 2:40
  in in ways that can be easier for
• 2:42
  physicians.
• 2:44
  Pull back some of that administrative burden, begin
• 2:46
  to provide them
• 2:48
  the tools to do better clinically
• 2:50
  and really harness the data that's available
• 2:53
  now in the industry and is increasingly
• 2:55
  it's growing, as there's more transparency and there's
• 2:58
  more interoperability,
• 3:00
  to really leverage those things. So I think
• 3:01
  that's the next season coming,
• 3:04
  in value based care. And it's something we've
• 3:05
  been focusing on at Clover Health.
• 3:09
  And let's shift a little bit toward digital
• 3:11
  innovation. So I'd love to know what role
• 3:13
  technology is playing in your organization's growth strategies.
• 3:16
  And if you could share specific examples, that'd
• 3:18
  be great.
• 3:20
  Yeah. So, just building off of the,
• 3:23
  the points around how to improve things in
• 3:25
  the industry, particularly with value based care.
• 3:28
  At Clover, we're a very tech centric organization
• 3:31
  with a very tight focus on driving clinical
• 3:34
  improvement. We wanna improve,
• 3:36
  the health of every life.
• 3:38
  And so we set out years ago to
• 3:41
  build a technology stack
• 3:43
  that would make it easier for physicians
• 3:46
  to diagnose,
• 3:48
  chronic disease earlier.
• 3:50
  To have better insights at the point of
• 3:52
  care as to what was going on with
• 3:54
  the patient, a more holistic view.
• 3:57
  And so this technology that we've built,
• 3:59
  we are going out and harnessing a 100
• 4:02
  plus sources of data.
• 4:04
  We're pulling that together,
• 4:06
  normalizing it, putting it into our warehouse, running,
• 4:10
  hundreds of AI algorithms, machine learning algorithms to
• 4:14
  surface insights right at the point of care
• 4:17
  at the visit,
• 4:19
  where the physician,
• 4:20
  and the patient are face to face.
• 4:23
  And what we're finding,
• 4:24
  from a results perspective, just to double click
• 4:27
  into one example,
• 4:29
  is that physicians are truly diagnosing earlier.
• 4:32
  They're also also
• 4:34
  able to see insights into medication adherence and
• 4:36
  transitions in care and close gaps in care.
• 4:40
  But that double click, I'll just share with
• 4:41
  you around diabetes.
• 4:43
  Where we see our physician users of the
• 4:46
  technology when compared to those that are not
• 4:48
  using the technology.
• 4:49
  And we have this out on a white
• 4:51
  paper.
• 4:52
  Are diagnosing diabetes about 3 years earlier.
• 4:55
  That's allowing them to then intervene,
• 4:58
  and treat 3 years earlier.
• 5:00
  And you sort of, you know, ask the
• 5:02
  the follow-up questions to that of is it
• 5:04
  really producing a difference in outcomes? And we're
• 5:06
  finding that it is.
• 5:08
  It's leading to,
• 5:10
  better
• 5:11
  control of blood sugar earlier. About again, about
• 5:13
  3 years earlier because we're treating earlier.
• 5:16
  Lower complications like hypoglycemia,
• 5:19
  lower insulin use.
• 5:21
  All these things are important. And the physicians
• 5:23
  that are using the technology see that as
• 5:25
  a value add. It's not uncommon for them
• 5:28
  to share stories about,
• 5:31
  the insights they were sharing that they just
• 5:33
  didn't know existed
• 5:35
  for the patients that they serve every day.
• 5:37
  Patient could have had a cancer diagnosis. They
• 5:39
  may have been in the hospital. They may
• 5:40
  have had an elevated lab study at a
• 5:42
  different health care facility.
• 5:44
  And so harnessing that big data
• 5:47
  and making it
• 5:48
  easy for the physician to use has been
• 5:51
  a differentiator for us.
• 5:53
  We're a 4 star Medicare Advantage plan.
• 5:55
  We have,
• 5:57
  we looked at the recent HEDIS metrics.
• 6:00
  And,
• 6:01
  our HEDIS score on the core quality metrics
• 6:04
  is 4.94.
• 6:05
  We've shared that publicly.
• 6:07
  That is one of the top, if not
• 6:08
  the top, HEDIS score, in the country for
• 6:11
  plans that are greater than 2,000 lives.
• 6:14
  And it really underscores the value of what
• 6:17
  we're doing
• 6:18
  and why we're continuing to improve the technology,
• 6:21
  for physicians at at the point of care
• 6:23
  each and every day.
• 6:26
  And how is technology supporting value based care
• 6:28
  or member focused initiatives at your organization? And
• 6:31
  what is exciting you in this space? Yeah.
• 6:33
  So this really is exciting for me because
• 6:35
  it's, right in the wheelhouse of what I've
• 6:37
  been charged to do.
• 6:39
  Is we've now taken that technology that we've
• 6:41
  been using for some time,
• 6:43
  for our,
• 6:45
  Clover Medicare Advantage members,
• 6:47
  in New Jersey and and in Georgia.
• 6:50
  And we've we've moved that technology into a
• 6:52
  subsidiary called Counterpart Health.
• 6:55
  We did that intentionally because
• 6:57
  we believe that the technology
• 6:59
  is not only proven, but it can make
• 7:00
  a difference at an industry level.
• 7:03
  It's it's designed in a way that it
• 7:05
  can be scalable.
• 7:06
  And so the exciting part is, is I
• 7:08
  get to help lead the effort
• 7:10
  to take that technology
• 7:11
  out to providers
• 7:13
  and to payers to help them also drive
• 7:16
  performance improvement like we've seen at at Clover.
• 7:20
  And, the the real exciting part about it
• 7:22
  is that today, physicians get inundated
• 7:25
  again from multiple insurance companies about these processes
• 7:29
  and things that they wanna drive and improve.
• 7:31
  And as we're deploying it, we're we're hearing
• 7:33
  from them of we want to do this
• 7:35
  type of work,
• 7:36
  value based care work in the same way,
• 7:39
  in a common way, in a similar workflow.
• 7:41
  And so the technology now is available,
• 7:44
  not just to implement our providers, but other
• 7:46
  payers can plug into it as well. They
• 7:48
  can make that decision to say, let's make
• 7:50
  this easier on on the physician.
• 7:53
  Let's allow them to work in a common
• 7:55
  format and leverage the technology,
• 7:58
  that we've made available.
• 8:00
  And I think that that over time in
• 8:01
  the coming years
• 8:03
  is not just gonna set us apart. It's
• 8:05
  gonna set a new,
• 8:07
  standard for best practice in the industry
• 8:10
  as an increasing number of,
• 8:12
  providers and payers plug into the technology. So
• 8:15
  we're just super excited about that.
• 8:17
  Wonderful. Well, Eric, thanks so much for joining
• 8:19
  me today on the Becker's Healthcare Podcast and
• 8:21
  sharing your insights on these topics. Again, we
• 8:23
  are recording live at the 2024
• 8:26
  fall payer issues roundtable. Thanks so much. Thank
• 8:29
  you.