Latest / Becker’s Payer Issues Podcast / Medicare Advantage, Value-Based Care and Improving Outcomes for Vulnerable Populations with Dr. Ken Cohen

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Medicare Advantage, Value-Based Care and Improving Outcomes for Vulnerable Populations with Dr. Ken Cohen · Becker’s Payer Issues Podcast

• 0:02
  - GLP ones, Medicare Advantage Headwinds, a Medicaid landscape
• 0:06
  - that looks different
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  - every quarter.
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  - Their leadership right now means making durable decisions
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  - in an environment that keeps moving, and the
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  - organizations pulling ahead are the ones that stopped
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  - Becker's fifth annual fall payer issues roundtable convenes
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  - at the Swiss Hotel Chicago.
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  - Two days of senior level dialogue on affordability,
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  - benefit design, value based care, and the strategies
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  - shaping how care gets financed
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  - and delivered, featuring a celebrity keynote from pro
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  - Click events in the upper right.
• 0:51
  - Hello, everyone. This is Jacob Emerson with the
• 0:53
  - Becker's Payer Issues podcast.
• 0:55
  - Thrilled today to be joined by doctor Ken
• 0:57
  - Cohen, who serves as chief medical officer at
• 1:00
  - Optum Health. Doctor Cohen, thank you so much
• 1:02
  - for taking the time to be with me
• 1:04
  - on the podcast today. Great to be with
• 1:06
  - you, Jacob.
• 1:07
  - Absolutely. Likewise, Ken, and, great to have you
• 1:09
  - back on the podcast with us.
• 1:12
  - We we've talked with you a lot in
• 1:14
  - the past,
• 1:15
  - about some of the research that you've done,
• 1:18
  - with with Optum and into the Medicare population.
• 1:21
  - But before we dive into your latest research,
• 1:24
  - hoping you could fill in our audience on
• 1:27
  - a little bit more about yourself,
• 1:29
  - your background in health care, and what it
• 1:31
  - is that you do today at Optum Health.
• 1:34
  - Happy to do that. So I'm an internist
• 1:36
  - by training, spent my first ten years in
• 1:38
  - academics,
• 1:39
  - and the next twenty five years as the
• 1:41
  - chief medical officer of a large physician group
• 1:43
  - in Denver. For the past ten years, I've
• 1:45
  - served various roles within OptumHealth. And as you
• 1:48
  - noted, today, I'm the chief medical officer of
• 1:51
  - OptumHealth.
• 1:52
  - And and that's where the physicians and patients
• 1:55
  - live within Optum.
• 1:57
  - Optum Health is a national
• 2:00
  - medical group, comprised
• 2:02
  - of around 7,000 or so employed,
• 2:05
  - physicians
• 2:06
  - and about 80,000 contracted physicians.
• 2:09
  - And we take care of 23,000,000
• 2:11
  - patients and about 5,000,000 of those are in
• 2:14
  - full risk, fully accountable care contracts.
• 2:17
  - Wonderful. Well, appreciate some context there, Ken. So
• 2:21
  - I mentioned at the start of our conversation
• 2:23
  - that you you've got some new research out,
• 2:26
  - published in the June edition of the American
• 2:28
  - Journal of Managed Care,
• 2:30
  - and you looked at social vulnerability across at
• 2:32
  - risk Medicare Advantage, fee for service,
• 2:35
  - Medicare, and traditional Medicare,
• 2:38
  - using the CDC social vulnerability index as a
• 2:41
  - proxy for social determinants of health. So,
• 2:45
  - tell our listeners
• 2:47
  - what ultimately was the most significant finding that
• 2:49
  - emerged from this this latest round of research
• 2:52
  - from you and and others,
• 2:54
  - that joined you?
• 2:55
  - Certainly. So the impact of social determinants
• 2:59
  - of health on health outcomes is a critical
• 3:01
  - issue,
• 3:02
  - and multiple studies suggest that this is a
• 3:05
  - major factor driving overall health outcomes.
• 3:08
  - For example, studies have been done showing marked
• 3:10
  - differences in mortality just in adjacent zip codes,
• 3:13
  - and these differences are largely accounted for and
• 3:16
  - by social determinants.
• 3:18
  - With this latest study, our Optum Health Outcomes
• 3:21
  - Research Team
• 3:22
  - in collaboration with APG, America's Physician Groups,
• 3:26
  - has now published a total of five studies,
• 3:29
  - all of which unequivocally
• 3:31
  - established that when physicians and physician organizations
• 3:34
  - accept responsibility
• 3:36
  - for total cost of care and full risk
• 3:38
  - models,
• 3:39
  - that patients experience both improved quality and efficiency
• 3:42
  - of care.
• 3:44
  - So to conduct these five studies, we amassed
• 3:46
  - a large dataset that included, 17 physician groups,
• 3:49
  - all members of APG,
• 3:51
  - over 15,000
• 3:53
  - PCPs,
• 3:54
  - and over 5,000,000 patient years, coming from 35
• 3:57
  - different health plans.
• 3:58
  - And this latest study
• 4:00
  - extended this research
• 4:02
  - by focusing on the population within Medicare and
• 4:05
  - Medicare Advantage
• 4:06
  - that had the highest levels of social vulnerability,
• 4:10
  - as you noted as measured by the SVI.
• 4:13
  - That was a tool developed by the CDC
• 4:16
  - that scores census tracks across the country according
• 4:19
  - to levels of poverty, unemployment,
• 4:22
  - minority status,
• 4:23
  - types of housing,
• 4:24
  - and other factors that reflect, social determinants of
• 4:28
  - health.
• 4:29
  - And the first take home point from this
• 4:31
  - study is that the population of beneficiaries
• 4:34
  - in Medicare Advantage are more socially vulnerable than
• 4:37
  - those in traditional Medicare.
• 4:39
  - This analysis showed that nearly 68% of the
• 4:42
  - beneficiaries
• 4:43
  - in full risk MA
• 4:45
  - and approximately sixty three percent of the beneficiaries
• 4:48
  - in fee for service MA
• 4:50
  - lived in areas with high levels of social
• 4:52
  - vulnerability,
• 4:54
  - which compared to only about fifty percent of
• 4:56
  - traditional Medicare beneficiaries.
• 4:58
  - And this is important because there has been
• 5:00
  - continued controversy
• 5:02
  - as to whether the MA population is more
• 5:04
  - ill and more costly
• 5:06
  - than the traditional Medicare population.
• 5:09
  - And these data confirm a higher level of
• 5:11
  - social vulnerability in the MA population,
• 5:13
  - which we know is correlated with higher burden
• 5:16
  - of illness and higher cost of care.
• 5:19
  - Next point was, as in our four prior
• 5:21
  - studies, we demonstrated that full risk Medicare Advantage
• 5:25
  - was associated with significantly higher care quality and
• 5:28
  - efficiency
• 5:29
  - compared to traditional Medicare.
• 5:31
  - But what was unique about the study and
• 5:33
  - is the important take home point
• 5:35
  - is that if you focus on the beneficiaries
• 5:38
  - with the highest social vulnerability risk,
• 5:41
  - you see the greatest improvements in care quality
• 5:43
  - and efficiency
• 5:45
  - comparing full risk MA to the traditional Medicare
• 5:48
  - population.
• 5:49
  - In other words, the higher the level of
• 5:51
  - social vulnerability,
• 5:53
  - the better the full risk MA model cares
• 5:56
  - for patients.
• 5:57
  - And the specific
• 5:58
  - examples of this that we derive from the
• 6:00
  - study
• 6:01
  - is if we look at acute inpatient hospital
• 6:04
  - admissions, for example,
• 6:06
  - there were 13%
• 6:08
  - fewer admissions in the less social vulnerable group,
• 6:12
  - but close to 17%
• 6:14
  - fewer admissions in the more socially vulnerable group.
• 6:17
  - Looking at inpatient admissions through the emergency department
• 6:20
  - is one of the most important metrics we
• 6:22
  - have. And here there were 11%
• 6:25
  - fewer hospital admissions in the less socially vulnerable
• 6:29
  - group, but 14%
• 6:30
  - fewer admissions in the more socially vulnerable group.
• 6:34
  - And then looking at reducing the use of
• 6:36
  - high risk medications,
• 6:38
  - there was a 23%
• 6:40
  - lower use in the less socially vulnerable group,
• 6:43
  - but 30 lower use
• 6:45
  - in the more socially vulnerable group. Just three
• 6:48
  - examples of how these data played out in
• 6:50
  - that study.
• 6:52
  - Understood. And I appreciate you laying that all
• 6:54
  - out for us, Ken, in a concise manner.
• 6:57
  - Basically, your your research is showing that the
• 6:59
  - gap between at risk Medicare Advantage and traditional
• 7:02
  - Medicare
• 7:03
  - has has widened for beneficiaries in high higher
• 7:06
  - vulnerability
• 7:07
  - areas, bigger reductions in admissions, ED visits,
• 7:11
  - high risk medication use than for lower vulnerability
• 7:14
  - beneficiaries.
• 7:16
  - It seems like then, you know, across your
• 7:18
  - body of research that you've done over the
• 7:20
  - years, there's there's a theme that keeps emerging
• 7:23
  - around,
• 7:24
  - the the greater the social risk, the the
• 7:27
  - greater the differences in outcomes between care models.
• 7:30
  - So we've got a lot of health care
• 7:31
  - leaders listening in from a lot of different
• 7:33
  - parts of the industry.
• 7:36
  - Why is that finding significant for them specifically?
• 7:40
  - It's a great question, Jacob.
• 7:42
  - Health care leaders need to understand
• 7:45
  - that not only can this high needs population
• 7:49
  - be successfully
• 7:50
  - managed in a fully accountable care model,
• 7:53
  - but the improvement in outcomes from this management
• 7:56
  - is even greater
• 7:57
  - than in other less vulnerable populations.
• 8:00
  - So this therefore represents not only an opportunity
• 8:03
  - for great health and social impact on these
• 8:06
  - patient lives,
• 8:07
  - but it's also a financially successful care model
• 8:10
  - when done well.
• 8:12
  - It's a double win.
• 8:14
  - However, it's not easy work and success isn't
• 8:17
  - guaranteed
• 8:18
  - because of the particular aspects of this population.
• 8:22
  - So therefore, in order to be successful, you
• 8:24
  - need to first address the factors that drive
• 8:26
  - their health care utilization.
• 8:29
  - This includes a lack of primary care access,
• 8:32
  - lack of transportation,
• 8:34
  - behavioral health and substance use needs,
• 8:36
  - medication affordability
• 8:38
  - adherence, and food insecurity, just to name a
• 8:41
  - few.
• 8:42
  - In the full risk Medicare Advantage model, part
• 8:44
  - of the premium dollars saved from the sufficient
• 8:46
  - care management
• 8:48
  - can be redirected to build infrastructure
• 8:51
  - to manage these aspects of care resulting in
• 8:53
  - the improved patient outcomes that we observe. And
• 8:55
  - next, these populations have a disease burden that's
• 8:58
  - higher than those that are less socially vulnerable.
• 9:02
  - They have higher incidence of tobacco use, air
• 9:04
  - pollution exposure,
• 9:06
  - obesity and diabetes, hypertension and coronary disease, just
• 9:10
  - to name a few.
• 9:11
  - So fully accountable care models require sophisticated population
• 9:15
  - risk stratification
• 9:16
  - technology
• 9:17
  - and intensive disease management programs
• 9:21
  - that reduce these preventable
• 9:22
  - ED visits and admissions.
• 9:25
  - And similarly, these patients have very high readmission
• 9:27
  - rates, and all of these things can be
• 9:30
  - avoided by programs including transitions of care and
• 9:33
  - care in the home post discharge.
• 9:36
  - And, Ken, I think what was interesting when
• 9:38
  - I read through the study myself is that
• 9:40
  - when you ran the same analysis
• 9:43
  - on dually eligible beneficiaries as a as a
• 9:46
  - sensitivity check, the effect was much smaller than
• 9:48
  - in the non dual population. And so
• 9:52
  - it seems like this is also highlighting highlighting
• 9:54
  - important differences between
• 9:56
  - dually eligible beneficiaries and other socially vulnerable populations.
• 10:00
  - And so
• 10:01
  - going off of what you just said about,
• 10:03
  - the the importance of building infrastructure around these
• 10:06
  - specific
• 10:07
  - populations to support them, What do you think
• 10:11
  - health care organizations overall that that serve these
• 10:14
  - patients,
• 10:14
  - what can they learn from these differences,
• 10:17
  - when it comes to designing support systems for
• 10:20
  - for these specific kinds of patients?
• 10:23
  - So,
• 10:25
  - we'll spend a little bit of time talking
• 10:27
  - about the infrastructure
• 10:28
  - in in just a moment because I really
• 10:30
  - think that's a foundationally important point. But you
• 10:33
  - you bring up a really, important observation about
• 10:36
  - this study. We specifically excluded duals from this
• 10:38
  - population.
• 10:39
  - And the reason we did so is that
• 10:42
  - duals have
• 10:43
  - a separate set of interventions that you can
• 10:46
  - apply to that population,
• 10:48
  - that the, socially vulnerable populations
• 10:51
  - that aren't in duals cannot avail themselves of.
• 10:54
  - And that's important that the duals population is
• 10:56
  - 19% of Medicare, but counts for 35% of
• 10:59
  - the spend with rates that are rapidly going
• 11:01
  - up. And interestingly, of the five studies that
• 11:04
  - we did,
• 11:05
  - the greatest improvements when you're comparing Medicare Advantage
• 11:08
  - to traditional Medicare
• 11:10
  - were actually seen when we looked at that
• 11:12
  - dually eligible population.
• 11:15
  - For example, hospital admissions and readmissions were 2433%
• 11:19
  - lower relative to TM. So so huge, huge
• 11:22
  - differences.
• 11:23
  - And I think that,
• 11:25
  - the striking differences
• 11:27
  - are
• 11:28
  - related to a couple of things. One is
• 11:30
  - the skill set of the physicians managing these
• 11:33
  - patients, and we'll talk about that a little
• 11:34
  - bit later as well.
• 11:36
  - But also duals have a specific infrastructure
• 11:39
  - that addresses health related social needs that no
• 11:42
  - other,
• 11:42
  - Medicare Advantage program has.
• 11:45
  - And then patients that are in MA D
• 11:47
  - SNP plans
• 11:48
  - have a whole another set of care interventions
• 11:50
  - that aren't available in traditional Medicare Advantage.
• 11:54
  - So that duals population, we've really been able
• 11:56
  - to focus,
• 11:57
  - so much
• 11:59
  - resource upon that we're driving very, very significant
• 12:02
  - improvements in that population.
• 12:04
  - Understood. And so, Ken, let's let's dive into
• 12:07
  - what you just mentioned, the infrastructure and the
• 12:09
  - capabilities that
• 12:11
  - organizations need in place to improve outcomes
• 12:14
  - for high risk populations.
• 12:17
  - The paper pointed to things like population risk
• 12:19
  - stratification,
• 12:20
  - case management,
• 12:22
  - integrated behavioral health, and social work support as
• 12:26
  - likely drivers.
• 12:28
  - But as I understand, it wasn't designed to
• 12:30
  - isolate which piece
• 12:31
  - matters most.
• 12:33
  - So can you talk a little bit about
• 12:34
  - that, some of the the infrastructure and capabilities
• 12:37
  - needed,
• 12:38
  - in place here to improve outcomes?
• 12:41
  - That's a critical element. And and, frankly,
• 12:44
  - as I mentioned, we believe that most of
• 12:46
  - the improvements that we see when we compare,
• 12:49
  - Medicare Advantage to traditional Medicare come from that
• 12:52
  - infrastructure.
• 12:53
  - So that that full medical management infrastructure
• 12:56
  - begins with active patient outreach
• 13:00
  - and sophisticated
• 13:01
  - population health risk stratification.
• 13:04
  - A significant part of this infrastructure, therefore, are
• 13:07
  - the IT and the tech components.
• 13:10
  - For example, within OptumHealth, we use AI driven
• 13:13
  - large language models for our population risk stratification
• 13:16
  - infrastructure.
• 13:17
  - We can identify those at high risk for
• 13:20
  - admission,
• 13:21
  - frailty. We can look at fall risk, polypharmacy
• 13:24
  - risk,
• 13:25
  - and we have highly accurate models of disease
• 13:28
  - progression for diabetes, COPD, heart failure, and chronic
• 13:31
  - kidney disease.
• 13:33
  - This infrastructure then moves to early engagement
• 13:36
  - with disease management capabilities,
• 13:39
  - including RNs, respiratory therapists,
• 13:42
  - embedded pharmacists and behavioral health professionals,
• 13:46
  - social workers, and community health workers among others.
• 13:50
  - And then when patients experience serious illness, care
• 13:53
  - then moves to the inpatient and sniff,
• 13:56
  - facilities.
• 13:57
  - And here, wherein many of our OptumHealth markets,
• 14:00
  - we have our own hospitalists, our own sniff
• 14:02
  - providers,
• 14:03
  - and they work hand in glove with our
• 14:05
  - care management teams.
• 14:07
  - When patients are discharged, we provide robust care
• 14:10
  - in the home.
• 14:11
  - So in short, when you think about this
• 14:13
  - holistic environment that is necessary to manage fully
• 14:16
  - accountable care models,
• 14:18
  - success requires that you engage your patients at
• 14:21
  - every point in their care journey.
• 14:23
  - And as you can imagine, this is costly.
• 14:26
  - And the funding of this infrastructure
• 14:29
  - can only come from the revenue that is
• 14:31
  - saved by providing better and more efficient care.
• 14:34
  - This possibility
• 14:35
  - to repurpose that revenue exists in Medicare Advantage,
• 14:40
  - but traditional Medicare doesn't provide the funding for
• 14:43
  - this infrastructure,
• 14:44
  - and this accounts for much of the difference
• 14:46
  - that we think we're seeing in our studies.
• 14:49
  - So, Ken, when we started our conversation today,
• 14:51
  - you had mentioned that this is now the
• 14:54
  - the fifth study in your series with America's
• 14:56
  - Physicians
• 14:57
  - physician groups,
• 14:58
  - and that follows the the fee for service,
• 15:01
  - Medicare Advantage, traditional Medicare spillover,
• 15:04
  - and dually eligible comparisons.
• 15:07
  - So,
• 15:08
  - can I ask you to step back for
• 15:09
  - a minute and reflect across your entire body
• 15:12
  - of work?
• 15:14
  - What do you think is the clearest message
• 15:15
  - the industry should take away from from all
• 15:18
  - of this research that you've done?
• 15:20
  - I think the defining message
• 15:23
  - is that when physicians and physician organizations
• 15:26
  - take accountability for the total cost of care,
• 15:29
  - patient outcomes and total cost of care both
• 15:32
  - improve.
• 15:34
  - CMS and CMMI appreciate this, and that's exactly
• 15:37
  - where they're going with advanced track MSSP and
• 15:40
  - the new ACO lead model.
• 15:43
  - And once you understand this, you then need
• 15:45
  - to ask, why are the outcomes better?
• 15:48
  - And I believe that there are three main
• 15:50
  - components to the model success.
• 15:53
  - First and
• 15:55
  - and problematically,
• 15:56
  - traditional Medicare pays exactly the same for high
• 15:59
  - value care and low value care.
• 16:01
  - And we won't be successful in expunging low
• 16:03
  - value care from our health care system until
• 16:05
  - we stop paying for it.
• 16:07
  - Fully accountable care models are disincented from providing
• 16:11
  - low value care. It's a really important point.
• 16:14
  - Second point is the infrastructure that I just
• 16:16
  - described, and it's funded in the full risk
• 16:18
  - MA model, but not in traditional Medicare.
• 16:21
  - And then the third, I hinted about just
• 16:22
  - a moment ago, and that's the skill set
• 16:24
  - of the physicians who practice in these full
• 16:26
  - risk models.
• 16:28
  - Recall that around 30% of care delivered in
• 16:30
  - this country doesn't improve health outcomes or quality
• 16:33
  - of life.
• 16:34
  - At best, this is wasted care, but quite
• 16:36
  - often, it's it's frankly harmful care.
• 16:39
  - If you can eliminate that one third of
• 16:41
  - care,
• 16:42
  - think about the resources you can then deploy
• 16:44
  - to those who will benefit.
• 16:46
  - And physicians that are practicing in fully accountable
• 16:49
  - care models have been educated around best evidence
• 16:52
  - based medicine.
• 16:53
  - They tend to not over order tests and
• 16:55
  - procedures.
• 16:56
  - They try to refer to the highest performing
• 16:59
  - specialists who practice at the most efficient sites
• 17:01
  - of service,
• 17:02
  - and they pay attention to drug costs.
• 17:05
  - One of the papers that you alluded to
• 17:07
  - in this series was was a fascinating
• 17:09
  - exploration of this impact.
• 17:11
  - We refer to spillover
• 17:13
  - when interventions in one cohort of patients spillover
• 17:16
  - into other cohorts.
• 17:18
  - And our spillover paper documents how the skill
• 17:20
  - set acquired
• 17:22
  - when patients are caring for full risk patients
• 17:25
  - actually improves outcomes in traditional Medicare.
• 17:28
  - So in this study, we looked at quality
• 17:30
  - and efficiency outcomes in two cohorts
• 17:33
  - of traditional Medicare patients. There was no MA
• 17:36
  - in this study, so both cohorts were traditional
• 17:39
  - Medicare.
• 17:40
  - However, one cohort was cared for by PCPs
• 17:43
  - who were highly experienced in full risk MA,
• 17:46
  - and the second cohort was cared for by
• 17:49
  - the broad US primary care population.
• 17:52
  - Relative to that broad PCP
• 17:54
  - population,
• 17:56
  - the risk experienced PCPs provided significantly better care
• 18:00
  - to their traditional Medicare patients
• 18:02
  - despite there being no incentive to do this.
• 18:04
  - It was just the care management, that skill
• 18:07
  - set that they had learned and adopted for
• 18:10
  - risk
• 18:11
  - now being applied to traditional Medicare because physicians
• 18:14
  - tend to treat all of their patients equally.
• 18:16
  - For example, in that study, eight of nine
• 18:19
  - of the causes for preventable hospital admission
• 18:22
  - were on average about ten to fifteen percent
• 18:25
  - lower in the risk experienced physicians.
• 18:28
  - Also, ED visits,
• 18:30
  - overall hospital admissions and hospital readmissions
• 18:33
  - were also significantly lower in the risk experienced
• 18:37
  - physicians,
• 18:38
  - again in that ten percent to fifteen percent
• 18:40
  - lower range.
• 18:42
  - And lastly, in that study, we saw that
• 18:44
  - overall office visits were 62%
• 18:46
  - higher
• 18:47
  - and annual wellness visits were 82% higher. So
• 18:51
  - remembering that all of these patients were in
• 18:53
  - traditional Medicare,
• 18:55
  - these benefits accrued directly to CMS as a
• 18:58
  - result of the risk experience physicians patient management.
• 19:01
  - If every PCP in The US practice the
• 19:04
  - same patterns as these risk experienced physicians,
• 19:07
  - the savings to CMS would literally be in
• 19:09
  - the tens of billions of dollars yearly.
• 19:12
  - Wow. I mean, there's just some amazing numbers
• 19:14
  - you decided there, Ken. And, going back to
• 19:17
  - what you just said at the start of
• 19:18
  - your answer there in terms of CMS pushing
• 19:21
  - toward full accountability for all beneficiaries,
• 19:24
  - by the end of the decade, 2030,
• 19:26
  - it's not that far away. And so as
• 19:29
  - we see the industry continue to move toward
• 19:31
  - greater accountability for outcomes and and total cost
• 19:34
  - of care,
• 19:36
  - Your your final thoughts for us, and for
• 19:39
  - the health care leaders listening in about how
• 19:41
  - they should be applying your findings to the
• 19:44
  - future of care delivery,
• 19:47
  - for for patients and members all across the
• 19:49
  - country?
• 19:51
  - Well, we could spend another podcast on that
• 19:53
  - topic, but, yeah, I'll I'll try to just,
• 19:56
  - give a few examples. I I think
• 19:58
  - first is the development
• 20:01
  - of the necessary infrastructure,
• 20:03
  - which is infrequently
• 20:04
  - present when physician groups and health systems are
• 20:06
  - not participating in full risk models.
• 20:10
  - Next, as I touched on, is the elimination
• 20:12
  - of wasted and harmful care.
• 20:14
  - And as I mentioned, this is 30% of
• 20:16
  - our spend. So I'll give just a one
• 20:18
  - really quick example of this.
• 20:20
  - Patients presenting with suspected coronary disease
• 20:23
  - can be evaluated by various forms of stress
• 20:25
  - testing, which we've been doing for years,
• 20:28
  - or they can undergo a new test known
• 20:30
  - as a coronary CTA with FFR
• 20:33
  - that uses a standard CAT scan but has
• 20:35
  - an AI software enhancement.
• 20:38
  - One of the most frequently used stress tests
• 20:40
  - today utilizes a PET scan and is reimbursed
• 20:42
  - in Medicare at $1,700.
• 20:45
  - The coronary CTA that I just mentioned is
• 20:47
  - less than a third of the cost,
• 20:50
  - and there is clear evidence from three well
• 20:52
  - done trials now that it reduces
• 20:54
  - unneeded heart catheterizations
• 20:56
  - by up to seventy five percent
• 20:58
  - and unnecessary coronary stents by up to forty
• 21:01
  - percent.
• 21:02
  - And yet nationwide,
• 21:03
  - less than fifteen percent of coronary evaluations are
• 21:06
  - currently done using CCA.
• 21:08
  - So when you think about this applied to
• 21:10
  - every specialty, there is just an enormous opportunity.
• 21:15
  - Next, we need to redesign specialty care.
• 21:18
  - Primary care has been practicing accountable care for
• 21:20
  - well over a decade now. However, ninety three
• 21:23
  - percent of specialists are paid straight fee for
• 21:25
  - service, and we have largely disenfranchised
• 21:27
  - them from value based care.
• 21:30
  - Within OptumHealth, we've begun to measure and transparently
• 21:34
  - report on quality and cost outcomes at the
• 21:37
  - level of every individual specialty,
• 21:39
  - and we are now beginning to change the
• 21:41
  - compensation models to include a component that is
• 21:44
  - calculated
• 21:45
  - from their individual value based care performance.
• 21:48
  - This would dramatically advance the success of fully
• 21:51
  - accountable care models if this was widely scaled.
• 21:54
  - And I think the last point is that
• 21:56
  - CMS and CMMI,
• 21:58
  - as I mentioned, are on a path that
• 21:59
  - will likely lead to mandatory full risk models
• 22:02
  - in order to meet their 2030 goal
• 22:05
  - of having all traditional Medicare beneficiaries
• 22:08
  - and fully accountable care models.
• 22:10
  - Healthcare leaders who have stayed on the sidelines
• 22:13
  - up till now
• 22:14
  - need to understand that future success will be
• 22:17
  - difficult
• 22:18
  - unless they quickly engage and develop the core
• 22:20
  - competencies
• 22:21
  - that are necessary
• 22:23
  - to manage patients in a full risk environment.
• 22:26
  - I think that's a fantastic
• 22:27
  - great last piece of advice,
• 22:29
  - to leave things on, doctor Cohen,
• 22:32
  - that the health care leaders who who may
• 22:34
  - have been sitting on the sidelines
• 22:35
  - need to get involved now, because it will
• 22:38
  - certainly not get any easier. So I wanna
• 22:41
  - thank you for taking the time to join
• 22:43
  - me here on the podcast
• 22:45
  - for breaking down this very important research for
• 22:47
  - our listeners,
• 22:49
  - and making it easy for for us all
• 22:51
  - to understand. Really appreciate you taking the time
• 22:53
  - to do so, Ken.
• 22:54
  - Great to be with you today, Jacob. Thank
• 22:56
  - you. And to our listeners, if you'd like
• 22:58
  - to listen to more podcasts from Becker's Healthcare,
• 23:01
  - you can visit beckershospitalreview.com.