Latest / Becker’s Payer Issues Podcast / Dr. Damanjeet Chaubey on Bridging Strategy and Execution in Medicare Advantage

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Dr. Damanjeet Chaubey on Bridging Strategy and Execution in Medicare Advantage · Becker’s Payer Issues Podcast

0:02
This is where health insurance leadership comes together.
0:05
Becker's fourth annual spring payer issues roundtable brings
0:09
together over 400 payer and health plan executives
0:12
and more than 100 speakers to Chicago April.
0:16
This year's event includes keynote conversations with the
0:19
industry's top leaders and former president George W.
0:23
Bush. For the full agenda and event details,
0:25
visit beckershospitalreview.com
0:27
and click on the events tab in the
0:29
upper right. We're looking forward to hosting you
0:31
here in Chicago.
0:33
Hello, everyone, and welcome to the Becker's Healthcare
0:36
Podcast. I'm Scott King. Thrilled today to be
0:38
joined by a very special guest, doctor Dominique
0:41
Chauby, vice president,
0:43
clinical affairs with Clover Health. Doctor Chauby, how
0:46
are you doing today? Thanks so much for
0:47
joining us. Oh, thank you so much, Scott,
0:50
and, thank you for giving me this opportunity
0:52
to share my perspectives.
0:54
Oh, no. It's wonderful to have you, and,
0:56
you know, we're gonna we're gonna need your
0:57
perspective, but there's a lot going on in
0:58
health care right now. So, before we get
1:01
to, you know, some of the topics I
1:02
wanted to ask you about, I was wondering
1:04
if you could please just tell us a
1:05
little bit about your your background in health
1:06
care and your your journey there.
1:08
Sure.
1:09
So as you mentioned, I'm Damanjeet Chabe. I'm
1:12
the vice president of clinical affairs
1:15
at Clover Health.
1:17
Been with Clover since November
1:20
2021.
1:21
But prior to that,
1:22
you know, I've been in the health care
1:24
industry for more than twenty five years on
1:26
the health care system side as a physician
1:29
leader
1:30
in a variety of,
1:31
you know, roles.
1:33
And,
1:34
and, actually, I think one of my passion
1:37
really is
1:39
how do we deliver the best,
1:41
quality care to our Medicare beneficiaries.
1:44
And that's really, I think, all my experience
1:48
is kind of coming together,
1:50
you know, in my position here at Yover.
1:54
Thanks for sharing that info. You know, definitely
1:56
paints a picture on why your perspective is
1:58
unique here. And the first thing I wanted
2:00
to ask you about is,
2:02
you know, how are your relationships with providers
2:04
changing
2:05
as both sides face cost pressure and, you
2:08
know, workforce shortages specifically?
2:10
Yeah.
2:11
I think that's a great question. I would
2:13
say the short answer is that,
2:16
you know, the rising cost pressure and workforce
2:18
shortages,
2:19
I they are, and they will continue to
2:22
shift away.
2:23
My my sense really is that, you know,
2:25
we are gonna see a shift away from
2:27
a simple fee for service contracting
2:30
towards people thinking more deeply
2:33
about,
2:34
you know, either risk sharing
2:36
or operational partnerships,
2:38
whether those are kind of like joint ventures
2:41
or value based primary care or home based
2:44
care models.
2:45
And for us at Clover Health,
2:47
I think our unique and very differentiated
2:50
model,
2:51
which is an MA plan, but is leveraged
2:54
with a technology platform
2:56
and a very mature home based care model
2:59
are the foundational strengths, you know, that are
3:02
driving this value based relationship with our primary
3:04
care providers
3:06
and that support our home based care model.
3:08
And, really, I think to my mind, you
3:11
know, I actually would love to, even, give
3:14
more color to this
3:16
because first, our,
3:18
you know, our, Clover Assistant Technology,
3:21
right, that our platform
3:23
really is a physician enablement,
3:27
AI platform.
3:28
And it kind of unifies data from more
3:31
than 100,
3:32
you know, sources,
3:33
EHRs,
3:34
HIEs,
3:35
labs, pharmacy claims,
3:37
and really surfaces
3:38
very specific,
3:40
patient specific
3:41
guideline aligned insights at the point of care.
3:44
So you can well imagine
3:46
physicians, primary care physicians who are so busy
3:49
in their offices,
3:50
for them to get this meaningful data,
3:54
you know, is extremely valuable, and it helps
3:56
in this cost equation and this very resource
4:00
scarce
4:01
environment because how do they even know many
4:04
a times who got admitted,
4:07
who got discharged,
4:08
what was the discharge diagnosis,
4:11
which patient is at high risk,
4:13
which patient hasn't had their screening mammogram.
4:16
So I think that's a huge value add.
4:18
You know, we we help them find that
4:20
needle in the haystack
4:22
so that they can focus on the clinical
4:24
care. And secondly, I would say that our
4:27
Clover home care program
4:29
really is helping support this cost pressure and
4:32
work shortage issue Mhmm. Because we, you know,
4:35
we have a we have an MD, NP,
4:38
led longitudinal care, which is delivered at home
4:42
at no cost to the patient.
4:44
It's really tailored to the medical and social
4:46
needs of our members
4:48
and supports them across their health care journey,
4:50
meaning from an acute crisis
4:53
to a chronic disease management,
4:56
trans you know, from palliative care at home
4:59
to transitioning them to hospice.
5:01
So
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imagine that the synergistic
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model that we have, that primary care,
5:07
you know, in the office
5:09
supported
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by, you know,
5:12
supported by, like, care at home for the
5:15
elderly, for the frail, for the ones who
5:18
are, like,
5:19
with advanced illness, limited life expectancy.
5:23
I mean, that really is a model that
5:25
combines,
5:27
you know, the best of both worlds so
5:29
that we can make a huge difference in
5:31
our patient population.
5:33
You know, I've I've spoken with a lot
5:34
of people on the payer side recently, and
5:36
they're kinda categorizing
5:38
that, you know, the the payer provider relationship
5:40
now is a lot
5:42
less transactional than it used to be. It's
5:44
a lot more kinda coming from an area
5:45
of of problem solving with you just you
5:48
know, some of the pressures we you just
5:49
talked about that Yeah. Kind of both sides
5:51
are facing. Is is that what you're seeing,
5:52
doctor Chabi? Is kind of Yes. Everyone's getting
5:55
together to problem solve more now? I think
5:57
so. I think I I I totally agree
5:59
with you. I think we see that.
6:01
You know, we need to problem solve together.
6:03
I think people realize that we have built
6:06
lots of silos.
6:07
Right? And, you know,
6:10
each one does their own thing within their
6:12
own silos,
6:13
and we are not able to do this
6:15
horizontal
6:16
connectivity,
6:18
as we really would like to do and
6:20
kind of reduce this fragmentation of care.
6:23
And, you know, so people are vying for
6:25
the same resources.
6:26
Right? And they're trying to solve the same
6:29
problems. So why don't we get, you know,
6:31
kind of combine our efforts,
6:33
for problem solving that?
6:36
Absolutely.
6:37
And the other thing I wanna ask you,
6:38
where do you see the biggest gap today
6:40
between payer strategy
6:42
and operational execution?
6:44
I, you know, I think I think plans
6:47
realize. Right? I think plans know that they
6:50
must manage utilization,
6:52
because
6:53
I what
6:55
and they cannot consistently intervene. Right? Early, in
6:58
person, and with clinical authority.
7:00
So what I'm seeing is that there is
7:03
this,
7:04
you know, that even though that most MA
7:06
plans, I would say, usually will have very
7:08
similar strategies, right, on paper.
7:11
But where peep where plans can fail
7:15
is when you do not translate those strategies
7:17
into kind of reliable, repeatable
7:20
execution,
7:21
so that you can kind of deliver the
7:23
right care to the right member at the
7:25
right time. So let's kind of, like you
7:27
know, I was thinking that,
7:29
like, when we think about this, you know,
7:31
what are some of kind of, like, illustrative
7:33
examples?
7:34
So let's just say that, you know, on
7:37
on paper, a strategy
7:39
may very well be that, right, we need
7:41
to manage utilization.
7:43
But
7:44
how do we reduce these avoidable admissions or
7:47
readmissions through a value based care or a
7:49
home based
7:50
services and better coordination.
7:52
Because
7:53
we find that even though that's the idea,
7:56
but in the execution,
7:58
the reality is that
8:00
we sometimes, the MA plan, don't even know,
8:04
you know, who those high risk members are.
8:06
And even if you identify them, then you
8:09
actually are identifying the event after it has
8:12
actually already happened. And then when you do
8:15
oppose discharge
8:16
kind of an outreach, it can be delayed.
8:19
And, really, it's telephonic.
8:21
Majority of the time, that's really what happens.
8:23
Right? And it's nonclinical.
8:26
Or if it is clinical, then it's a
8:27
kind of a low authority. It's an RN
8:29
based care management based phone calls,
8:33
who really don't have any prescribing power.
8:36
So I feel that the interventions then become
8:38
too late. They are too weak. And the
8:40
execution gap really becomes, I think, this decisive
8:43
clinical action, which I think is just so
8:46
important.
8:47
Because if we don't control
8:49
the clinical capacity and how that clinical capacity
8:52
actually acts,
8:54
that is really the gap which I see
8:57
because you really can't phone coach your way
8:59
out of, you know, like, this acute instability.
9:05
And having joint you know, like, having delegation,
9:08
working with vendors sometimes,
9:10
having value based contracts don't necessarily
9:13
guarantee execution.
9:15
So I think that's where the gap could
9:16
be because
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everyone's busy. Health systems are inpatient
9:21
centric.
9:22
PCPs are overloaded.
9:24
You know, and there's home you know, and
9:25
home health has its own capacity constraints.
9:28
So I it all becomes like, you know,
9:30
what we think about the strategy as home
9:33
based care, for example, but the operation actually
9:36
becomes just a telephonic care. And we have
9:38
to kind of, like I think that be
9:40
that is kind of, like, the biggest,
9:42
observations that I've had.
9:45
And that is why I feel that
9:47
even having data, you can have risk models,
9:50
you can have predictive analytics, you can have
9:52
dashboards.
9:53
But if those insights don't actually reach your
9:56
frontline clinicians,
9:58
those alerts are really not actionable.
10:01
And they have to be in real time.
10:04
So, otherwise, analytics without this activation is just
10:07
kind of reporting. So what we do differently
10:10
at Clover, honestly, is we have our own
10:12
clinical teams,
10:15
and we act on within few days on
10:19
our ADT feed notifications.
10:21
And we really have, you know, clinicians
10:25
who are prescribing clinicians at the center of
10:28
these transitions,
10:29
so that we don't merely treat these post
10:32
discharge events,
10:33
you know, as care management task, but we
10:35
are actually
10:38
treating these post discharge,
10:40
you know, events as medical events. And then
10:43
our CA technology
10:45
really helps to surface those actionable information at
10:48
the point of care, which I think is
10:51
really, really, really important. Because
10:53
as you know, in the MA world,
10:56
you know, you can't
10:57
reprice midyear. You can't negotiate your way out.
11:01
I think coding has its own drawbacks.
11:05
So you have to change utilization.
11:07
So you say that we wanna manage utilization,
11:10
but do we truly have the wherewithal, or
11:13
do we have really the operational, you know,
11:17
I think the operational,
11:19
insights or the operational execution
11:22
in a way that it really matters? Because
11:25
utilization will only change when someone shows up
11:28
early and fixes the problem.
11:31
What's one investment or initiative you believe will
11:34
most reshape how health plans operate over the
11:36
next two to three years?
11:39
So, Scott, I think in my view,
11:42
MA winners,
11:45
over the next three years will invest
11:47
kind of, like, I think in maybe in
11:49
fewer bets, but execute it deeply because we
11:52
just talked about it. Right? What's the difference
11:54
between strategy and operations?
11:56
And so you have to execute deeply.
11:59
And while the traditional thought process,
12:02
centers around making choices
12:04
or selecting from an array of goals that
12:07
are always important, growth, profitability,
12:10
member experience,
12:11
retention,
12:12
or kind of like the heaters and stars,
12:14
you know,
12:16
or managing cost via
12:19
I think these are just traditional
12:21
foundational
12:22
principles.
12:23
However, I feel that if MA plans
12:28
can bet on executing a care delivery model
12:32
that leverages data and technology,
12:35
care that is anchored in primary care,
12:38
care that is rooted in a mastery of
12:40
chronic disease management,
12:42
and care that is delivered at home.
12:45
Because if we do that well and we
12:47
execute that well, I believe that's where quality,
12:50
cost, and member trust intersect.
12:54
So I I think if we can bet
12:56
on that, and it all comes to,
12:59
do we have a care delivery model that
13:02
meets those needs?
13:03
That's really how
13:05
powerful it can be to reshape and build
13:08
upon, you know, the traditional health plan models
13:10
because we know the population is aging. Right?
13:12
It's aging fast. We have, like, more than
13:15
fifteen percent of people above the age of
13:17
85.
13:18
There's a huge chronic disease burden.
13:21
We also know that chronic disease and multimorbidity
13:24
is a primary driver
13:26
of Medicare
13:27
utilization.
13:29
We know that if we don't manage it
13:31
well, if we don't manage chronic disease well,
13:33
it's directly linked to frequent ER visits,
13:37
preventable hospital admissions,
13:40
higher readmission rates, and just a very poor
13:42
patient experience.
13:43
I have seen the cycle of inpatient, outpatient,
13:48
you know, very
13:49
closely,
13:50
and I've always been
13:52
looking to see how can I impact and
13:54
make that better,
13:56
because
13:58
I you know,
14:00
this is this kind of, I think, is
14:02
that if if if the MA plans can
14:04
invest in this effective
14:06
care delivery system, I think we'll all reap
14:09
the benefits of managing the utilization
14:12
and actually,
14:13
member trust in us? Because the more trust
14:16
we have, if it's a trust driven relationship,
14:20
you know,
14:21
it it it really makes a difference.
14:24
If yeah. You know, I'm happy to actually
14:26
share a little, you know, a story to
14:28
illustrate what I'm talking about because I was
14:30
recently accompanying our clinical team during a home
14:33
visit.
14:34
And prior to the actual visit, our clinicians
14:36
had visibility into this meaningful information
14:39
about our patient. So our technology platform had
14:42
surfaced, what her existing conditions were, that they
14:45
you know, the patient was discharged recently from
14:47
the hospital after a surgical procedure.
14:50
The patient had some, a colon surgery,
14:53
and really had a colostomy, which is, like,
14:55
let's just say, you know, it creates a
14:57
stoma and an opening in the abdomen,
15:00
which is connecting the intestine from the inside
15:02
to the outside.
15:03
And she was not a happy camper at
15:05
all.
15:06
You know, this person was,
15:09
you know, when we reached in you know,
15:10
when we were in the home, we found
15:12
her despondent. We found her overwhelmed,
15:15
unable to walk, not taking care of her
15:17
colostomy,
15:18
for her surgical instructions, not picking up the
15:21
phone from her doctor's office, not taking her
15:23
medications.
15:24
And and the family was just urging her
15:26
to go back to the emergency room.
15:28
And this team, you know, like our home
15:30
care team, they assessed and they managed all
15:32
those medical concerns,
15:34
whether it was a colostomy bag, provided education,
15:37
or the DM me, connected to her to
15:39
our behavioral health team, called the primary care
15:42
physician, who, by the way, was not even
15:44
aware that the patient had surgery,
15:47
called the surgeon's office, arranged transportation,
15:50
called the daughter. So you can just, you
15:53
know, if you just sense
15:55
all the things that are happening when you're
15:57
actually in the member's home and you are
15:59
problem solving and you are actually resolving those
16:02
issues,
16:03
this cannot be done if you don't have,
16:06
you know, a clinical team exercising
16:09
not only good clinical judgment,
16:11
but actually executing on the clinical care.
16:15
While these are everyday stories, by the way,
16:17
let's not forget that these are powerful examples
16:20
of the right care at the right time
16:23
because they do contribute to good outcomes.
16:25
And, really, my thesis is that,
16:28
you know, our kind of, like, our CLOVER
16:30
advantage
16:31
is that it's PCP centric care.
16:34
And that's why, you know, we are supporting
16:36
how to identify, how to manage.
16:39
And this this kind of strategy that we
16:41
were talking about, like bridge the silos
16:44
between the providers, patients, and the systems
16:47
is probably
16:48
is probably key. So I think that any
16:50
plans
16:51
that will, you know, kind of,
16:54
plans that will
16:55
invest
16:57
in an effective care delivery system
16:59
will surely reap the benefits,
17:02
you know, in the years to come for
17:03
managing their population.
17:06
I appreciate you sharing that story. That's such
17:07
a good example of of your team just,
17:09
you know, willing to go above and beyond,
17:11
for a member. I I think that says
17:13
a lot about about, Clover's operations and what
17:16
they're willing to do for members. So thank
17:17
you for sharing that. And
17:19
the next question I have for you, doctor
17:22
Shabi,
17:23
is if you could change one regulatory or
17:25
industry practice tomorrow to improve affordability and access,
17:29
what would it be and why?
17:31
Yeah. I think there are lots. But, like,
17:33
maybe the one thing that I think, Scott,
17:35
I feel that is really important. I think
17:37
if the industry and CMS,
17:40
even though that we have made progress, let's
17:42
just say, if if we can make the
17:44
ability to exchange data,
17:47
you know, via via the FHIR,
17:50
and based APIs
17:52
among providers and peers, like, really make it
17:55
a ground reality,
17:57
you know, it'll be a huge opportunity to
17:59
improve care and cut cost.
18:02
You know, while there is progress,
18:04
I still don't think that we,
18:07
you know,
18:08
we are where we need to be because
18:11
I I think day to day, we don't
18:13
realize
18:14
how this interoperability
18:16
allows us to bring the most sophisticated
18:19
care coordination,
18:21
to any provider, right, anywhere. And even if
18:24
that provider is not part of an integrated
18:26
health system.
18:27
So I think if we could just, you
18:29
know, get health care industry and CMS to
18:32
support that,
18:34
because smaller plans and independent clinicians,
18:37
you know, they cannot compete if vertically
18:39
integrated,
18:41
you know,
18:42
with their I mean, they cannot compete with
18:44
this vertical integration,
18:46
programs,
18:48
because they have proprietary data advantages.
18:50
And I think all the examples that I
18:52
gave you, like,
18:54
to just know what is happening with our
18:57
members, when, where, so that we can intervene
19:00
at the right time is just critical to,
19:03
you know, providing the best care. So I
19:05
I think that, to my mind, is really
19:08
very important. And, of course, you know, like,
19:10
can we revise our,
19:13
you know, STAR measures to be more meaningful?
19:15
You know? I think that's another opportunity.
19:18
I mean, if you look at medication adherence
19:20
measure, which I've been delving very deeply,
19:23
have been involved very deeply in managing some
19:26
of those measures,
19:28
and understanding them.
19:30
You know, there's so much duplication.
19:31
There is there's so much at odds with
19:33
each other, although they are well intended.
19:36
But I I don't think that we actually
19:40
measure actual adherence.
19:42
Maybe we are just measuring dispensing.
19:45
Having said that,
19:47
I think claims data analysis
19:49
is never,
19:51
you know, the best,
19:53
way forward to understand
19:55
why
19:56
why people are being treated the way they
19:58
are being treated and why they are not
20:00
being treated with certain drugs if they are
20:02
not being treated. So, I I mean, I
20:04
think there's always room to improve,
20:06
you know, how you know, measurements.
20:08
But,
20:09
I would think that the most important thing
20:12
to my mind is
20:14
shared data.
20:15
Share the data in a visible way
20:18
because it would impact so much in terms
20:21
of access, in terms of cost, and in
20:24
terms of driving quality.
20:26
And the last question I have for you,
20:28
doctor Chawbi,
20:29
what issue is putting the most pressure
20:32
on health plan margins right now,
20:34
and how are you responding differently in in
20:36
2026?
20:39
Well, I I think everyone is probably, you
20:42
know, facing rising medical cost, right, including including
20:45
prescription drug cost.
20:47
And, of course, for every, I I think,
20:49
for every plan that kind of predicts and,
20:51
you know,
20:53
plans
20:54
for growth and managing cost,
20:56
I don't know whether,
20:59
does utilization
21:00
outpace the premium growth,
21:03
and then the headwinds for all payers,
21:06
which, you know,
21:07
some are known and some are potentially unknown.
21:11
But, you know, I do think prescription drug
21:14
cost,
21:15
are playing,
21:17
they're a major structural pressure point.
21:20
You know, we know that
21:21
the Inflation Reduction Act, I think it has
21:24
put, more,
21:25
responsibility.
21:26
So plans need to bear a much larger
21:29
share of the drug cost. And I think
21:30
the other thing is as we innovate, as,
21:34
you know, science and technology,
21:37
you know,
21:38
give us more options.
21:40
The high cost specialty drugs,
21:43
you know, oncology, obesity, or the GLP ones
21:46
are, you know, growing rapidly
21:48
and can
21:50
influence the increase in spend per member.
21:53
But at the same time, that is why
21:55
I think that,
21:57
you know, it's really important that we have
22:01
a better relationship with our providers.
22:03
We think about cost management
22:05
outside
22:06
just, you know,
22:08
standard
22:09
rate negotiations because we have to focus on,
22:12
are we delivering the right care?
22:15
And, yes, you have to have good data
22:17
and analytics. You know, you have to invest,
22:20
so that you can identify who are the
22:21
high drivers of the utilization and really tailor
22:24
the interventions
22:25
according to that.
22:27
So while,
22:29
many plans are tightening their portfolios,
22:32
you know, to focus on more profitable markets
22:34
and population,
22:36
given these constraints that we are just talking
22:38
about, utilization,
22:41
you know, and revenue,
22:42
we at Clover
22:44
are taking a strategic approach of measured growth,
22:48
because we have a strong conviction in our
22:50
model of care.
22:52
We've seen about 53%
22:54
growth this year,
22:55
but we also have had 95
22:58
retention.
23:00
We've had favorable, you know, impact of our
23:03
four stars.
23:05
And we also see a very strong and
23:07
improved cohort economics,
23:09
to say.
23:10
So I think that
23:12
and the reason we see that is because
23:14
we have this differentiated layering of our Clover
23:17
Assistant technology
23:19
and the clinical services that are in house.
23:21
Right? It you know, it's our teams
23:24
who manage.
23:25
So while our Clover Assistant technology is an
23:28
AI leader in MA,
23:30
it supports the physicians in improved, you know,
23:33
better quality care. We see outcomes
23:35
for we see better outcomes. If our physicians
23:37
use our Clover Assistant technology,
23:40
we see better outcomes for diabetes, chronic kidney
23:43
disease,
23:44
for example. So I think that's a great
23:46
differential.
23:46
And then we have a very strong and
23:48
mature home based MDNP driven clinical program
23:51
that uses our technology and cost effectively manages
23:54
care,
23:55
for a rising risk and the highest risk
23:57
patient population. So
23:59
I think to I would say that we
24:02
are responding,
24:03
therefore,
24:04
very purposefully
24:06
and with intention,
24:07
understanding our strengths,
24:10
while also being very
24:12
cognizant of all these potential headwinds,
24:16
you know, for sure.
24:17
Well, I think it's the right way to
24:19
to move forward right now. And and, doctor
24:21
Chawbi, thank you so much for joining the
24:22
podcast and for your time and and all
24:24
your great insights. Really looking forward to having
24:26
you speak at our spring payer issues roundtable
24:28
in April.
24:29
Likewise. Thank you for giving me this opportunity,
24:32
Scott.