Healthcare Unbound_Chuck Feerick & Emily Roesing: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Intro:
Welcome to Healthcare Unbound, a podcast powered by Clarify Health, where healthcare's changemakers discuss ways to advance care outcomes, cost, and affordability.
Saul Marquez:
Hey everybody! Welcome back to the Healthcare Unbound podcast. I'm Saul Marquez, CEO of Outcomes Rocket, hosting today's episode. Joining me today are Chuck Feerik, VP of Growth and Product Strategy, and Emily Roesing, Senior Director for Products for Clarify Health. We've had a lot of discussions on the podcast around value-based care incentives and so many things that we could be considering for the structures that we're putting together to drive behaviors. Today on the podcast, we're going to be talking about ways that we could put all of these ideas to practice. And so, with that, I want to welcome Emily and Chuck to the podcast. Thanks so much for joining me today.
Chuck Feerick:
Awesome.
Emily Roesing:
Great to be here.
Saul Marquez:
It's great to have you both. And look, before we dive in and begin the discussion specific to building the building blocks around how we put this all together, tell us a little bit about you and your work in this space and why you do it.
Chuck Feerick:
Sure, I'm happy to get started, Saul. Like you said, I lead product strategy and growth here for Clarify, focused on our physician incentives and business and how that fits into overall network strategy and value-based care. My entire career has been in healthcare for the past 15 years, working with large health plans as well as now being at Clarify for almost five years now and sort of leading our go-to-market strategy across a lot of these different products. So very excited when we made the acquisition of Embedded Healthcare about a year and a half ago, and having re-platformed onto the Clarify platform, and now being able to scale and grow this to really impact a lot of payers across the healthcare ecosystem, and most importantly, how it's going to save their members money at the end of the day. So excited to talk more in this conversation. And Emily, I'll pass it over to you.
Emily Roesing:
Sure, I've loved working with Chuck the last year or two at Clarify. Prior to that, I was at Embedded Healthcare with Dr. Amol Navathe and Zeke Emanuel, who you've had on the podcast before. So I spent many years focused on bringing a lot of the behavioral economics concepts that they discussed into the physicians' workplace. And like Chuck, prior to that, had spent many years focused on healthcare. I think many of us who work in this field are driven by some kind of personal experience with the American healthcare system, which causes us to want to bang our head against the wall and try to improve certain aspects of it. And in my career, that's led me to several different roles that focus on either payment the business case for paying for value instead of fee for service or member incentives and benefit design, finding ways to apply strategies that will actually help improve the way care is paid for and delivered to patients. So excited to be here and discuss what that looks like today.
Saul Marquez:
Thank you, Emily, and thank you, Chuck. Your backgrounds are both just well aligned to this topic, and so we're focused today on building and delivering on the ideas that we've talked about on the previous podcast, and in particular, around incentive design and network strategy. Can you guys talk to us a little bit about how we could put these to work?
Emily Roesing:
I can start, and then Chuck, feel free to build. Several years ago, when I started working with Amol and Zeke at Embedded Healthcare, we were working with national payers, small, and regional, and national size payers, who all faced the same consistent challenge with trying to innovate on how they motivate physicians in their network to do something different. And there are a lot of different types of behaviors that payers are seeking to drive. They want to see care gaps closed, they want to see referral patterns change. Then there's the whole world about negotiating kind of in-network out of network and pricing. While we were thinking about what would be the most impactful and the most appropriate type of behavior to target, we're using a lot of the behavioral design that they had studied at Penn. We ended up focusing on network choices. And when I say that, I'm referencing the suite of behaviors and choices that both patients and physicians make alike that influence where patients are receiving care and by whom; and this can range from where you get labs drawn, where you get an imaging or an MRI scan, who you're visiting for an entire lifetime of specialty care, an oncologist, a nephrologist, a neurologist. All of these things add up. And because in American healthcare, there's just such wide variation, particularly in the commercial line of business in what we pay and the quality of that care, and we know that those two things are not correlated, finding ways to get patients to the right specialist, the right facility, we found to be high stakes enough to focus on when it came to physician incentives. The other reason we thought it was compelling is because oftentimes, referral choices, you know, those are things that are made in an instant. Somebody chooses what lab to send your order to, and that's where the patient goes. Similarly, as patients, and Saul and Chuck, I'm sure you all can relate, when it comes time to select a specialist, when you need care, you don't really know where to start, and oftentimes, you might be consulting your physician to find out who would you recommend I see for this orthopedic issue that I'm having, you talk to your primary care physician. And so you go to the person you trust, which is often your physician, and so figuring out how you could get into the physician's office and empower them with information to make better referral choices, to make more patient-centric decisions about facilities, we thought we saw a whole confluence of things that came together that made that a compelling choice.
Saul Marquez:
Yeah. Thank you, Emily. And Chuck, give us your perspective on how we can put these ideas to work.
Chuck Feerick:
Well, I'd just add one thing on to what Emily said, which was a fantastic description, is that the other part of this is maintaining the clinician's autonomy in terms of their decision-making. So the things that we're looking at incentivizing are helping them do more of the good things that they are already doing, and we can get into a bit more detail on that, but it still remains the clinician's decision about, does this patient need this surgery? Has it been approved by the health plan? Where do I think is clinically appropriate to do that behavior? And then we're looking at nudging them in terms of ways that helps them drive better outcomes and helps the patient save money and maintain the quality of the care that's being delivered. And so I think that's important because then when it comes to the rubber meeting the road, as you were talking about, we're looking at ways to engage those clinicians in ways that they actually want to engage with us. And a big part of this is, first off, designing the right structures and the right incentives that Emily talked about. The clinician then has to believe that I can make this change, and I believe in the insights that you're giving to me. And we can talk a bit more about, later on, about why this has or hasn't worked from health plans in the past, but the clinician needs to understand that when we give them a list of preferred specialists to make a referral to, or we make a suggestion that there's a more affordable, higher quality facility that they can move a procedure to, they need to believe and understand why that's a better option for their patients. PCPs, especially, are really focused on making sure that they're taking good care of their patients. It's why they got into the field, right? It's what drives a primary care physician to want to care about their entire panel and focus on their end-to-end outcomes. And a lot of the behavioral economics that are woven into the type of nudges that we use are basically saying you can trust and believe the insights that we're giving you because it's backed in data, and it's data that you didn't have previously. In most cases, the incentives and the data sharing are not aligned between the health plan and the provider, and oftentimes, because that data doesn't exist in a way that's actually usable to the provider. And so coming back to sort of where I started on having the rubber hit the road, it's about identifying how does this provider believe what we're telling them, feel like they can actually achieve the goals and the targets that we've set for them, and then successfully be able to get their patients or their members to those locations that are going to drive those better outcomes.
Saul Marquez:
Really great discussion, Emily and Chuck, and really, it's creating these behaviors that matters most. Talk to us a little bit about the curation of these types of designs. How important is it that they're tailored to a particular plan and their desires?
Emily Roesing:
We've spent a ton of time ensuring that we're designing for the specific challenges a physician faces related to the decision we're asking them to focus on. So I'll give you two examples and how they're different to try to draw a comparison. When a PCP, for example, is referring a patient to a specialist, they want to do right by their patient, but they are incredibly busy, and they have to rely on heuristics to decide; I want to make the best choice, and I want to give them what I know, but I don't have access to the latest quality data. I have not seen cost data from the payer that actually tells me how much these specialists cost, and so I am left to rely on what I do know. And that's a natural inclination for any person, not just physicians. So you rely on reputation, you rely on your past experience, what you've heard from your patients and what their experience has been visiting those specialists, potentially things like hospital affiliation or system affiliation, or honestly, potentially it's just people that you play golf with is what we've heard a lot from primary care physicians is they refer to who they know. So as we have thought about changing this pattern, the friction that we're overcoming is actually, it's not that it's difficult for them in their workflow to refer a patient from one person to another. They're not the ones that are going to be delivering the specialty care. It's that it's deeply embedded in their psyche that they believe that certain specialists are good, those are the ones they've been using for years. And so when we've designed the incentive program, we have to lead with information that will cause them, like Chuck said, to trust in the fact that it might be best to make a different choice. And so, as we've worked with primary care physicians, we think about bringing them an abundance of data that will help them understand the virtue of some of these other specialists available in the market, like quality data, or wait time, patient reviews, payer costs. If only I had these things, maybe I would think twice before sending them to that orthopod that I've been using for years. Now, by contrast, you take a completely different scenario. You know, a surgeon who's scheduling themselves, they've chosen to be credentialed and have blocked time at certain facilities, and asking them to change where that surgeon is going to do their jobs; their course of their day is heavily impacted by where they've chosen to conduct their own procedures. That's huge. They can't flip a switch and change that right away. That could impact, in their mind, what time they get home at night, how long they spend in the car, how convenient their workweek is, and whether they can make it to their daughter's soccer game at a certain time. So the amount of friction for this set of behaviors is high. Once we can get somebody to do it, they'll stick with it. But we have to be motivating, and so in that scenario, we really lead with the financial side of the incentive. You know, how do you make it worth it to that physician to make a different choice to take those added steps to get credentialed somewhere new? So it's very different. You know, what creates friction in those two instances are very different, and what motivation they need to buy into the decisions are very different. And for us, at Clarify and at Embedded, spending an abundance of time with physicians to figure out, well, what is it that you need, and how can we motivate you, and how can we design the recommendation in a way that's as easy for you as possible? Those are the things that we have found have made the difference in actually delivering, you know, applying an incentive structure and actually delivering the outcome that we want to see.
Saul Marquez:
And thank you, Emily. It really sounds like there's a lot of opportunity in, number one, really getting to know the end person that we're trying to influence, whether it's physician choosing where they're going to operate or a physician, a PCP referring, giving them the right information. There's a ton of information missing that if they only had it, they would be making different choices. And so all of these things, they make a lot of sense, and certainly, it feels like it could work. How does it fit into what health plans are doing today already, and what are some of the differentiators that could be impactful?
Chuck Feerick:
Before I answer that, Saul, I wanted to put one more point, because you're getting, I'm touching on another subject that's important as well when we talk about this. So everything that Emily just described about the physician being able to make the decision, have the data, we've heard this time and time again, and we've seen this sort of breakdown in healthcare, Hey, why didn't my primary care provider look at my Apple Watch data that I sent? Or why didn't they get the alert when I stepped on the scale, and my weight was higher than it was the day before? Physicians are overwhelmed with data and things that they need to do in their day just for the general care of their patients. So what we are not asking providers to do is to have some massive workflow change, to log into a new portal, to remember a username and password, to do an entire retraining of their staff about how to do this. The mechanism that we've put in place to actually deliver these incentives and use these behavioral economics is simple workflow by delivering reports, and updates, and information to providers directly through their email, and they should expect about an email once a month. That way, they can then work with their scheduling team, work with their referral coordinators to give them that list of who their preferred providers are, and then help automate that into the system, but the list remains low. On our side, we're looking at the data. We want to make sure that the providers participating in the program are actually getting the outcomes that they want from a financial incentive perspective, but most importantly, driving savings for their patients who get higher quality, more efficient care. And so when we see some variation for performance and some derivation in performance, we have a coaching team that's going to reach out to that provider and try to figure out what's going on, figure out if they got a new scheduler or did they lose credentialing somewhere, have they moved out of the area and so maybe they're no longer in-network? And that way, we can do that root cause analysis to hopefully make some easy corrections without a big lift in the provider's workflow to help get them back on track. And so those are just a couple of the other pieces that sort of wrap around what Emily was describing in terms of making this very easy for a provider to participate.
Saul Marquez:
Yeah, that's really great. You know, it's good to know some of the specific tools and the process that you guys use to help a provider get back on track. Really appreciate you sharing that, Chuck. And really, there's not much change, is what you're saying.
Chuck Feerick:
That's right. It should be very easy for the provider, again, we try to find as many ways as we can, and this is in the fantastic work that Emily and team have done of translating behavioral economics into what it means in real life to try to encourage that provider to do more of the good things that they're already doing, or that their peers are doing so they're motivated to do so, versus entirely net new decisions being asked to them; which is, I think, a great transition into the question that you were asking a moment ago, Saul, about sort of what have health plans tried in the past and what has or hasn't worked. And from, in my personal experience, trying to lead patient-centered medical home rollout for Amerigroup Corporation when I was there, there's this discoordination that happens when a provider is making a referral to someone downstream, and that information getting back to that primary care physician. Health plans have a lot of data, but they don't have all the data. And so one of the things that's unique about our program is we can sort of look outside of the four walls of the data that the health plan has, and that means we're able to identify who are providers that, maybe not for your health plan members, but for the rest of the panel that they see, they're actually making some of those good decisions. They are using lower-cost sites of care, they are sending to higher-quality physicians that we know are a part of your network. And so that additional data that we bring in sort of helps more providers be eligible for the program by allowing us to identify how much real opportunity exists with every one of those providers. So that's one big component of it. The other is that, this is not entirely novel, right? Like, the concept of physicians choosing lower-cost sites of care or trying to refer to other high-quality providers is not something new. It's been around for years. I've tried to implement this at the health plans that I've worked at. The challenge is that, first off, the health plan has to go define who they decide are the high-quality, most efficient specialists to deem them a high-performing network or a clinically designated network that become who that preferred options are for referrals within their network. But then the translation of that is a provider relations rep who has a thousand other things that they have to do on their plate, taking out a list of providers to a doctor, and saying, Dr. Jones, here are the 150 best cardiologists in Nashville, please refer your patients to them. And Dr. Jones says, I have no idea who these providers are. I've never referred to them before. You've given me no insight into why they are going to be designated or why you've said that they're high-performing. What does that actually mean? And lastly, don't know where these providers are. They need to be geographically accessible to where I am and where my patients live because they actually need to get to those appointments. And so we take all that to the next level, right? We share with the providers why these physicians have been designated as high-quality. We're looking at the total longitudinal cost of care. So how efficient really is a provider? They may be a little bit higher cost, but if they're preventing a ton of downstream utilization, we want to go to do more utilization at that provider and sending referrals there. And so those are a couple of the other things that we bring into the picture to help sort of round out the approach that we take.
Saul Marquez:
Yeah, a lot of contextual information. Yeah, and Emily, please. Yeah, we'd love to hear your perspective on that one.
Emily Roesing:
I was going to say, speaking of certain things in healthcare not being novel, a lot's been tried, and one of the major existing strategies that health plans rely on to try to motivate network choices is benefit design. How do you structure for the patient and for the member the right incentive to see those high-performing providers that are in that designated network that Chuck is referencing? Too often, you know, in previous jobs where I worked with employers on value-based care and benefit design, we find that payers aren't pairing, necessarily, what their payment strategies are with what their benefit design strategies are, so that they're sending consistent signals. And there's a real opportunity in what we're describing here to marry the incentive that you're delivering to the physician, to use a certain set of specialists or to select a certain subset of facilities, marrying that with how you structure the benefit design for your members, because then everybody is truly on the same team and you're going to see a reinforcing cycle of positive selection and positive network change. And so I'm excited about the potential to work with our payers to figure out how our physician incentives program can reinforce what they're already trying with benefit design. Ultimately, we know that the, certain benefit designs are incredibly effective at directing patients to some providers over others. And yet, as patients, do any of us have an easy time figuring out what physician to see, or what hospital to visit, or what specialist to get into? No, it is just as difficult for those of us who work in healthcare as anybody to figure out who to go and how it interfaces with our network plan. And so I still believe that tying it to your physician and making sure that physicians can continue to be a resource for their patients, you know, that's something that will be very powerful in unlocking positive network selection.
Saul Marquez:
Yeah, I think that's a great call out, Emily. And for everybody listening to today's episode, there's really a huge opportunity in having more data. And when you have that additional data to make the decisions, what you could do could really make a difference in a patient's lives, but also in the way that you're structuring the plan design and the benefit design, to Emily's point here. So look, guys, this has been an extraordinary conversation. I've really enjoyed it. What closing thoughts would you like to leave the listeners with before we conclude?
Chuck Feerick:
I can start, and I think mine will probably be more tactical than Emily's. But for our health plan listeners, this is where I get so excited when I get to work with really leading-edge health plans that are thinking strategically about this. But it's thinking about Clarify Advance and physician incentives through the lens of creating a holistic network strategy. Emily touched on a lot of that, right? There's ways to design a network that sort of has implied nudges through benefit design or copays or network tiering to help members get to the high performers you've seen. There's also the whole segment that we just talked about around how do we use incentives to get physicians to make better behaviors, and then there's a third component that looks at how are you working with your providers. What is the provider relations strategy that you have? How do your providers see? Do they see you as a good partner, or do they see you as a combative partner who uses utilization management to deny all their claims? And so, as you think about how Advance fits into your health plan, let's think about it through the entire network strategy and what else can we build around it? What other insights and data can we bring to that equation such that you can be successful not just with these physician incentives, but the rest of the impact that that's going to create on the entire network strategy?
Saul Marquez:
Yeah. Thank you, Chuck. And Emily?
Emily Roesing:
I'll just end by saying, you know, the next time you need healthcare, I encourage you to go to your physician, ask them who they recommend and why. And if they're drawing on specific cost data, whether they understand what your plan design is, whether they have any access to quality information, be pushing on that because that's what physicians deserve to have, and that's exactly what we're trying to empower them to have at their fingertips in that exact moment that you as a patient need to make a decision about what to do.
Saul Marquez:
That's a great close there, Emily, and I want to thank you both for sharing your insights today. And listeners, make sure you check out the show notes for ways to learn more about the different ideas that have been shared on today's podcast. Also, for ways to get in touch with Chuck and Emily. If you want to learn more and extend the conversation. Chuck, Emily, really appreciate you guys jumping on with us. This has been a good one.
Chuck Feerick:
You bet.
Emily Roesing:
Thanks, Saul ...
Chuck Feerick:
Thanks. Appreciate it.
Intro:
Thank you for listening to Healthcare Unbound. We hope today's episode was insightful. If you want more information on how Clarify Health can help you, please visit ClarifyHealth.com.
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