[Virtual Session] An Industry in Crisis Can Payers & Providers Care as One / HealthChoice

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good morning we're good afternoon depending on where you are in this country welcome to the webinar an industry in crisis and payers and providers care as one lots of stuff to talk about really exciting this is dr. David Hayes chief medical officer here at innovator and I will be moderating today's panel and really excited about this particular presentation during this time that we are all worried wondering what's the future is going to be for

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healthcare first before I get started however I would like to give a couple ground keeping rules so we will be taking questions at the end so please enter any questions you have during the webinar m-- into the chat box the xxx we will use those questions toward the end to bring up questions to our panelists as we go along so with that let me introduce our speakers for today so first I mean we're very pleased to

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introduce Francoise ceman Fran most recently was executive vice president of CVS health Aetna long career through that whole acquisition strategy that led to the combined entity and is currently president of the healthcare management and transformation and advisory Fran welcome to this webinar thanks David

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it's good to be here welcome to everyone and I hope everyone is safe and abiding by the CDC guidelines out there awesome awesome good to have you here and Patrick Conway who most recently was president and CEO of Blue Cross Blue Shield North Carolina and formerly many of us know him where he was at the CMS as chief medical officer and deputy administrator for the Center for Medicaid Medicare innovation Patrick welcome that's great to be here

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David and thanks everybody for joining awesome so I'm these are very very difficult times so we have a lot to talk about you know there's a global pandemic there's a large if not the largest number of cases now new cases in the United States to try and our stimulus bill we've been relaxing telehealth regulations and macroeconomic changes are occurring everywhere we're all worried about the economy or portfolios

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wondering if our health care system is stressed to the breaking point so with that I just want to first ask you guys are probably quarantined at home how are you guys doing Fran let's start with you well thanks for asking David I'm doing fine you know it is a difference a different kind of pace and environment not being able to socialize like I'm accustomed to families stressed young

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younger you know children I should say adult children but nevertheless they've been affected by this there Kyle in college disappointment one is graduating commencement cancelled you know they worked hard to get to that point so yeah I'm sure many of you are out there experiencing the same kinds of things and you know things we never ever anticipated or now we're faced with and it's our new world but you know we'll get through this and that's the message

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that I conveyed in my family to keep their upper spirits as high as possible you know thanks for that and I think many of us would feel it the same way right now we're at Patrick how about yourself how are you doing yes we're we're home in North Carolina and have been for a few weeks and four kids are doing Virtual School so yeah I mean look I just I just we want to recognize the

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healthcare professionals on the front line I still work as a physician but very intermittently now and we've got a lot of people and including many that I know serving on the front lines each every day during this crisis so just want to thank them for what they're doing on behalf of patient yeah and you know I really want to reiterate that I saw a little story on the news last night about a police officer who whatever physician who was speeding on her way to the hospital and he was pretty strict

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with her and Stern and his warning about speeding the dangers of speeding he walked back to his car he came back and he offered her a ten pack of his own n95 respirators and said good luck we need you so you know it's really really great stories to see the kind of people coming together so with that let's get into it so this is a historic move right to trillion dollar stimulus plan offering lots of relief for lots of different things a one-time you know direct

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payment for individuals and couples a little bit more for children you know requirements for health plans and insurance to provide preventive services related to coronavirus without cost-sharing tax credits so on and so forth I've never seen we've never seen a stimulus package like this so how much is this gonna help that's the big question people are asking are we gonna need to do another one at some point your position let's start with you

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what's your perspective yes I'd say a few things I think one obviously as you said historic package so I think I'm definitely wrecked I think we've also seen CMS and others laughing regulatory requirements to allow people to care for patients you know that being said I think we'll have to continue to track and monitor you know give a tangible example you know I'm very worried you know you've got for example smaller health systems and

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independent primary care and specialty care fractions across the u.s. that generally have a low amount of reserve capital and a hit like this could really take a dramatic negative impact for example an independent primary care across the US and I think all of us will have to band together if you will to support the health system we want in the future support physician practices across the u.s. and smaller systems as they transition through this both at the federal level and you know across other

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payers for example so I think more to come on this but a definite step in the right direction Fran have a long career in the health plan side but your perspective this is going to help well it certainly will help it's just despite the fact that it's a historic package and its size I think we have to recognize it was done at a time very early in the process where the

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uncertainties were you know enormous and and and they continue to be significant that I think it's highly likely more is going to be needed in virtually every category and probably some categories that weren't considered the first time around you know I think about what's happening I'll use Hong Kong as an example I was reading earlier today they're sort of the first to come out of lockdown and and there are already an

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incidence of recurrence of of code 19 and and that's going to be our world at some point you know we've had a just-in-time PP East approach and what's what's the cost of changing that and who pays for it so the the stimulus was it was an important a critically important step but that was before the unemployment numbers came out they were far greater than anyone

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expected I think we're gonna need more I think it's gonna take a lot longer for things to come back and therefore you know Congress is gonna have to address this again no it seems to be a consensus amongst quite a number of people particularly with seasonality it occurs which is also likely so I mean these are great perspectives and you know I think many of us been thinking about this and wondering us we don't know but let's go to the level of a patient right family

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you know their out-of-pocket costs are going up many of them many of them have lost their job or a few other jobs are threatened you know historically individuals had more out-of-pocket costs to begin with in this country but we've been you know relatively a you know fairly wealthy country overall but right now we've got people incurring costs huge costs even as a result of just being armed in their home and you know not being able to be discharged from a hospital or whatnot and you know we've

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tried to make the test for any viruses essential benefit but you know this is going to be pain for patients and Families I'd love for you each to comment on that just kind of give your perspective of what its gonna be like for patients I think I should they think about it bran let's talk start with you sure well I think we have to really attack it kind of by segments you know in the commercial population we have

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self-funded employers who they're the ones are going to have to think about you know what they're prepared to to do because they're they're in a position where they could wait they could waive much of the cost-sharing if they so choose you know the health plans are really the administrators of these programs so then you have the fully insured side where the health plans are at risk and many have already stepped up to wave

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various components of the cost share whether it's the co-pays or the coinsurance or some elements of the deductibles yet there you can read about those in the public domain and then you have the Medicare side the Original Medicare and then Medicare Advantage and the federal government could certainly do something CMS could do something on the original Medicare or Medicare Advantage plans could certainly do something Medicaid I

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think is the least affected because there's very little out-of-pocket cost sharing arrangements with Medicaid so I think it has to be attacked by bide by segments Patrick yes so I mean I think obviously both the the health social and financial concerns are dramatic for individuals and families across the country you know first on the health I

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think you know how do we meet a huge health demand and people worrying about the effect on themselves and their families you know I think on the the social including mental health you know how do we support individuals and families through this including virtually and through various platforms and then on the financial side as Fran said I think you know how can payers employers whether it's through co-pays

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deductibles you know leave and support from employers you know how do we really provide the financial backing and support that individuals and families are going to need through this crisis and so I think you know it's going to be an across-the-board set of solutions we're going to need to address these individual and family needs makes sense and you know a lot of families are just worried about the Costas this may incur to them and you know much of that will come from the

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reception they get right when they call and they need services they need help you know I've been thinking about this in terms of both the impact for providers as well as payers and you know right here in San Francisco we're experiencing where the providers are feeling like they're not getting the support they need you know we have a you know 20% increase in Medicare reimbursement for cases we've got still a loss that we see financially for providers when we think about how this is going to play out in the future you

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know some people have said that'll be a reamer jhin's of a gatekeeper model or you know some form of tighter care management because to get everything constrained cost and Patrick you've led you know a charge toward moving toward value-based care as have you Fran for quite some time so you know what do you think is currently needed in the next 6 to 12 months so continued focus on value-based care or a move away from this is Patrick maybe I'll start and Frank and I tonight you know I don't

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think it's a move away from it I the way I was you know if I were still at Blue Cross North Carolina the way out of approach this is you know how do we support the hospitals the doctors the clinicians through this crisis and that is everything from you know waiving certain rules so telehealth and virtual care can be maximized front-loading payments to you know every way we could support them through the crisis and I think you know I think the value-based care push will continue you know mike

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you waive two-sided risk because this was an unexpected hit and you acknowledge that yes I think you would definitely want to take a look at that I was in North Carolina right now so yeah I think it's a partnership model I do think there's also a I think this is going to dramatically impact how care is provided long-term so you know I would argue sort of virtual care and telehealth has always been at the periphery you know right now I think we have an opportunity to read find how you can deliver care in the

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home both in person and virtually you know how can telehealth and virtual care really support hold people's needs and sort of across the whole care continuum but if there's a positive that might come out of this I think it could have a dramatic positive effect and sort of really pushing telehealth virtual care care in the home you know dramatically more forward than it would have been had this not happened in a short time and I think I could do that in the short timeframe I couldn't agree more with

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with Patrick but particularly the last the last part of this statement you know the pandemic if we've heard it once we heard it a thousand times from Governor Cuomo as well as what we're hearing from Washington and Louisiana and probably other states will follow as as the pandemic really starts to explode in other states across the country is

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that there is a capacity challenge here and the answer isn't to build more hospitals and add more beds for what might be you know periodic demand it's really about how do you repurpose what's provided in the home and how do you do so with technology and support it with you know having a better model that

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rewards clinical professionals to see patients in the home and I think you know that goes hand in glove with value-based care in my mind and so I really think that's where the emphasis needs to be placed because I I don't think we're going to be out of the woods with Kovan 19:4 you know anytime in the near future it could be every bit of 12 to 18 months and who's to say that there

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would be something that follows down the road you know another another virus that that we you know that could be just as bad so I think we we have to face the reality particularly with the graying of America and another 20 million Americans aging into Medicare eligibility over the next 15 years we're gonna be up to over 83 million Americans over the age of 65

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now I know it's interesting you've had a long experience and the payer side and Patrick as well more recently I spent I think I was on calls with at least four or five different CEOs or other executives for a large some of the largest health fairs in the country yesterday you know interesting they're they're experiencing a couple things one is they can't get the attention of their usual calls and meetings with their network there are large network providers and then they're very concerned about this issue about the

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inquiries that they're getting in my cover you know its own and so forth from members and they're expecting a lot of cost of care to hit them you know people have said will that end up in more narrow networks again or restructuring of you know their their customers employer benefits friend how do you think right now for the next six months payer should be thinking of this well you know is it's gonna be interesting let me say you know right right up front that I don't have any inside information

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on this so I'm speculating in terms of what the actuaries might be thinking in terms of how they're going to be developing their rate models you know they at first they've got to anticipate how the current pandemic is going to play out how long it will how long the tale will be and how severe will be in terms of its effect on on their particular population and then you have

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sort of the pent-up demand of all other services that weren't affected directly by the cove at 19 but services that weren't provided because there was you know discouraging to have those services provided that this particular time so that could be delayed either later this year or into 2021 and so you know they have to think about building that into the into the rate

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models so you you could you know you could see larger trend increases proposed for the future and that never sits well with with employers and trust me payers don't like delivering that message so they're gonna have to be thinking of ways to mitigate that and obviously there's different different things they can offer and you know network is certainly one not one that

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they necessarily like to to to have to introduce narrow networks because it can be disruptive and people like choice consumers like choice benefit plan designs you know the higher deductible plans I think it's fair to say have not lived up to what people thought they were going to do in fact they may have done more harm than good so you know I think it's it comes back to value-based

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and in terms of you know the payers and the providers working closer together to drive better outcomes find ways to eliminate inefficiencies defects you know it we really have to really have to focus there because I think squeezing the benefit plans more is just not the right answer it really isn't now that's really insightful and you know to that same point you know Patrick you you've spent

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a lot of your career trying to think about this payer provider collaboration and thinking about you know more value-based models that require collaboration right you two sided risk that people were moving toward is it for example where requires that kind of call raishin so think about this today as we're moving into that and the payers can collaborate with providers right now how might they help in regard to this these fears that everyone has their

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providers families around this impact of this how can they best collaborate yeah I mean looking as you alluded to everybody comes their own perspective I think the sort of payer provider collaboration is critically general generally to drive our health system change we want I think even more important during a pandemic like this so to give some more color and emphasize some points there you know I think

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through the pandemic if it's everything from financial support to payers making sure rules aren't getting the way to you know even thinking about are there ways payers might have staff that could deploy we're sure toward time doing clinically because payers have a lot of clinical staff so I think think about all the levers on private payers you know my previous CMS role and I still talk to folks in the federal government including a CMS you know it's the same how do you pull all the various levers

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to support providers you know longer term you know I think you're seeing a trend that will continue and I think accelerate of payer provider collaboration where they become very mixed but you call it a visor or whatever term you want to put on it you know payers that are increasingly providing care providers that may become payers or in many examples and this is what we were doing in North Carolina we were not a single organization but we were trying

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to build a virtual organization that was caring for people so if you thought of something like blue premier which is our big partnership with large systems it was you know how do we work on behalf of the patients and the people we serve to deliver a better quality better experience and lower total cost of care and how do we share in that how we side who does what how do we have the right data flows how do we you know have a payment model that supports that how do we have a trust and a culture that is really centered that way and is

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not adversarial so that I think of those same sort of principles are going to be at least if not more important post this and Emmet yeah thanks for those comments you know as people think about kind of rebuilding trust and rebuilding our healthcare system in a different way to be more resilient to this it's a lot of focus on virtual care telehealth I can't a man in the past three weeks this is all I hear when I'm talking to providers payers what they're doing many practices

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I talked to even just yesterday or just you know just incorporated telehealth capabilities into their practice and you know we both talked about four years of new settings of care and how do we connect people make things interoperable have people operating in the same page what I would like to do is have a discussion about that but first let's ask for audience kind of where they're at right now with trying to use technology so we're gonna have a little poll that comes up for those in the audience just go on and take your ball a

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couple questions just select all or true so you're not using technology and responding to cover 19 you're using technology to screen and triage patients you were using telehealth diversely meet with patients with them in their homes or you're using technology to automate your outreach and maybe even using bots and artificial intelligence things like that so why that's coming up let's have a little discussion while we're waiting for people to answer start with you Tran role of Technology we've all talked

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about this virtual healthcare are we gonna have a new healthcare system when we connect I think inevitably we've been evolving that way for the last probably decade I think it's it's likely to accelerate I I think Patrick and I are pretty much aligned and are thinking about how how it is evolving I think that the days of well at least I'll say

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in the last 10 years I seen the what used to be a lot of tension between payers and providers mitigate tremendously and while they're still you know periodic examples of but still being in existence it's it's it's not nearly as prevalent so I think that that bodes well for you know strong collaboration and finding ways to you

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know find that win-win-win and the wind when when is defined as the provider wins the payer wins and the customer wins the consumer wins and you know that that it has to be a three-way has to be a three-way win and this this crisis that we're managing for right now is really going to be I think a nation you know national wake-up call it and and

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this this is what our we as a nation always rised that to do our best is when we've got a crisis and I think there's going to be so many new innovative solutions introduced that's going to advance things faster things that you know probably have been on the drawing board that have just not been able to get off the drawing board now they're going to be you know accept it and

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execute it I just think that there's a greater sense of urgency now because of what we're dealing with and in a greater sense of reality of the economic consequences there's a lot at stake here you know we cannot be caught flat-footed again and everyone's going to have to work together so I I really think there'll be a renewed spirit to build a

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better healthcare system defined as in the broadest sense of the word where payers providers consumers employer customers customers are working much more harmoniously the future now that that makes a lot of sense looks that take a quick pull up it looks like our poll is done and pull up these results and see what people are doing it's Siri are interesting Patrick what

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do you think of these results surprising um you know I mean I honestly probably about what I would expect just sort of tick through them I think you know using till else to virtually meet with patients yeah I bet it wouldn't have been 76 percent a month ago for Kovan 19 or generally so my guess was the number one out a lot but for kovat that make sense I would guess it will go even higher over time screening I would have thought might have been a little higher

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but you know once again I think I bet it's trending in the right direction and then you know an automation for large organizations my guess is they're using automation maybe a little less for smaller organizations but yeah I think that met my guess I think my takeaway here is the sort of the green purple and yellow bars probably have all gone up significantly over the last few weeks and will continue to go up over time and then I don't think they'll drop back to

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their pre level you know beyond Kovach 19 I think you'll see more technology to screen in triage base and telehealth and technology to automate post-crisis as well and then we can go back to baseline that makes a lot of sense you know we often think about in innovation right there's a lot of Business School that discuss this like when certain things reach a tipping point and we've all read Malcolm Gladwell's book and you know spend lots of time thinking when is this gonna happen this tipping point and you

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know one of the questions will be as we get through this and that may take time you know will our notion or concept of value in healthcare above right we've had debates about should it be a single government you know role a single government health plan should the role of social determinants you know Fran you've thought about this as a the payer landscape do you think all of this will catalyze a change in the way we think about what value is I think

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has to I mean we we've evolved value in fact you know I think we struggled early on and defining what is value and and and III I'm not sure we're still quite there because value to in the mind of a provider is going to be a little different than value and the mind of a payer it's going to be different in the minds of a plan sponsor and certainly in the mind of a consumer but what we have

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to instead of you know kind of fighting over what it is is there a common definition because when I was on the healthcare transformation task force what I was proposing is you know look for the common theme and not get so hung up on it has to be identical because I don't think there is you know I don't think we're ever going to get there there there's commonality and sort of a theme and that's what we should rally

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around that's that's what I would propose now that makes sense and you know Patrick you thought a lot about this right what's that he got an input from lots of different stakeholders and we often think about this whole idea of innovation requiring this wheel of identifying goals and designing things differently and then assessing whether they work and you did a lot of it at CMMI and also it crossed you know how do you think this will evolve what are your perspective about this movement in value-based care and as a

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result of all this sue give a few thoughts I think historically like in the past I think you had sort of quality experience over cost and quality historically was more really quality of care experience may or may not have really been measured and sort of cost you know the trends in costing country have not been positive at a macro level I think we're evolving now where quality is broader sort of health outcomes view

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and population health you experience I think we're measuring more reliably reliably and I think costs are made to be seen but I think there's definitely more of a focus on total cost of care and true affordability to individuals families and employers you know I think I think the way this will evolve I think that focus will remain the same and France point is a good one I think we've struggled with value to whom and let's define it crisply you know I think some you know in an ideal

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state we'd really get to value down to that individual family like sapphire level like what do I value and therefore what is value to me and we're gonna measure that reliably and reward that as we do in other markets and sort of decision prophecies I I don't think we're there yet but I think this will push us to get closer to there where you're really defining value to a higher level of fidelity if that makes sense and closer to the real purchaser of care

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you know I'll give you a sorry little longer answer on this one but you know could there be products develops that are you know how do you deliver care to people in their home that you know they really want to have as close to as possible full in-home care delivery for either for personal reasons or their homebound or you know whatever their sort of reason for wanting a more in-home and virtual experience that we build products around delivering that to

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people I think that's a real tangible possibility post this environment that that probably wouldn't have happened as quickly if this hadn't happened so I you know I'm a this is obviously a horrible series of events but I think our collective challenge is how do we manage through it and then how do we create some positive opportunities and changes from our our learnings if you will brand your thoughts particularly around this concept of you know thinking more about

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public health that perspective and changing that the concept of value well I think this pandemic has really brought into focus the public health aspect of of health here I mean we're living it live right now right with social distancing it it is it is the epicenter of of this whole

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thing I mean every part of our lives has been affected by this by coab at 19 I never would have dreamt that we would be confined to our homes and limited to you know visits to a grocery store and the pharmacy and that would define you know kind of our lives over the last several weeks and probably through the end of the month of April so public health its

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it has to be front and center now I think we we if if this isn't if this isn't the you know the the case to demonstrate I don't know what is no I think many of us are thinking the same thing and that question is do we get there you know it's so interesting just before this happened right we've all talked about this role of Patrick your comments about new products deliver here

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in the home and all requires technology right we're all using zoom every day now just to talk to friends as well as business or some other other services other connectivity services in the internet is holding up and so there was this release of the interoperability role the continued emotion you know the use of api's leverage people to use whatever app they want on their cell phone greater connectivity and a relaxation of telehealth tickling around this issue of delivering care in the home they even a question that came in

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from the audience like do we believe that we that relaxation and the telehealth rules and HIPAA rules will that become permanent curious to see in the next year your thoughts on that Patrick yeah so I think it's definitely possible you know I don't I don't lead CMS anymore um and some of them are statutory and regulatory but you know if I was at CMS

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and and I I'm guessing and I think probably the many of the folks there right now are having these thoughts as well I would certainly contemplate which of these waivers and other regulatory flexibility we put in place should become the new norm and so my hypothesis is CMS and HHS will do that and I think it's the right thing to do you know some of the changes some of the changes you need our statutory so Congress have to take action I think once again I think this opens the door for that to happen

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so you know I think the push towards interoperability will continue I think with the bipartisan ideal I think telehealth which it actually always frustrated me a little bit when I was in CMS that we couldn't push telehealth further and whether it was waivers or statutory changes it just seemed very hard to get them done you know I think this will push those sort of regulatory and statutory changes farther much faster and I think some of them will

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become permanent and I think that's a positive for our health system can I say one is it just on the public health infrastructure I can't I would just echo friends point like this we knew it before this happened we sure as heck should know it now this happened we have under invested in our public health infrastructure as a nation and at a state level as well to both federal and state and community you know hopefully to be a wake-up call that the the level of investment you're talking about no

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overall federal budget is actually relatively minor so I hope that we heed that warning and invest in the public health infrastructure going for yeah yeah we've actually you know one of the things we've done here anniversary support a number of these accountable communities of health that have brought health care and the community organizations together and you know it's nice to see that movement Fran your thoughts I mean you mentioned that was social distancing right you've got new

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ways of thinking and working and you know a lot of this relaxation where your thoughts in this future role of Technology telehealth well I think you know one caution I have is is that you know there there are gonna be things that are missed in telehealth and I just would encourage patients I guess is the

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word it meaning that you know this will continue to evolve the protocols will continue to involve evolve and that's not you know let's not throw the baby out of the bath water it's new and it's been it's being used at a at a time where we have a crisis and it's filling a critical need so I just want to make sure that you know the anecdotal bad you know the bad

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experience or the bad story doesn't sort of take on a life of its own and because inevitably they're gonna it's gonna surface you can you can get I can guarantee it so that's sort of a kind of a caution I put out there I'm a proponent of telemedicine telehealth but it has to be it has to have a strong governance process backed by clinical protocols and and I'm not a clinician so I'm you know I'm not here to to suggest

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what they look like but the experts should should put them in place and there should be a good management process with good reporting and demonstrated outcomes that can compare and contrast you know what telemedicine telehealth produces in the way of outcomes relative to an in-office visit so that there is

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you know the ability to determine are they comparable better and hopefully not worse and I don't think they will be so I guess you're short but the short version is the technology should enhance should be it should lead to better outcomes lower cost and a better experience for

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the patient consumer that's the definition of value-based care goals thank you it's a great question like how are we gonna achieve it how are we gonna line everything you know I'm gonna use this opportunity to bring up some of these questions that are coming in there was a question specifically for Patrick like can you address the issue of 50 different state medicaid efforts addressing cope in nineteen just as an example right when we made a base Medicare being very centralized and you know this whole will how do we become more MORE about public health like what

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are your thoughts yeah I can say this now because I'm no longer in CMS it's one of the bonuses you know I don't think this will happen anytime soon but I think it is there is a open question is the 50 state framework for Medicaid does it actually make sense anymore or would a national Medicaid program make sense that's a huge political list I don't wanna minimize that it's not going to happen anytime soon I'm not I'm not I'm not even saying there's pros and

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cons by the way but you know I actually think it's a good policy question to at least raise it's the kind of policy question unfortunately in the current environment we don't often have these sort of legitimate policy debates you know that being said on this sort of you know I think our our sort of issue in kovat which the question refers to is yeah I think what we should try to do is there's some national at least floor and

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I mean floor in a you know these is these are the bare minimum that just evidence says should apply across the nation and let's deliver that evidence base across the nation whether it's social distancing or issues around sort of PPE delivery or what-have-you then I think there is room for variability based on evidence hopefully on sort of you know some states and communities based on what happens in that state and community are going to need different solutions and I get in the Medicaid

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program to the advantage of the 50 solution as we've been all the tests different things you know the disadvantage is sometimes that variability creates creates disparities and other issues so look you know at its core whether it's through this crisis or value-based care I think we're on a journey you sort of looted the secretary Leavitt who used to be my boss at one point earlier I know I think you're going to come up in the slides later you know even back when I worked with him in

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the Bush administration and then the Obama administration obviously in the private sector both on the provider side and the payer side you know I think the core challenge we're trying to manage through is how do you have a true learning system that delivers better quality exceptional experience and lower cost over time it is iterating much faster and I think that's what our customers and patients and consumers are telling us they need and I think that's the core issue whether it's during the colloid crisis or post crisis so

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that's what I would say yeah I think that rapid iteration is so critical and you know it's something we do all the time in here in Silicon Valley technology companies you know if you're gonna measure right if you're gonna do rapid iteration you need data and you know we've all talked about how we can use technology for writing things not just our health but in doing that cycle of innovation you know getting the data across what you need trusting it new testing out new hypotheses seeing what works but doesn't work that's iteration and then we've got new tools right like

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artificial intelligence and automated workflows bran you didn't a lot of this perspective and from a health plan perspective you know what are your thoughts about how data may actually help us going forward got this interoperability rule and maybe an opportunity to come out of this crisis with a little bolster of moving more toward connectivity what are your thoughts about this well I think that what we've learned when you know when I was with with that net for the seven

46:28

years data was the key to unlock so many different solutions that either you know created new programs to help our members whether it was in you know chronic disease management or programs that were preventative in nature data that is

47:02

you know the date data has to be turned into information and you know we've got a lot of data sight we had a lot of data scientists that were just brilliant and they created algorithms that that allowed us to make you know predictive modeling and that and we were just don't you know look just on the leading edge of so many different things so I think that you know provided the data is is

47:36

reliable and it has to be you know ideally come in aligned with you know the data that you're looking at as a payer is is is the same data that the provider is looking at so that you're talking the same language so I think as we you know going back to the collaboration you you want to be able to be able to be aligned in terms of you know what you're trying to accomplish

48:09

with any given patient and the data is the key to that so you know again back to value-based data makes it happen it makes yeah I couldn't agree more and you know both of you have been you know helping us out a lot and a baster of thinking about this and you know our concept as you know is a connected care framework you know how do you actually address on the left-hand side bringing in data from all these different folks including communities right community

48:41

health organizations the social determinants and and really getting everybody operating Fran you said it was when the same record on the same page right and then being able to give decision support from predictive analytics and having people care is one working together around the patient using command centers if you're managing a large population being able to innovate you know with new applications personalizing the engagement looking at behavior change for the patients and nudging things like that understanding

49:13

the personas like Kaiser has been doing work talking to them about that and how do you transfer our practices I got I have so many questions that have come in about as my practice when to survive you know it's it's phenomenal people are very nervous about this people Patrick you know I talked about this yesterday you know the veteran downside risk I appreciate your comments about you know maybe alleviating that or providing some benchmark alleviation people are concerned that they're gonna lose their shirts and moving into value-based care

49:44

so I think if you connect people and have people both payers providers and pharmacies all working on the same page it's really going to create a new different world and we have cloud technology and other things that allow us to do that you know Patrick you you you mentioned you know as we've been talking now for 45 minutes about predictions of a post pandemic future this comment that is part of the accountable care learning collaborative which we're a part of here you know secretary Leavitt said we may see in the

50:16

days to come something we don't expect an increase in surprise billing to recoup money restructuring benefits narrow networks or emergence of gatekeeper models any closing thoughts before we ask one of these two questions that have come in which is now 60 questions any thoughts closing thoughts about what the future might be and what we need to be careful of Brandon let's just start with you well I think it's gonna take

50:47

time for for everyone to really evaluate the lessons learned and there will be some that can be moved on immediately others will take time I I'm cautiously optimistic that we're not going to do anything trakone Ian and that the actions that will be taken by you know all the various players will be done in a spirit of of advancing the cause in

51:18

the right direction I you know I don't want to repeat my comments from earlier and on the call in terms of you know now my visa land employee benefits and there networks but I really think that it has everything has to be done in a thoughtful way and not in an emotional way I and I really believe that that's likely what will happen it'll be done then it'll be done in a thoughtful way

51:50

no I you know as funny as we talked about this and my apologies I didn't mean to move to that slide so Kate these questions Patrick before you give your closing thoughts you know some of these questions every common denominator is really kind of fear the future like what's going like will there be savings in telehealth where will they come from physicians are still risk for malpractice as a patient I'm accepting in telemedicine appointment with my provider but I'd rather see them and I'm being charged the same amount I mean all these questions kind of relate to here

52:23

right like it am I going to be able to survive this financially am I going to get the care I need am I going to be able to survive in this environment so with that context and back drop what positive closing thoughts can you give us about what this may bode for us as an American as Americans in an American future yeah I just I'll be brief on the fear I mean my my

52:54

sister is a solo practitioner doc my other sisters into two doc practice my brother-in-law's in a specialty practice was about 25 GI dots I mean and I've got all kind of friends in those environments the unbelievable fear they will not pay ourselves or our partners for the next three months don't have cash on hand what does it mean for rent so I mean I think there's a whole litany of things that is an opportunity to support it's not about my sisters or brother-in-law but all the providers and

53:26

clinical practices in those kind of environments that have a lot of people propria fear by the way while I'm dealing with huge health issues yeah I think I'm the opportunity I won't say it all again because I know we're close on time I think there's a huge telehealth and in-home care delivery upwards I think there's an opportunity of mental health and social sports to really redefine how you provide integrated mental health care and deliver on on social needs and I think you know the

53:57

work on data flow value based care etc that I know is court of a much of the discussion today you know there may be a we may have to take an appropriate not pause but adjustment given what's going on right now but then I think that work will be at least if not more important in the future yeah that's great and you know I've been very positive about what I've seen I mean this is truly a sense of Americans comes coming together I can tell you

54:28

what we've done here is fascinating and our 600 and plus employees here at innovator we've you know risen to that the case of really trying to provide a solution for people to take care of so I mean we just brainstormed and I know both of you who have been on cause with us to help us think through this about how do you assess people at home given the material they need to take care of themselves get them to the right place for quarantine care and then be able to have as a provider be able to get those results right away and risk stratify

55:00

them say who really needs my help now and then connect with them to a telehealth visit so you can see them and assess them and make sure they're getting to where they need to be you know initially the result is focused so in testing it's really about triage connecting with people and we're doing the analytics across and we're doing that across many different countries not just here in the US but deploying it to a number of health systems health plans and and and public health systems to the point we've talked about the public health so for those than the audience I

55:32

just want to say we will send out a little bit of information about this we are offering these solutions for free as our way of giving back and trying to help out chip in there's a limitation for how long we'll continue to do that I think just to be able to stay viable but it's it's been scaling very rapidly so advise you as you take a look at that to please take advantage of our contribution to getting this service out for free so that you can assess people get them to where they need to be electronically identify their risk and

56:03

then connect with them by telehealth to help with that so let's just take a few of these questions because I've seen a number come in you know there's a lot of question like will you see Prior us going up you know whoa Medicare approved more telehealth codes some list what's the payer perspective what do you think we can just expect from this Tran the prior us I don't think the be any kind of overcorrection on that I

56:35

think the industry is quite sensitive to you know the administrative burden that presents for providers I think prior offs I think the industry is getting better and better at understanding which works which you know which of those are really effective and that's really how it should be approached it should be done in a in a very you know logical

57:06

basis in terms of what's what's the goal you know you're and it's really about areas that that tend to be either over utilized and reutilized for the wrong reasons and so I so I I don't I don't think there's going to be an overcorrection there the tell the telehealth I I do I really I am cautiously optimistic that that not only

57:38

CMS for Medicare but I but I also think for Medicaid the Medicaid program that telehealth will be more widely accepted likely more stringent requirements because there's always fear of fraud particularly with Medicare and Medicaid and there's a history of fraud and Patrick knows this as well he could probably speak to that better than I but

58:09

that's there's always that you know that that risk and therefore you know there's going to need to be protections in place to make sure that it's not abused now that makes sense you know there are two thirds of these questions really that dala health which is interesting and as I mentioned we we've deployed the solutions but remarkably well received Patrick you know any thoughts about this relaxation

58:40

on HIPAA and you know will this we'll be able to you in that direction or the wrister people in doing it yeah I mean so I think you know my hypothesis you're sort of seeing maximal if you think about a baseline you're sure to say maximal or trying to provide you know significant flexibility across rules regulations telehealth etcetera yeah I think it'll come back some like once you get the crisis I think some of those will be rolled back but I still think you'll be

59:14

at a much different place than baseline and that will be the new normal so that's the short version of what I think will happen I think that'll be true across public payers and I think it'll be I think it likely will be true across many private payers so that side view this sort of trajectory will right brain well we were able to get to a number of the questions than not all of them I want to just thank both of you gentlemen Fran thank you and Patrick for giving your insights and participating this webinar and thank you everybody in the

59:45

audience and we have about 700 people today for attending the webinar the presentation will be emailed to all the registration soon as well as some information about our coven 19 free offering to help you assess triage and manage people at home get them where they need to be if they're at risk so with that thank you gentlemen I'm much appreciated your your participation all right pleasure thank you thank you to our audience as well take care have a good

01:00:22

you

[Virtual Session] An Industry in Crisis Can Payers & Providers Care as One

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