1. What are the key drivers for health care transformation?
There are several drivers for health care transformation. However, improved value for the entire US health care system, Medicare insolvency, and the challenges and opportunities to expand services precipitated by the pandemic are the key three right now.
Our current health care system is unsustainable without drastic changes. US health spending is growing between two and three times faster than GDP, which exceeds that in Canada and EU by 50+%. Spending also varies across health systems and markets in ways unrelated to population needs. Higher spending is not demonstrably associated with improved health. In fact, a 2002 published study correlated higher spending with:
Recent analysis from Capitol Hill suggests that Medicare will be insolvent by 2024. This impending challenge presents an opportunity for transformation and drive toward value with improved clinical outcomes and decrease cost of care. Medicare is actively developing many different models to address this need, from ACOs, MSSPs, Medicare Advantage programs, DCE, BPCIA, CJRs, etc.
The COVID pandemic presented US healthcare with a unique set of challenges, including patients' inability to see their physicians, barriers in the post-acute settings for care delivery, and the need to lower the barrier to access to physicians. One of the unique solutions to increase value during this time is the rise of telemedicine and increased capability of home health settings. With the loosening of telemedicine rules, there came a unique opportunity to reach more patients in a highly effective way. As a result of expansions to home health options, we see more patients migrating to such options. Many studies show that patients with the right resources do best in home settings. COVID demonstrated how home care can be optimized to the "next level."
2. What are the top priorities for your organization this year?
Sound Physicians has extensive experience in value-based care and has developed robust episode of care models applicable to different models/payers, including Medicare BPCIA, ACOs, Medicare Advantage, and DCE.
This year, Sound Physicians' top priorities are focused on developing enhanced home-based care for our episode of care model. We partner with various healthcare organizations to create care in the home setting that can provide higher acuity patients with skilled nursing facility levels of care. We are also expanding Sound's telemedicine to support home health, SNFs, and direct-to-patients to meet patients in a wide variety of care settings. Additionally, we are developing increased care coordination with patients throughout the episode of care.
3. Who is Sound Physicians, and how can they impact value-based care for patients?
Sound Physicians is a national physician practice in 40 states and over 350 hospital-based practices. At its inception, we ventured into value-based care seven years ago in Medicare's BCPI program and learned how to succeed in an episode of care model. We are currently in 107 BPCIA hospital programs and over 150 VBC contracts in about $2 billion annual at-risk spend with over 100,000 annual episodes. We collaborate with a wide array of partners in our value-based care approach, including over 60 distinct ACOs, multiple major national payers, individual physician groups, large hospital systems, and individual hospital partners.
Sound has created a solution for the acute episode of care that impacts the single most significant area of spend for patient care. Over 50% of healthcare spend is around the acute episode of care. We have developed effective interventions driven by engaged physicians and supported by technology-enabled workflows.
With our effective solution for this area, we have shown greater than a $1,000/episode cost decrease that was 50% faster than national trends, and a 26% reduction in readmissions while decreasing SNF utilization by 15% and LTACH utilization by 60%. We have increased our advanced care planning discussions from 2% in 2017 to over 26% via physician trained encounters. Our physicians have effectively engaged in accurate HCC documentation, which has resulted in better patient outcomes, an increase in 0.54 RAF, and chronic conditions getting appropriate attention by our physicians to help prevent future complications.
4. What motivates you to keep doing the work that you do?
When I began my population health work with Sound Physicians, I was a practicing hospitalist and still practice today. Early on, I saw the potential for improved coordination and services outside traditional care settings to help improve patient outcomes, decrease readmissions, and enhance their clinical presentations.
Participating in our value-based care efforts has allowed me to a part of the solution for our patients. We improve patient experience and clinical outcomes while reducing costs for the patient and healthcare system. This motivation to improve patient care and our healthcare system motivates the work I do.
5. What is it like to practice medicine while in a business leadership role?
Continuing to practice medicine and be in a leadership role gives me a unique perspective on patient care. As CMO of Population Health, I develop creative solutions on a large scale to improve patient care and decrease costs. This role gives me a clear "macro-view" of our health system and patient care. I get to see the "bigger picture" and be a part of the team developing that bigger picture.
As a practicing hospitalist, I also gain a different perspective. I get to participate in any of the changes/plans we implement for our frontline physicians. This view gives me an accurate, real-time pulse on our doctors and workflows, while letting me gauge, first-hand, what works. Last, I get to help patients on a "micro-level" through crucial one-on-one interactions and learn how our clinical management impacts their care. My connection to patient care empowers me to be a better leader and gives me the proper perspective on everything we are trying to do.