Listening In (With Permission): Conversations About Today's Pressing Health Care Topics

Suzanne calls Kelsey Brykman, Senior Program Officer at the Center for Health Care Strategies to talk about the intersection of primary care and health equity.

Kelsey describes her work under the Promoting Health Equity through Primary Care Innovation in Medicaid Managed Care Project, working with a variety of state Medicaid agencies Kelsey and her team help them think through what levers they have for advancing health equity through primary care.

"It's because primary care is so foundational both as an entry point into the health system and also as, ideally, as the way in which patients develop longitudinal relationships with their care team that it is a critical piece of advancing health equity."

Suzanne calls Rachael Jones, Senior Vice President, Performance Analytics & Quality at Cotiviti, to discuss health equity and what employers and other health care purchasers can do to advance it.

"You really have to have a comprehensive strategy that looks at clinical data, financial data, member stratification, gaps in care..."

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"Beyond having that strategy, payers should also think about this problem, or this issue of health equity, as not only theirs to solve. It's about a community and village of partnerships in the health care ecosystem..."

Suzanne calls up Bob Galvin, CMO of Blackstone and chairman of CPR's board of directors, to follow up on their previous discussion on the state of payment reform. So where are we at? Progress is slow, yet steady -- we've had rain delays, changing pitchers, changing managers, but the game isn't over.

"It's hard getting through, inning by inning when you're creating something from a blank slate."

All is not lost, "I could list 10 or 15 [hospital] systems where you really do have quality improvement, but I think where we've gotten hurt pretty much across the board is, we just haven't gotten at the affordability."

So what's the answer? "Figuring out some ways to help regulate the market...government intervention in the market. I want to be quick to say that I'm not talking about a single-payer system, I'm not talking about price setting, but I'm talking about two things. I'm talking about one, making markets competitive...and doing something about price..."

Suzanne calls up Aneesh Chopra, Co-Founder and President of CareJourney, to talk about the current state of health care transparency policy and how the US is faring. So, what’s the mood on current regulations and government oversight? “The general feeling in the field is one of skepticism,” says Chopra, but he’s much more bullish on it. According to Chopra, based on research CareJourney conducted in partnership with Turquoise Health, “two thirds of hospitals as of the spring of 2022…actually have meaningful, high-quality transparency data.” The question now is are we going to see this information put to use?

Suzanne calls Alice Hm Chen, Chief Medical Officer at Covered California, and asks about her work in quality measurement and health equity.

As the nation's largest state-based health insurance exchange, how is Covered California thinking about its responsibility to deliver equitable care to its member population?

"I think a key thing for everyone to embrace is, equity is quality...you won't get to true high-quality care unless you are addressing equity."

Suzanne calls up Dr. Jeff Wells, CEO and co-founder of Marathon Health to talk about advanced primary care models and how it fits in with onsite and near-site clinic, and virtual care.

Suzanne and Jeff dive into the term advanced primary care and how it differs from prior terminology used to describe high-value primary care strategies. In addition, they discuss why there is a lack of primary care providers compared to most other developed countries and what the future looks like for primary care.

Suzanne calls up Peter Lee, the former Executive Director of Covered California to talk about the last twenty years in health care reform. He explains how many of the payment reforms executed in the commercial space have really been on the margins, and many employees are spending more for worse care than ever before.

So what's the problem? Lack of real alignment on measures, and not enough dollars at play at the right level. "We focused a lot on provider level payment...not at the health plans. Health care is a team sport, if we aren't making the quarterback of the team, the health plans, accountable for quality and value, nothing is going to happen."

Suzanne Delbanco speaks with Roslyn (Roz) Murray, a doctoral candidate at The University of Michigan School of Public Health and former Catalyst for Payment Reform Employee. Roz delves into her first peer-reviewed paper in Health Affairs, which concludes that the evidence on commercial value-based payment models is mixed. Suzanne and Roz dive into why there is such little research in the commercial sector on value-based payment and compare Roz’s findings to research done in the public sector.

“80% of providers believe that the unpaid caregiver should have a seat at table, but only 20% believe they actually do.”

Suzanne Delbanco speaks with Alexandra Drane, Co-Founder & CEO of ARCHANGELS, diving into the critical role of caregivers and why they must be part of the clinical care team.

She also discusses how ARCHANGELS’ Caregiver Intensity Index (CII) is designed to engage caregivers and help them see themselves in the role. It also calculates the level of “intensity” when measuring the impact of caregiver duties on caregiver health – the higher the intensity, the more likely caregivers are experiencing an adverse mental health impact. CII looks at the influence of multiple compounding impacts on caregiver health (cohorts include age, race, unpaid, essential worker, etc.).

Lastly, Alexandra explains the role that ARCHANGELS plays in helping caregivers understand and assess their intensity, and connects people to existing resources (e.g., EAP programs and community, state, and local resources, etc.) to support them.

Suzanne Delbanco speaks with Dr. Irene Dankwa-Mullan, Chief Health Equity Officer at IBM Watson Health and Deputy Chief Health Officer within the Center for AI, Research & Evaluation. As an industry physician and scientist working at the intersection of AI, health equity, and health care, Dr. Dankwa-Mullan speaks to best practices for employers interested in measuring and addressing health inequities being experienced by those in their health benefits program, building on a Health Affairs article that she co-authored in December of 2020.

Dr. Dankwa-Mullan cites definitions pioneered by Dr. Paula Bravemen for understanding what health equity and health disparities signify in the context of health care benefits. Health equity calls on stakeholders to focus on the unfair differences in health experienced by social groups based on the varying degrees of social advantages and disadvantages conferred to these groups, often across socially constructed racial and ethnic groupings. Diving deeper, Dr. Dankwa-Mullan highlights the lack of a uniform approach to collecting race and ethnicity data for use in addressing disparities. Amidst the lack of standardization and other challenges, the most important best practice is to have patients and/or plan members self-identify their race, ethnicity, primary language, and other cultural attributes that are important to their identity. Self-identification avoids inaccurate and incomplete categorizations.

As employers and other stakeholders know all too well, health care benefits are a costly line item in any organization’s budget. But inequitable health care adds even more costs. Dr. Dankwa-Mullan offers the following rationales for why employers should collect and measure health statistics by race and ethnicity.

1. To ensure that the employer’s investment is reaching the full covered population in an equitable manner

2. To discover opportunities to improve population health

3. To demonstrate an organizational commitment to health equity

Altogether, Dr. Irene Dankwa-Mullan highlights the need for employers and their business associates – including TPAs, consultants, and other partners - to acknowledge that health inequities exist and use their role as plan sponsors and benefits administrators to address them through comprehensive, data-driven, health equity strategies.