Ep. 8: Innovatus Health

Host: 

Hello, and welcome to HeartBeats. I'm Cathy Murtagh-Schaffer and I'm your host for this episode of HeartBeats. This podcast is brought to you by Shipley Cardiothoracic Center, an educational series dedicated to providing our patients and the community with information and education about our cardiothoracic surgery program, Lee Health and matters affecting your health. Today, I have the great pleasure of talking with Dr. Marilyn Kole, Vice-President of Clinical Performance and Medical Director of Innovatus Health. And today's topic is what is Innovatus Health. Dr. Kole, thank you so much for being here today. I'd like to start the conversation off by asking you to tell our listeners a little bit about your background. How long have you been at Lee and how did the VP of clinical performance become the medical director for Innovatus Health?

Dr.Kole : 

Good morning. And thank you, Cathy. So just to start off about a little bit about me, I'm a pulmonary critical care doctor. I work occasionally in the ICU to keep up my clinical skills, but most of my time is really spent in the population health realm. Population Health is a separate department of Lee Health, and it has several different products or business lines, and one of them is our ACO or next-gen, Accountable Care Organization. The second one is our Vavida product, which is really a Medicaid product, taking care of most of our Medicaid pediatrics. And the third is really Innovative Health, which was designed to become a clinically integrated network with over 2000 providers. And the purpose is to put together providers to improve quality and to enhance the patient experience from the inpatient side and the outpatient side together. So we can look at comprehensive medical care and try to take the mystery about patient having to navigate the system on their own.

Host:

The introductory statement about innovators on the website page states, Innovatus Health is a group of healthcare providers working together to improve health outcomes and patient experience while reducing costs, which is what you just alluded to. This sounds very ambitious. And what were the thought leaders thinking when they developed this concept?

Dr.Kole :

So about four years ago, we started with an accountable care organization, a contract with Medicare to decrease over-utilization, to increase patient awareness and outpatient follow up yearly exams, really looking at quality metrics and with an end result of reducing cost. So the focus has always been on a patient and we put it into a bucket called value-based care. Um, most of us are used to fee for service. We do a service, we bill Medicare, we get paid. Medicare itself is converted into what we call alternative payment models. And we join these alternate models in order to perform in order to decrease costs, to be more effective and more efficient. So that is the general overview. This is a way that the insurance companies and Medicare are heading. And so we have joined in with, um, these programs in an effort to learn and also to improve outcomes for patients in our community.

Host

The Innovatus page also notes that the project's overarching goals and objectives, one of them is being the highest quality of care to the patient population. We serve stratified for those with the most needs. I know you've developed a nurse navigator program for patients in this cohort, and I wonder if you could share your thoughts about why you think nurse navigators and care managers can influence cost containment.

Dr.Kole :

So, great question. Um, one of the things we did early on is when you look at a health plan or when you look at a community it's a lot to do about preventing illness, as much as it is about treating illness. So one of the things that we know is that there is a high amount of cost that's fixed within a health system within the hospital walls, but outside the hospital walls, the patients have to figure out how to fend for themselves. So what we do is we use a risk stratification tool, meaning that patients are placed into a low, moderate or high risk category based on their diagnosis, based on their hospitalizations, ed visits, age, and multiple other factors that have to do with social determinants of health, such as transportation, um, food, housing. So we take all those things into consideration.

We know that the Medicare patient is vulnerable. So we do focus a lot of our efforts on those, on that group. And then we focus on the most vulnerable of that group. So when you're out in a community, the way that we have found out from national leaders, from the advisory board, from best practices, from CMS and other regulatory agencies is really the patient needs to be connected. In order to connect a patient who is out in the community, we need some type of communication. So we followed a similar model to the advisory board and to major organizations and we develop a nurse navigator program that we already had that was servicing self-paid and charity patients, which we continue to do today. And we expanded it to include Medicare patients, meaning that they do phone visits, we have a social worker that goes in and works with the patient on their social needs, in addition to our nurse navigators, we look at the patient's environment, we try to figure out, do they need help with transportation to the physician's office? Can we accompany them to the physician's office? We like to put that service in the home, in the nursing home, with home health and come alongside the patient so that we could add clarity and provide a 24/7 service so if a patient has a question- I'm not sure about my appointment, I'm not sure about my medications. I don't understand my instructions about, um, my walking or about my diet- that we can intervene right then and there try to keep the patients safe, informed, and with resources in the outpatient environment.

Host

One of the questions that comes to mind, as you're saying all of this, I know that Lee Health system doesn't have all of these types of resources that a patient needs as far as a lot of the social issues that they have. Are we working with agencies within the community to provide some of those things?

Dr.Kole :

So great question. When I mentioned that our nurse navigators had originally started with charity patients. So they are a very challenged group in our community and they have become experts at all sorts of resources within the community. So whether it's within the community or if patients live outside our zip codes, we have connections to multiple services. Something new that we would like to do is we'd like to work with our community partners even more so with our parish nurses, with volunteers in the community. So whatever we can do to reach patients so that we can help give them a network of safety and be able to reach out to us if they have questions, that's really where our fought where our goal is.

Host

I think one of the statements that struck me as the most ambitious is this idea of a balance between volume and value-based reimbursement. You and I have been around long enough to see that the burnout that has occurred as providers try to keep up with the need for volume and their practices just to make ends meet, most practicing physicians, I believe would love to be able to provide value-based care, but in the past, this has not been a reimbursable aspect of care. How has innovate is changing now?

Dr.Kole :

So I think overall value-based care is still a mystery and if it's a word rather than something that's tangible or something that physicians can see. So part of our programs that a part of our being separated by a different overarching company from Lee health is so that we can participate with Medicare and shared savings. So within a lot of our programs, we take something called risk, which means that we have to perform in order to be successful. And in order to be financially successful, when we are successful, we can share those savings with physicians. So that brings a different perspective to the conversation because we can't continue to ask people to do more and more and more with nothing in order for value-based medicine to really work. We are now in a transition phase where a majority of our work that we do in our community is fee for service. And now we're bringing in this concept of value-based care, but it's not going to totally supplement a physician's income. What we have to do is start that journey so that what we do is based on quality, based on value to the patient, to the patient's family, and that we connect our community from inpatient to outpatient and provide very efficient, effective care that the patient understands and that the patient participates in.

Host

It's really exciting to hear you talk about this, because what I see is Lee Health is painting a path to the future for healthcare and I think that's just incredible actually. (Dr.Kole) It's very exciting work. (host) As an option for employer-provided health care models, why would an employer want to consider using Innovatus as part of their healthcare delivery plan?

Dr.Kole:

So we do have the Lee employee health plan that participates with Innovatus, with our network of physicians, and our opportunity there is to step outside the Medicare world and really work with the employer world to see what we can do in the healthy space to help develop programs for employees, for wellness, for exercise, for healthy living, and really try to understand what does the employee need, or what does their family need for them to remain healthy? Of course, you can see the advantages, the better that we do with that work, the healthier the patients are the healthier our employees are, the more satisfied our employees are, and we all end up in a much better place as far as work hours and health and decrease hospitalizations. So if we do this well within our own system, then it's really something that you could bring out into the community, but it's really about what can we do for our employees to give them the best health plan possible with as much opportunity for self-management, for self-care and for preventive care. Because honestly, when we're talking about community, we're talking about preventative care, and if we are able to find a diabetic prior to them getting full diabetes, a hypertension patient prior to them having any heart or kidney issues, then we are really successful and that's what we want to be.

Host

Last week I interviewed Dr. Nygaard and Dr. Hummel about the future of healthcare and one of the questions I asked was "what do you think the leading cause of death will be in 10 to 15 years?" Both of them agreed that it will likely be cancer. We know that we're making some remarkable advances in cancer treatment with gene directed therapies and new drugs coming on the market all the time. However, we also know that cancer is a very costly disease to treat. How do you think Innovatus is going to impact that cost?

Dr.Kole:

So a lot of the work we do, we said prevention, but prevention to the fact of mammography’s, of colorectal screening, just physical exams, cessation of smoking, and also really looking at the current situation we're in with COVID where patients and family members of workers are all in the same household, the stress associated with that, the increased use of alcohol or other products because of that, because of just the stress of social isolation. So I think that we have a lot of prevention that we can do with cancer as a leading cause of death for early diagnosis or early treatment, and frankly, for prevention. And I think if we really put our efforts there, then our community is healthier, people are aware, and it's not this dreaded thing of, Oh, I have to go to the doctor's office.

It's more about that. The community is aware that screening is important, but you can know from your own family members trying to convince even a family member to get their screening, they're like, no, no, no, I don't really need that, you know, I'll wait until next year, and we all realize how important it is to just be on the lookout and being on the prevention side so that we aren't, we're not looking at later stage cancers, we're looking at things that are, things that we can find that we can treat early and patients have great outcomes. And that's really our goal.

Host

I think one of the biggest hurdles to what you're talking about prevention, first of all, is educating the general public in the fact that you do need prevention. You do need to see your care provider; you do need to make regular visits. But also there's this whole concept of like you were mentioning, I don't want to do this. I don't want to, I don't want to go for a colonoscopy, I don't want to go for a mammogram, and there are all these controversies that people spew out in the community and I think there's a huge educational gap that needs to be filled. Would you agree with that?

Dr.Kole:

I do think that education is critical and the problem is there's a lot of fear. So there's fear that if I go and something's found something bad is going to happen. So if I ignore it, then I don't have to worry about it. And I think with any of us, when we go for a screening test or we go for anything, when somebody says, Oh, there's an abnormality, we're going to follow it up. I mean, there's a huge amount of anxiety and of course there's the internet, which is great and not so great about going in and trying to, you know, self-diagnose yourself. But I really think if we made it a normal part of our society, same as behavioral health, same as counseling. If we made those things, part of our normal daily activities, it wouldn't be so foreign to people. It wouldn't be so unusual that somebody would say, Oh, I know I'm usually the counselor, or I have some concerns that I'm reaching out. We want to make these things accessible. And I think there's a lot of stigma out there about this disease, about screening, about behavioral health or substance use and I really think we have a long way to go to educate our community and let them know there are resources there and we are ready to help them.

Host

You bring up a great topic, one of the things that is near and dear to my heart is the whole issue of substance abuse and recovery. The CDC is predicting that substance abuse will increase by 147% by 2025, which means that many of our patient lives, health lives are going to be masked with alcohol or drug abuse in our Lee community health needs assessment for 2020 substance abuse was the number two concern for the community. Mental health was number one, although in my mind, they're two peas in a pod has Innovatus developed a treatment plan for patients with substance abuse or mental health disorders?

Dr.Kole :

We are lucky that we have a psychologist Dr. Paul Simione, who has been leading so many initiatives, both inpatient and outpatient in order to get behavioral health, not only in our conversations about part of our entire patient evaluations. In Innovatus in November, we started behavioral health screening for our patients and of course, it's, you know, we ask the patient's permission in order to do that, but it is to try to find out if the patient needs support and then offer support to the patient. So that's been something that was spearheaded by Dr. Simione, is a really great part of our work. I think it's still very underutilized and underdiagnosed because many patients are not available for it, they may be discharged to an alternative care setting and they miss that screening. But I would say the more that we can start to identify patients and make that a normal part of our conversation, the more likely we are to find patients who are in need.

Host

How is technology going to influence the success of Innovatus?

Dr.Kole:

Currently have two data and technology partners. We have a large partner that's helping us understand, interpret and make decisions about Medicare data, which is critical for us. In addition, for shared savings for physicians to participate in, we have quality metrics. So, some of those quality metrics are based on remissions or how many times patients use the emergency room rather than their primary care doctor. In addition, we have another data and analytic partner that will help us produce a physician-directed scorecard so they can look at by the specific contract, how they're performing with care gaps- did my patients get their mammography’s or their colonoscopies, or their blood tests for diabetes. Did my patients go to their yearly exam? - Things like that, so that we can constantly monitor and encourage patients to come in for those types of screens.

Host

When it's all said and done, how will you judge the success of Innovatus?

Dr.Kole:

The success of any program like we have today is really that we can provide access for patients, and the patients no longer are left to wonder about who to call or what they should do on what medicine to take. And patients in this community know that there are resources out there to help them. We see a higher number of patients being screened, and we see a lower number of chronic diseases.

Host:

Before we close is there anything else you'd like to add?

Dr.Kole

I just wanted to thank you for the opportunity to speak about value-based care. There's a lot of information on the CMS website, and other governmental sides about what is value-based care. You can follow a lot of the large national companies that are looking for opportunities for their employees about how to get the best care, even if it's having patients relocate temporarily to another place to get the best care about the best providers. So we want to provide the best care with the best providers here in Fort Myers for our community.

(host)That's incredibly exciting. Dr. Marilyn Kole, thank you so much for your thoughtful insights into this discussion. As always, it's been a pleasure to spend time with you. I'm Cathy Murtagh-Schaffer, and this has been HeartBeats Shipley, Cardiothoracic Centers, podcast, dedicated to bringing research innovation and education to our patients and the community.