The Reverse Mullet Healthcare Podcast
Ellen Brown, Justin Politi, and Dave Pavlik bring their 90 collective years of healthcare experience to BP2 Health where they're on a mission to effect real change in the industry. Connect with BP2 Health Here: https://bp2health.com/contact/
The Reverse Mullet Healthcare Podcast
Seeing Patients as Stories, Not Charts with Andrew Molosky
Andrew Molosky, the charismatic President and CEO of Chapters Health System and CareNu, joins us on the Reverse Mullet Healthcare Podcast for a spirited discussion. Andrew shares his journey from a chance encounter with Nikki Sixx of Mötley Crüe to championing patient-centered care. We unravel how viewing patients as unique stories, rather than mere numbers, can revolutionize healthcare delivery. With over two decades in the field, Andrew brings a wealth of insights into innovative risk-bearing programs and addresses the vital role of social determinants in shaping healthcare outcomes.
As we reflect on the future of healthcare, we explore the transformative shift from fee-for-service to value-based care—a shift that prioritizes empathetic treatment over sheer volume. We discuss the need for redesigning health systems to better serve vulnerable populations, such as the elderly and chronically ill. Andrew shares his expertise in integrating Medicare and Medicaid services to create a more unified care model, emphasizing the importance of home and community-based services and exploring innovative care models like PACE and GUIDE.
These care models showcase the significance of holistic, patient-centered approaches that account for both clinical and social environments. Our conversation also highlights the economic alignment necessary for successful value-based care and the challenges different institutions face during this transition. We commend grassroots efforts and legislative support in expanding these programs, acknowledging the Centers for Medicare & Medicaid Innovation's role in driving change.
Join us for a lively talk that imagines a future where healthcare leaves a legacy of superior patient experiences and embraces meaningful transformation.
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https://bp2health.com/contact/
Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health. Today we're in the studio talking with Andrew Malosky, President and CEO of Chapters Health System and CareNew, about seeing patients as stories, not diagnostic codes. But first, who are we? Why are we here? Why did we name our podcast the Reverse Mullet Healthcare Podcast?
Speaker 2:Well, we want to be relevant, informative and creative. We also want to be entertaining and have fun. So it's like a party in the front and business in the back, like a mullet or a horse.
Speaker 3:Here are your hosts, selin Brown.
Speaker 2:Dave.
Speaker 1:Pavlik and Justin Politti. We are passionate, innovative and collaborative and are committed to solving some of our industry's most important issues together with our clients. We have a combined 90 years experience.
Speaker 2:A bunch of old folks.
Speaker 1:that's what we are, yes with Andrew it's probably at least it's got to be 120, I would say right, there you go, all right. So in this episode we're going to dig into a hot healthcare topic and dig into each other a little bit.
Speaker 3:But just please don't dig into me. Be gentle on me please.
Speaker 1:We never really gentle on her because she's like our little sister and we will dig, dig and keep digging.
Speaker 2:Well, I'll just dig right back Noogies, noogies, noogies. That's what I always say.
Speaker 1:Yes yes, yes, exactly. Well. Malosky is the President and Chief Executive Officer of Chapters Health System, one of the nation's premier community-based healthcare delivery systems. Chapters Health is a progressive leader in delivering innovative risk-bearing programming, hospice, palliative care, home health, durable medical equipment and pharmacy services designed to improve the lives of those affected by advancing age and illness, serving a wide geographic area including the Southeast and Mid-Atlantic regions of the United States. He is also CEO of CareNew.
Speaker 3:Yeah, because that wasn't enough. That other thing isn't enough.
Speaker 1:There's more, there's more. He's the CEO of CareNew, a value-based subsidiary of Chapters Health System, providing predictive analytics, case management and one of our favorite things social determinants to care delivery. Andrew served in executive leadership for more than 20 years, spanning an array of geographies.
Speaker 4:You got it.
Speaker 1:20 years, exactly Including publicly traded organizations, privately held and not-for-profit. He led UnityPoint at home, held leadership positions at Seasons Hospice and Palliative Care and Medicis Home Health and Hospice and Heartland Home Health Care and Hospice.
Speaker 3:Okay, but before we jump in, even to the party in the front we're going to make it even more party in the front. So before we recorded, Andrew might have donned the mullet. He might not have. No one will ever know. It's like a tree falling in the forest. And as he put it on, you guys said Justin said he looked like Nikki Sixx.
Speaker 1:I mean, it was a spinning image.
Speaker 3:And there was a story and I said wait, but wait, who's?
Speaker 1:Nikki Sixx. Some people might not know, who Nikki Sixx is.
Speaker 2:If we have to describe who Nikki Sixx is, I don't want the listeners.
Speaker 3:No, no, no, no. You can't say that. Explain who Nikki is. We don't want to.
Speaker 2:I want to alienate listeners?
Speaker 4:Well, let me do that, because who. Nikki Sixx is is fundamental to the story itself. Okay.
Speaker 3:All right Perfect.
Speaker 4:Told in a very succinct fashion. Right, there are people of a certain age and recognition. Nikki Sixx is a household name. My wife is not one of them. So as I'm traveling through an airport a number of years ago, it was very clearly obvious that Nikki Sixx was about to board the plane with me, because he is very clearly Nikki Sixx it's tattooed on the knuckles, the hair is distinguishable, the dress is distinguishable and he had autograph seekers all around him. So I had the privilege of sitting next to Nikki Sixx on a plane flight right after his book had come out, and he was an exceptionally nice person. By the way, for those of you always looking for testaments as to who is this person, he was very kind, very conversational and wasn't bothered at all by my fandom right. So in this process, I had just read the book, of course, and said to him you know, you got to tell me what I don't know, especially about the day you died twice, and his exact comment was that was a terrible day, poignant, prescient, right.
Speaker 2:I mean talk about a quotable moment. You can deliver a line huh, yeah, yeah with emphasis, and so I text.
Speaker 4:My wife and I said I'm sitting next to Nikki Sixx and she said she sounds 80s hot. And I said, well, first it's a he and you're right. So that is when someone drops a Nikki Sixx reference. I thought, oh, there's a special someone in my life who, I just have to make it clear, is the last to know who Nikki Sixx is.
Speaker 2:But thank you for the reinforcement.
Speaker 1:But after all of that, hold on though. After all of that, that was outstanding. We still didn't say who he is. Motley Crue.
Speaker 2:Thank you, drummer. Kickstart man Tommy Lee. No, tommy Lee is the drummer. Oh, that's right.
Speaker 3:Oh, my gosh Bass player Justin's going to disown you too. I know man. This is really disturbing.
Speaker 2:What is going on on that side of the table?
Speaker 1:I made a mistake. He's the bass player. But come on See, nobody knows who bass players are singer.
Speaker 2:All right, there we go.
Speaker 3:I feel like we need to stop now. All right, I feel like the whole BP2 partnership could fall apart right now, like you need to move on from that. So thank you for that fantastic story.
Speaker 2:Okay, so after that, that was actually awesome. Appreciate it.
Speaker 4:I try to bring value where I can.
Speaker 3:Is it going to be?
Speaker 2:awesome.
Speaker 1:Well, everything else is Party in the front to a new level Wow.
Speaker 3:Maybe you could bring Nikki Sixx next time. I'll work on it. That would really take it to a new level.
Speaker 4:Yeah, that would be my takeaway.
Speaker 2:Let's get into your love of water sports and the saltwater aquarium where you raise corals and reefs. Can we hear a little bit about that?
Speaker 4:Yeah, certainly. I mean, people all have passions and hobbies. A lot of folks are into gardening, a lot of books turned to cooking and, you know, along the way I picked up this hobby, if you will, that started off, as many you know, in that space do you get your first little aquarium for Christmas and, you know, killed off a couple of goldfish and usually people give up at that point. But you know, mine kind of hung around for a little bit longer. And so in that process, you know, as I grew up and lived in environments where I had access to those sorts of things, it became a real passion.
Speaker 4:I moved past a hobby and now into something that I actually have the opportunity to give back a little bit into the world. And so, yes, as you indicated, we in our home have a very large fish tank, but one of the bigger parts of that is where we're able to have a little coral garden and we're able to raise captive coral fragments to take back out and reseed the reefs in collaboration with very well-respected institutions. I'm not just out there freelancing on my own but, um, you know, it is a nice thing when your hobby can actually be taking, giving back to nature, as opposed to purely just taking from it.
Speaker 4:So yeah, how many gallons is said tank? Uh, said tank is a little over a thousand gallons, right, so it's uh.
Speaker 1:I actually had saltwater tanks growing up as well. Growing up now as an adult I should say, killed the goldfish growing up but loved saltwater fish and I don't know. I guess I eventually killed them off too, mine was 70 gallons, Yep, Yep.
Speaker 4:And you know it's like many things, right? The principles remain the same and it's just how you apply them. And, ironically enough, you know, there comes an analogy that I draw out to a lot of our healthcare pursuits from time to time, and that's you know nothing. Nothing good happens fast, right? You know if the tendency to react and do things quickly or on a whim or on a spur usually backfires more often than it succeeds, Right? And so you know an aquarium hobby, as you firsthand know, is it takes time, it takes love. You can't fix things fast, you can't make them happen fast, and you just have to be planned and methodical and patient and stick to your stick to your guns and good things happen over time. And so that's been a pretty practical lesson to apply to the health care environment, which will eventually come around, I'm sure yeah, yeah, we will and we're getting close and you know what?
Speaker 1:I think, the last guest we had, we had this conversation and and now with you here, I I now know more than ever that ellen we get, we pick guests because they do iron mans and stuff like that. So so here we are again with yet another guest that has these shared interests with Ellen related to little things like Ironmen and Ironmans.
Speaker 3:Is it an Ironman or?
Speaker 1:Ironmans, how do you say?
Speaker 3:I'm a sporty girl. That's the bottom line. I'm a sporty girl.
Speaker 4:No arguments from this. Try to be well-rounded, right. Yes, pets and musicians, and outdoor activities.
Speaker 3:I play one on TV, but let me assure you I am rocking the top knot most of the time of my life in sporty clothes.
Speaker 1:I like that. Yes, tell us about it.
Speaker 3:What is it? First of all, we had to define who Nikki Sixx is.
Speaker 4:That's right. What is an actual Ironman In the spirit?
Speaker 3:of Nikki Sixx, I think I know what an.
Speaker 4:Ironman is Complete an Ironman there's got to be some questions I'm not allowed to weigh in on right. I think I know what an.
Speaker 1:Ironman is Can I try to guess? Yes, okay, it's running, swimming and biking.
Speaker 3:Yes.
Speaker 4:Okay, I don't know the distances though Excellent, that's so much better because oftentimes if you hear Robert Downey Jr's name come in, it's the wrong Ironman. We're not talking about that. So, yeah, the distances the Ironman refers to a specific set of distances. Of course, triathlon is the sport itself. And then when you say to someone I ran an Ironman or I'm training for an Ironman, it's a specific brand and it's indicative of certain distances. Oh, okay, and those distances in an Ironman are 2.4-mile swim, 112-mile bike and then a full marathon which is 26.2 miles of running or walking or crawling, as it may be more often than not the case. So, yeah, to say you do Ironman is indicative of that's your level of commitment and again, like the aquarium hobby, like the healthcare pursuit, it's fast if you're really doing it. Well, it's very slow in my case, but it's methodical and it's a great day out. No, that's not true.
Speaker 3:I just want to be clear that. Okay, so I had, as Dave and Justin know, cause we have all worked together for 20 years off and on. Yeah, and they truly are my brothers and um. So I had my Ironman phase. Right, we all have our phases, but I was half Ironman phase.
Speaker 4:I just want to be clear.
Speaker 3:But I will tell you, the half is always my distance. I love a half marathon, which is 13.1 miles. I like half distance. So the half Ironman was like perfect for me Super competitive, ended up going to world championships, got my podium there. It was amazing. And Kona. So I am jealous, though, because Kona is on my list. But what I've decided is I don't make good life choices when I'm training for races. So now what I do is I train with friends who are doing races so that I can say no, right, they're still on the ball. But then I say no, but I am saving for the Ironman until I'm in my 60s, because then not as many fast girls show up and I have a better chance at qualifying for world. So so when you said, in my case you're not telling the truth, because you also shared with us that you qualified to go to the world championships fire and man, and I know race times and I know your age group and you're not walking it.
Speaker 3:Let me be, clear, so tell us, tell us about your most recent experiences.
Speaker 4:Yeah, ironically, I think it was this weekend. It may have very well been, it was September 10th of last year?
Speaker 3:Did you do Utah?
Speaker 4:No, I did Nice, france, okay, and it was this weekend last year. It was a great privilege to go and you know.
Speaker 3:Oh Worlds, I'm sorry, I thought you were talking about your qualifying.
Speaker 4:Oh my apologies. No, the last full distance Iron man that I actually did was Worlds, literally almost a year ago today. Oh so apologies, no, the last full distance Ironman that I actually did was Worlds, literally almost a year ago today.
Speaker 3:Oh, so you've just right, exactly.
Speaker 4:And then have been doing a number of things over the course of the summer and the spring.
Speaker 1:I don't want to say I took the year off.
Speaker 4:That's not even accurate. But as full distance Ironman goes, that was a pretty fun day for me and so we're in a little spell. We'll do a half here in Florida in December.
Speaker 2:So, that's the next one on the books, and yeah.
Speaker 4:and then to your point about Kona, I have the privilege of saying I'm already locked for October of 2026.
Speaker 3:Nice. So you're re-qualified and you get to go to.
Speaker 4:Kona. You will be in Kona, yes, and realizing that dream. So one of these days, very soon.
Speaker 3:Yes, anyways, all right, I'm geeking out on this. I learned?
Speaker 1:what I learned here is that a triathlon can be as long as it's the three events swimming, running and bicycling. It can be different distances. Exactly so now what I'm wondering is that Justin and I could do a triathlon we could do a sprint.
Speaker 3:Do a sprint triathlon, or when I get back.
Speaker 1:Absolutely when I get back to my friends. Maybe that's an event.
Speaker 2:Have you ever seen what these people look like swimming, like crashing into each other?
Speaker 1:I'm talking about swimming 50 yards, biking about half a mile.
Speaker 3:Well, a sprint is. I think sprints is a very manageable distance.
Speaker 2:Absolutely Well. It's something to. We'll have a future podcast episode about our Dave and I training for it. Okay, love it about our Dave and I training for it Okay, love it. Let's do it All right. No more triathlon talk for now. Okay, for now, partying the fronts over.
Speaker 1:Yeah, it is Wah-wah, wah-wah-wah.
Speaker 2:So let's talk about what you think could affect real change, and that real is in caps, because that's what we ask all our guests in this important issue, and so I'm really interested to hear what your thoughts are.
Speaker 4:Yeah, you know, and it was kind of queued up in the introduction and I really like that. That was the case, right, I think. Most simplistically put, I think real change can happen independent of your space within healthcare, right, Because we speak of healthcare writ large, but what people fail to capture is there's so many parts to health care, there's so many segments of health care, focuses, niches, et cetera. To effect change, though, I think, is a universal answer, and I think when the system again the royal we sees patients as a story, doesn't see them as their chart, as some of their medical diagnosis, as a billing code or part of a sequence of events, as a billing code or part of a sequence of events.
Speaker 4:When you look at someone and you see a 56-year-old engineer who's just trying to get to their daughter's graduation, if you see someone as a mother of three who wants to make certain her kids have the most time with them possible, your approach to delivering care changes, your empathy changes, your look at what is the best care for them changes, and that follows all the way down the pathway. Your views on reimbursement change, your views on follow-up and accountability change, and it sounds so simple to do, but it's the old butterfly effect right, or dropping a stone into the water and watching the ripples take. That initial approach has such long-lasting ramifications to the entire system that that's just kind of the soapbox that I like to get on, because you say what one simple thing can really hold impact and change. That's where I always start.
Speaker 3:I will say this I wanted to be a physician when I was growing up and I couldn't cut it in college chemistry and so then I got into the business side of health care eventually and I always said I feel like I can impact people's lives if I can help bring outcomes-based payment transformation, healthcare delivery into mainstream medicine. Because if physicians are incented to help people with their outcomes right which is this idea of the person as a person with their story, how to handle that, as opposed to how many times they can come see me so I can get more money right? So I'm totally with you that it is. I've always believed that that paradigm shift is absolutely paramount to shifting and really affecting change.
Speaker 2:So yeah, I think it's needed. In our system today, the way we're so fragmented and it's very easy just to look at somebody and treat like just where you are within the spectrum, as opposed to like looking the person holistically and really understanding what it? Is Like they're a person, you know person first.
Speaker 1:That's why you're a perfect guest for this podcast, because we've literally spent decades I mean decades on payment transformation right, shifting from fee-for-service to value-based care and outcome. So tell us the good, bad and the ugly in terms of shifting from fee-for-service to value-based.
Speaker 4:Well, I'm glad I bring more than knowledge of 80s hair metal.
Speaker 3:Yes, you do, and that's why we always have the party in the front.
Speaker 4:The layers of the onion right.
Speaker 2:Don't discount the effectiveness of that. That was very effective.
Speaker 4:You find your in where you can right Justin's like, let's just wrap it now.
Speaker 1:We're done.
Speaker 4:It's a fantastic podcast.
Speaker 4:Yeah, the goods, bads and uglies of transformational healthcare delivery. Right, I'll actually probably avoid the the ugly I don't know that ugly is is necessarily a component of this to me, but I think goods and bads are a fair starting point. And I think there's an old adage and I'm not going to give credit properly, but you know there's a saying, and apologies to whoever coined it. You know every system is perfectly designed to get what it gets right. And and you know it sounds simple when it's said out loud, but when you really stop to think about it, you know it's not the system's fault, it's how a system is applied. And if you don't like the results you're getting, you work on how that system is built right. And to that end, we at the organizations that I had the privilege of representing, with both chapters and Care New, had said okay, our problem is not the people, our problem is not the patients, it's not the payer mechanisms, the problem is the system. And if we don't like that, then we should take the bull by the horns and try to address the systemic issues. And in doing so, we focused first on the good. What is the best part of what you do? It's your mission, it's your orientation, it's your calling, and in our specific line of work, which really focuses on care for the chronic ill, the elderly, the frail, right, as opposed to you know more the maintaining the wellness of the youthful populations, things of that nature, you know we have a very specific population that we look to work with and in that process we realized we needed a very specific type of employee base, right, and so you can start to see where this goes. Now you have a different group being served than has historically been served. You have a different workforce being cultivated and nurtured than has traditionally been cultivated and nurtured and you start to build a system in its own right and eventually and listeners are going to be asking that sounds great how do you get paid, right, if you bring a value proposition to the table that says, statistically we're different, culturally we are, know, as care outcomes go, we're different, we're targeting a population that's different.
Speaker 4:You have created a system, or you have at least embraced a system, differently than exists today and that creates audiences, that creates buy-in and it creates sort of that cultural competency and currency of an organization to say, now we have enough traction to do this differently than others, right, the bad is if you don't have the good fortune of an organization to be nimble, to be quick to change, to have stakeholders who are lined up behind you on this journey. You've got some headwinds right. It's not a secret. I'm going to again screw up the numbers, but the concept is accurate. The United States economy is one of the largest in journey. You've got some headwinds right. It's not a secret. I'm going to again screw up the numbers, but the concept is accurate. The United States economy is one of the largest in the world. Our healthcare spend as a portion of our own economy is one of the largest parts.
Speaker 3:Four trillion, four trillion. I thought it was four, six Over four trillion. It's like four and a half.
Speaker 1:I didn't want to take a chance on record of getting it wrong, but I feel that much better, but the per capita expenditure is twice as much as the next.
Speaker 3:Yeah, and our outcomes are the worst.
Speaker 1:Bingo. You finished my statement.
Speaker 2:Sorry, no, no, absolutely. We're finishing sentences now.
Speaker 4:This is going Very prescient crew, you know, into that end. That means there's a lot of system already in place. There are a lot of stakeholders or a lot of investors or a lot of protocols. If you, as an organization, are going to build from the ground up, you have the good fortune of saying yes, we don't have a lot of traction today, but we get to start this the way we want it to be. If you're a very large institution with years of muscle memory, so to speak, you're going to have a different path to that. But to your point about good and bad.
Speaker 3:You know, it's still a system and, like any system, it starts with moving one brick at a time, one Lego at a time, one block at a time, however that looks, and you just have to determine your path. You said it really well and I want to go back to this point. It is and you didn't say it exactly like this, but it was the idea that, economically, you have to align with the outcome. So, hey, look at the savings that I'm generating, look at the economic value that I bring in the model of care that I have created, in the system of care delivery that I have created, that I have created in the system of care delivery that I have created. And you're willing to stand up and say and I'm confident in that and I'll stand behind that commitment and guess what, if I save that money, it's mine to keep, but if I lose it, it's also mine to lose.
Speaker 3:Unfortunately, that's where we, again, we have created a system that doesn't require that, where we, again, we have created a system that doesn't require that. And so to your point if you're reporting to a board that's used to seeing margins on a bed, on a stay, on an admission, on a DRG basis right, it's very difficult to think about the financial risk associated with a $12,000 a year premium versus an $1,800 daily bed rate. Do you know what I'm saying? Absolutely, I think that's a really important aspect of value-based care that people can't seem to get over. And then we all point fingers at each other, right, but there is an absolute that when you create the value, they will come. That's right.
Speaker 4:Well, you know, and I tend to draw oftentimes bad metaphors or bad analogies, and I speak in them and my team has just gotten used to it so they can decipher what I'm trying to say. So I'll be very kind to the audience and not go down that path, but I will attempt one shabby one. You know, last night, as I was kind of just thinking through tomorrow, as we often do, I was like all right, what are what are going to be my speaking points? How is this going to come out articulately? And I kid you not, in the time that I was just sitting there with TV running in the background, two or three law firms came on and the same adage was there you don't pay anything unless we win right. And then there was a pizza at a local pizzeria. It's like, you know, if you're not completely satisfied, get your money back.
Speaker 4:And I thought to myself accountability and value-based exists in almost every other line of work. Why is healthcare the last and it so often is the last to adopt what the rest of the world knows about? If you have a product and you're confident in your delivery, and if you are accountable to the results and you're an expert in your space. The notion shouldn't scare you. The problem exists as people have gotten comfortable and people have these well-oiled machines and expectations. People have gotten comfortable and people have these well-oiled machines and expectations. So oftentimes I would tell people you probably have more competence than you realize. What you have lacked is a purposeful strategic plan on how you change other stakeholders' views on this. I doubt very sincerely you've had any guest on this podcast who doesn't believe they're providing top quality care to their patient or their member or whomever their population is. But you probably had more than a couple who said but I wouldn't be able to convince other people to go a different direction. So that's what I usually focus my conversation.
Speaker 3:Well, I think part of it is. It's also just a fundamental. I just want to be clear too is taking insurance risk is very different than offering healthcare delivery, and so it is a it's a bonus if you're willing to do that and and, quite frankly, there's no incentive to do it and it's much scarier to do it. So I, so I get it. So, justin, you have a lot of experience. I mean you're like the king of experience. We, we have worked with you to implement a lot of the value based care care, but I mean you speak from this experience.
Speaker 2:Yeah, no, absolutely, and a lot of that comes from you mentioned product right, and then we're talking insurance risk. We have so many different systems, right, and when I say systems, we're talking Medicare, commercial Medicaid that have different insurance amounts tied to the individuals right, that you would be taking risk for In my background it was a fully integrated plan for Medicare and Medicaid right, so you're able to take both sets of dollars together, right, and provide a more unified bring those stakeholders together that you've talked about in a way that you know when you're siloed you just can't. So I guess where I go to is I found the value, particularly for community, home and community-based services. Can you tell us your thoughts about home and community-based services and what you've worked?
Speaker 4:Yeah, more than pleased to. It's always one of these moments where that's a wide open door that I kind of run full speed through. And so I tend to also realize, as I've listened to these you know encounters in my past, I like it when people give me an example, something that's live to work with they, our PACE centers not too long ago, and for those of you to the uninitiated, pace is the Program for All-Inclusive Care of the Elderly. But to your point, it is a Medicare-driven program with a Medicaid component, so you have the federal and state elements and, to your point, it is a fully integrated delivery focused on that home and community-based approach. So it's kind of the perfect example to play with as we speak. And you know I had.
Speaker 4:If any part of my next statement comes out as my taking credit for my team's good work, let me apologize in advance, because these people are phenomenal, the staff are phenomenal, the members are phenomenal, the participants are phenomenal and in this they're engaged in their own care.
Speaker 4:By the very virtue of how PACE is set up, it looks to reward living right. It looks to reward experience, it looks to see people as that story that I spoke of initially. And yes, there are absolutely medical components, right, you know, multi-specialty care, primary care, any unexpected or unplanned episodes that might come through. But the real magic happens in their social engagement, it's in their travel, it's in their family engagement, it's in their travel, it's in their family story, it's in coming to the Pace Center. And it really is illustrative of, to me, that perfect Venn diagram of where great attention to social determinants, great attention to the medical components and great attention to that psychosocial, spiritual, emotional component intersect. And that, to me, is value-based care. Value-based care, I know, carries a connotation of upside-downside risk, sub-delegation, capitation, all those terms, and that's fine.
Speaker 4:That's a part of it, that's the financial, that, to me, is the economics of it, that's not the delivery of it, it's not the heart of it. Right, you pay your check at a restaurant, but the restaurant is not about the check. The restaurant is about the experience, right? And so, to that end that's what we always say we define value-based care. The setting is home and community-based. It's where patients and families want to be, it's where outcomes can be delivered and it's where the highest level of engagement in someone's social and emotional well-being takes place. The model is a proven chronic illness model that you know, as you might expect, is rooted in statistical outcomes and clinical outcomes, and the social side is based in the health equity components of this. And we, as an organization I won't turn this into a commercial, but have aggressively pursued health equity certifications because we believe in that three-legged stool, if you will, of how to approach true value-based care.
Speaker 2:So these models have been around for decades. This is what I like to bring up in a lot of the discussion, because we tend to think like ooh, the latest new idea is the greatest. I am super passionate about PACE, the fully integrated programs, but they've been around for a really long time. Why do you think they're getting more traction, particularly PACE, at this point in time?
Speaker 4:You know I don't ever point to one moment, right, you know, it's almost like asking somebody how did society get the way it is? There's no one moment. There's certainly a precipitating set of factors, but let's lay out a couple of those. One, you know the aging population supply demand curve is clearly something that everybody is aware of. A diminishing workforce, a rapidly multiplying population in need of care and that dynamic has shifted.
Speaker 4:You have the you know, adult, the sandwich generation, where adults caring for children and their own parents, right, and so where often does that happen? In the home, as opposed to you know the other piece. And then it's even very simple but kind of mind-blowing numbers. We built a health care ecosystem around the few days a year that you're in a hospital, a physician's office, a nursing home, never really fully giving credit to the fact that you're probably in your own private residence 300, 300, 320, 350, if it's a great year, 360 days, right, sheer percentages. Why is more of the healthcare ecosystem not driven where you're at 90, 95% of the time, right. And if you really think about wellness or sickness, or proactivity over reactivity, that's where that's going to happen Lowest cost, ideal setting, most engaged patient population and ultimately gives the clinical practitioners themselves that sense of fulfillment that many of us daydreamed about and tried to really make a difference.
Speaker 2:So how do we get?
Speaker 4:a pace on every corner.
Speaker 1:Well.
Speaker 3:Walgreens has real estate available because Bill and Jim D is opened up. I think there's a new business model coming out. So, do you want to answer that? Because I have another question how do we get a pace on every quarter? Do I get any free?
Speaker 4:passes that I can take. I know I think honestly it's. You know I hate the word grassroots because it has such an overplayed usage, but the reality is it's to your point. It's been around a long time. You don't find anybody who has experienced it and not liked it, which you find more often than not, as those who have said. I don't know what that is. It's like anything in its organic state. You really just need to look for every opportunity to promote and discuss and press, and so thank you for that being here today. Secondly, it's as the members themselves are engaged. It's having them tell the story, and then, of course, there are legislative and political components to that too. Anything that's codependent on budgets at a state and federal level has more headwinds than a lot of programs do as well. But whether it's PACE or whether it's Accountable Care or whether it's any of the other programs that approach this, you're starting to spread the word.
Speaker 3:So that was going to be my next point programs that approach this. You're starting to spread the word, so that was going to be my next point. So a lot of people bash CMS and, believe me, there's a lot of stuff that they do that is, I think, a little bit too aggressive and it aggregates sort of ambiguously and it shouldn't. But CMMI, in my opinion, is one of the really good things that came from ACA and there have been a lot of really good programs that have come out of that, and so the one that I want to talk about a little bit today is Guide. So it's one of the new.
Speaker 3:So, just to put this into context for the people that are listening that may not know, this is, cmmi is the innovation center under the Centers for Medicare and Medicaid right, and they have, in the first decade of their existence, they put 50 programs in place and they are all value-based programs and their goal is that every Medicare and most Medicaid people will be under a form of value-based care by 2030. And that's only six years from now. So that's a very aspirational. That's their second decade plan. So this new program, guide, I think, is a perfect example of what we're talking about so, and we've talked to a number of clients that have implemented it or are going to implement it as part of their value-based care portfolio.
Speaker 3:But it's those that are listening. It stands for it's a new program. This year it's Guiding, an Improved Dementia Experience. I have to look at that because it's a new acronym for me. Unlike the other ones, I can spit out still at the top.
Speaker 1:CMS never puts out new acronyms. No, no, no.
Speaker 3:But this one, actually, when you talk about the sandwich generation, this one's actually near and dear to my heart, because my mom was recently diagnosed with moderate to severe vascular dementia, which again, for those that are listening, that was that is actually a will be her cause of death from being an uncontrolled diabetic for 10 years. That that's it. And so, like, when we talk about, you know, cardiometabolic disease and we talk about all these things that are happening in your thirties, your forties, you're setting yourself up for that dementia right, she set herself on that path, but we are now finding ourselves as a family trying to navigate dementia right, and so I was like I've got to ask Andrew after this if he has anything over on the East Coast, so tell us. You guys are one of the inaugural participants in the guide program beginning this year.
Speaker 4:Yes, absolutely correct. There's about a dozen things in there I wanted to get to. Yeah, I figured, I figured, I just asked you like a ton, but this is a really I love talking about these value-based programs.
Speaker 4:So on. I think we got here by the route of you explaining where CMS and CMMI sort of motivations lie in that 2030 deadline. And it's funny you say that. You know, in our office I have a little countdown clock right and it's actually set to 2030. And I don't remember the last count. I think it's a little over 2200 days, probably give or take.
Speaker 4:But that notion is that that to us, is a bit of the North Star right. That is that moment where and they've not shown any wavering from that commitment with emerging models and with recommitment to those models and making them move from, you know, demonstration projects into statutory projects or programs, you know. So we believe fully in the 2030, you know ambition right and chapters and Care. New, by its portfolio of business investments, are all in on that. And so the guide model was one that we pursued with vigor for several reasons. One it fits our core audience, our core disease management platform.
Speaker 4:It's certainly something that many of us have a personal connection with. I do have no problem giving a shameless plug. I had the privilege of serving on the Gulf Coast chapter of the Alzheimer's Association board and those folks do just do tremendous work. And for those who have ever personally experienced it with a family member, professionally experienced it in a clinical caregiving setting, you know the stress it takes not just on the patient but on the family as well. So when you start to look at CMMI, investing in models that are equally focused on caring for a patient but also the patient's social environment, that to me is a giant leap forward.
Speaker 4:Right, there's lots and lots of programs out there, all of which are exceptional, but they're very clinically driven. Right, it's all about a certain test, it's all about a certain threshold. There's not as many models that are focused on that social component, the familial component, the societal component, and you start to see things like ACO, reach and the guide program, and I want to give credit to the federal team for realizing and bringing. You know it's a big ship, they always say. You know, turning a giant ship takes time. So this to me is no small feat. Right, they're starting to move into things that are disease specific. But take into account those three circles that I say create the ideal Venn diagram for successful, value-based care.
Speaker 4:And this is just yet another illustration of it. Right, and so you know I have nothing, but we haven't seen a kickoff yet. Certainly there are bumps or rough edges to any program, no matter who administers it, so we'll get through that. But yeah, we're certainly excited about that.
Speaker 3:Yeah, it's good stuff.
Speaker 1:Yeah, got to give them credit 50-plus programs in the first 10 years.
Speaker 4:Yeah, yeah, I mean I try it. When we come Friday night We've got to figure out where we're going to have dinner as a family.
Speaker 3:We there's four of- us and we can't settle on one answer. I cannot imagine finding a perfect solution for all of America. We can't even have family movie night anymore in my house, like literally, I think we can have one a year.
Speaker 3:That's when everyone has their phone out staring at something different, on the couch together, or like you get into a huge it's either you pick something and within five minutes someone leaves or you get, or you or you get in such an epic fight that you can't even pick a movie, and then someone storms off and then you end up with like two or three people at best, and then I end up just going to bed. You know it's like well, we try.
Speaker 4:I'm going to work on health care, some things I've given up on.
Speaker 3:Getting a little more serious.
Speaker 2:Like I say serious, no, sorry, go ahead. Serious about your legacy. Can you tell us what your legacy like your legacy to be in healthcare?
Speaker 4:That's a great question and there's, you know there's so many. I'm going to address it from kind of an organizational perspective because certainly what I ambition to do is very different.
Speaker 2:And maybe I'll answer both just to give the listeners a wider view.
Speaker 4:So, organizationally, if this all happened tomorrow, if I retired tomorrow and Chapters said that's it, we are just going to freeze everything we've ever done and we want to be remembered for this day.
Speaker 4:I hope that people remember Chapters as an organization that was focused on three things First and foremost, a superior experience by not just the patients but their families, the volunteers, the patients but their families, the volunteers, the donors, the philanthropists, everything that we support. We wanted to have changed how our communities viewed the resource that we were, because that does you know ebb and flow, where some days we're doing lots of things for lots of people, other days we're more focused, but we want to always be able to say we've made a big difference. We weren't a transactional part of someone's life, I would say. The second piece that would be a great legacy organization to leave is that little eye roll when someone's like man. They were always on the edge, they were always pushing the envelope, they weren't afraid to try Bend, don't break. Be innovators, right. I would be really sad if we were ever thought of in the same sentence as the word status quo.
Speaker 3:That would be a fail to me. It would be the opposite of legacy.
Speaker 4:Exactly right, I mean that's certainly a legacy, but it's not one that we want to leave and I'm not suggesting there's not a place for that. There's great parts of healthcare that don't need to evolve as much. That's just not where we're focusing our time, and I'll offer you this one, because it he made the team his focus and in doing so, any success he may have incurred was done the right way.
Speaker 1:We have.
Speaker 4:I think we're trademarked. If not, we're working on being trademarked On a phrase that I believe very passionately about, and there's only two jobs. No matter what our HR team would say, the manual is bigger than this, but there's only real two jobs at our organization, and that's be caring for patients or caring for those who do. And if you can't look at the stack of work on your desk and correlate it to either improving one of our team members experiences or one of our patients experiences, rethink your priority set, because I do strongly believe that that is the. You know, those are the lead measures that ultimately create the change that you're looking to implement. So, as legacies go, personally I want to have been that kind of leader in organization. We want to have left that kind of mark.
Speaker 1:That sounds like a piece of cake, though.
Speaker 4:Done and done. I mean, all you got to do is say it and will it into existence, right?
Speaker 1:All right. No, I mean you talked about in-home patient care and all that, and it's like what did you say? Say that one more time Either be caring for a patient or there are two jobs at our organization be caring for patients or caring for those who do I love that that's fantastic.
Speaker 3:So what are some of the key areas that have to be addressed to move towards value-based care? For those that are listening, they're like, if I have to do it by 2030, maybe I do have to start thinking about this. I was on a call this morning talking about this with the health system that's fully integrated with the change management that they're dealing with, to try to move more towards value and away from fee-for-service transactional.
Speaker 4:That's right, and so you know we've we've had this laugh. You know, uh, executive of my team and she's shy individual, doesn't like to be called out by name, so I'll avoid that, but she's listening right now. She knows I'm talking about her. You know, she asked me once. She said so what are we going to do when we're successful?
Speaker 1:I said that's a great question, right?
Speaker 4:Because if you sell this to your board or to your investors, or to your stakeholders, or whomever it is you need to help convince, come on this journey there's going to be a moment where they look at you and say, that's a good idea, let's do that, and then it's going to land back in your court. You know it's intellectual tennis. Now the ball is back to me, and what am I going to do with it? So here's what I would suggest You're going to call BP too. That's right, there you go, sorry.
Speaker 2:It starts with this. Now work from our sponsor.
Speaker 4:But wait, there's more. Yeah, we can have some laughs about that, but that is not an inaccurate statement. There are answers out there. This is not something that's never been done. It's not something that can't be done. It just requires, like we talked about with an aquarium or with a 10-hour, 12-hour, 15-hour race. Right, it's one step at a time and you don't think about a finish line or finished product. You think about the next water station, you think about the next waypoint right and, for those of you who've ever done a marathon, half floor.
Speaker 3:I'm envisioning the. I'm literally envisioning putting ice in my cap as I'm trying to finish the last three miles of the run.
Speaker 4:Yeah, yeah, a race medal is a long way off. I need a cup of Gatorade. It's got to get there next. And to that end, I would say that design, or the migration to value-based care, follows a pathway. Take a look at your organization and everything that you have built. Check that right. Is this ready? And if it's not, then you have to make sure in your following kind of a rate limiting or a lowest common denominator approach. So, is your workforce ready for value-based care? Are their compensation structures aligned to quality over quantity? Are there recruitment, training, development, retention tools? Are there promotionary pathways for those who perform well, because it's not about necessarily tenure? There are some skill sets. That translates better. You can follow the workforce path. That becomes very real.
Speaker 4:What are your capital needs? If you're going to have to have reserves to take a dual integrated plan to be in an ACO, right? Do you need to drive margins for a few years in order to put reserves on the shelf and make that migration? Do you have an outside investor? Do you have to change your real estate portfolio to be less intensive on acute care structure and more on home community based? So there's that component right, and then you have to look at your business acumen. Who is handling your contracts? How locked into certain things are you? What is your ability to handle a massive switch from revenue streams based on you know all? So all these components are things. There's not one solution. You don't wake up one day and hire a value-based care expert and say now go, do your thing. In a vacuum.
Speaker 4:Value-based care is not a niche. It's not a single provider or single service line. It has to be kind of an organizational ethos, and that's what I would suggest to people is. Value-based care often carries this sort of business acumen connotation. What I would suggest is is your company or is your organization ready to move to a quality over quantity approach? Because that's a little bit different. You can embrace quality over quantity and still keep a lot of your traditional business models, but it will change the whole ethos, which is a nice transition to when you have to put your money at risk. Right, if you're just really focused on quality, you can still be in a fee-for-service environment, delivering exceptional, innovative care and starting to squirrel away a few dollars for when you have to put some things at risk in the more traditional definition of the word. So I'm all over the place.
Speaker 3:But Well, no, I think and I and I appreciated what you said too about you can't just hire a value-based care expert, because it's true, it's, it is, it is change management and you have to operationalize some things. You have to it's and and like, we have a lot of times where we literally get the call because McKinsey's come in, or some big firm has come in and dropped it, and everyone's gone, yes, we're going to do value-based care, and then they leave and everyone's like what do we do now?
Speaker 4:You know like.
Speaker 3:I mean, now we have to do all the things that you just said and we don't. We don't even know what all those things are. And then that's when we get the calls like, well, can you actually make us, help us do it, because you know it's like it's, it's a, it is, it is redesign, it is structural redesign, it is system, it is really system redesign, it's engineering, almost right, it's like how do I re-engineer my wife and I?
Speaker 4:we like to pick at each other because she's, you know, also in the healthcare space, and so our, our, our dinner talk is quite interesting, but she got chickens not too long ago and I kind of chuckled. I said so are we a farmer now?
Speaker 1:Yeah, Actual chickens egg laying chickens.
Speaker 4:They're in, they're in a coop and the whole thing yeah.
Speaker 1:Yeah.
Speaker 4:And if you ever came to know me as an individual, you know this is about as far from my natural tendency as possible and I said are we farmers? And she said, oh yeah, cause when you have a chicken you're automatically a farmer. But I kind of laughed because I, you know, the analogy here is apropos. You know, so are. Does a value-based design make right? It's a commitment. You know, if you want to be a farmer, and a good one, you need the space, you need the acumen, you need someone to teach you, you need all the equipment, you need to understand the weather patterns. To be in value-based care is not just a trend or a current payment model or a single contract.
Speaker 3:It's a. Thing. So Justin you're trying to jump in, sorry.
Speaker 2:Well, now I know how he's getting in such good shape, as he's chasing the chickens around. You know they like their eggs.
Speaker 1:So when do you become a farmer? Do you have to have pigs too, or what's the where's?
Speaker 3:the line. Oh, you're getting ready for the last question.
Speaker 2:Yeah, so yeah.
Speaker 3:Wait, yes. Do you have a definition of when you become a farmer?
Speaker 4:Uh, I think we were done when, when my legacy is left because I don't have farming in my future.
Speaker 3:But we have a last question for you.
Speaker 2:We do so. We ask all our guests what their buy a world of Coke or pigs when pigs fly?
Speaker 1:When pigs fly. That's where I was going. Yes, right Segway.
Speaker 2:For fixing the health care system. So what is yours?
Speaker 4:I kind of gave away my secret a little earlier you know and I don't know if this is the technical definition of how the phrase Occam's razor is used.
Speaker 4:But but what I'd like to impart is I do actually believe that the solutions oftentimes are as simple as they're presented right. Healthcare at its core yes, there are, you know, components. Yes, there are, you know, tests and diagnoses, codes. Those are all very vital parts of it, but what it really is is humans caring for humans for the most part. Now AI takes over and we're all working for the machines. We'll revise this podcast then, but until that, day the machines will revise it for us.
Speaker 3:They'll do it for us.
Speaker 4:I wouldn't even need it for that. But until then I think we have some time. It is humans caring for humans. It is not humans administering tests to humans. Caring is, I think, the critical word. So when we at the organization believe you have two jobs, tie the work on your desk to one of two jobs taking care of our patients and if you're not in that capacity, then you're taking care of those who do. That to me, I believe, would fundamentally shift healthcare.
Speaker 4:There's a lot of headwinds to getting there. There's investors who need their money back. There's regulatory statutes that keep things from getting done. There's a lot of red tape involved. It's what we've built. We can unwind it, just the way we wound it. But I do think it starts with fundamentally recognizing that health care, when done right, whether it's acute, post-acute, non-acute, whatever it might be, it is fundamentally humans caring for humans. It is fundamentally humans caring for humans. And if we can strip all the noise and all the layers of nonsense away from that principle and direct our resources, our time and our attention to that, I think things change Well mic drop, that's it and that would be my Coke, because my wife would disown me if that was my Pepsi.
Speaker 4:We're a Coca-Cola household unwaveringly Well sometimes.
Speaker 1:I mean, is that the cue for the song?
Speaker 3:No, oh, come on, we aren't going to sing it today.
Speaker 1:We're going to get a season to sing it. Do it real quick, do it real quick. I'd like to teach the world that was it. Never mind Forget it.
Speaker 3:All right.
Speaker 2:It's only a matter of time before Coke suites us Right, so we've kickstarted my heart If you want to do that, no.
Speaker 4:They would that I was not. I'll be a farmer before I'll be a big deal replacement. You're like thank God you didn't keep singing because I wasn't ready for that. Well, andrew, thank you so much for your time today. We appreciate you coming my pleasure. Thanks for highlighting something so important to us.
Speaker 3:Well, thanks again. I'm Ellen Brown.
Speaker 1:I'm Dave Pavlik, I'm Justin Politi. We are the partners at BP2 Health your best chance for real change. As you can tell, we talk about this stuff all day. It's on our website at 2healthcom.