Bright Spots in Healthcare – Details, episodes & analysis

Alec Peterson, MD, Chief Medical Officer of Acute and Specialty Care at Devoted Health, joins Eric to explore the innovative care delivery model that sets Devoted Health apart from other Medicare Advantage plans. Devoted Health uniquely integrates healthcare coverage with its in-house, virtual, and in-home care provider, Devoted Medical, in partnership with leading healthcare providers to offer comprehensive care for older Americans.

Alec shares the key strategies behind Devoted Health’s impressive success and delves into how Devoted Medical’s groundbreaking model has driven high member satisfaction and improved clinical outcomes. He also unveils the roadmap for achieving a 5-star rating from CMS for their Medicare Advantage plans in Florida and Ohio.

About Alec

Alec Petersen, MD, is an internal medicine physician and Chief Medical Officer, Acute & Specialty Care with the Devoted Medical team of Devoted Health. In his role, Petersen leads Devoted Health’s Care on Demand program and focuses on maximizing the potential of innovative at-home care delivery without overstressing an already maxed-out healthcare workforce.

After receiving his medical degree from Vanderbilt University School of Medicine, Alec completed a clinical fellowship and MBA at Harvard. Before his career in medicine, he served as a military intelligence officer. 

About Devoted Health

Founded in 2017 by brothers Todd and Ed Park, Devoted Health is a new kind of healthcare company providing all-in-one care for older Americans. Members of the company’s best-in-class insurance plans can receive care through their trusted PCP and complementary preventative care services through Devoted Medical, the first virtual and in-home medical group built from the ground up to serve the specific needs of the Medicare population. The Devoted Medical team of mission-oriented clinicians works closely with members’ primary care physicians and Devoted’s full-service Guides to deliver a new model of advanced primary care, powered by deeply specialized clinical programs and proprietary technology that enables intensive care coordination.

Rachel Winokur, CEO, TailorCare and Alex Bateman, CEO, United Musculoskeletal

Partners (UMP) join Eric to discuss the evolution and adoption of specialty value-based care, highlighting the significant improvements in patient care, customer satisfaction scores, cost reduction and value creation.

Hear how their two organizations partner with a commercial payer to manage musculoskeletal cases, ensuring they assess patients, understand their needs, and match them with the best providers in the market.

Rachel and Alex also touched on the keys to implementing a successful value-based care strategy and underscored the transformative power of data analytics in shaping the future of healthcare.

Segments

1. Origin Story

2. Payer Experience

3. Patient Experience

4. Pitfalls

5. Strategy/Building

An episode of The Bear, is referenced in the interview. Here is a link to a summary of the episode (Season 2, Ep. 2) https://www.imdb.com/title/tt26230348/

About Alex

Alex  is an accomplished, results-driven healthcare leader with 20 years of development and operations experience in multi-state, multi-site healthcare services organizations. He is a proven talent and team builder who adapts and thrives in the changing healthcare space. He is analytical, confident in challenging environments, and regarded as a top company performer in both leadership and growth/development.

About Rachel

Rachel is the co-founder and CEO of TailorCare, a risk-based care navigation and health management company that provides deeply personal, data-driven support and clinical access to patients living with joint, back, and muscle pain. Prior to founding TailorCare, Rachel launched Bright Health Group, a value-based healthcare company committed to managing population risk. She served as Chief Business Officer of Bright before serving as the CEO of NeueHealth, the risk-based primary care delivery, provider enablement, and network management company she created within Bright. Rachel built her career in executive and leadership roles at Aetna, where she helped start the health plan’s population health management division, The Carlyle Group, as a healthcare investor, and at Datascope, a public medical device company she helped take private. Rachel has previously held positions at Bertelsmann and Goldman Sachs.

About United Musculoskeletal Partners

United Musculoskeletal Partners (UMP) was formed in December 2021 by Resurgens Orthopaedics, one of the nation's largest orthopedic practices. UMP partners with entrepreneurial, physician-owned orthopedic practices to deliver exceptional clinical care to patients around the country while simplifying the management functions of the practices under one umbrella company. Website: www.umpartners.com

This episode is sponsored by TailorCare

TailorCare is a risk-based care navigation program that provides deeply personal support to patients living with joint, back, and muscle pain. By combining a careful assessment of patients’ symptoms, health history, preferences and goals with predictive data and the latest evidence-based guidelines, TailorCare helps patients choose—and navigate—the most effective treatment pathway for them, every step of the way. Website: www.tailorcare.com

Esteemed leaders from CVS Health, Florida Blue, Highmark, and Vori Health delved into the impact of health equity on chronic care. They not only shared strategies and solutions to enhance healthcare accessibility but also shed light on specific programs they have successfully implemented to bridge the health equity gap in chronic disease prevention and treatment. 

Guests:

• Joneigh S. Khaldun, MD, MPH, FACEP, Vice President and Chief Health Equity Officer, CVS Health

• Kelli Tice, MD, Vice President, Medical Affairs & Chief Health Equity Officer, Florida Blue

• Nebeyou Abebe, Senior Vice President, Social Determinants of Health, Highmark Health

• Mary O'Connor, MD, Co-Founder & Chief Medical Officer, Vori Health

https://www.brightspotsinhealthcare.com/events/navigating-the-intersection-of-health-equity-and-chronic-care/

Links to programs mentioned during the episode

• Advancing Health Equity | CVS Health: https://www.cvshealth.com/impact/health-equity.html

• CVS Health launches Community Equity Alliance to improve health outcomes in underserved communities: https://www.cvshealth.com/news/health-equity/cvs-health-launches-community-equity-alliance-to-improve-health-outcomes.html

• Spoken Rx - Prescription Reader | CVS Pharmacy: https://www.cvs.com/content/pharmacy/spoken-rx

• Highmark Community Support Platform: https://highmark.findhelp.com/

•  

This episode is sponsored by our partner, Vori Health

Vori Health is a specialty medical practice delivering a virtual-first musculoskeletal (MSK) solution to help members get back to their lives faster. As the only nationwide MSK practice with doctor-led care teams, Vori Health is the most convenient way to access appropriate care for back, neck, and joint pain without bouncing around the healthcare system. Whether members need a diagnosis, non-opioid prescription, personalized physical therapy, or health coaching, they can turn to Vori Health for evidence-based care and effective end-to-end support. This holistic model reduces unnecessary surgeries, enables faster recoveries, and lowers MSK spend with up to a 4:1 ROI. For more information, visit www.vorihealth.com.

Dan Fishbein, President of Sun Life U.S., joins Eric to discuss Sun Life’s commitment to supporting holistic care for mental health and how it leverages digital technology to enhance the overall delivery of mental health and caregiver support to all clients. 

The conversation also touches on how Sun Life is helping patients navigate a challenging healthcare system. It’s using data and analytics to identify trends and unmet needs and AI to summarize health records quickly to improve health outcomes.

In addition, Dan elaborates on Sun Life’s redefined role as a healthcare benefits provider and its collaborations with various healthcare organizations to help promote health and well-being. 

About Dan

As president of Sun Life U.S., Dan has transformed the company into a leader in health-related benefits and services that connect to the broader healthcare ecosystem to help people access the care and coverage they need.

Since joining Sun Life in 2014, Dan has overseen several successful acquisitions that have grown the company and its capabilities, including DentaQuest (2022), PinnacleCare (2021), Maxwell Health (2018), and Assurant Employee Benefits (2016). Since 2014 Sun Life U.S. has grown three-fold to $8 billion in revenues, offering more than 50 million Americans group benefits and services through employers, partners and government programs. It serves a block of in-force individual life insurance policyholders. 

Before Sun Life, he served as Aetna’s President, Specialty Businesses and held several other senior leadership positions during his 16-year tenure. He previously served in leadership posts at New York Life and MassMutual.

Dan earned a bachelor’s degree and a Doctor of Medicine from Boston University. He is a member of the Massachusetts Medical Society and Maine Medical Association. Dan is also a past chair and active board member of Spurwink Services in Portland, Maine, and serves in an advisory capacity on the board of Collective Health, an insurtech start-up based in San Francisco.

About Sun Life

Sun Life is a leading financial services company that helps clients achieve lifetime financial security and live healthier lives. Sun Life has operations in a number of markets worldwide, including Canada, the United States, the United Kingdom, Ireland, Hong Kong, the Philippines, Japan, Indonesia, India, China, Australia, Singapore, Vietnam, Malaysia and Bermuda.

Leaders from Ballad Health, Baystate Health, Stony Brook Medicine and Purple Lab share how health systems can take a more sophisticated and consumer-focused approach to attracting new patients. 

Our expert panel leads a thought-provoking discussion on the importance of seeing patients as healthcare consumers and understanding how they make decisions, what motivates them, and how, where, and why they engage with the broader healthcare system. 

You will discover innovative patient acquisition strategies and best practices you can implement in your organization to break through the market clutter, differentiate your health system’s offerings and create a message that resonates with customers.

Themes covered:

• Consumer Centricity & The Patient Journey

• Personalized, Data-Driven Marketing

• Health Equity

Guests:

• Ebrahim Barkoudah, MD, MPH, MBA, System Chief of Hospital Medicine and Regional Chief Medical Officer/Regional Quality Officer, Baystate Health

• Timothy Brown, Chief Communications and Marketing Officer, Stony Brook Medicine

• Molly Luton, Chief Marketing and Communications Officer, Ballad Health

• Ted Sweetser, Vice President, Strategy, Healthcare, Purple Labs

Bios: https://www.brightspotsinhealthcare.com/events/how-top-hospital-systems-are-capturing-new-patients/

We are proud to have Purple Lab as the sponsor of this event. Their support is Instrumental in bringing you this insightful discussion.

PurpleLab is a health tech company that puts valuable healthcare insights in customers' hands, enabling the healthcare industry to drive better outcomes through access to real-world data. https://purplelab.com/

Leaders from Independence Blue Cross, Oscar Health and TytoCare explore

how health plans can leverage various solutions effectively to optimize pricing structures; exploring technology adoption, cost-effectiveness, and market competitiveness. Our panel of industry experts will share successful strategies and real-world examples you can implement in your organization.

Topics covered include:

• Matching benefits with member personas

• Evolving virtual care beyond video

• Various innovations in product design 

• Bringing price transparency to ACA and Medicare Advantage products

• How to penetrate new, highly competitive markets

Guests:

Jonathan Stump, Vice President, Product Services, Independence Blue Cross

Bill Bradley, Vice President, Insurance Product Development, Oscar Health

Meni Shikhman, Vice President, TytoCare

Bios: https://www.brightspotsinhealthcare.com/events/differentiating-your-product-in-the-healthcare-insurance-marketplace/

This episode is sponsored by TytoCare

TytoCare is a virtual healthcare company that enables leading health plans and providers to deliver remote healthcare to the whole family through its Home Smart Clinic. Combining a cutting-edge, easy-to-use, FDA-cleared device with AI-powered guidance and diagnostic support, the Home Smart Clinic enables the whole family to conduct remote physical exams with a doctor, replicating in-clinic exams for immediate answers from home. TytoCare drives utilization rates that are five times higher than traditional telehealth services, reduces the total cost of care by an average of five percent, diverts ED visits by an average of 10.8%; and has a high average NPS of 83. The Home Smart Clinic includes Tyto Engagement Labs™, a proven framework of engagement journeys designed for successfully deploying and adopting the solution. To complete its offering, TytoCare also provides the Pro Smart Clinic, for professional settings outside the home to serve rural clinics, schools, workplaces, and more. TytoCare serves over 220 major health systems and plans in the U.S., Europe, Asia, Latin America, and the Middle East. For more information, visit us at tytocare.com.

Kody Kinsley, Secretary of North Carolina’s Department of Health and Human Services, joins Eric to discuss how his state is improving the lives of families and children by expanding Medicaid and improving the mental health system. 

Secretary Kinsley shares strategies for improving behavioral healthcare access and benefit design for North Carolina’s Medicaid and Medicare members, including peer support programs, mental health crisis lines, and data systems to track the availability of beds and individuals in need. 

The conversation also explores the importance of improving healthcare infrastructure through Medicaid, focusing on preventative measures and addressing social determinants of health. 

About Secretary Kinsley

Kody Kinsley serves as North Carolina’s Secretary of Health & Human Services, overseeing a department with over 18,000 staff and a $38 billion budget.

With experience centered on health policy and operations, Kinsley worked on digital healthcare transformation, national education, and labor policies and served as the COO and CFO of the U.S. Treasury.

Secretary Kinsley’s three priorities for the department include Investing in behavioral health and resilience, improving child and family well-being, and building a solid and inclusive workforce. Under his leadership, North Carolina expanded Medicaid and received the most significant investment to bolster the mental health system in over a decade.

Kinsley grew up in Wilmington, earning his bachelor’s degree from Brevard College and his master’s in Public Policy from the University of California at Berkeley. 

Leaders from Humana, Blue Cross, and Blue Shield of Rhode Island delve into the dynamic landscape of specialty value-based care, sharing valuable insights and actionable strategies for navigating its complexities. 

Show Guests:

Alexander Ding, MD, MS, MBA, Associate Vice President for Physician Strategy and Medical Affairs, Humana 

Nick Lefeber, Senior Vice President, Value-Based Care, Contracting, Data & Analytics, Blue Cross Blue Shield of Rhode Island

Rachel Winokur, Chief Executive Officer, TailorCare

https://www.brightspotsinhealthcare.com/events/the-evolution-of-specialty-value-based-care/

This episode is sponsored by TailorCare

TailorCare is a risk-based care navigation program that provides deeply personal support to patients living with joint, back, and muscle pain. By combining a careful assessment of patients’ symptoms, health history, preferences and goals with predictive data and the latest evidence-based guidelines, TailorCare helps patients choose —and navigate—the most effective treatment pathway for them, every step of the way.

Melissa Newton Smith, Founder of Newton Smith, and Keslie Crichton, Chief Sales Officer of BeneLynk, join Eric to discuss the introduction of the CMS Health Equity Index, which will replace the reward factor within the Medicare Advantage Star Rating program measurement. The Health Equity Index will be a seismic change for Medicare Advantage plans and impact revenue associated with Star Ratings. Melissa and Keslie share success stories from plans preparing for the change. 

Links

"Associations Between Annual Medicare Part D Low-Income Subsidy Loss and Prescription Drug Spending and Use": https://jamanetwork.com/journals/jama-health-forum/fullarticle/2814604

Book Links

$2.00 a Day: Living on Almost Nothing in America:  https://www.amazon.com/2-00-Day-audiobook/dp/B012E8RDS2/ref=sr_1_1?crid=29MW28TUOFAG0&keywords=%242+a+day&qid=1708126201&s=books&sprefix=2+a+day%2Cstripbooks%2C125&sr=1-1

Because I Said I Would: https://store.becauseisaidiwould.org/store/thebook/?_gl=1*qfwy3p*_ga*OTY3NTIzNTYzLjE3MDgxMjYyNDc.*_ga_9YFXHXM1VK*MTcwODEyNjI0Ny4xLjAuMTcwODEyNjI1NC41My4wLjA. 

The Ethical Case Manager: https://www.amazon.com/dp/194388918X/ref=cm_sw_r_apin_dp_GVBYY6XZGAK9RK9VRHE8

About Melissa

Melissa is the founder of Newton Smith. She brings over 25 years of experience in Star Ratings, strategy, sales, and marketing for health plans, providers, pharmacy benefit managers, and industry vendors. Most recently, she served as Chief Consulting Officer at Healthmine.

Melissa is a well-known healthcare strategist with proven success developing enterprise-wide solutions to improve Star Ratings, quality performance, health outcomes, and the member experience. 

About Keslie

Keslie has worked in managed care for over 25 years, focusing on SDoH solutions that improve members' lives and provide a return on investment for our clients.

Keslie drives enterprise growth and innovative partnerships to improve outreach strategies and health outcomes for our client’s members.  Keslie works closely with BeneLynk’s product team to offer differentiated services and capabilities to maintain its market leader position. 

This episode is sponsored by BeneLynk

BeneLynk is a national provider of Social Care solutions for Medicare Advantage and Managed Medicaid health plans. They serve plans and their members by creating a human-to-human connection and providing the assistance a member needs to get the benefits they deserve.

Leaders from Independence Blue Cross, Banner| Aetna, and Scene Health share exclusive insights on successfully accomplishing chronic condition management success with fewer resources. 

Our expert panel explores patient-centered and technology-enabled approaches that elevate chronic care management efficiency and effectiveness. Don't miss the opportunity to learn about strategic solutions tailored to the unique challenges of Medicaid and Medicare health plans.

Panelists:

Robert Groves, MD, Chief Medical Officer & Executive Vice President, Banner| Aetna

Reetika Kumar, MD, FACP, Vice President, Market Clinical Solutions and Pharmacy Services, Independence Blue Cross

Sebastian Seiguer, CEO & Co-Founder, Scene Health

Bios: https://www.brightspotsinhealthcare.com/events/meeting-goals-for-chronic-condition-management-with-fewer-resources/

This episode is sponsored by Scene Health

Meet Scene Health, the industry leader in MedEngagement. They are going beyond traditional medication adherence to transform disease management.

Scene’s MedEngagement approach uses 1:1 async video to deliver medication support at scale.

Scene helps members get better fast—getting to the doctor, getting their meds, taking them as prescribed, and getting labs and vitals—driving cost-effective utilization and improving multiple clinical and quality measures in as little as 90 days.

Scene was commercialized out of Johns Hopkins, and has developed the most extensive catalog of peer-reviewed publications among medication adherence companies. Visit its website at www.scene.health for more information.