Lisa Farren (Host): Hello, and welcome to Crushing Healthcare, where we explore diverse perspectives regarding the state of healthcare today and gutsy visions for a more affordable, accessible, equitable, and sustainable healthcare model. My name is Lisa Farren, and I'll be your host today. I am honored to introduce today's guest, Lisa Trumble.

Lisa is the president and CEO of Southern New England Health Care, also known as SoNE Health. SoNE Health is a clinically integrated network providing population health management support to its network providers. Since joining SoNE in 2020, Lisa has successfully led the development of the organizational infrastructure and capacities, including clinical and quality programs, governance and leadership structures, data, technology, and analytics to drive success in value-based contracts, which has saved health plans $144 million over the past seven years.

You can learn more about Lisa's impressive credentials and more about SoNE Health at crushinghealthcare.com. So now, let's dive in. Hello, Lisa, and welcome.

Lisa Trumble, MBA: Hi, Lisa. It's a pleasure to be here.

Host: Our theme for today's episode is the status of healthcare today. So, we are all healthcare consumers and have firsthand experiences interacting with the health system and our providers. Healthcare is something that touches us all. Over the past years in particular, the pandemic has placed much attention on healthcare. On the one hand, we've seen an outpouring of support and awareness for healthcare workers and their dedication to patient care. On the flip side, there is a heightened awareness for needed changes and improvements, including such things as healthcare disparities, access and, of course, rising costs. So Lisa, as a senior healthcare executive, how would you describe the state of healthcare in our country?

Lisa Trumble, MBA: Well, Lisa, I think the best way to describe the state of healthcare today is that there are a lot of exciting changes that are positive that present a future promise for our healthcare system, like the development of technology and new drugs and the advancement in more investment in primary care. But there are other aspects of healthcare that are concerning that we all as citizens and potential patients should be concerned about with our healthcare system.

Many of these concerns have to do with the fact that we have an aging population that's going to grow. We have a 50% increase in the Medicare eligibles that'll occur between now and 2030, and that'll increase the demand on the services that we have for healthcare. As people age, they require more complex treatments and more healthcare services than you typically do as you're younger. And the reason that this is concerning, as the demand is almost doubling, the workforce is shrinking in healthcare. So, we are having massive retirements and people leaving the healthcare industry for a variety of reasons, much of which has to do with lifestyle and, you know, what the pandemic has created for us, but also because some of those workers are actually retiring and aging out. So, we have increasing demand, workforce shortages at a time that healthcare expenditures are predicted to be about 20% of the GDP. So, this is a storm that we'll be facing in the next couple of years by, you know, the beginning part of 2025 that could create real pressure on the system. And a situation where it makes the system unable to address the demand that they will be facing. I would say that the healthcare situation, while bright and promising in certain aspects, there's quite a bit that we need to be concerned about.

Host: Wow. It sounds that way. That was a lot. So given all that, what do you feel are the biggest and/or the most urgent challenges facing us today with healthcare?

Lisa Trumble, MBA: Yeah. I think the most urgent challenges, certainly coming out of the pandemic, we are all feeling inflationary pressures, and that inflationary pressure is also hitting the healthcare industry. We anticipate that that inflation in the healthcare industry will increase the the overall premiums for healthcare and the cost to those of us that purchase healthcare at the same time that we're facing this increase for demand and a lack of a workforce to be able to meet the needs of that demand.

I also think that the urgent challenges that we're facing are a rapid cycle of change that is occurring in the industry, to be able to better manage the patient populations that most healthcare providers take care of, so that they get the right care in the right place at the right time at a time when the system is strained. So, you have the system being strained, you have the workforce constrained, you have inflation that's hitting. And then, you know, we add in the fact that a lot of us want to see changes in our healthcare system. We want better costs, we want better quality, we want all this change to occur in our system so that, you know, as consumers we have a better healthcare system for ourselves and for, you know, our children and the rest of our family. But it's occurring at a time that's challenging for the industry itself to be able to respond to the needs of the day-to-day consumer and the needs of the population that'll be aging.

Host: Well, that's a lot of forces coming at us all at once, and it can be intimidating. Is there anything we as healthcare consumers can actually do to help facilitate change in the healthcare system?

Lisa Trumble, MBA: I think the most important thing as a healthcare consumer is to be active and participate in your healthcare. Being an advocate for yourself, an advocate for your family; actively seeking out a primary care provider that you trust, that can guide your care, that can make decisions about your care at the right time and can facilitate you getting to the right providers, so that you're not spending your time, your energy, your money, wasting it in places where you're not going to get the value or the services or the right answers that you need. So, you need that trusted professional, and that trusted professional is a primary care provider. I think they're incredibly important to being able to obtain high quality effective healthcare for you and your family.

If you are employed or on Medicare, I would seek plans that are able to wrap services around you. Look for those health plans that are more comprehensive, that cover many aspects of the care that you might receive. Nowadays, it's great to see that medicare plans are offering things like dental and further prescription coverage as well as other benefits. But it's really important that you have access to healthcare insurance and coverage. You know, whether it's through your employer or through Medicare or on the exchange to be able to cover your family. It's very important at this point in time to make sure that those services that you need and have access to, you're not exposed to the financial ramifications of utilizing those services.

The worst thing that you could do as a consumer is avoid care. We see it too much. We've seen it during the pandemic where patients avoided care and the care worsened. And when the care worsens, the cost and the treatment for that care worsens too. So, I would look for the availability of healthcare, maintain a connection with your primary care provider, seek out those services and regular visits with your primary care provider to avoid any potential catastrophe or avoid any potential for a diagnosis that could have been prevented had you had that care upfront. So, accessing a primary care or trusted professional, making sure you have the insurance coverage that you need and actively utilizing that insurance coverage, I think, are very important as a consumer.

Host: It's good to know as healthcare consumers that there is a role we can play and take an active participation role in the process of improving healthcare. So, on a more granular level, as the president and CEO at SoNE Health, can you share with us how your organization is working to address these issues you've discussed today?

Lisa Trumble, MBA: Our organization and our providers believe very much in what we call value-based care. And simply, put that means providing the right care to the right patients at the right point in time that is effective from a clinical perspective and produces high quality, at the same time, reducing costs or exposure to costs.

Our providers believe strongly that we need to be leading this and at the forefront of this type of change. We need to focus on healthcare equity. We need to be responsible for the services that are provided to our patients. So as a result, our providers have invested in their practices and alternative primary care structures that allow for team-based care or more comprehensive care in a primary care setting. They've invested in organizations like SoNE, where our patients have access to pharmacists and to complex care managers and health coaches that can help guide them through their care or help them manage a chronic condition that is quite frankly challenging. So, there are a number of places where our organization has invested and is looking to strategically deploy those investments across the populations of patients that are managed in their individual practices. And of course a lot of this starts with primary care providers. What's wrapped around the primary care provider is a whole network of supportive specialists, hospitals and other services that can be accessed at the appropriate time as a patient's needs presents.

So, I think our network believes strongly that the goal here for us is to be able to manage as much of the patient's needs as possible and avoid those unnecessary services that really won't help improve the condition of the patient at this point in time. And, you know, a lot of the tools that we bring to bear allow us to understand what are the chronic conditions that we have in our populations, how many of our patients are diabetic, how many patients have congestive heart failure or some other condition that could result in multiple hospitalizations that might be avoided if they had access to a complex care manager, a pharmacist that could help them with their medications or a licensed social worker that could help them with food insecurity or diet or other connections within the community that could be supportive to the patient during their care. And in SoNe, Southern New England Healthcare Organization, our entire focus is on population health and health equity.

Host: Wow, that's fantastic. It's great to hear how SoNE is working really to wrap around patients and address all their needs to really deliver high quality care and improve patient outcomes. So, well done.

Lisa Trumble, MBA: Thank you, Lisa. You know, I think it's important too to point out that one of the things that the American healthcare system has ignored as part of our general healthcare is that we tend to focus on fixing things that are wrong. You know, we don't address the diabetic until they actually have diabetes. We wait for someone to have a heart attack before we address their heart conditions. And we're in the business at the moment of fixing things either after they've occurred, rather than going further upstream to try to prevent them to begin with.

This type of activity going upstream to prevent conditions requires putting more dollars and resources into prevention and wellness strategies, which is something the American healthcare system has undervalued over the decades that we've had healthcare. We've just structured our healthcare system to deal with things when they're at the most acute and when they're the most expensive, rather than trying to invest in the resources that are necessary upfront to prevent a condition from occurring to begin with. You know, a lot of the health equity work and the social determinant of health work that we do is to move us further upstream to try to get to that point of preventing these conditions from occurring or worsening, so that we may lessen the situations that our patients and patients' families may be dealing with in the future.

Host: Yeah, it sounds as if, as you discuss sort of going back upstream as you will, it really ties into the need and the importance of everyone really having a good, strong relationship with their PCP.

Lisa Trumble, MBA: That's right. I think the other thing to point out is we have migrated away from a community system of care. If you look at the evolution of healthcare back in the days when, you know, I was a kid or my parents were a kid, the local town physician would go, you know, to homes and visit patients, and the community would be involved in helping people that have significant illnesses. And, you know, we had a cleaner environment. There were many, many differences between where we started with our healthcare system and where we are today.

And one of the material differences that we have is that we've lost sight of community. Healthcare is local. It will always be local. It's never going to be something that, you know, you want someone at a national level deciding for you or, you know, someone in Connecticut, in Massachusetts, you don't want someone in California making the decisions for you. You want your local healthcare provider to assist in that decision-making and, where possible, you want local community resources to be helpful in supporting you during a difficult period, you know, in your healthcare journey. And we've lost those community connections. And part of the getting upstream in the healthcare system is to look to be able to stitch together those community connections again, so that there's a supportive network for patients and families that are going through significant health challenges.

And, you know, our healthcare system isn't easy to navigate. So, one of the things that SoNE is able to do and successful at doing, is helping to provide some of these services and navigation and connections to the community that are important to our patients and help them resolve really complicated issues. And I'm proud of the work that our team does. I'm proud of our organization, proud of our providers, who every day look to do this type of work, to advance the system of healthcare for our patients. But it's going to take major changes in our healthcare system to get to that point.

Host: Yes. It sounds like it's going to be a work in progress. But SoNE is definitely paving the way in that arena, which is great. So, great insights today. You've given us a lot to think about. As I said before, it can be intimidating. The subject of value-based care can be intimidating and healthcare in general. So, thank you, Lisa, for offering this informative situational update of healthcare and providing a lens into value-based care and what that means, and value-based care as a means to transform our healthcare system and in doing so, in such a way we can all process and understand it and giving us sort of some takeaways, if you will. For those out there who haven't maybe visited their PCP lately, maybe that's today's takeaway, is make sure you see your PCP.

Lisa Trumble, MBA: Absolutely. Well, Lisa, thank you for having me. It's been a pleasure to talk to you. And for our patients out there, we appreciate you every day and we look forward to continuing to deliver excellent care to you.

Host: Thank you, Lisa. And thank you everyone for joining us today. Remember, as healthcare consumers, we all have a role to play in healthcare transformation, so join us as we crush healthcare.