Transcription:

Roxanna Gapstur PhD, RN (Host): On this episode of Inspiring Health, we're talking about WellSpan's goal to lead the region in value and how the partnership with Capital Blue Cross is bringing big ideas to life. Joining me is Dr. Geoff Nicholson, Senior Vice President of Population Health. Geoff's responsible for guiding WellSpan's value-based strategy. And he also provides physician leadership for the WellSpan Provider Network and WellSpan Population Health Service's Board of Directors. Geoff, welcome to Inspiring Health.

Geoff Nicholson, MD (Guest): Well, thanks Roxanna. Thanks for having me. I'm happy to be here.

Host: Geoff, we know value is one of the biggest buzzwords in healthcare, and it can mean a lot of things to different people. In the context of WellSpan's 2025 strategic plan, the central focus of value is to deliver the highest quality and exceptional experiences at an affordable price. And we want to be the leader in value-based care within the region. What does value mean to you and the work you're leading?

Dr. Nicholson: Yeah. When we talk about value, we're really talking about the triple aim and that's a framework that was instituted by the Institute for Healthcare Improvement. And it's really around optimizing health system performance. As you might guess, there are really three areas of focus in that framework. The first is improving health. We're talking about things like exceptional clinical quality, clinical excellence and a passionate commitment to safety. The second component of the framework is really around the patient experience. It's true that patients expect exceptional care, but they also expect convenience and highly coordinated care and compassionate delivery of that care.

And the third piece is really around lowering costs. By reducing variation and eliminating waste; we can reduce costs and pass that through to patients in the form of savings. As an organization, if our vision is to lead the region in value, that means managing all three of those components really, really well. And if we do that, meaning if we provide the highest value care, we can grow the number of patients who find, use and stay with WellSpan as their care choice.

Host: That's right. And we can earn more loyal patients and grow by being bigger. We can also do it by being better. When consumers find greater satisfaction, greater value with WellSpan, we're achieving that goal. Now we've talked before on this podcast about the importance of partnerships to be better in a rapidly changing healthcare environment. Partnerships are becoming increasingly important. They're essential in helping us develop new capabilities and to grow as a value-based organization. So WellSpan has a partnership with Capital Blue Cross. Could you tell us a bit about the partnership and where we're headed?

Dr. Nicholson: Absolutely. So in 2019, we established a new partnership with Capital and that's really to position our organization similar to other health systems that have both caring and coverage under one roof. And since that time we've been working, about a hundred representatives of Capitol and WellSpan working, really collaborated in three foundational areas.

The first point of focus is improving health, improving health outcomes. Great example of this, last fall we opened the Joint Health and Wellness Center called Capital Blue Cross Connect. That's in Chambersburg on our WellSpan campus there, and the center combines member services around health plans, coverage and Medicare options with consultation in services like health coaching or scheduling a biometric screenings, blood pressure checks, or cholesterol checks. We do phlebotomy there. And if patients need additional levels of service that can't be provided, we can schedule directly into a WellSpan office right there using My WellSpan. As the name suggests it's really about better health through better connections.

We've also partnered with Capital to improve prescription drug adherence. A great example of this is around our performance for a statin use. Statins are medications used to control high cholesterol and from 2019 to 2020, we've improved performance in adherence from 54% to 89% through collaboration with Capital Blue Cross and our population health pharmacy.

That's just better care. The second area of focus for Capital Blue Cross and the team has really been focused around innovation. I know that Brian Pollack at Dr. Brian Pollock has been on the podcast recently and has talked about duo healthcare, the online primary care options. So I won't spend time on that. But I would focus on Babyscripts. Babyscripts is an app that we use with maternity patients really designed to improve access and eliminate barriers to care. Expectant moms who are both WellSpan patients and Capital members get access to timely health information and education throughout their pregnancy.

And it's really tailored to specifically where they are. That's really cool. But on the other side, WellSpan gets information about moms, biometric screenings on moms. So we can understand, who is well and perhaps doesn't need to come see us, but also who might be at risk so we can provide more timely care.

Both of those things offer a better experience for the patient and help us reduce the cost. So really cool stuff going on in innovation with Capital Blue Cross and the third focal point centers on new payment models that reward improved outcomes, which result from care innovation. A key driver that runs across all of these is really collaboration powered by comprehensive data sharing. And I'm really excited about what we've seen so far and what's ahead of us.

Host: Yes. And I love the example you gave about the pharmacy management partnership. It's so impressive and it shows how we put the data to work when we have more insights. Geoff, tell us a bit more about how the data really drives the innovation.

Dr. Nicholson: Well, data drives deeper insights into the health risks of our patients. It helps us better understand how they're receiving care or in some cases how they're not receiving care, where they may have gaps. Through healthcare claims data, we can see every visit that patients have and better understand what they need, but there's also tremendous opportunity to combine clinical data and claims data together. When we do that, we think about things like improved risk stratification algorithms, improved predictive analytics models. We think about the ability to provide more highly coordinated, comprehensive care while at the same time, reducing duplication of services. That's important because it's a better experience that reduces costs.

Host: Yeah, understanding the data is a really important piece of WellSpan's transformation work and it impacts all three parts of the triple aim that you mentioned, the health outcomes, the experience and the cost. Geoff let's shift gears now, and talk about what's next with Capital. We're adding a series of joint Medicare Advantage products for Capital Blue Cross members, 65 or older to WellSpan's existing slate of offerings so that we can continue to leverage the power of the shared data and provide greater value. There's a lot to Medicare and there are many reasons healthcare providers want in on the Medicare market. What's your take on it?

Dr. Nicholson: Well, Medicare can be complicated, but I don't know that it needs to be. And that's really why WellSpan's entering this space. You know, just a quick primer on Medicare, most people appreciate that Medicare is health insurance, typically for people aged 65 and older, but Medicare Advantage, specifically bundles part A or hospital insurance with part B or traditional physician and medical insurance, and usually part D with prescription coverage, all in the one plan. That plan's more comprehensive and it's easier to use than traditional Medicare.

Frankly, because the care is coordinated and managed, the costs tend to be lower. That allows the most competitive plans to take that cost and offer more benefits like vision, hearing and dental services, so, the plans are more comprehensive and because of that, Medicare is actually the fastest growing segment in the market.

In fact, the Kaiser Family Foundation reported earlier this year that there are more than 26 million beneficiaries enrolled in Medicare Advantage Plans, which is about 42% of the total Medicare population. And that number continues to grow each year. To highlight a little bit about the competitive nature, the average Medicare beneficiary in 2021, actually has access to 33 different Medicare Advantage plans to choose from, which is the largest number that we've seen, in about the last decade or so.

So there's a lot of competition in the space, but that's where our partnership with Capital Blue Cross comes in. If we think about partnering with Capital in the way that we've discussed, we can improve outcomes, the experience and lower costs, and that in turn drives growth and sustainability for both organizations. You know, traditionally when healthcare providers improve outcomes and reduce avoidable utilization, it's the health insurer that benefits from reduced costs. But the nature of our new relationship with Capital Blue Cross is that it aligns both organizations and rewards them for innovation around the triple aim. And that's just great for WellSpan patients.

Host: That's right. And while the dollars and cents add up favorably from a business standpoint, the partnership is a tangible demonstration of WellSpan values. It's just the right thing to do when we can be better positioned to improve health and lower costs. Now we certainly have relationships with other payers, but what makes this different?

Dr. Nicholson: Certainly all of our relationships are important, but this relationship is fundamentally different in a few really unique ways. So, first we're launching a suite of WellSpan co-branded Medicare Advantage products across our entire geography, really intended to build on the trusted relationship that WellSpan's developed with our patients and our communities.

Next we've created comprehensive and competitive benefits packages at what I believe will be the lowest market price. I've already mentioned the comprehensive more traditional healthcare services that are layered in like vision and benefits, but think about adding things like telehealth options, fitness benefits, transportation assistance to and from appointments, even an over the counter medication allowance, that can be used either online or in the retail space. If we know that convenient and timely access to care is critical for outcomes at lower cost, these plans are purpose built to deliver that.

And then probably something that's most exciting for me as a physician is that the medical management of patients, something that's traditionally managed by health insurers, in this particular relationship will be managed by WellSpan. That means leveraging the trusted relationships of our doctors, nurses, pharmacists, and care team, to drive better outcomes, lower costs. And it reduces the likelihood that the patient gets caught between the physician and their health insurer.

We're just entering the enrollment period. It actually runs from October 15th through December 7th. And if folks are interested, they can go to our website at togetherforyoumedicare.com to learn about the partnership or any of the Medicare Advantage products. And even to enroll, if you're looking for the best Medicare option in the region.

Host: Geoff, I'm so glad you mentioned this. Ultimately, that's what it's all about. When we find innovative ways to partner with other like-minded organizations, WellSpan patients can reap the benefit. And so for those of you listening today, if you or a family member are 65 or older, now is the time to make changes or to sign up for Medicare. Like Geoff said, you can visit togetherforyoumedicare.com to see the product details. And I think you'll be surprised by just how easy it is to sign up. And you'll be impressed by the extra benefits of the WellSpan and Capital plans that keep your care local and affordable. Geoff, as we wrap up any final thoughts?

Dr. Nicholson: I'd just like to thank our partners at Capital Blue Cross, their collaboration has been fantastic. Very good partners. I'd like to thank our care teams at WellSpan who were re-imagining health care and inspiring health. It's really through the creation of new product offerings like this, by improving care coordination, using data to improve our outcomes and the experience that patients get higher value care. And that's just good for all of us.

Host: Well said. Thanks, Geoff. That's all the time we have for today. We hope you'll join us for the next episode of Inspiring Health.