Carrot Shtick – Episode 1

Published on September 21, 2020

Consumers and What’s Missing in Healthcare with Spencer Pratt

Kurt had the pleasure of sitting down with Carrot Health’s own Spencer Pratt recently for a conversation about consumers, what’s missing in healthcare, and, more importantly, what can we do to help? Spencer is our Vice President of Product with unique expertise at the intersection of healthcare, data science, and consumer behavior.

Transcript

Kurt 

Well, good afternoon, Spencer. And thanks for joining me today. I think my first question is, how did your move go over the weekend? I think you relocated over the last couple of days.

Spencer 

I did, I’m settled into the new house here. We are living in the new house; I wouldn’t say that we’re fully up and running. With everything put in place. It went pretty well. But it’s a lot of work to move. And I with my wife being pregnant with our firstborn, I did a lot of solo lifting for items that required two to three people. So, a little bit sore, to say the least.

Kurt 

Well, hopefully, we’ll give you a little bit of a break this afternoon. And you can sit down, and just we can have a chat on the phone instead of moving boxes around.

Spencer 

That sounds great.

Kurt 

You know, one of the things that you and I have talked about over the years is how our health system is designed wrong, right? That we’ve designed the system to treat sick people, but what consumers actually want is to be healthy, and that seems like a fundamental disconnect. I don’t know if you have more to elaborate on that. How do you think about it?

Spencer 

Yeah, I think the way that our system is set up today is that we’re set up to treat illness as opposed to prevent illness. And there are many reasons why we’re set up that way. Two fundamental reasons that I generally think about are the payment mechanisms, and the funding models that we have in healthcare do not incentivize healthcare organizations to treat the whole consumer and really think about health holistically and from a preventive perspective. And I think another reason is that we just don’t have the right data in healthcare to treat the healthcare patient, like a healthcare consumer. We think about patients as a set of diagnostic codes and procedure codes. And we don’t think about all the other factors that impact the overall health and wellbeing of an individual. And so, I think between the funding model and the data that we use in health care, we’re treating illness as opposed to preventing illness. And that represents a lot of opportunity for us as an industry to think about ways in which we can get further upstream to think about the consumer more holistically and get more to that preventative approach.

Kurt 

So, what you’re saying is that traditionally the meter didn’t really start running until I walked through the front door of the hospital. And that was the first point where they began collecting data about me. What do you mean when you say upstream?

Spencer 

So, what I mean by upstream is, we know that health behaviors and health outcomes are driven largely by where we live, who we live, with, how we live our lives, what types of things we engage in, and not necessarily the type of healthcare that we receive. And so, the way that we’re currently set up, as you mentioned, Kurt, is that somebody walks through the doors of my clinic or my hospital, and we code that person. We identify what the problem is, and then we react to that problem and try to manage it. The best We can, as opposed to getting further upstream from that and thinking about all of the different things that that individual is engaging with outside of the four walls of healthcare. And how can we use those insights and those data points to understand what event is likely to happen in the future for that individual? What is the adverse outcome or event that is likely to happen? One year down the road, five years down the road? Fifteen years down the road? And how do we engage and interact from a social and behavioral perspective to prevent those things from happening to ensure that the consumer can live a full, long healthy life and prevent whatever that event is from happening in the future as opposed to reacting to that event? Once that individual walks through the doors of my clinic or my hospital?

Kurt 

Yeah, I like that as a concept. So, what I think what you’re suggesting is that the way in which someone will need to be treated, So, the health conditions that arise are actually influenced by a number of factors that happen many, sometimes many years before they show up in the hospital. What do you have examples of what some of those factors might be?

Spencer 

Yeah, you know, we look at a lot of these non-clinical non-traditional data points within our organization here at Carrot Health. So, we look at a lot of things related to social factors, environmental factors, behavioral factors, and under, and we correlate and analyze the relationship between those non-traditional non-clinical factors and health behaviors and health outcomes. So, a couple of good examples that you know, we typically like to share are related to loneliness or social isolation. We see that seniors who are lonely and have a lack of connection with close friends or acquaintances or family members there to support them are significantly more likely to readmitted to the hospital after being discharged and significantly more likely to use the emergency Seat apartments at a frequent rate, as opposed to primary care. There’s a lot of different, you know, attributes and data points that we can look at for a given consumer to understand that risk of loneliness, things like, does that consumer vote frequently? Does that? Does that individual have a family member living within five to 10 miles of their home? Do they live alone? Or do they live with another family member, other opportunities within their neighborhood to engage socially through clubs and other opportunities? So, those are, you know, data points that we would look at to assess the likelihood that a senior is socially isolated or lonely, which, you know, if we can identify that prior to them admitting to the hospital or readmitted to the hospital, we can connect that consumer to a social connected connection program, or a telephonic wellness or care management program that can help engage that individual through a non-clinical method. But a method nonetheless, that’s effective — preventing that future adverse health outcome from occurring. And there’s a number of other data points that we look at related to things like food insecurity and housing instability, transportation needs. We know that consumers that don’t have a registered vehicle are 50% more likely to use the emergency department at higher rates. We know from an environmental perspective, you know, we think about opportunities that we have as consumers to engage with things like going to a fitness center or going to a grocery store or maybe heading down the street to McDonald’s to get a Big Mac. And we know things like that are very influential in understanding health behaviors and health outcomes. One great example is if you live closer to a fast food restaurant than a grocery store, you’re 25% more likely to be clinically obese. And that’s not necessarily causal. It’s correlative in nature. But it’s these interesting data points that we can look at and marry up to non-traditional non-clinical factors with health behaviors and health outcomes to really understand how we can make it Difference through social and economic interventions.

Kurt 

Yeah, that food insecurity topic is a really fascinating one to me because I think the traditional approach has been to put a Band-Aid on it right let’s, let’s start a farmer’s market in the parking lot of the hospital or let’s see if we can raise money to put a grocery store in a food desert. But it seems that what we’re finding in the results is that it’s a lot more complicated than that, that particularly when you look at the other factors that influence food insecurity, it’s also related to time-poor single parents who are choosing a quick option over a more labor-intensive healthy food approach. It’s an income problem over can you even afford the fresh food if it’s in your neighborhood and, and ultimately, a lot of these things tend to point back to racial and ethnic disparities, where you might even within the same neighborhood have different people who are on are not able to access the food system in that compounds? Do we see that in the health record?

Spencer 

You know, we don’t see that in the health record. Generally, what we see in the health record is a diagnosis code and a procedure code based on how that individual has received the care historically. And we know that the average consumer visits their doctor within a clinic or a hospital setting two times per year. So, that’s two data points that our industry has relied on historically, and still does, to a large extent, to drive everything that we do in terms of how we deliver care, how we provide a good experience within the healthcare setting, how we develop new programs and interventions to address some of the things that you’re talking about currently that, frankly, are just not there in the data to allow us to do those things in an informed way informed by the data. So, you know, one thing that can lead to is inequity, and on even distribution of health care goods in our country. We know that. You know, I mentioned that the average number of visits that an individual has to the healthcare setting in a given year is two, but 30 to 40% of consumers don’t engage with the health care system at all. And what happens is, you know, the industry today uses the very limited information that we have from prior engagement to determine where care is going to be distributed moving forward, who do we focus on for disease management, who do we focus on for care management, wellness programs and the like. And because we’re largely ignoring the 30, for 30 to 40% of consumers that have not received care historically, we’re not providing opportunity for those individuals to take advantage of some of those health management programs and offerings that are available. And largely the reason that some of those consumers are not receiving care is because of barriers like you mentioned, economic barriers, transportation barriers, other environmental barriers, and so, solely focusing on those two historical encounters with the system and focusing on those individuals moving forward is exacerbating the inequity that we have in this country. And that’s largely leading to disenfranchisement of protected groups and, and certain classes of people that, frankly, we need to get ahead of. And that’s part of the whole concept of getting further upstream and getting to proactive as opposed to reactive.

Kurt 

So, if I have someone in my neighborhood who doesn’t have access to transportation and is unable to seek care, they then don’t have those two visits a year that are tracked by the health system. So, the health system thinks that they must be healthy, assumes they’re healthy, and therefore they don’t get the care they need, and other programs that might help them aren’t, offered that they’re not invested in — no one invests in trying to make them healthier. So, it’s sort of a self-perpetuating cycle.

Spencer 

Exactly current and that example that you highlighted, there is a great Rate example of the two key themes that we talked about at the beginning of the conversation, the funding mechanisms and payment models that are that exist in healthcare today. And the data that’s used in healthcare today. If we’re solely looking at the clinical information, and those two data points to drive everything that we do, we’re gonna ignore the 40% of consumers or people in this country that don’t engage with the health care system today, not because they don’t need the health care system, but because they haven’t had the opportunity to engage with the health care system for a variety of reasons and barriers that exist in their lives. And as a health care organization, if I’m not incentivized to get ahead of those 40% of consumers, and figure out how do we get you the care that you need? How do we get you in for at least an annual wellness visit or a primary care physician visit within a given year? If I’m not incentivized to do that, I likely won’t do that. And that leaves that 30 to 40% of the population who’s much more vulnerable has much higher levels of social and economic, and environmental risk behind.

Kurt 

So, incentives, you talk about incentivizing people to do the right thing. How, how is the health system incentivized or not incentivized to think about this problem.

Spencer 

You know, we talked about this volume to value revolution, moving from fee for service healthcare to a value-based system. And we’re moving there as an industry in a system currently and have been for many years, albeit be very slowly. And the majority of the system today is still set up on that fee for service type of payment model. So, we see bits and pieces of it, but as a whole, and in large part, we’re still not seeing the industry, fully incentivized to prevent and drive patient engagement throughout that full continuum of care, as opposed to just think about, you know, encounters coming in and procedures being done and payment being exchanged for those services. So, We’re not there as an industry as of yet. And another thing that’s disincentivizing some of the investment into upstream health and full, full health of the individual accounting for those non-clinical things that we’ve been talking about the social the economic, the environmental, is that those data points aren’t fed into reimbursement models in healthcare today. Reimbursement models are driven by the clinical risk of an individual consumer as determined by their set of diagnosis codes, that’s used to drive the risk adjustment program within the healthcare system that’s used to weight quality measures and how well health care organizations are doing at delivering care for their patients. Those risk models that we use for all of that today don’t account for the social complexity of an individual. And we know through a lot of research that the social complexity is really what makes up the overall vulnerability of an individual consumer in this country. Especially given that So, many people in this country are living in poverty, and that’s not taking into account within our reimbursement models or our clinical risk views. So, between the slow movement from fee for service to value, that value-based system, and the limited view that we have into the risk of an individual that’s used to drive reimbursements for managing care, those two things are largely contributing to the problem that we find ourselves in today.

Kurt 

Yeah, so, exploring that further — in the fee for service world, the physician and the health system get paid for doing a service. So, I come into the doctor’s office, we, you know, have a visit where they may do some diagnostics or what have you. And then they submit a bill that either I as the consumer pay or, more likely, my insurance company pays. So, they have the incentive to do more services get paid more. And then, when you talk about risk adjustments or reimbursement strategies. The insurance companies or the states, or the federal government are adjusting those payments based on the clinical complexity of the population being managed. So, if you’re serving a population that is sicker, it’s going to require more care to treat them. So, you get paid you get adjusted to get paid more is that that’s the basic idea.

Spencer 

That is the basic idea. And I’ll lay out an example of what that looks like in reality if you’re a clinic or a hospital providing care for very affluent patients who might have a high level of clinical risk because it might be a Medicare age population. So, a number of Medicare beneficiaries that are highly affluence and are living with a certain set of chronic conditions, but managing them well, due to their fluency and ability to manage their care. That clinic or hospital providing care for those patients will be reimbursed at a higher rate than another clinic or hospital in a rural area, treating a number of individuals on Medicaid that might not have chronic conditions but they have a lot of issues with their personal financial situation, or transportation or they can’t put healthy food on the table due to their financial issues. And there’s a lot of other social vulnerability and complexity that we see with these Medicaid populations in rural areas that might not have manifested itself into a clinical diagnosis code yet or a chronic condition yet, but it still is very costly to manage the care for those individuals given the high level of dependency on the hospital in the emergency department. So, clinics and hospitals that are providing care for those socially complex individuals are not receiving the funding and the reimbursement that the other clinics and hospitals are for caring for the clinically risky patients and health care consumers and that that’s a great example. Of how, you know, funding is largely tied to the clinical diagnosis code, which might not be representative of the full risk of the individual that’s being managed by a particular healthcare organization.

Kurt 

Right. So, if the example that I one of the examples that we’ve seen here in Minnesota is that if you have a population of adult diabetics that are being managed by a health system, they get measured on clinical quality, right, what percentage of those diabetics manage their HbA1cs on a regular basis? Do they get their annual exams And some other quality components and if you look at the clinics across the state of Minnesota in how and kind of rank them in quality of outcomes, the populations that have higher levels of commercially insured individuals, wealthier neighborhoods, suburban neighborhoods, you know, places like that are served by companies like Park Nicollet care services out of the health partner system, they tend to rank at the top of that list. At the bottom of the list are the populations that handle the uninsured, the, you know, immigrant populations, the individuals on Medicaid, a lot of the federally qualified health centers would be at the bottom of those quality rankings. But I think one of the things that would be interesting to get your take on is you talk about using the social and behavioral data to risk adjust to really say, actually, the populations being managed by those HbA1cs are more likely to be food insecure, more likely to have unstable housing situations, they may struggle to pay for insulin. We have to think of them as riskier than the commercial population when we’re evaluating that risk. How do you go about doing that?

Spencer 

That is a great question. That’s the $64,000 question, Kurt. There are a lot of examples of organizations and state Medicaid agencies as an example, MassHealth out Massachusetts has started looking into this. I know I know several governmental organizations within the state of Minnesota have looked into this to look at social risk at a geographic level. And think about within a given census tract as an example, what’s the level of vulnerability, or what’s the level of stress or deprivation that we see within that area? There’s a couple of good examples of these types of scores that exist. University of Wisconsin came up with the area deprivation index, the CDC has the social vulnerability index, and that’s generally how we as an industry have viewed social determinants of health data up to this point, at a geographic level. And we’ve used that to spread that risk across every individual that lives within that region, geographic unit to say, here’s the likely level of social vulnerability that we would expect for patients or consumers in that area. The challenge with that is not everybody living in the same zip code, or census tract or county represents the same level of risk. You wouldn’t take the average diabetic rate within Hennepin County in Minnesota, which is where Minneapolis says, and assume that everybody in Hennepin County’s at the same risk of diabetes. The reason you wouldn’t do that is because there’s about 110,000 people that live in a given County. There’s about 8000 that live in a given zip code and about 4500 that live in a given census tract. So, while that data is helpful, in providing directional insights and doing some interesting heat mapping across the country, it’s not as helpful and understanding the unique fingerprint of risk that we would expect for an individual healthcare consumer, analogous to how we would view a diagnosis or a clinical record. So, where we need to get to as an industry is we need to get to individualize taxonomy of non-clinical risk, that can be used to complement what we know about individual consumers in the healthcare space from a clinical perspective. So, if we had that individualized, non-clinical taxonomy of risk that captured the social determinants, the economic determinants, the environmental determinants, we could use that to drive a lot of great research, we could use that to drive a lot of great new policy, adjusting for social complexities the way that we do with clinical complexities today. And really, you know, to get to that upstream model that we’ve been talking about in this conversation, that’s where we need to get to as an industry. And you know, we’re doing a lot of great work around that concept here at carrot health with our social risk grouper taxonomy, which is a taxonomy to identify that social risk at the individual level. And that’s something that we’re going to continue to drive forward to make that significant shift in how we address risk from a health care First Mac context.

Kurt 

Boy, that makes a lot of sense, you know, just thinking of my own neighborhood and, you know, kind of thinking house by house by house. Everybody’s facing different challenges. And as unique individuals or unique households, you know, it would be great if we treated them as unique as opposed to kind of treated them all as a single unit. What are the, you know, it was you kind of go back upstream and say — Well, why do we want to make these changes? What are the benefits that we get by implementing a taxonomy like this and, you know, making it more widely available across the healthcare landscape?

Spencer 

That’s, that’s a great question, Kurt. And I’ll step back and start out kind of a high level around why do we want to do this, and I think, you know, outside of consumer desire and the way that we want to engage with the healthcare system and be viewed as complete consumers, from our healthcare payers and providers, as opposed to a set of clinical diagnosis codes or procedure codes. From a broader context, we see a significant gap in life expectancy across this country. If you look at a county level across the US, there’s a 21-year gap between the longest and the shortest life expectancy. It ranges from 66 to 87 years old, and county level. So, that hundred and 10,000 people per county 21-year difference. And if you take a more localized approach that you can look at cities like Boston or New Orleans, where there’s a gap in life expectancy of 25 years in neighborhoods that are literally one mile apart, maybe across the highway. So, you know, at a high level, that’s the issue, and that’s why we want to change and start incorporating some of this more upstream thinking and more comprehensive approaches to assessing risk and understanding healthcare consumers. We want to close that gap. We want to provide equal opportunity and care for everybody in this country, irrespective of how they engage with the traditional healthcare system. I think secondarily, as we think about the experience for consumers in the healthcare industry today, we aren’t viewed as healthy as, as full consumers, we’re, like I said, reviewed as those clinical diagnosis codes, and that’s going to drive the full experience that we get from our health system, or our insurance company. And, you know, there’s a great example of how consumers think about this that I heard in a primary research study a couple of years ago, and it was a member of a health plan who verbatim said, I’m a mother, a daughter, a sister, and a friend, not the disease I’m battling. But that’s the experience that we’re providing within the healthcare landscape today, and to fulfill consumer desires to have a great experience in, in the healthcare industry and providing the ability for people to manage their care in a way that is intuitive and makes sense and works within their, their, their lifestyle, and their setting is something that we just need to get to as an industry, and I think a lot of the things that we’ve Talking about here getting upstream and pulling in more data developing that full understanding of who an individual is, and what the best intervention or program is for them, is where we need to get to close the gap and provide a better experience for consumers.

Kurt 

Yeah, that’s So, powerful. I hear really two strong themes in there. One, it’s the consumer experience and what the consumer really wants out of healthcare is to be healthy and to be treated like an individual, right? And so, better understanding who that consumer is, like you said, a mother or a sister or a daughter or a friend, not a disease. So, that’s one thread. And then the other is this massive level of inequity, where you’re, you know, I think you said that in a place like New Orleans, you see a 25-year mortality gap just a few miles apart. That’s shocking that we have that level of inequity, or do all these things just roll up to income. Are there other drivers of work there?

Spencer 

You know, I heard it at a conference a couple of years ago, I forget who said it, but I heard the quote, “If you fix poverty, you fix health care.” So, a lot of the issues are driven by poverty and financial situations, economic factors. But there’s a lot of other factors at play related to social support. And the threat of loneliness that we talked about a little bit earlier. There are other elements of just generally, where do you live? And what options do you have from a healthy living perspective? Do you have easy access to a grocery store? Are you surrounded by fast-food restaurants and bowling alleys, and that’s kind of your go-to? But a lot of it does tie back to economic situations. You know, 50% of Medicare beneficiaries in this country have less than $75,000 in savings as an example. And we continue to deliver a model of care that focuses more on the condition and the business and if we’re providing disease management and care management programs to Medicare beneficiaries that have $20,000 in savings and struggled to put a roof over their head and food on the plate, we’re missing the mark there, we’re not providing the thing that’s most relevant for that consumer. And that’s not an anomaly, that that’s the norm. And that’s what we see across a lot of the government programs that ensure half of the individuals living in this country. So, poverty definitely is the undertone and kind of the thread that stitches a lot of these things together. But like I said earlier, you know, you have to look at each individual consumer and their individual level of risk. You can be moderate to high income but still struggle with social support. As an example,

Kurt 

I remember in business school, they told us there can be only one bottleneck at a time, and that’s what you have to work on. And it seems like that that might be the case for each individual here. We have to figure out what the barrier is that they are all ready and willing to work on, you know, kind of the analogy of, well, you’re not going to worry about your insulin and managing your blood sugar levels if you’re if you don’t have a roof over your head. So, it’s kind of like Maslow’s hierarchy, right, we have to search out what that condition is that’s blocking all the rest.

Spencer 

That is right. You know, end of the day, humans are complex, but we’re not too complex. We have a set of needs and desires and things that we need to stabilize in our lives before we move on to the next thing. And if we’re focused on a diabetes disease management program, or we’re focused on another form of case management or disease management, and we’re providing that to a member of our health plan, and that that individual is struggling to put food on their table or a roof over their head. There’s a very minimal chance that we’re going to be successful and engaging that person in the right way to Provide them what they need and ultimately improve their prospect of living a full and healthy life. And a lot of consumers of, you know, health plans in this country feel that they feel that their insurer, their health system doesn’t fully understand them, or doesn’t know, you know, whether their health is doing well or if it’s on-demand or if it’s getting worse. There’s a lot of really good research out there. You know, we do a lot of work in Medicare here at carrot health as one kind of primary business line that we work in. And there’s a lot of interesting research out there that shows that about one in five Medicare beneficiaries says that their health plan knows them well. So, 80% of Medicare beneficiaries in this country, which represents a pretty significant portion of overall health care spending in this country is engaging in the system thinking that their health plan doesn’t know them very well. And about one in five also, say that they don’t think their health plan knows that their health is getting better or worse. So, that’s how we feel as consumers in the industry today, which means that there’s a pretty significant problem upstream. And we need to fundamentally shift the way that we’re one understanding who our health healthcare consumers are and then do understanding what’s the best way to address their needs.

Kurt 

Yeah, that that core understanding is an interesting one, you know, and kind of peeling apart the thing that might be preventing them from being healthy. You know, earlier, you talked about the difference between loneliness and social isolation. And clearly, in the data, we can see evidence of social isolation, right, someone who does all their shopping online and doesn’t vote and doesn’t, you know, have access to transportation, or lives in a rural area, right. Those might be factors which indicate social isolation. But I had an interesting conversation with a man who’s 70 years old. He’d been retired for two years. In those years, his wife had developed a serious condition of Alzheimer’s. And so, even though he had a spouse at home, he was moderately well off. He had, you know, access to transportation. He couldn’t have an adult conversation at home. And that was causing him to feel extremely lonely in a way that wouldn’t be picked up in the data. How do we manage that level of complexity in life and in a way that’s actionable, right? How do we peel that apart from a data perspective and make it useful to the health plan or the provider So, that they’re aware of that unique condition?

Spencer 

You know, there’s a lot of great data out there that you can stitch together to develop what we generally think of as a 360-degree view of an individual. I’m providing a comprehensive profile that can pick up on things that the health care system is missing today. You mentioned not having the ability to have an adult conversation at home with a loved one. So, there’s a lot of great data out there, we use a lot of that a carrot health. But at the end of the day, a lot of that is passively collected data. It’s experiential data. It’s numbers. It’s historical behaviors that you use to identify the most likely level of risk of an individual or the most likely, next best thing that you can do for that individual. But at the end of the day, you need to pare passively collected data, which always provides you a really good, you know, perspective on an individual consumer, you need to pair that with actively collected data. They call this the psychographic data, understanding attitudes and beliefs and feelings, which are sometimes kind of hard to pick up in big data. And you do this then through the form of surveys; you do it through the form of codified notes from the Community Health Board. Or a care manager or a nurse working with that individual. And so, much of that psychographic data that is there in healthcare today isn’t codified in a way that’s useful to be able to pull that back in and really understand how do we stitch that, that psychographic information back end with the passively collected data around behaviors and risks to create that full view? And so, that’s something that we’ve been working on, you know, like carrot health and thinking about how do we combine the active and the passive, two very different approaches? And another way to think about that is the soft data versus the big data? How do we stitch that together to create a more comprehensive understanding of the patient, the member, and use that to inform the next conversation that we have with them?

Kurt 

you’re fond of saying that the data can cut both ways that there are dangers inherent in using this sort of database approach. Are there examples of areas where we have to be cautious about how to apply how to make sure we’re using the data for good, not evil?

Spencer 

Absolutely. And that’s, that’s one of the more important parts of using data in healthcare. Like you’re always trying to use it for good. You’re always trying to use it to identify areas where there are inequities that exist or areas where we’re not fully providing the care or the experience that we could be to enable somebody to live their healthiest life. So, when you’re using big data like this and pulling together the traditional healthcare data and pairing it with non-traditional non-clinical information, you need to ensure that you’re applying that in a way where you’re not disenfranchising certain groups of people. There’s a lot of responsibility on the users of this data to ensure that you’re providing equal opportunity for everybody. The great thing is that you can use it to reduce the inequities and get ahead of some of the issues that exist today. Like you know, what we were talking about before the 30% of people that don’t use health care are ignored largely today. And we know that a lot of those people are much more vulnerable. There are higher levels of minority populations, lower levels of income, higher levels of social, and other economic needs. We can use this information to get ahead of those populations and ensure that they’re getting an equal opportunity to take advantage of health services that are available to them. But there are also, other ways that this information could be used for, you know, not good purposes. Things like pricing and things like accepting an insurance policy on behalf of the consumer, given their full profile. I’m targeting people only that you think are going to be profitable or financially sustainable for your business. So, you do have to be careful about how those things are used. And a lot of that just comes down to education and ensuring that the full visibility of risks with that type of information is known by all parties.

Kurt 

That’s really important to think about that the data itself is inherently biased because of how it was collected clinical data particularly. So, how do we accommodate that in our thinking, which is a really good, good way to think about it? So, I guess the last topic I’d like to get to really is what can we do as an industry to solve some of these issues? How do we, how do we in the short term or even longer-term? How do we use this information and make changes to the good? Where do we start So, that we’re not overwhelmed with the proverbial trying to boil the ocean?

Spencer 

Yeah, that’s a great question. We talk with a lot of health plans and health systems that we work with about that very thing. And it’s So, easy to boil the ocean with social determinants of health and getting upstream of health and doing a lot of the things that we’ve been talking about here today. Um, you know, as an individual health care organizer, I think it’s really important to focus on what are the one or two key things that you really want to address in your population that you can create an action plan for, you can understand how you’re going to measure it, what stakeholders you need to buy in, what the downstream implications are on your IT departments or management teams, your reporting, and healthcare economics teams, fully understanding how you would implement one of these solutions to address one or two key problems in your population is a great place to start understanding what are the one or two key things that you want to focus on, you know, I believe comes from the data and follow the data, understand what that’s telling you and use that to make your investments and prioritize accordingly. As an industry, you know, from a policy perspective or other perspectives, I think there are some key areas where we can start thinking about how do we adjust for the social complexity of consumers when it comes to Quality ratings. So, Kurt, what are some of the things that you mentioned earlier about the quality measures that are being used to drive reimbursement for health systems? How do we ensure that those health systems that are treating the highly socially complex Medicaid population out in a rural area are compensated at the same rate that a health system in a well to do suburb of Minneapolis is compensated for treating a higher effluent population from and then the risk adjustment models we talked a little bit about, you know, this is already happening at a state level within Medicaid programs, incorporating some of these social and economic complexities into risk adjustment reimbursement, given that we know So, much of care is driven by those non-clinical factors. So, I think from a policy perspective, between quality measures and risk adjustment being used to drive funding, that that’s a great place that we can start as an industry to start to align the incentives financially and then within individual plans. It’s really just the crawl, walk, run, approach, and really identifying one or two key things that you can fully implement and measure end to end and make a case for from an ROI perspective — and then using that to move into the next big thing. The whole thing is it’s a marathon. It’s not a sprint. That’s going to take time. So, I think staying focused, driving alignment, using data to guide us through this journey are the key tenants of success from my perspective.

Kurt 

Yeah, Spencer, I think that’s really powerful the way you’ve outlined it, you know, if we go back to the very beginning of our conversation, we know that consumers want to be healthy, but we have a system that’s designed to treat sick people. So, we wait until they get sick and spend the money. What you’re really saying is if we could spend that money earlier and spend it to prevent people from being sick in the first place, if we could identify, you know, incorporating the social determinants of health — these barriers — into our funding mechanisms. So, that instead of waiting for someone to spend 20 years with a poor diet before they show up as a diabetic, we could spend that money to remove the barriers that are preventing them from eating a good diet in the first place. And really prevent that issue of diabetes from existing at all. That’s really what consumers want. And I have a feeling based on some of the analysis that that’s going to be cheaper in the long run. It’s just a question of timing. And so, you know, if we could change that funding mechanism, follow the money upstream, spend it in advance, that’s really what people want. People don’t want to be sick in the first place.

Spencer

You know, I think that’s what people want. People definitely don’t want to be sick. Health is such an important part of our ability to live long and fulfilled lives across the board. And that’s where we need to get as a health care system and as a country. You know, one interesting thing is if you compare the United States to other developed countries like France, Germany, the U.K., Canada, Australia, and many others, and if you look at percent of spending on health care versus social care, as a percent of GDP, the US as at about, two to one, health care to social care spending, versus all of those other developed countries that I mentioned — it’s flipped. They’re at two to one social versus health care spending. So, there’s something fundamentally wrong with that. The United States is an outlier when it comes to that, and our spending per capita on health care is exorbitant. And we’re not seeing the results in terms of morbidity and mortality that we would expect to with the levels of spending that we see. So, that’s what we need to get to. A lot of it starts with the funding mechanisms, a lot of it starts with the data we’re using and ensuring that we’re able to take advantage of a lot of the things we’ve been talking about today through the data and that we’re incentivized to do that through a funding mechanism.

Kurt

Wonderful. Spencer, I think that’s been a really insightful line of thought, and thought-provoking. I hope we can do this again sometime. Thank you for joining us here today.

Spencer

Always great to chat with you, Kurt. Thanks for having me on.

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