HealthIMPACT Live Presents: Healthcare Delivery 2025 - Optimizing the Care Team For a Virtual Value-Based Healthcare Model
YouTube Video: https://youtu.be/vO2yqaqES98
Originally Published: Aug 22, 2022
The COVID-19 pandemic forced health care providers nationwide to adopt clinical practices that align with value-based care, and CMS has made value-based care a priority stating that it is integral to solving physician burnout, health inequities, and lack of affordability. Yet many providers remain hesitant to accelerate their participation in value-based care. Providers remain unwilling to accept downstream risk, fearing the impact on revenue stability and sustainability. In addition, they are concerned about unpredictable effects on revenue, where long payment cycles and annual incentives don’t effectively address the costly nature of managing the care. Finally, and perhaps the biggest barrier is the lack of upfront capital to secure the care team needed to manage the care. Especially now, staffing shortages for wrap-around care, including registered nurses, behavioral health providers, and pharmacists, make it difficult. In this session, we’ll discuss the barriers but, most importantly, the programs innovative healthcare providers are using to thrive in today’s environment through investment, patient engagement, regulations, and partnerships.
Angelo Sinopoli, MD Chief Network Officer, UpStream
Janae Sharp, Founder, The Sharp Index
Janae Sharp she/her: Hello, I'm Jenny Sharp, and I'm sitting down here today to talk with Dr snow believe I'm looking forward to this because we got to hear from Dr. Reardon. Last time, he talked about value-based care and about being able to coordinate between care teams and practice at the top of your license. So I would love to hear what you have to say about it and more about your background, because for those of you watching, Dr. Snuggly has kind of an awesome career bathroom he's worked with centers for Medicaid innovation like you know a lot and I feel like people, people need that knowledge, so if you want to tell us about that'd be awesome.
Angelo Sinopoli: Sure, so, so thank you, and I appreciate the opportunity today. So, yes, I'm a pulmonary critical care physician by training, but I've spent the last 15 years or so of my career actively involved in value-based care population health and, more recently, before I came to Upstream, which we'll talk about in a few minutes. I worked on developing an integrated delivery system called prison my health in South Carolina. I was the Chief Clinical Officer there and facilitated the merger of the Greenville Health System in the upper part of South Carolina and the pop mental health system in the Midlands of South Carolina into a single integrated delivery system called prisoner health in that role responsible for many of the clinical functions of the physician practice group, etc, but also in the upstate of South Carolina built the clinically integrated network from scratch and then, as we worst merge those two networks into one large network, which in total compromise comprise about 5000 providers across the network, which made it a fairly large network.
And we had 320,000 patients of sun some kind of alternative payment model risk arrangement across all product lines, including MSP medicare advantage. Commercial director employer Medicaid so fairly broad experience there. And one of the things I realized immediately as we were building the network is that we really needed the expertise to drive the success of the network and build a separate freestanding company called the care coordination Institute which is where we house our data and analytics our care management teams our process improvement teams our population health teams.
And we did that to isolate them away from the daily urgencies of the delivery system so that they can wake up every morning focused on the needs of the network and the patients within our value-based products and that that works pretty well with the other pieces of my experience. I've been very active nationally doing consulting work for other clinically integrated networks but also was one of the original members of the cms land guiding committee and been on that committee for about six years have been all the physicians' technical advisory committee for CMI for now about four years and have really enjoyed that work, and I've been on multiple other committees over the years, healthcare transformation Task Force board of directors for Americans physician groups, etc.
And so i'd say all that to demonstrate my passion for alternative payment models population, health and the time and effort that i've put into it over the years, so.
23
00:04:04.230 --> 00:04:14.610
Janae Sharp she/her: Yes, you've really dedicated a lot to it, I think it's interesting speaking to different people in the industry about that you know they've been talking about value based care about moving.
24
00:04:15.840 --> 00:04:24.660
Janae Sharp she/her: This idea that we're not paying people for improving health is not if you know you've been around since since people started talking about that and.
25
00:04:26.880 --> 00:04:31.110
Janae Sharp she/her: I think it's always interesting to ask people a little bit about.
26
00:04:33.090 --> 00:04:40.560
Janae Sharp she/her: About that disconnect like obviously we want people to be reimbursed for the work they do, and we want people.
27
00:04:41.520 --> 00:04:50.520
Janae Sharp she/her: physicians clinicians healthcare delivery systems to be able to improve the appeal to improve the population, health, improve the health of the people they're.
28
00:04:50.940 --> 00:04:57.990
Janae Sharp she/her: Hoping and sometimes that doesn't happen so i'd love to kind of hear your unique perspective about like.
29
00:04:58.590 --> 00:05:09.360
Janae Sharp she/her: About that gap like, why is the technology so cumbersome, why is it so slow why haven't you know, adopting these payment models.
30
00:05:10.080 --> 00:05:19.590
Janae Sharp she/her: we've been hearing about that, for years, you know people talk about it here about different theories hear people say oh you got to be scared of that you know i've heard a lot.
31
00:05:20.520 --> 00:05:30.330
Janae Sharp she/her: So i'd love to hear your perspective about about why that is like Why is this so hard for people i've asked i've asked a lot of people that i'm like so if it's so good, why is it so slow.
32
00:05:33.720 --> 00:05:34.380
Angelo Sinopoli: The question.
33
00:05:35.730 --> 00:05:43.440
Angelo Sinopoli: And you hit the nail on the head, so you know our entire healthcare system today is built around the fee for service model.
34
00:05:45.930 --> 00:06:00.570
Angelo Sinopoli: delivery systems physicians are used to that you know, and let me create a widget let me get paid for it it's clean and simple all the business models and all the technology have been built around that model.
35
00:06:02.430 --> 00:06:03.600
Angelo Sinopoli: em ours which.
36
00:06:05.490 --> 00:06:25.860
Angelo Sinopoli: should be helpful to us and being able to evaluate our patient populations and what our patients need there they're really documentation instruments and billing instruments and they're they're really built for what I call last year's business okay.
37
00:06:25.920 --> 00:06:26.400
Yes.
38
00:06:27.900 --> 00:06:29.370
Janae Sharp she/her: they're good at last year's business.
39
00:06:30.480 --> 00:06:33.900
Angelo Sinopoli: Business yes, and so they really don't provide the.
40
00:06:34.230 --> 00:06:48.930
Angelo Sinopoli: Technology and the insight, we need to manage today's risk arrangements and healthcare and don't give us the kind of insight into our patient populations, we need to make the kind of population health decisions, we need to make.
41
00:06:50.370 --> 00:06:58.380
Angelo Sinopoli: And what i've recognized working in our networking and no other networks, you know being on these committees that are trying to figure out.
42
00:06:58.950 --> 00:07:20.520
Angelo Sinopoli: How as a nation, do we drive value based care across the country and, and what I realized is there's a number of barriers that stop that and unfortunately it's not just one simple fix it is a number of things, and so one of the first barriers is that.
43
00:07:22.200 --> 00:07:39.150
Angelo Sinopoli: You physicians and even delivery systems are unwilling or unable to take significant downside risks today, I mean if you think about a two or four man physician practice and tell him he's got to go down that risk and.
44
00:07:40.020 --> 00:07:46.680
Angelo Sinopoli: put up a million dollars worth the risk that this is just unfeasible even delivery systems.
45
00:07:47.760 --> 00:07:51.900
Angelo Sinopoli: are here to quarterly budgets right.
46
00:07:52.620 --> 00:07:54.960
Janae Sharp she/her: Maybe you could quantify that a little bit because.
47
00:07:55.110 --> 00:08:00.090
Janae Sharp she/her: you're saying take a million dollars of breath people don't make like a million dollars a year on patient right like.
48
00:08:00.360 --> 00:08:03.240
Janae Sharp she/her: what's that like that's a huge amount of money when I.
49
00:08:03.930 --> 00:08:07.590
Janae Sharp she/her: When you kind of look at those contracts, but I don't really understand.
50
00:08:12.840 --> 00:08:20.940
Angelo Sinopoli: A good question so so as a practicing physician, you know you make your living in today's world of e&m visits.
51
00:08:21.120 --> 00:08:35.340
Angelo Sinopoli: Okay, as you see patients are billing for that individual visit Okay, when you move to what's called global risk where you're taking risk for that entire patients care.
52
00:08:36.390 --> 00:08:53.820
Angelo Sinopoli: Then that grows beyond your your little income stream to what could be millions of dollars, that would be spent on the populations, healthcare, including their Murcia room visits their office visits there.
53
00:08:55.110 --> 00:09:04.140
Angelo Sinopoli: Right radiology interventions laboratory studies, all those things, then become aggregated into that dollar amount.
54
00:09:04.620 --> 00:09:18.360
Angelo Sinopoli: and support individual physician and say oh yeah i'm willing to take risk for all that, when there's not a proven model and he doesn't have the financial backing to do that is a huge barrier and so.
55
00:09:19.560 --> 00:09:28.110
Angelo Sinopoli: In either even from big delivery systems that have certainly deeper pockets to be able to do that they're worried about their bond rating they're worried about.
56
00:09:28.530 --> 00:09:39.390
Angelo Sinopoli: Other things because now in their books, they even have a risk of what could be 100 million dollars and their case because they're taking risk for maybe you know, several hundred thousand patients.
57
00:09:39.960 --> 00:10:00.060
Angelo Sinopoli: Right so so that's a that's a huge barrier and when you can't take that downside risk you can't access enough upside potential to make an alternative payment model worthwhile and if you're only going to share a couple of percent savings.
58
00:10:01.500 --> 00:10:03.360
Angelo Sinopoli: Then it's just not worthwhile.
59
00:10:03.810 --> 00:10:09.030
Angelo Sinopoli: yeah if you don't have enough patient volume is the other barrier and so.
60
00:10:10.050 --> 00:10:23.670
Angelo Sinopoli: practices that do a little bit of alternative payment models care where they may only have a few thousand patients involved in it it's not a big enough percentage of their practice to really redirect how they work, day in and day out.
61
00:10:25.500 --> 00:10:31.500
Angelo Sinopoli: The other barrier is that to make these models work you've got to have expertise.
62
00:10:32.100 --> 00:10:32.400
and
63
00:10:33.510 --> 00:10:34.410
Angelo Sinopoli: You can't expect.
64
00:10:34.530 --> 00:10:35.760
Janae Sharp she/her: To not improve health.
65
00:10:36.090 --> 00:10:48.030
Angelo Sinopoli: You have to know how to improve hill that exactly when you can't rely on your office nurse or just hiring an extra body in the office to really understand how to drive all of those outcomes.
66
00:10:48.450 --> 00:10:55.020
Angelo Sinopoli: And then expertise nowadays is fairly expensive as the most practices or even delivery systems again.
67
00:10:55.860 --> 00:11:08.190
Angelo Sinopoli: we're talking about investments of millions of dollars to hire those people up front, not knowing if you're going to get a return on investment down the road okay so that's another barrier to it.
68
00:11:09.300 --> 00:11:12.900
Angelo Sinopoli: And then the last barrier is in the models today.
69
00:11:14.190 --> 00:11:26.880
Angelo Sinopoli: The way it works is you go at risk or a patient population, the doctors work all year they sometimes have very unclear line of sight in terms of how well they're doing.
70
00:11:27.450 --> 00:11:35.880
Angelo Sinopoli: And then into the year the contract closes and they wait eight or nine months to find out whether they did well or not, and whether they're going to get any shared savings or not.
71
00:11:36.480 --> 00:11:38.580
Janae Sharp she/her: People are really going to delay gratification.
72
00:11:40.650 --> 00:11:50.700
Angelo Sinopoli: huge delay gratification then so so that that just doesn't incentivize the practices to function differently very well and that model.
73
00:11:51.120 --> 00:11:55.380
Angelo Sinopoli: And so what's really needed as a model for the doctors are seeing instant gratification.
74
00:11:56.220 --> 00:12:04.530
Angelo Sinopoli: And so, as they're driving quality and driving improve patient care they can see it both clinically and they can see it financially they.
75
00:12:05.010 --> 00:12:14.280
Angelo Sinopoli: are making strides and they are going to be able to cover their investments and their staff they've hire an accelerant not have to wait 18 months to to see if they've.
76
00:12:15.420 --> 00:12:20.610
Angelo Sinopoli: Broken even or not so, so all those are barriers that have to be addressed.
77
00:12:20.820 --> 00:12:27.210
Janae Sharp she/her: yeah so I like that they're rewarding people for giving them care.
78
00:12:28.560 --> 00:12:39.720
Janae Sharp she/her: They being upstream right, so I love to hear more about about them like about why you know you have this broad background, why did you choose that.
79
00:12:40.140 --> 00:12:42.060
Angelo Sinopoli: Yes, I good good question so.
80
00:12:43.140 --> 00:12:51.270
Angelo Sinopoli: So I am now, the chief network officer for upstream and I have been so since last February and when.
81
00:12:51.690 --> 00:12:58.170
Angelo Sinopoli: Elections are Thank you i've really enjoyed being here and went upstream called me and described their model.
82
00:12:59.040 --> 00:13:12.720
Angelo Sinopoli: And I had heard bits and pieces about it, prior to them call me, but as I heard their model I thought gosh that solves all the barriers that i've run into over the years, and so the upstream model.
83
00:13:14.040 --> 00:13:17.610
Angelo Sinopoli: Is a model in which upstream takes all that downside risk.
84
00:13:18.840 --> 00:13:30.810
Angelo Sinopoli: They move contracts into global risk arrangement, including reach versus the new governmental program we partner with medicare advantage programs to do global risk.
85
00:13:31.290 --> 00:13:38.850
Angelo Sinopoli: But upstream takes that downside risk off the doctors and off delivery systems, so they don't have to worry about that anymore.
86
00:13:39.990 --> 00:13:54.780
Angelo Sinopoli: And then we do two other things that really enables us to take that risk one is that we embed clinical teams within the primary care practices we think primary care is really the key to driving these ultimate outcomes.
87
00:13:56.010 --> 00:14:06.150
Angelo Sinopoli: Not in isolation, but they are the most important key and as long as they're connected to the other parts of the delivery system and the care model across the Community.
88
00:14:06.960 --> 00:14:16.440
Angelo Sinopoli: that that is a an area where with what we call linear integrity, where we always are connecting back to the primary care doctor we're driving those outcomes.
89
00:14:16.890 --> 00:14:27.840
Angelo Sinopoli: And we have bad clinical pharmacist and clinical care teams within the practice itself they identify those high risk patients.
90
00:14:28.320 --> 00:14:38.970
Angelo Sinopoli: that we know are driving cost and are driving poor quality outcomes and those clinical teams will meet face to face with those patients.
91
00:14:39.840 --> 00:14:57.840
Angelo Sinopoli: And really help manage their care, working with the primary care doctor to identify their risk to close their gaps to identify their social determinants of health risk, make sure they've got transportation, all these things but it's not telephonic from 1000 miles away.
92
00:14:57.900 --> 00:15:13.710
Angelo Sinopoli: it's a known provider that those patients develop relationships with that they trust they know that they're acting on behalf of the doctor that they're, seeing as their primary care doctor, and so we have found that that model works really well.
93
00:15:15.180 --> 00:15:18.810
Janae Sharp she/her: I like that i'd love to talk a little bit more about that, like share.
94
00:15:19.200 --> 00:15:38.010
Janae Sharp she/her: Your why primary care like I, I have a lot of feelings about that, and I think it's interesting to see the way payments are structured and also like the most expensive things aren't always taken care of by a primary care doctor but you're investing there so maybe you could talk about.
95
00:15:39.480 --> 00:15:39.810
Janae Sharp she/her: I mean.
96
00:15:40.110 --> 00:15:53.160
Angelo Sinopoli: Why yeah so so primary care is utilizing the way it should be so primary care practices are making sure that those patients are coming in and being seen even the low risk patients, we.
97
00:15:54.030 --> 00:16:00.630
Angelo Sinopoli: try to make sure those patients are coming in and being seen at least at least once a year that's an opportunity to document.
98
00:16:01.590 --> 00:16:12.690
Angelo Sinopoli: All the issues that are occurring with that patient to identify whether they've got you know rising risk, as we call it where they're developing diabetes, where what their needs are if this.
99
00:16:13.170 --> 00:16:21.390
Angelo Sinopoli: opportunity to get to know their social situation, their family support mechanisms their transportation abilities, etc.
100
00:16:22.290 --> 00:16:30.630
Angelo Sinopoli: And so, as we do that, and particularly as we identify those patients that have multiple chronic diseases that need more intervention.
101
00:16:31.560 --> 00:16:50.970
Angelo Sinopoli: Then in that environment we can intervene very early and stop those er visits and stop those interventions that are unnecessary stop the progression of their diabetes, stop the progression of their heart disease and really create a significant.
102
00:16:52.350 --> 00:17:03.900
Angelo Sinopoli: band in the cost curve, so to speak, and what we have found is that most patients, they were actually intensively managing to the end of 12 months we've driven the hospitalization rates down about least 45%.
103
00:17:04.410 --> 00:17:04.860
Janae Sharp she/her: that's huge.
104
00:17:05.310 --> 00:17:15.870
Angelo Sinopoli: it's huge it's huge and the difference between that own site relationship management, the onsite care management and telephonic care management is night and day.
105
00:17:16.380 --> 00:17:20.460
Angelo Sinopoli: Yes, that's really what drives the outcomes, is that relationship.
106
00:17:20.970 --> 00:17:36.930
Janae Sharp she/her: that's um so your CEO the upstream CEO recently spoke about about the importance for that, like how now is the time to invest in primary care physicians and that it's a perfect storm for the need.
107
00:17:37.650 --> 00:17:38.130
and
108
00:17:41.880 --> 00:17:45.000
Janae Sharp she/her: Just the amount of money, you have to float for some of that stuff means.
109
00:17:45.090 --> 00:17:50.730
Janae Sharp she/her: You know we're losing people's health because we didn't have the money to you know.
110
00:17:51.810 --> 00:17:52.830
Janae Sharp she/her: It wasn't emergency.
111
00:17:54.030 --> 00:18:03.840
Janae Sharp she/her: i'd love to hear more about your opinion on that, like what does that mean the perfect storm with need with you know investment technology is almost like we've already done all the testing.
112
00:18:05.550 --> 00:18:06.120
Janae Sharp she/her: marlon.
113
00:18:07.770 --> 00:18:26.730
Angelo Sinopoli: Well, I think the money that needs to be invested needs to be invested in the right places, and I think so i'm a former critical care physician, so I can tell you, as a specialist I can say this as a specialist that spent a specialist are extremely important in the care model itself.
114
00:18:27.840 --> 00:18:40.200
Angelo Sinopoli: But in the past, we have not focused on primary care is really the Center of care for those patients and we've spent a lot of money, developing technology, a lot of money.
115
00:18:40.950 --> 00:18:49.860
Angelo Sinopoli: Developing specialty care, but not a lot on primary care and primary care prevention and that's really where it needs to move.
116
00:18:50.700 --> 00:19:07.200
Angelo Sinopoli: And and in Defense you know what's happened is is that again getting back to the emr the doctors have very little had very little technology support and understanding what their patients needed and so until emr change.
117
00:19:08.400 --> 00:19:31.440
Angelo Sinopoli: You know what typically has to happen is so we have our all data analytics platform that we plug into the practices emr and extract clinical data we can extract payment data claims data from the insurance companies combine all that and we can get a very clear picture of.
118
00:19:32.850 --> 00:19:43.980
Angelo Sinopoli: What those patients risk are and who is most likely to have to come to the emergency room and most likely to have to have an intervention and we can intervene early.
119
00:19:44.460 --> 00:19:52.920
Angelo Sinopoli: We also have technology that connects to the hospitals and the emergency rooms, that if those patients show up we get an automatic notification, so we.
120
00:19:53.250 --> 00:20:00.000
Angelo Sinopoli: We know in real time what's happening to that patient across the continuum and we can intervene real time.
121
00:20:00.690 --> 00:20:04.890
Angelo Sinopoli: primary care practices have not had that kind of information and data before.
122
00:20:05.310 --> 00:20:18.270
Angelo Sinopoli: And it's mostly miss Smith shows backup for follow up care and describes to the primary care doctor well i've been to the mercer in three times and i've been admitted want so i've had all this stuff done and he's had no ability to intervene during that.
123
00:20:18.390 --> 00:20:19.200
Janae Sharp she/her: That time.
124
00:20:20.010 --> 00:20:20.730
Angelo Sinopoli: So I think the.
125
00:20:21.540 --> 00:20:22.560
Janae Sharp she/her: bottom line on top.
126
00:20:23.250 --> 00:20:25.260
Angelo Sinopoli: of mind for in both directions so.
127
00:20:26.400 --> 00:20:32.880
Angelo Sinopoli: So I think the the new technology platforms that are evolving are going to help solve some of that problem.
128
00:20:33.180 --> 00:20:43.440
Janae Sharp she/her: yeah I like what you say about how you know electronic health records are great at managing last year's business earlier today, a lot of people have spoken about.
129
00:20:44.550 --> 00:20:48.810
Janae Sharp she/her: how important it is to get the right tools for.
130
00:20:50.610 --> 00:20:53.610
Janae Sharp she/her: People providing care, we know that healthcare.
131
00:20:54.900 --> 00:20:56.310
Janae Sharp she/her: A lot of people quit but we.
132
00:20:56.880 --> 00:21:07.440
Janae Sharp she/her: know enough, you know they're calling it a great resignation massive structural changes have been necessary we see people who are posting billion dollar losses.
133
00:21:08.370 --> 00:21:08.580
So.
134
00:21:10.350 --> 00:21:12.840
Angelo Sinopoli: I think, particularly for physicians, as you know.
135
00:21:14.100 --> 00:21:18.600
Angelo Sinopoli: As well there's been a huge physician burnout over the last couple of couple of years.
136
00:21:19.440 --> 00:21:28.620
Angelo Sinopoli: You know the stresses of coven the stresses of trying to manage a practice and to break break even and unfortunately it's a reflection of.
137
00:21:29.100 --> 00:21:36.090
Angelo Sinopoli: Again last year's business model for medicine and it's been a very much a hamster wheel.
138
00:21:36.750 --> 00:21:46.380
Angelo Sinopoli: going to see more patients today i've got to work patients then i've got a fee fee for service model over I don't get paid unless i'm seeing a patient and actually intervening and doing something to them.
139
00:21:46.980 --> 00:21:55.830
Angelo Sinopoli: That model needs to change and the advantage of these alternative payment models, particularly if you're taking global risk is that.
140
00:21:56.220 --> 00:22:03.540
Angelo Sinopoli: You do have more time to spend with your patients it's not about creating a hamster wheel it's about creating outcomes.
141
00:22:04.230 --> 00:22:13.050
Angelo Sinopoli: And it's also about partnering with teams, and so the teams are doing a lot of the work and the physician then becomes the captain of the ship.
142
00:22:13.410 --> 00:22:28.590
Angelo Sinopoli: And is driving the strategy and driving the needs of the patients being met, but that team has taken a lot of that day to day workload off the physician and giving him time to function more as a physician and not not stuck in that hamster wheel.
143
00:22:29.820 --> 00:22:33.330
Angelo Sinopoli: But we've seen is that our our docs and our model.
144
00:22:34.590 --> 00:22:46.410
Angelo Sinopoli: have been more productive they've been happier they're getting home on time they're actually covering more patients than they were before but they've got this expert team that's helping create that model for.
145
00:22:46.470 --> 00:22:58.530
Janae Sharp she/her: yeah, I think, too, and we talked about practicing at the top of your license and how it makes sense, like physicians didn't go into medicine, so they could learn how to type.
146
00:22:59.220 --> 00:22:59.550
Right.
147
00:23:00.840 --> 00:23:01.860
Janae Sharp she/her: Which is lucky because.
148
00:23:03.060 --> 00:23:03.180
Janae Sharp she/her: It.
149
00:23:05.310 --> 00:23:20.940
Janae Sharp she/her: will work that you have and the current state what does it mean to practice at the top of your license in this when your understand, basically, is it is it the upstream comes in, and they have extra people or what is it that helps.
150
00:23:21.150 --> 00:23:23.730
Angelo Sinopoli: So it's a combination of things it's it is.
151
00:23:25.050 --> 00:23:37.350
Angelo Sinopoli: It is extra people they're doing a lot of extra work but it's also what they're focused on, and so what it allows the doctors do is to free themselves up to do what doctors do.
152
00:23:38.190 --> 00:23:50.580
Angelo Sinopoli: Is you talk to any doctor today they'll tell you they spend an inordinate amount of time signing off on pre authorizations and pre certifications and dealing with pharmacy calls and insurance calls and the.
153
00:23:50.640 --> 00:23:51.240
Angelo Sinopoli: house.
154
00:23:51.420 --> 00:23:54.150
Angelo Sinopoli: kind of administrative stuff that you were mentioning.
155
00:23:55.380 --> 00:23:58.740
Angelo Sinopoli: It eats up a lot of their time and it's not a rewarding time.
156
00:23:59.850 --> 00:24:00.480
Angelo Sinopoli: This team.
157
00:24:00.510 --> 00:24:02.370
Janae Sharp she/her: black people don't like talking to the insurance.
158
00:24:02.370 --> 00:24:03.660
Angelo Sinopoli: Company you imagine.
159
00:24:03.840 --> 00:24:04.470
Janae Sharp she/her: never heard that.
160
00:24:06.450 --> 00:24:14.280
Angelo Sinopoli: This plane takes that burden off the doctor they take all those pre off calls and pretty sort calls and calls from the pharmacies and insurance companies.
161
00:24:15.330 --> 00:24:28.020
Angelo Sinopoli: And census a clinical pharmacist, they can handle those those calls and work with the position now the now the physicians free to do clinical work to spend time in an exam room to.
162
00:24:29.130 --> 00:24:30.510
Angelo Sinopoli: Patient and the family, you know.
163
00:24:31.590 --> 00:24:38.370
Angelo Sinopoli: And then they can step outside the exam room and say you know I want you to see my clinical pharmacist because you've got these three issues and you're all.
164
00:24:38.640 --> 00:24:49.320
Angelo Sinopoli: 10 different medicines and we needed, we need to look at that more closely, but now he's got an expert team that can do that for him and he's not having to spend a lot of that administrative time.
165
00:24:49.740 --> 00:24:55.380
Janae Sharp she/her: I love that like I like the idea of partnering more with pharmacists, because sometimes you go to the pharmacy you're like I don't know.
166
00:24:56.430 --> 00:24:56.850
Janae Sharp she/her: Like it's.
167
00:24:57.210 --> 00:24:57.570
Angelo Sinopoli: it's like a.
168
00:24:57.720 --> 00:25:06.780
Janae Sharp she/her: Different world you're like I don't understand because we, I thought I went to the doctor, but you know that coordination saves a lot of times for patients to.
169
00:25:07.170 --> 00:25:13.890
Angelo Sinopoli: save a lot of time for patients and they have another trusted partner in that practice and they become very attached to.
170
00:25:14.520 --> 00:25:17.610
Angelo Sinopoli: And the clinical pharmacist love the work because.
171
00:25:18.180 --> 00:25:28.230
Angelo Sinopoli: They also love working with physicians they love working with patients directly and educating and trying to figure out problems solve problems for patients.
172
00:25:28.560 --> 00:25:33.090
Angelo Sinopoli: When you compare that to counting to 30 multiple times a day all day long.
173
00:25:33.900 --> 00:25:46.380
Angelo Sinopoli: it's a huge opportunity for cloud pharmacist to function at the top of their license because they're certainly much more qualified than just filling prescriptions and so we've found it has been very attractive to the pharmacist so.
174
00:25:46.440 --> 00:25:46.740
Like.
175
00:25:48.930 --> 00:25:54.270
Janae Sharp she/her: I would love to hear more, you mentioned that you had a 45% oh sorry.
176
00:25:55.770 --> 00:25:57.030
Janae Sharp she/her: So the hair my face.
177
00:25:58.320 --> 00:26:02.880
Janae Sharp she/her: yeah you mentioned that you have a 40% reduction in.
178
00:26:03.930 --> 00:26:04.950
Janae Sharp she/her: Was it yeah.
179
00:26:06.990 --> 00:26:13.860
Angelo Sinopoli: admissions in that population that we're intensively managing we see a 45% decrease in the hospital admissions.
180
00:26:14.280 --> 00:26:14.940
Janae Sharp she/her: that's big.
181
00:26:16.350 --> 00:26:27.570
Janae Sharp she/her: Tell me more about that, like what does it mean when you have more coordination, what are there other outcomes that you've seen that aren't usual or the people would notice.
182
00:26:28.320 --> 00:26:30.630
Angelo Sinopoli: yeah I think the biggest thing for the.
183
00:26:31.950 --> 00:26:38.100
Angelo Sinopoli: For the model is that it was identify these patients through our technology we realized that.
184
00:26:39.450 --> 00:26:44.490
Angelo Sinopoli: All across the board, those that are sick and those that are considered to be relatively healthy.
185
00:26:45.060 --> 00:26:53.520
Angelo Sinopoli: They all have what are called gaps in care, and so we have many, many of those that have not gotten your mammograms have not gotten the colonoscopy is that.
186
00:26:54.030 --> 00:26:59.430
Angelo Sinopoli: have not gotten their blood pressure, checked, or if they've gotten a church have not gotten it under control.
187
00:26:59.730 --> 00:27:09.810
Angelo Sinopoli: A lot of times we find us because they are not getting their prescriptions field, they were either too expensive, or they didn't have transportation to get to the pharmacy to get them field are.
188
00:27:10.230 --> 00:27:18.360
Angelo Sinopoli: The pharmacy their prescriptions are on 10 medications and their prescriptions are out of sync and so they're having to go to the pharmacy.
189
00:27:18.720 --> 00:27:31.230
Angelo Sinopoli: You know, two times every week to get various prescriptions failed, instead of just get them all filled in the same day, once a month and so it's little things like that transportation awareness.
190
00:27:32.550 --> 00:27:36.480
Angelo Sinopoli: That really impedes a patient's ability to get the care.
191
00:27:37.320 --> 00:27:49.020
Angelo Sinopoli: Once they start getting that good care and getting those things done, they feel better and they're more active and they're doing things are more likely to follow up on the doctor's recommendations when they know they've got the help and support.
192
00:27:49.470 --> 00:27:58.740
Janae Sharp she/her: yeah when you look at your look at this through your lens of population health, what are the changes that stand out amongst.
193
00:27:59.940 --> 00:28:08.550
Angelo Sinopoli: So think over the years is become more and more recognized how important social determinants of health is to overall outcomes.
194
00:28:09.210 --> 00:28:17.610
Angelo Sinopoli: In the office practice and decision making, there is obviously extremely important the decision making, from the specialist is extremely important.
195
00:28:18.210 --> 00:28:23.910
Angelo Sinopoli: With that overlay of their social situations and their social determinants.
196
00:28:24.450 --> 00:28:34.650
Angelo Sinopoli: where they live, what street they live on where their streets are safe, where they have transportation in those years to get to the grocery store where they have food deserts are not.
197
00:28:35.130 --> 00:28:43.860
Angelo Sinopoli: All of that plays such a huge part and patient outcomes and in one of my previous roles we actually map that out across the.
198
00:28:43.860 --> 00:28:44.790
Janae Sharp she/her: Geography la.
199
00:28:45.060 --> 00:29:04.950
Angelo Sinopoli: area and you could identify that here's and here's an underserved area, and you can tell that the outcomes and quality outcomes in that area are much lower than other areas and so intervening with Community health workers who, I think, is going to be one of the workforce of the future.
200
00:29:06.930 --> 00:29:16.320
Angelo Sinopoli: made a huge difference there's somebody in that Community who's recognized that Community as being someone like them, depending on their nationality, etc.
201
00:29:16.860 --> 00:29:29.010
Angelo Sinopoli: That can communicate, we can train that can communicate with them make sure they're getting to the doctor, making sure they're getting food, making sure they're getting their medications that end of the spectrum, from healthcare.
202
00:29:30.360 --> 00:29:40.560
Angelo Sinopoli: Years ago had been totally ignored, and this is evolving as becoming probably the single biggest benefit of population health.
203
00:29:40.980 --> 00:29:41.400
yeah.
204
00:29:42.870 --> 00:29:47.400
Janae Sharp she/her: I that is important, like if you go into an area where they don't trust you.
205
00:29:48.330 --> 00:29:48.660
Right.
206
00:29:50.460 --> 00:29:51.870
Janae Sharp she/her: yeah a lot of traction there.
207
00:29:52.260 --> 00:29:54.840
Angelo Sinopoli: that's exactly right we've had.
208
00:29:55.470 --> 00:30:03.030
Angelo Sinopoli: areas populated areas where the cultural there was that they didn't trust anybody unless they knew them are listed lives and that.
209
00:30:03.480 --> 00:30:04.890
Janae Sharp she/her: They didn't trust anybody it's not just.
210
00:30:05.310 --> 00:30:05.550
yeah.
211
00:30:07.590 --> 00:30:09.030
Janae Sharp she/her: I feel like I know these people.
212
00:30:11.640 --> 00:30:27.360
Janae Sharp she/her: You have to have that foundation where where they know you care about them, you talked about how that will be a bigger part of the future and I like I like the predictions people make like so what what other changes do you see.
213
00:30:28.890 --> 00:30:43.380
Angelo Sinopoli: So I think the biggest change is going to be creating the technology that so you can't do without two people there's always gonna be people there that are driving you know the.
214
00:30:43.560 --> 00:30:44.850
Janae Sharp she/her: Health care without people.
215
00:30:45.000 --> 00:30:45.570
Angelo Sinopoli: I figured out.
216
00:30:46.920 --> 00:30:47.430
Angelo Sinopoli: But.
217
00:30:48.990 --> 00:31:06.960
Angelo Sinopoli: I think one of the biggest changes as we develop the technology that that connects all that they can next the primary care doctor the specialty care to the to their own community and their social determinant needs that are specific to their communities, right now, that is so fragmented.
218
00:31:08.160 --> 00:31:15.990
Angelo Sinopoli: It really takes a huge lift a lot of investment and a lot of various technologies to pull all that together.
219
00:31:17.550 --> 00:31:24.150
Angelo Sinopoli: That has to be solved and as that solve you're going to see healthcare improve related to.
220
00:31:25.230 --> 00:31:28.890
Angelo Sinopoli: that integration is i'll call it across all those pieces.
221
00:31:29.670 --> 00:31:35.250
Janae Sharp she/her: So you expect it to improve what this isn't writing this is official on the record.
222
00:31:36.480 --> 00:31:39.570
Angelo Sinopoli: I do expect it to improve I think it's going to be.
223
00:31:40.650 --> 00:31:42.000
Angelo Sinopoli: slow and.
224
00:31:43.470 --> 00:31:44.070
Angelo Sinopoli: I think.
225
00:31:45.360 --> 00:31:50.730
Angelo Sinopoli: That medicare is going to play a big factor in this because they control such a huge.
226
00:31:51.870 --> 00:32:04.890
Angelo Sinopoli: percent of the population and so and medicare is making efforts to move in those directions and they're trying to figure out how to enhance and facilitate and centers around moving in that direction.
227
00:32:05.580 --> 00:32:15.540
Angelo Sinopoli: But then I think it's going to take private equity is going to take businesses to understand that there's a business opportunity here for them to create that technology.
228
00:32:16.440 --> 00:32:29.520
Angelo Sinopoli: And as the payment models change and begin to influence businesses to create that technology that I think will slowly see see that accomplished, but it's not going to be in the next year or two.
229
00:32:29.760 --> 00:32:30.450
Janae Sharp she/her: it's going to rain it's.
230
00:32:30.660 --> 00:32:31.530
Janae Sharp she/her: going to be tomorrow.
231
00:32:31.770 --> 00:32:33.810
Angelo Sinopoli: I can be tomorrow it will be the next decade.
232
00:32:34.170 --> 00:32:49.650
Janae Sharp she/her: You said it would take private equity i've heard a lot about these partnerships with public private investment that everybody thinks that part that they are already part of should be the one that kind of saves everything and.
233
00:32:51.510 --> 00:32:52.230
Janae Sharp she/her: Why is that.
234
00:32:54.090 --> 00:32:55.380
Angelo Sinopoli: Well, I think you know.
235
00:32:57.210 --> 00:33:05.010
Angelo Sinopoli: Again, it goes back to the same conversation I had about the practices and the delivery systems not having enough cash reserves.
236
00:33:06.000 --> 00:33:16.920
Angelo Sinopoli: To make the right investments governments don't at least local government governance don't either you know, so you think about it, local city or county government.
237
00:33:18.510 --> 00:33:32.220
Angelo Sinopoli: Many of those people recognize the issues within their communities and know that eating enough money and being able to hire the expertise to fix those problems is problematic and so partnering with a.
238
00:33:33.960 --> 00:33:35.220
Angelo Sinopoli: Private Company.
239
00:33:35.670 --> 00:33:41.130
Angelo Sinopoli: That can come in and help, even if, on their part is is part of the R amp D efforts.
240
00:33:41.580 --> 00:33:55.830
Angelo Sinopoli: We just see you know, is this problem solvable how's it solvable can we partner to a private, public partnership to try to figure out what the issues are, how to identify them how to fix them I think it's going to take tape of that.
241
00:33:56.940 --> 00:33:58.200
Angelo Sinopoli: private equities.
242
00:33:59.640 --> 00:34:02.790
Angelo Sinopoli: expertise and money to help solve those problems.
243
00:34:03.030 --> 00:34:11.370
Janae Sharp she/her: yeah that's a great perspective I hadn't really considered that, like it floating that is a huge endeavor, especially for government.
244
00:34:12.960 --> 00:34:23.940
Janae Sharp she/her: Almost out of time, even though after this, we do have a Roundtable, so I hope everyone listening now will come, and we can have live questions if you want to know more.
245
00:34:24.510 --> 00:34:34.110
Janae Sharp she/her: and love, in closing, for you to tell me what you would tell a health system leader, you said, the process will improve but it'll be slow.
246
00:34:34.620 --> 00:34:38.250
Janae Sharp she/her: Why do health system leaders need to do and what can they do to speed it up.
247
00:34:39.840 --> 00:34:49.140
Angelo Sinopoli: So health system leaders i've got to view this as a very strategic process and.
248
00:34:50.490 --> 00:35:11.910
Angelo Sinopoli: It is, in my opinion, and their best interest to be investing in this now because as medicare moves more and more into alternative payment models and they're committed that by 2030 you know all the medicare will be in some type of alternative payment models.
249
00:35:13.380 --> 00:35:27.450
Angelo Sinopoli: And and delivery system to be successful in those things it's not something that on Friday afternoon you meet in corporate and say we're going to become proficient in alternative payment models and then Monday you wake up and you're proficient.
250
00:35:27.450 --> 00:35:40.110
Angelo Sinopoli: Alternatively, it makes a decade to build the infrastructure of the game, the experience, etc, etc, and so, if you're not at least moving into that market today.
251
00:35:40.680 --> 00:35:49.710
Angelo Sinopoli: you're going to be caught behind when all of a sudden that hits and there are lots of private equity companies out there that are rapidly getting into that space.
252
00:35:50.220 --> 00:36:01.890
Angelo Sinopoli: And so delivery systems have either got to figure out how to partner with somebody like that or do it on their own, and if they're going to do it on their own, they need to get started now because 10 years it'll be too late.
253
00:36:02.400 --> 00:36:04.260
Janae Sharp she/her: Right that's a lot of fancy now.
254
00:36:05.010 --> 00:36:05.220
yeah.
255
00:36:08.040 --> 00:36:13.470
Janae Sharp she/her: I wanted to thank you for your time today and for your expertise and sharing it and.
256
00:36:14.190 --> 00:36:31.170
Janae Sharp she/her: I I think it's amazing that you've created a system or a zoom has that that allows physicians clinicians nurses to to see the benefit to be rewarded for improving patient health and to work in partnership more.
257
00:36:31.800 --> 00:36:46.950
Angelo Sinopoli: The one thing we did not talk about and didn't emphasizes the fact that within that model, as opposed to waiting eight or nine etc, the end of the year we're actually paying our doctors, based on their quality scores every month, and as.
258
00:36:47.130 --> 00:36:48.180
Janae Sharp she/her: Every month that's huge.
259
00:36:48.450 --> 00:36:52.920
Angelo Sinopoli: Every month, and so as their quality scores improve over the course of the year.
260
00:36:53.520 --> 00:37:03.810
Angelo Sinopoli: We pay them more every month, based on their quality scores that our teams are driving forward, and so our teams are improving closing those gaps and driving their quality outcomes.
261
00:37:04.350 --> 00:37:16.770
Angelo Sinopoli: And so, for a Doc it's real time incentive, I can see that i'm improving my patients care i'm improving their quality outcomes and i'm seeing a financial reward for it immediately not 18 months from now, so.
262
00:37:17.400 --> 00:37:18.810
Janae Sharp she/her: And that means you have to be able to sell it.
263
00:37:19.920 --> 00:37:24.510
Angelo Sinopoli: To the short term, right now, can I have the technology and the outcomes right now right.
264
00:37:24.600 --> 00:37:28.830
Janae Sharp she/her: That is a huge, but as a huge technological endeavor and that you just threw in there.
265
00:37:30.210 --> 00:37:31.110
Janae Sharp she/her: Now okay.
266
00:37:31.170 --> 00:37:31.440
Angelo Sinopoli: well.
267
00:37:31.800 --> 00:37:33.990
Angelo Sinopoli: that's easy yeah well.
268
00:37:35.010 --> 00:37:38.610
Angelo Sinopoli: Your morals won't do it, but our systems will will do that so.
269
00:37:39.540 --> 00:37:48.810
Janae Sharp she/her: I hope more people can can learn about that, and everyone will come to hear you at the at the live Q amp a and if you have any questions.
270
00:37:49.200 --> 00:37:59.820
Janae Sharp she/her: You can reach out will have the contact information for upstream, and thank you so much for today and for having this conversation about value based care, it is still around.
271
00:38:00.450 --> 00:38:01.080
Angelo Sinopoli: Still around.
272
00:38:02.580 --> 00:38:04.560
Angelo Sinopoli: Thank you, I appreciate the time and enjoyed it.
273
00:38:05.070 --> 00:38:07.050
Janae Sharp she/her: Thank you