In this episode Melissa Pollock, CHESS Director of ACO Compliance and Regulatory affairs has a conversation with Megan Reyna, System Vice President of Population Health Midwest for Advocate Health about how they approach value-based care through wrap around services for the provider allowing better care for the patient.

Well Megan thank you so much for joining us on the move to value podcast and we're really excited to talk with you today about the great work that you're doing at the population health at Advocate Health so, can you tell us a little bit about your role at Advocate Health and what you guys do?

Yes, thanks for having me Melissa. So I'm assistant vice president with population health in the Midwest region with Advocate Health. We have recently merged, I should say combined, back in December of 2022, and you know population health and moving to value is a strong tenant of Advocate Health and we've been doing this work for some time and excited to share our journey with you.

Great! So I know that you kind of mentioned there's been a few changes in the past year or so with Advocate Health, so can you explain a little bit about what's happening at the population health level?

Yes. So we are coming together across both the Midwest and the southeast region. I will talk - so Advocate, which is the legacy Advocate Aurora in the Midwest and then Atrium in the southeast - what I'll speak to today is specifically the Midwest, that's really where my history is from and the work that we've been doing there.

So can you tell me a little bit about Advocate Aurora the areas that they came from? I know it's two separate states and I always I tend to get them confused so I'm just curious

Sorry about that so that's a problem it's Illinois and Wisconsin. We have about 6500 physicians that are participating in value-based care. Wisconsin is mainly an employed Medical Group with some independent tins that that participate in value and then Illinois is a strong pluralistic model with both a Medical Group and independent, what we call aligned physicians, that participate in a large clinically integrated network. We have about 1.3 million lives participating in value-based care contracts across both Illinois and Wisconsin, and we've been doing this as I said for some time. The clinically integrated network in Illinois has roots back to 1995 and became a clinically integrated network, one of the first in the country in the early 2000s. So currently have over 40 different value based care contracts that we participate in. We do have, we've moved a lot towards risk, so we have $1.2 billion in capitation risk that we currently take and that's actually where we we started a lot of our journey taking that risk, so you know and then have moved on to other programs as well within shared savings etcetera.

So I'm curious you talked about capitation. What does that journey look like for providers? For your independent providers versus your employed providers? Has that been difficult? Just curious about that that journey for Advocate?

So we started in capitation in 1995, so we've been at this for for quite some time, probably a different story than others across the country who have started with the shared savings platform and then moved to capitation or are looking to move to capitation. We really started with full risk and then also as the as the country started to take on more value based care contracts um started to get into those as well. So we have always looked at a support model that has wrap around services to our physicians participating in value based care contracts and how we really help support them be successful, and it's a true partnership between operations at the local level and that's operations with the hospital, that's operations with the Medical Group, and that's also the practicing physicians and their practicing teams as well back at their practices and how we are able to innovate and come up with new solutions to issues that we're trying to solve and how we can show success within value based care contracts - capitation or shared savings.

That's really interesting because it's almost like you guys did it backwards, I think, than what most of the healthcare systems in the country are, you know, they're trying to progress towards capitation. As far as population health data and analytics, you mentioned a little bit about helping wrap around services for the providers. What does that look like for Advocate? what kind of services have you guys provided and analytics to help the providers in value-based care?

So analytics and data is the root of everything that we do in population health. It's how we tackle our issues it's how we tackle our problems and really overcome our obstacles. We not only have data and really look at data across at the enterprise level but then we also look at data really locally. So locally at a hospital area and then locally within a physician practice as well, and what we try to do is really take a medical economics perspective of where, from a larger system perspective, do we have areas of opportunity that we need to go deep on, and then also from that practice perspective about where do they need support, and where do they need to focus. And so we have an infrastructure within the hospital and the local practicing physician area that looks at data to say, where do we have an opportunity with readmissions and then we start to go deep. And what do we need to do to really improve that admission those readmissions. Is it on a specific disease state, is there something with access that we need to fix, what is it that we need to get to that root cause? And then in a practicing physician level really where are their issues with being able to close care gaps and where do they need to focus? And we have an entire team that really works with our practices to say you have an opportunity in this care gap or how you know what's your workflow look like and how can we can how can we help support that? One of the programs that I am most proud of that we started a little over a year and a half ago is our comprehensive annual visit which came out of looking at data and realizing that after we completed Medicare Wellness visits we still have 45% of our care gaps open. And we looked at how can we provide an innovative program which is taking a nurse practitioner seen as a an extender of that physician practice to help go into patients’ homes and close those care gaps that were still open after the Medicare Wellness visit and so we're proactively working with our physician practices and sending nurse practitioners out into patients’ homes and closing those care gaps and we've seen great success within that program. We also have physicians who are able to refer into that program and really see that program as an extension of their practice and help them succeed within value.

That's a really amazing program to hear about. Just the fact that they're going to the patient’s home and trying to you know close those care gaps at a place that maybe you know patients aren't always able to come in and we've seen those barriers over the years. Have you done a lot of visits this way? Have you seen it be pretty successful?

Yes. So last year we completed over 700 visits and we were able to reevaluate over 1400 chronic conditions, close over 650 quality care gaps that that were still open, and we're looking to expand that program. So saw a lot of success with that program and that was just within our Medicare Advantage space and now how do we expand that program to our other value contracts to continue to close those gaps in care and make sure that patients make sure that patients are able to get the services that they need? And one of the great things about that program, like you had just said Melissa, is that sometimes these are patients who aren't coming into the primary care practice and so how do we get them connected with services such as advanced practice at home or how do we get them if they need home health etcetera, to be able to manage their chronic conditions? We also a core tenant of this program is really making sure that patients get that needed primary care visit if they don't already have one, and so one of the things that we do before we leave the home is actually schedule that appointment for that patient and make sure that they have the needed transportation, it's on a day that they can get there, to get back into care so that there isn't that gap. We're not just going to the patients home and then leaving and continuing to have gaps in care.

That's really great, kind of meeting the patient where they're at I really love that idea and it makes me think about kind of the buzz term that we're hearing now about health equity, which also makes me think about a contract that you and I have worked together on that CHESS is involved in, and Advocate as well, which is the ACO REACH program through the Innovation Center. I'm curious how you guys have seen this innovative model that CMS has put out as kind of a catalyst for population health in communities? I think that's from you know from my understanding that's really the focus of ACO REACH is something new and different in payment structure but also with a really intentional focus on health equity for populations of patients, so just curious what you guys are seeing on the Advocate Health side in that contract?

Yes. So in the Midwest we very intentionally went into this program to look at our populations of patients that would most benefit from this program. So we actually segmented out of our Medicare and shared savings program some tins and that's tax ID numbers that participate within that that are practice participates within the Medicare shared savings program which practices would most benefit and ultimately patients would benefit from ACO REACH. So we very intentionally limited and focused for that program and the idea is if we have the right value based care contract that's going to help patients succeed in managing their conditions, then we are going to also be successful. And so we looked really at different pockets of populations within Milwaukee and then the South side of Chicago and are really innovating on our care model to participate in that ACO REACH program. After we have our ROI and really a model that's going to be successful, we will continue to spread that model to our other value based care contracts the ACO REACH is one model, it does not address all inequities within the healthcare system and sometimes I even think is missing populations of patients based on how they're calculating with the area of deprivation index. And so it's really important that we take that care model and then spread it to our other value based care contracts. So things like this comprehensive annual visit are huge tenet of our ACO REACH program but then we're also going beyond just the comprehensive annual visit and continuing to look at different behavioral health issues, how are we providing wrap around services of transportation, et cetera, and really looking at what that model looks like and how we how we provide those services to patients so they're best able to manage their conditions.

Well Megan thank you so much for joining us today and I think we probably still have a lot to talk about so maybe we'll pivot to a Part 2 of this, but we really appreciate your thoughts and insights into what Advocate Health is doing and population health.

My pleasure. Thank you for having me, Melissa. Happy to come back.