The Dynamic Duo Helping MSK Populations!

Brian Urban:

Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban, and today we have a dynamic duo talking about a partnership that is growing and very impactful to the population challenged with MSK, musculoskeletal conditions. And I'm so excited to have on our show today a new friend and a returning one in a new uniform as well. So let's welcome to the show here from Humana Dr. Alex Ding, Associate Vice President, Physician Strategy and Medical Affairs, and Chief Strategy Officer of TailorCare, John Petito. Gentlemen, welcome to the show.

John Petito:

Thanks for having us, Brian.

Dr. Alex Ding:

Thanks so much.

Brian Urban:

This is going to be a lot of fun. So let's start off real quick here with John, because John, you've been on the show before. You were with SCAN. You did a wonderful job there for many years, and now you're at an exciting new adventure at TailorCare. I mentioned the new uniform. Here it is. I think you just celebrated your year anniversary as an organization making an impact in the ecosystem. So tell us what you've been up to since the last time we spoke. I think over a year ago or something like that.

John Petito:

It's been a couple years. Yeah, funny how time does fly. But Brian, I just want to say thanks. It really is great to be back on the show and honored, thrilled to be doing so in a great company with Dr. Ding. As you mentioned, when we last spoke, which I think was almost two years ago now, I was with SCAN, which is a regional not-for-profit Medicare Advantage organization.

Tenure there, saw a lot of change, a lot of rapid expansion, growth, new lines of businesses. It was a great, great experience. I loved my time there, very proud of all the great accomplishments of the organization, and now a proud alum cheerleading from the sidelines. My favorite part of the role there was really building new things, new programs, new services, really transforming the organization.

So when I reconnected, I don't remember exactly when, but reconnected with Rachel Winokur, the CEO of TailorCare, someone who I have a lot of respect for, had worked with at Aetna more than a decade ago, the opportunity to help build a new business from the ground up was something I couldn't say no to and I leapt at it. TailorCare, what we're doing here, it's a specialty value-based care organization.

We're focused on musculoskeletal, MSK, conditions, so think osteoarthritis, back pain, joint pain to name a few. We take full risk from payers, risk bearers, and we deliver a deeply personalized program to patients that are either living with those conditions or at risk for those conditions.

We're backed by Valtruis is a Welsh, Carson company that is only focused on value-based care organizations, and we've got a great partner in Humana that we're actively working with and serving their patients. And as you point out, I have been here, I'm turning one at TailorCare in the next couple of months, and I'm still having a blast.

Brian Urban:

That is so awesome to hear, John, and your enthusiasm and various experience across the ecosystem I'm sure brings a ton of value to what you're doing, the population that you're serving in specific now. And speaking of MSK and speaking of taking on full risk and value-based care, Humana is no stranger to all of those. And Dr. Ding, you're no stranger to that on your own as well. Welcome to the show.

You're a new face for the Healthcare Rethink Podcast, and we love to get to know our new guests. And John has done something similar for us in the past walking through his journey and how he has come to the position he's in today. Let's take that same path for yourself. You didn't just wake up and become VP of Physician Strategy and Medical Affairs at Humana. You had a journey. So how did you get into healthcare and why and tell us where you are today? Bring us through the whole story.

Dr. Alex Ding:

Yeah, thank you so much for having me on the podcast today. I'm really excited to join you and to join John as well. So I've been at Humana for the past four years, two in my current role as the AVP for Physician Strategy and Medical Affairs. So this current role focuses on physician engagement, provider advocacy, and the advancement of value-based care. That having been said, I'm first and foremost a physician and clinician. I'm a diagnostic and interventional radiologist.

In fact, I still practice clinically. I'm on faculty at the University of Louisville where I still do hands-on patient care and teach resident trainees as well. So prior to moving to Louisville, I spent the majority of my life in the San Francisco Bay Area and the majority of my career in private practice medicine. I found that while I really enjoyed patient care and clinical care, there really was a limit to my ability to scale impact in healthcare seeing one patient at a time.

And I found that I had a knack for and an interest in management and administration and worked my way up to being the managing partner of my practice, which is a privately held semi-partner practice in the San Francisco Bay Area. In that leadership role, I ended up in a couple of other hospital leadership roles. I was the vice chief of staff of the Public County Safety Net Hospital, the chief of radiology at Sutter Health, which is a large integrated delivery network in Northern California.

And I found that this was one way for me to scale that impact along with some other areas I've since discovered and have had a hand in, including working advocacy and policy and technology and innovations. And while I always saw myself first and foremost as a clinician, I also thought I had a different perspective on healthcare than my other colleagues. So I was an econ major. I then worked at Goldman and at the Economist before I went to medical school.

I really felt like cost was totally ignored in medical school and in the practice of medicine. There really was a strong focus on quality, safety, but none of it was really in the context of costs. I would say I've got a little story to share. In fact, I would say, was even taboo to mention. I remember I was doing an ICU rotation in medical school where I felt like a patient was receiving futile care at an enormous cost to the healthcare system. And I asked about cost considerations and as a result was berated by my attending.

But at the same time, we also know that a significant proportion of our healthcare spending in this country is in the last year of life. And that really crowds out spending on other more high-value care for everyone else in the population. And so when I was in residency in Boston, I got an invitation to a seminar put on by Michael Porter. In fact, I think John went to the seminar as well. It was about value in healthcare, and all of a sudden, it clicked for me.

This was an opportunity to not only align incentives between the payer and the provider, but it was really balancing the cost considerations with that of the quality imperative. And being good stewards of scarce and precious healthcare resources and thinking about value in healthcare to me really became the only way to think about how we create a sustainable healthcare system that really hits on all three parts of that triple aim.

That's a long-winded way of telling you how I eventually found myself over at Humana, which as you mentioned, has been a leader in value-based care. I just feel so fortunate I get to work with people like John and others who really are driven toward value in healthcare.

Brian Urban:

I love that and it's never enough detail, Alex, because our listeners truly find something to identify and learn from from our podcast series here at the Healthcare Rethink. And a couple of questions for you, but this one's going to be for both of you. I would like to start on your side here of the story, Dr. Ding, talking about your partnership. And both of you have a very interesting background relative to healthcare administration, working for banking institutions, and also from an economics perspective, how you look at healthcare.

So I can see the synergies and the population specifically, obviously there's a synergy there too. So the population that you're serving, MSK conditions, musculoskeletal, is the keystone to what you both do. So what does this partnership look like today in terms of how many lives you're serving? Is it a geographical presence? Let's get an update here on what your work is like together.

Dr. Alex Ding:

Sure. So maybe I'll start off at a high level and pass it over to John for maybe a little bit more of the details. But I would say the keystone to the partnership is really this shared drive between both of the organizations to provide better care at greater value to reduce low value care, to improving patient access, and really to look after that patient experience. So TailorCare is Humana's upstream end-to-end MSK solution starting out in the Atlanta market.

And really for us it's about helping patients get the right care at the right time, helping patients to understand and navigate a very complex and difficult to understand healthcare system, which is too often just piecemeal, keeps patients from getting holistic and comprehensive care. And so TailorCare for us is taking total cost of care risk for MSK for our MA population. They've been able to help us and our members really think about MSK care more holistically than just a procedure or just a surgery.

And some of the ways in which we're looking at metrics and outcomes for MSK care is what we've been doing for value-based primary care as well. The same things are important. You've patient satisfaction, improving clinical outcomes and MSK care that happens to be things like pain reduction and functional improvement, but also improved access to care, providing more wraparound services, and addressing total cost of care.

Brian Urban:

Really helpful, Dr. Ding, to see how that end-to-end solution is being put in place for this specific population. And John, take us through the journey here, what a patient experiences working with TailorCare and then how that's integrated into Humana today. I think our audience would be thrilled to learn that because, again, you're one years old and there's so much more room for growth and impact.

John Petito:

Yeah, absolutely would love to. As Dr. Ding mentioned, we've taken full risk and are managing a population in the Southeast market. It's about nearly 150,000 members that we're currently managing, and we're specifically focused on providing effectively a patient navigation service focused on musculoskeletal conditions, MSK. A year in, we've served several thousand patients and are seeing very positive indicators, not just patient engagement, but also pain and function improvement, industry-leading NPS.

We're very proud, we've had consistently high in the 90s, which is a great indicator of the impact and the experience that we're creating for Humana's members. And just to reiterate, really grateful to be able to work with leaders in value-based care like Humana that have the vision and the foresight to deploy models like this to serve their patients. What it looks like, fundamentally TailorCare is a patient navigation service.

So we engage patients who are either at risk for or currently seeking care related to MSK. The goal is to help them get on the right care pathway based on their clinical indicators and their preferences and objectives for the care and then match them to the best, highest quality and I would say the highest value provider they have access to. So how does this work?

And I can go a level deeper here, which is the model's about deploying clinical expertise at the point in time that it can be used to influence the care pathway of the patient. I mean, going as far upstream and early into the care journey as possible. And so that starts with finding the right patients. And so we do this through a variety of ways. We use advanced analytics and predictive modeling to identify folks from data sources like claims and UM, et cetera, to figure out who to reach out to and educate them about the service that Humana has made available to them in TailorCare.

And the other piece, which we view is also critical for driving engagement with the right patients, is actually engaging the network providers as partners. And so that includes both the PCPs, but also orthopedic groups where they're actually referring patients to us and we're then evaluating the patients and then starting the process with them. So once we find the patients, once we engage with them, our navigators who are licensed physical therapists, they conduct a very thorough intake.

So they're asking questions to pinpoint not only what is the right type of care that the patient needs, but also what does the patient care about? What are their preferences? What are they trying to achieve? Are they just trying to play with their grandchild, or do they want to do something else, like they want to reach the top of in their kitchen? Those are all important considerations and figuring out what to do and what is the right care, most appropriate care for the patient.

Intake responses then feed into a model we built that uses evidence-based guidelines that then suggests appropriate care pathways for the patient, and the navigators then discuss with the patient through shared decision making what is the most appropriate and preferred care pathway for them. And then like I mentioned, we use quality data, cost data, value data to identify the most appropriate provider they have access to, whether that's a physical therapist or if they need an orthopedic surgeon to get them to the best orthopedic surgeon in Humana's network and go from there.

We don't walk away at that point. We stay engaged with the patients over the course of their journey. A critical part and because we've taken full risk is to ensure that the care is working. It's achieving the intended outcomes. And so we stay engaged with them through the episode of care. Sometimes we switch pathways if that's what's indicated based on how they're performing and the care how it's working. And we also share the information, so we communicate what's happening with the patient back to the PCPs and other care delivery partners.

Brian Urban:

That is extremely helpful, John. So really not a point solution by any means. Very much throughput. And I love the fact that you threw out that Humana is adopting a very forward-thinking model such as what TailorCare is offering today. And obviously that's going to continue to advance as you're learning things through the first 150,000 MA members that you're serving. That is a big number to start with. Obviously you're proven from populations you've served in the past, but 150, that's a big number to then roll into serving even more members in the future.

Big-time kudos for you, Dr. Ding and Humana, because I'd worked for a private health plan for many years. I think the most innovative thing we did at the time was acquire other technology, not just integrate it into a model. So I love that you're pulling them in as a I'd say earned and rightfully so, earned partner in the process of treating this population. So with the whole model John just walked us through, Dr. Ding, I was thinking about our conversation today and pulled some general statistics.

Really cool JAMA article from '23 by Dr. Fong, and he had put out some metrics as a aggregate total spend from '22 to '23, about $380 billion related to MSK conditions. That is a huge chunk of spend, and I think it's overshadowed by a lot of other chronic conditions in the US, diabetes, hypertension, cancers, et cetera. And when I think about this number, it can't be just that top cost of MSK, joint pain, surgical procedures. It has to be a trickle-down effect related to other conditions that maybe immobilizes somebody.

So can you tell us what some of the biggest challenges facing MSK patients might be today and how you're starting to address that through the model John just described?

Dr. Alex Ding:

Yeah, I think so many of those things that you mentioned, Brian, are true and concerning. We often don't think about MSK care or pain, especially chronic pain, because it's not as dramatic as managing a heart attack or a stroke. And so we often forget about what a big deal it is not just in terms of the cost that you've mentioned, but also in terms of the prevalence and the amount of people in our society that are facing these challenges. Most people don't know this, but MSK conditions are one of the leading contributors to disability in this country.

And low back pain is the single leading cause of disability in this country, as you alluded to. This results in a lot of spend. And so the problem isn't so much that we are spending so much on it. The problem is more that we are spending so much on it and not getting great value. Oftentimes patients are getting low value care that is medical services or procedures that aren't really helping, or they aren't getting to potentially less invasive solutions like physical therapy before jumping to something more invasive like surgery.

And you're right, there's interactions between chronic pain and substance use disorder and mental health challenges as well. Chronic pain is often associated with higher rates of depression and anxiety, which can lead to substance use disorders. Not to mention, the treatment of pain with too many opioids can lead to substance use disorder and may be a contributing factor to the opioid epidemic this country is facing, unfortunately. And the problem is that there are also access challenges to the healthcare system.

Health literacy challenges, challenges navigating the system, and so much of this care is piecemeal and each different specialist you see is offering a different service. There's not enough coordination. There's not enough navigation. There's not enough holistic care of the patient. There's really a lot of fragmented care, which leads to patient frustration, patient confusion. And there's not really a real quarterback to holistically manage all of the patient's care and pain management strategy.

And just as you mentioned, while there are these direct costs that are associated with pain and MSK care, I think that indirect costs are likely even more astronomical in terms of disability, like lost days of work and productivity, decreased quality of life. And so it's an even bigger deal than that already astronomical figure that you cited with this question.

Brian Urban:

This is the economic side of Dr. Ding's brain here that I love because you're looking at the lives you serve, not just from the needs they have from a clinical perspective, but all of the indirect impacts as well. And what John mentioned earlier I thought was fascinating is the quality of care match to the network in terms of provider. I think you're solving so many things.

So that $380 billion metric I just threw out there from Dr. Fong's research in JAMA, I think if he ever followed up on this specific population in a year or two and really focused on Humana's MA members, that number would be significantly different because you're addressing the payment infrastructure challenge in terms of full risk. You're taking that on. You're having more quality physicians working with these folks. And the throughput model, I can't get away from that because there's so many solutions out there.

HIMSS this year in March 2024. I've never seen so many new healthcare tech startups. I don't know if they're going to be around next year, which is crazy, but they're all point solutions. I saw so many points of this and this and that, but not with TailorCare. And I love that. And John, something Dr. Ding just mentioned is that you're looking at a lot of different things impacting the patients, members here. I know this is probably too far to look out, but what does the future look like in terms of TailorCare's growth and innovation?

Is it looking at remote patient monitoring, additional telehealth services, social determinants of health, addressing a lot of challenges in terms of disparities, access to care, health literacy? Is there a certain new stack of innovation that's going to come into the future for TailorCare?

John Petito:

Yeah, I love the question and it's the right question. I'll answer it a couple different ways. I would say one, we are continually looking at how we evolve our model. I think going deep and focusing and specializing in a specific condition area like MSK is a luxury that few organizations have. And I think what it does is it gives us access to both data, but also more importantly, the insights that are unavailable to any individual actor or stakeholder in the healthcare ecosystem.

And I think what we're learning about some of Humana's patients and the insights we're able to share back with Humana about what we're seeing as far as care delivery, outcomes, costs, comorbidity, social determinant, access issues, I mean, these are all things that I think we're still learning from as we're uncovering the insights, and so how these things come together both to improve the individual experience and care journey for a patient, an individual patient at an N of one, but also to manage an entire population.

These are insights that we're still unpacking over the course of the first year that we've had it effectively up and running. I would say one of the things that we have very intentionally done is invested in a very capable, heavy hitting data science and analytics capability at TailorCare. I think part of our thinking is that we need to be able to unpack this data, unpack the insights in service of improving all aspects of our business and our model, but more importantly, the clinical model, which I think is where you were originally asking about.

And I'd say how we're going to approach that, how we're going to approach that is really about following the data in order to determine where we expand our service offering, what types of programs, what clinical intervention, what does the library of interventions need to look like to best manage that population given the complexity of the set of conditions that MSK represents.

And I sometimes use the example, it's not just a left elbow or a right elbow or a left knee or a right knee, it is the entire human body that falls into the scope of MSK that we're managing. While I won't comment on specific interventions or areas that we're exploring investing, I will say...

Brian Urban:

You did a better tease. I knew you're going to do that.

John Petito:

I will say, social determinants are a core part of the dialogue in the discussion. I think we all recognize they have an outsized impact on access, quality, and cost. And I'll say we're fortunate to have a partnership with Humana who has been out ahead on social determinants for a long time now and understands the value of investing in social determinants to improve cost, quality, and access.

Brian Urban:

I love that, John, because now you have a partner that's going to be pulling you forward to be able to address the needs that are non-clinical for the population that you're both serving. I love where this relationship's going, and a lot of this conversation coming up made me think about how Humana has historically addressed value-based care, because there's been just non-stop I'd say challenges with finding the right way in terms of payment methodologies, contracting provider relationships, total medical cost benchmarking, everything, such that there's been a few leaders that have clearly risen to the top.

And I think about primary care centers like ChenMed who've done this for I think over 10 years now. I think of Humana in terms of a larger health plan. And the Center for Medicare and Medicaid Innovation, that's been around post-Obama administration for 10 plus years now, and they had a bunch of great insights they released on about 50 value-based care models touching over 40 million lives. A terrific insight report.

And Humana kind of at the same time within the last few weeks here, but Humana also had a 10-year retro reflection on advancing value-based care. And I would love to have your reflection here on this, Dr. Ding, for other health plan leaders that tune into our podcast on what you've learned in the last 10 years and how you've gotten to the point right now in terms of progressing value-based care in the ecosystem.

Dr. Alex Ding:

One of the things we do every year is we publish this annual report on our experience with value-based care in hopes that our experience will provide proof points that value-based care works in practice. And so in this past report, which we published at the end of 2023, took a look and reflected back on a decade's worth of experience. In fact, if your listeners are interested, you can find this resource at humana.com/vbc.

And some of the key takeaways from that report showed that value-based care means more time with your primary care doc, less time in the emergency department or the hospital. We found there was better coordination of care, better care for the patient holistically, including resources for addressing health related social needs. There was more preventative care, better quality of care, better patient satisfaction. There's more cost savings not only to the system, but also out-of-pocket to the member and the patient.

All at the same time, physician practices made more money making for more sustainable practices. And in fact, our value-based arrangements continue to grow with now over 70% of our members seeing primary care physicians in value-based care arrangements. But at the same time, I think we have to know that we have to meet practices where they are and to do what we can to help support and get them to where they want to go.

And so I think we have to recognize that value-based care is a fundamentally different financial model and business model for clinics, but that also means that there are fundamentally different operating models and clinical models. And everyone knows that change is hard. And so we want to be there to help support practices get to where they want to go, but not really push them toward where they're not ready for.

So we also have some data that shows that there are opportunities for value-based care and value-based care principles to not only hit that triple aim in healthcare, which is quality access, patient satisfaction, that we can actually push toward that quintupling, which is also addressing physician and health professional satisfaction and health equity all at the same time. And so over 10 years for us, most of that progress in value-based care has been made in Medicare Advantage.

And we know that that is due to the design of MA that facilitates that. But at the same time, the principles, the learnings, the lessons can also be applicable to so many other places in healthcare. One, I think there are applications to other insurance lines of business, particularly the Medicaid markets. We also think there are opportunities to use it in other care delivery service lines like we're trying to now do in our home health business.

And then of course, specialty care, which is what we're having this discussion about today. So that includes MSK, that includes renal care, that includes oncology, and we're just trying to think more expansively about how we can apply those principles to so many various different other parts based on the lessons we learned over the past 10 years.

Brian Urban:

I love that. That is really I'd say like a spread offense strategy. You're looking at all the different things you've been successful in and how can you scale this across all of the populations with all the different needs they have in the geographies that you've been serving them. So this is really cool to hear your reflection, looking back at all of the different specific things that you mentioned there, in-home care, renal as well is very specific. So this is really, really cool.

It makes me think too about the 70% of your MA members having and actively seeing their primary care physician. John, with that considered, what would your, I guess, suggestion or guidance or motivation be to primary care physicians of any capacity, whether hospital-owned, private, et cetera, how would you say they need to rethink primary care in terms of addressing population's challenge with MSK-related conditions?

John Petito:

It's a great question as always, Brian. Good question.

Brian Urban:

First of all, you're not a doctor. I'll say that.

John Petito:

I would say I don't know that I have specific advice for primary care docs in particular. I think we as leaders in healthcare are thinking about the system that we, and I'll use just healthcare system very intentionally in quotes, that we need to have or should build, should think about. And this may be an esoteric or cerebral sort of way of thinking about it, but I think about the fact that our system fundamentally was not built around the types of conditions that America is facing today, the predominant forms of medical issues.

It was really built around acute illnesses. And I think about the specialization on top of that, the specialization, the proliferation of treatment and therapeutic options that now exist, especially when you're talking about complex conditions like MSK, only exacerbates the fact that the foundation was not built for the house that we need or want to live in. And in that context, I think about a priori, what would an intentional design look like had we known what the situation would be today?

What conditions we'd be trying to manage? What therapeutic options would be available to us? And in my view, there's a missing link. I think patient navigation grounded in evidence and clinical expertise may have been one of the core competencies we would've put into that design. I also think about the fact that primary care today is expected to do so much. In a certain sense, it's the atlas of US healthcare. And I think rethinking primary care means unburdening it. I think it means investing in it.

For example, how can you expect a primary care doc to fully understand the clinical needs and personal preferences of a patient in a 15-minute visit that takes one of our navigators 40 to 45 minutes to unpack the same set of information to then make a determination with the expertise and training they have in MSK about what is the right care journey, the right pathway for that patient? And further to understand the quality and cost implications of the various options that patient has in their network to then match them to the right place.

It is unfathomable and unrealistic to expect that. And so I think there is a need for, as we think about rethinking primary care, a need for building and supporting infrastructure with programs like TailorCare that can enable primary care by bringing specialist expertise at point in time where it matters and where it can be useful in informing the path, the journey that the patient ultimately goes on.

And so I think this has to be done in concert with primary care, not outside of it, but I also think it is not a primary care problem. I think it is a US healthcare system problem that we all play a part in.

Brian Urban:

Spoken like a true chief strategy officer these days with that comment being, we need to rethink the infrastructure around primary care. I love that, John, and TailorCare is a big part of rethinking that infrastructure. So gentlemen, such a great conversation. I want to close our talk here with a look into the future, maybe five plus years down the road.

So several steps out there in the evolution of TailorCare and the partnership that exists today with Humana. So starting with Dr. Ding here, what do you think your partnership is going to turn into relative to the impact you're ultimately going to have to the MSK population, the lives that you serve, struggling with these related conditions?

Dr. Alex Ding:

Yeah, I think that's a great question, and I think the bottom line is it's about scaling and maturation. I think figuring out the actual operating and clinical model of value-based practice in new areas can be very difficult. I mean, it took over a decade to start to get traction and operational maturity in primary care value-based care. Now we're trying to apply the principles to specialty care, but we've still got a very steep learning curve in the development of operating and clinical models for value-based specialty care.

One area that we've had at least a handful years of experience with is in bundled payments for hip and knee replacements. So in 2023, the Humana team published a peer-reviewed paper in JAMA Health Forum on these bundled payments as a proof point that value-based care in these episodic scope-limited episodes can work. We showed that there was about a $600 savings just under a 3% per joint replacement without any difference in the quality of care.

There was also less time spent in the hospital, less time in post-acute skilled nursing facilities, meaning people have more time back at home, which is where patients tell us they prefer to rest and recover. And so I mentioned this as an example of some of the early experience of value-based care with specialty care. We've got similar bundles for spinal fusion, cardiac bypass surgeries. But for me, these are just small beach heads of proof points for the principles of how you apply value-based care into specialty care.

What we think are the next level with specialty value-based care is really broadening that aperture of what that episode is such that it isn't that the bundle hits when it's just time for surgery, but rather when it might be when the patient presents with a particular complaint of a pain somewhere. And so this allows for more holistic management of the problem with opportunities to delay the progression of disease.

It allows leveraging other less invasive effective evidence-based treatments such as physical therapy, lifestyle medicine, or intermediate solutions like injections, allows more proactive management of anticipated issues. And quite frankly, it allows for more judicious use of scarce healthcare resources.

And so I think in the next five plus years, we're going to be looking at other opportunities to look at other specialties, how we might apply those principles of value-based care to those unique practice patterns and specialist workflows and in how to widen that aperture for what is considered within the care set of that value episode.

And just an example of this that we're already starting to think about is we published a value-based care issue brief on renal care just a couple of weeks ago, highlighting these principles and concepts and how we're working on this particular specialty and what early as we have that also, again, show improvements in quality, costs, and patient satisfactions in these models of care as compared to traditional fee-for-service.

Brian Urban:

I love the arc you just gave us, Dr. Ding, from the bundled payment models of joint replacement to now what does specialty care look like in the next generation relative to a value-based care payment methodology. That view, I think, will definitely stick in our audience's heads and how they can make an impact in their own respective worlds. I love that you're pushing the limits of effectiveness in terms of the scarcity we have with specialty physicians, not to mention primary care, more frontline, midline, mid-level practicing physicians as well, geriatricians across the board.

This is an amazing view you've just given us. And John, for you as a technology model enhancement leader, I'd say, short praise, how do you see some of these different trends across the ecosystem staying in place and growing? Not just TailorCare's model, but other models that are similar to addressing needs for populations that have a lot of these similar conditions that you wouldn't think have a high spend and a high trickle-down effect, but they do. What do you see sticking around over the next five-plus years?

John Petito:

I, unfortunately, didn't bring my crystal ball to this discussion. I wish I had and I could give you a really great answer. My view for the future is, and you commented on this earlier, there are a lot of point solutions. There's been a lot of investment, wave of investment and excitement in a lot of different types of companies, models. MSK in particular has seen its fair share of investment, if not more than fair share. And my view is, an aspiration I think for the future is with Humana, we scale.

We prove out every aspect of this model, and we build a scalable platform that becomes available to any Humana member regardless of where they choose or happen to live. And that then becomes the basis and effectively clearing the path and being a torchbearer for systemic change. I think some of these other point solutions may fall in, may roll in to the model, but my view is that we're able and have an opportunity to demonstrate the value of a more comprehensive solution with navigation and patients at the center.

And if we can prove the value of that rolling in some of these other solutions or perhaps some of those things fall to the side, we have created a model that for MSK shows the impact we can have on, excuse me, cost, quality, and access that then we can expand that to a broader set of conditions, a broader set of patients that may even set the stage for policy change that actually systemically changes the reimbursement environment and climate that facilitates even more transformation of the system.

Brian Urban:

Wow. I couldn't be more thrilled that we ended our conversation there because that's a serious cliffhanger. I feel a follow-up coming on year plus from now to revisit how the partnership is doing, the impact being made. So thankful to have both of you, a dynamic duo, like I said earlier, on the Healthcare Rethink Podcast. So a big thank you to Dr. Alex Ding, Associate Vice President, Physician Strategy and Medical Affairs at Humana, and Chief Strategy Officer at TailorCare, John Petito. Thank you gentlemen for joining our little show here today.

John Petito:

Brian, pleasure. Thanks for having us.

Dr. Alex Ding:

Thank you so much. Really enjoyed it.

Brian Urban:

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