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      How myPlace Health is Changing Healthcare

      Healthcare Rethink - Episode 17

      From myPlace Health, Rhiannon Iorio Perry and Dr. Rob Schreiber join the podcast to share their stories and efforts to expand health at home for seniors across the United States. myPlace believes building a new care model—one that provides care and dignity, focusing on the social and physical well-being of elder populations—is the only way to enable their members to enjoy their life to the fullest as they age in their own preferred place, on their own terms, and where they feel the most comfortable.

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      Healthcare Rethink: Hear From Leading Changemakers

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      Brian Urban (00:22):
      Here we go. This is the Healthcare Rethink podcast. I am your host, Brian Urban. And today, we are going to be talking about care and dignity in healthcare, how we must better serve our seniors across United States? Who better to represent that expertise than myPlace Health? Joining us today is Rhiannon Iorio Perry and Dr. Rob Schreiber.

      So, we're going to jump right into this, and we want to get to know our guests a little bit more and talk about who exactly myPlace Health is today, and how are they accelerating, really scaling the PACE model. This is going to be a good one. So, without further ado, I would love to introduce Rhiannon, please tell us a little bit about how you got into myPlace Health, your background. We know you have public health expertise. Tell us a little bit about yourself, and then we'll transition to Dr. Schreiber.

      Rhiannon Iorio Perry (01:18):
      Thanks Brian. So excited to be here today. So, I'm originally from Syracuse, New York. And then, I went to Boston to go to Boston University for undergrad and grad where I have my masters in public health, and healthcare administration and policy. And that's what really kicked off my deep interest, my strategy and operations and care model design.

      I had this really cool opportunity to do an administrative fellowship at Geisinger. And that's like a two-year stint where you go and you go to the executive team and you learn how to make strategic decisions at a higher level, but you also get really cool leadership opportunities as well.

      And one of the things I got to do was to think about how to decrease total cost of care for folks 65 and older with multiple chronic conditions. And it was my first time ever building something from the ground up, thinking about the business plan, the staffing, all of the operations, like who's on the care team, how do they work together, what's the marketing plan, the data plan, all of that. And I was like, "I love this. I want to do this all day."

      And so, did a pivot to Cityblock Health where I got to work in strategy and ops there, and build up a lot of their virtual side of their care model, which I again thought was so fun. And then, went to Tia from there. So, that was my second startup, where I was really interested in how do you scale an organization in a care model.

      And so, got to work there for a bit. And then, found myPlace Health, and was so excited about the work that we're doing because it's this really amazing opportunity to think about how do we deliver care to folks who are 55 and over with multiple chronic conditions in a way that meets them where they're at, and enables them to stay in their community.

      And as we think about the population that's aging, I really want to make sure that we're building something that is super exciting, that we're transforming this care, and that we're able to provide access to more and more individuals as they age.

      Brian Urban (03:04):
      Whew. I told you expertise when I opened the show, that is expertise. And I love there I say the name-dropping too, Geisinger, Cityblock Health. They are leaders in this space, front running food delivery model in terms of the Fresh Food Farmacy from Geisinger. Cityblock Health in terms of addressing SDOH barriers at the bedside patient with physicians.

      So, I love that you have had this journey and it's so fitting that you're touching older vulnerable populations, really leveraging the PACE model and we'll get into that, but just so, so exciting. Thank you, Rhiannon. And obviously, Dr. Schreiber, great transition to you.

      You're well-known in this space, being a physician by background, but also coming into the data and analytics space as well. This is really an evolution that you're standing up, not necessarily a service model or product, but it's really an evolution in the way I see it. So, would love for you to share a little bit more about Dr. Schreiber before the MD and how you got to myPlace Health.

      Dr. Rob Schreiber (04:11):
      Yeah, that takes quite a long time there, Brian, because I'm a little older than both of you. So, prior, I was always interested in taking and helping others. Part of my Jewish heritage is healing the world and trying to do the best for others. So, that's always stuck with me. I had a natural affinity. There are physicians in my family, and I had the opportunity of learning from them. But it was really, I liked doing a lot of different things and I just migrated into the health professions.

      After having multiple options in college, I decided to go into medical school and was lucky to be accepted. Then, I went on a course really dealing with primary care because I wanted to deal with the whole person. Coming out of my residency in the '80s, I was able to actually work in a geriatric health center. It was actually like a federally qualified health center.It was in Danbury, Connecticut. This was a center for older adults that had retired or had been forced out of their jobs.

      It was a milling town, they used to make hats. But a lot of these individuals were left with limited means, and the government as part of the settlement, allowed them to get healthcare for the rest of their lives. And so, that's how I got exposed to geriatrics right after my residency.

      Long story short, I found I had an affinity for it. It was the most challenging population. But oftentimes, most of my peers as well as my mentors really didn't think much of it. They thought, "Well, we all are geriatricians, we all take care of older people." But there was really a whole evidence-basedbase that had been developed in England.

      I actually had the chance to meet and learn from a geriatrician from Scotland by the name of Ian Lawson at this health center. And then, I actually got connected to the University of Connecticut where they had the Travelers Aging Center and Richard Besdine had a geriatric fellowship program, and I got entwined in geriatrics.

      Sicne that time, I've really worked with multi-specialty groups, and I've focused on building systems of care for older adults, most often complex, vulnerable, frail, nursing home eligible or soon to be. I found that to be not only the most challenging, but the most rewarding population. One of the things I learned was that it's great to do models and build things, but the thing that frustrated me, we found things that work but they never really scaled.

      And so, the opportunity that came across when SCAN Health Plan and Commonwealth Care Alliance decided to fund and co-sponsor myPlace Health was to take a PACE model, which I had been doing literally for the previous six years and scaling it. This  is again, something that we're very excited to be able to do because of that opportunity to really make this evidence-based model which does exist, it's been well-proven and really bring it to the masses.

      Brian Urban (07:20):
      Wow. I can just see how you fell in love with geriatric care there because of where you were positioned and the work you did earlier in your career. But then, the connections you made and you really saw the value of caring for this particular population that has very complex needs that also ripple across caregivers as well. And we're going to get into that as well.

      Dr. Rob Schreiber (07:45):
      Just one thing to add to that, that's so spot on. The thing I really did not mention, which shame on me, I did not. As much as I was helping them, they helped me. The lessons I learned, the way they dealt with adversity, the legacies they had left when you learned about their lives and the challenges they had to face to get to where they were, just absolutely amazing, awe-inspiring.

      A matter of fact, as what I'm talking now, I'm just, I'm having flashbacks with people that had truly impacted me, patients who I was caring for, but in a way they were also helping me and caring for me.

      Brian Urban (08:26):
      Wow. That's why people become healthcare professionals, physicians. And that is clearly a part of you, Dr. Schreiber. And thank you for sharing that because that shows us the mission-based purpose of myPlace Health, and what we need attention on, really now more than ever. We have a humongous aging population. And, of course, there's the sandwich generation folks in their late 30s, 40s that have young children, and quickly aging or in poor health, parents or previous guardians.

      So, man, it is a challenging economic health, mental health, and strain on healthcare systems and health centers. So, it's a big task you all are going after. So, I'm really excited to learn a little bit more, and thank you both for sharing your backgrounds and it shows us the culture that myPlace Health is really exuding. So, that's exciting for our listeners.

      So, let's get into myPlace Health a little bit deeper here. So, you gave some background in terms of Commonwealth Care Alliance and SCAN Group sharing a partnership with you all, and you're leveraging the PACE model, just to define that, it's the program for all-inclusive care for elderly that's been around since the '70s, and you had mentioned your experience working in across the pond there with some leaders back in the day.

      So, tell us more about your approach with the PACE model, and what myPlace Health truly is today. And then, we can get into the impact you want to make, but who's myPlace Health and tell us about the PACE model integrated into your organization.

      Rhiannon Iorio Perry (10:15):
      We're an organization that's building a care delivery model that's really focused on enabling frail seniors and elderly adults to remain living in their communities as long as possible, independently rather than crashing into nursing homes later.

      And so, this is a huge opportunity here to ensure that we're able to support folks in meeting what matters most to them. And for many people, that's staying at home and in their communities. And so, first as we mentioned, we're going to launch the PACE model, so that's where we're going to start. But we also recognized this really cool opportunity to expand our model beyond PACE and to other clinically similar populations.

      So, this is an opportunity to expand access to folks who need it the most. And we also have noticed this really cool growth opportunity. So, as we mentioned, we have SCAN Health Plan and Commonwealth's Care Alliance, and we want to continue to find other mission driven health plans an important players in the community like CBOs as well that we can partner with to really have PACE serve as a direct extension of their model. So, there's a lot of opportunity here in what we're trying to kick off.

      Dr. Rob Schreiber (11:22):
      Yeah. So, just to build on what Rhiannon said, and going back to what you had brought up, Brian. We are really fortunate to have co-sponsors like SCAN Health Plan and Commonwealth Care Alliance. They're giving us this opportunity and they're supporting it to really bring this to scale and it's not really being done in healthcare to take a model of care that we have. (and we'll talk about the outcomes of that and some of the outcomes of why it's better)

      But really, taking it as part of their mission, their DNA, which is really to improve health of populations, especially those that are low income and vulnerable, and really bringing it to the masses and trying to then develop partnerships with like-minded as Brianna said, like-minded organizations.

      So, that's really critical because even if we have this mission and passion, if we don't have that type of support, we're only going to be so successful. That’s been some of the challenges that healthcare has faced. Even if you have a great model, unless it's truly universally adapted as a goal and a strategy, it's not going to go where it needs to go.

      So, with that and the other piece, I just want to add to what Rhiannon said, one of the other things as we know when we're talking about this population is helping the caregiver manage the care as well as manage themselves, so that they can be not only supportive of the individual and help them live their best possible life, which is pretty hard. And we can talk more about that. But it's also, how do they care for themselves and how do we help them really run this marathon?

      It's not a sprint, it's a marathon and we want them to finish and finish in good shape. We don't want them collapsing once they get to the finish line. So, how do we do that? How does that baked in? So, it's not only just about the older adult, it's also the unit and the caregiver support and family around them, so that they all can live their best possible lives.

      Brian Urban (13:22):
      Excellent breakdown of who myPlace Health is, from a sponsored perspective with SCAN and Commonwealth, then also however you're leveraging the PACE model. It's not just about the patients that are vulnerable, older populations, but it's about the caregiver as well. And that whole community it can face a high amount of mental health stress. And then, also, healthcare costs associated with that.

      And if they're not caring for themselves, they're putting all their efforts into caring for their loved ones, that will not work well. That's the marathon approach. I love that you're saying that. And Rhiannon, you mentioned something that made me want to know a little bit more about the current patient experience today that is, how difficult is it to navigate services?

      Say I'm 65 and older, I think the average participant in PACE is about 75 years approximately. But, I mean, how difficult is it for these individuals to navigate or and even enroll in services just to start to get health and different services at home, like food, transportation, different therapies, medication delivery, that's a lot. How hard is that for someone right now

      Rhiannon Iorio Perry (14:40):
      Yeah, it's a great question. I mean, I think it's so challenging. Even if we think about ourselves navigating healthcare is so complex. There's so many moving pieces. And when you think about folks who are in the PACE model, as you mentioned, the average age of a PACE participant is 77. They might have six chronic conditions like, they might be impaired with two to five activities of daily living. So, like toileting, feeding, 50% may have Alzheimer's or dementia.

      So, these folks are really complex and they're navigating this healthcare system that is not very straightforward, and it's not very clear all the time of what is offered in your state, how to get access to services in your state. And if you think about the healthcare system today, it's really focused on illness and a lot of times it's very reactive.

      And so, there's a huge opportunity here to focus, as you mentioned on the social pieces. So, access to transportation, to food, to housing, all of these things that folks need access to in order for them to have more comprehensive care. And today, there's an interesting stat, medical care only impacts 10% to 20% of health outcomes.

      That is not a lot at all, which means that this focus on the social piece is huge as, of course, along with the behavioral side too, which is why I think PACE is so special and important because it really provides that integrated approach. It's focused on the social piece by ensuring that your interdisciplinary team is wrapping around the participant and understanding what their access to these social services are. And if there are gaps, ensuring that we're able to meet those.

      An example is, providing transportation to every single appointment, including specialist appointments that exist at PACE. That is amazing. We're having a dietician on your care team, who's thinking with you about access to food, food that fits your needs or for whatever chronic conditions you might have, access to housing. And if you're in jeopardy of losing that housing, partnering with community-based organizations to be able to ensure that we're able to support you through that. And then, of course, the focus on the medical and the behavioral piece.

      So, I think that it's challenging. It's so challenging. There's so much that needs support in terms of coordination of services and access to those and PACE is really well set up, and so is myPlace Health to be able to support participants in navigating and getting access to those services.

      Brian Urban (17:02):
      And you've highlighted, for me, not being an expert in the space, it makes me feel where do we start? And you're starting with the PACE model clearly, and then you're building up from there, and there's a lot of different components that you're building on top of that with your sponsors too.

      But I want to dig into PACE a little bit more, so our audience can understand how valuable this is as a foundation for serving older populations that are vulnerable, that have complex and high needs. So, I understand PACE has been around for a good while now. It's pretty established in about 36 states or so, 270 plus centers, physical centers in the US.

      But the model needs support, and you have a strong focus on, I understand building the relationships with CBOs through the PACE model, community-based organizations for that reference there for our audience. But I want to know if you can tell me a little bit more about what your impact is going to be through using this model? I understand as a foundation, but that's conceptual for me.

      We'd love to understand how you build on top of this model. And Rhiannon, let's stick with you right now. And then, Dr. Schreiber, please, please later on. But I am just enthralled right now and learning from you as well. We're at the same time over our little show here. So, Rhiannon, educate me please on PACE and how you're building up from them.

      Rhiannon Iorio Perry 
      Yeah, so I think that as we think about PACE, as you mentioned, it's been around for 50 years. So, it's not necessarily new though, a lot of people actually don't know about it, which is very interesting, and it's not offered in every state as we know. But it is focused on the most complex, costly and challenging populations.

      And I think that the impact, as we mentioned before, there's of course, an impact on the participant themselves meeting what matters most to them, ensuring they have a high quality of life, giving them meaning and purpose and the ability to participate in their communities while also reducing caregiver burden as well.

      There's an impact on your total cost of care in terms of inpatient admits, ED admits, so many other pieces there. But I think what's really cool with PACE too is that, there's also a lot of opportunity in terms of programming that we can create that impact people in different ways that we might not even think about. And one of those is connectedness.

      And if we think about the elderly population, something that we noticed during the pandemic is social isolation. Folks were stuck at home, and there's loneliness in many of these folks. And so, there's opportunity to also impact people in terms of building community within PACE, like within the centers that will create and meeting people whether they need to be met virtually, if they're at home or going to their home.

      But also, creating different programs to support them wherever they might be, whether that's them attending a Zoom yoga class or a book club or whatever it might be. Just different discussion groups with folks who are also in the same PACE center. I think that's a really big impact, that might not be super obvious to folks, but I think that's some of the really interesting pieces of PACE is it goes beyond, just like the medical outcome piece. It's really tied to your quality of life.

      Dr. Rob Schreiber (20:25):
      Thank you, Rhiannon. That's spot on. And let me try to add some additional things. So, Brian, I think getting back to what PACE is for the people listening to this and others, I think that is not only don't they understand what PACE is or know about it, but even if they've heard of PACE, they don't really understand what involves pace. And Rhiannon and I think brought this up, the interdisciplinary team is the secret sauce.

      So, these are 11 disciplines that are mandated by the federal regulations that require us to have these people around the table for each individual. So, think of concierge medicine, but this is concierge health for dual eligible, nursing home eligible populations, 55 and older that would be living in a nursing home but has a team of 11 people of all different disciplines, social work, nursing, home care, physical therapy, occupational therapy, nutrition, transportation, the center administration providers and health aid, or a personal care attendant, all these individuals whose goal is to really meet and understand what is most important to that individual, what they want to achieve, how they want to live. And our mission is to make that happen.

      Where does that happen in healthcare? Matter of fact, has any of us ever experienced a care team coming over and saying, "Hey, Rob, what's really important to you? What do you want to achieve and how can we help?" That is the PACE model. Now, it's easier said than done, okay, because not only are we a provider of care, we provide home care. We have an adult day center, but we also are an insurance plan.

      So, we're a provider and an insurer. So, we are regulated. There's incredible regulations in terms of things we have to do  and report on. And if we're not doing things, we have to let CMS know that we've fallen down, and what we're doing about correcting it.

      So, the model is very intense. That's part of the reason why it hasn't scaled, although it's been around for 50 years and it is one of the few truly evidence-based models that have been recognized by CMS as a validated model of care. So, as a result, the challenge is, how do we really bring this out to the masses so that every community can have it? And that's really, again, where our co-sponsors and developing this movement.

      And I really do believe it's a movement to really get care for all of us, especially as you age. You're going to age, and if you live long enough, you're going to become frail and nursing home eligible. Most people want to live a long life. If you'd want to live a long life, then that's where you're going. But what is going to be the model? What is going to be the approach?

      And again, playing off what Rhiannon said, not only are we doing this in PACE, but how do we inform other systems of care, how other health products, how do we push that upstream? Lastly, it really is about the money. So, the dual eligible population is about 15% of Medicaid census that drives a very significant portion of the Medicare and Medicaid dollars. This group spend 35% of the dollars for Medicare and Medicaid are spent by this dual population.

      So, in our population is like the top 5% of that group. And so, the numbers are huge. So, in terms of sustainability and how we care for this demographic of aging baby boomers, of which I'm one, although at the end of the baby boomer wave, but how are we going to do that? And so, this type of model really does need to scale, and we need to continue to evolve it and improve it.

      Brian Urban (24:32):
      That is extremely helpful. One, for me, being educated on the PACE and building up from there, that model, but also for our audience as well. So, also coordinating care I heard is extremely important in this model, and how you do that to avoid unnecessary healthcare expenses, complicated services as well. And then, also thinking about Medicaid coverage, not disrupting coverage and how you stay engaged with this population and their families.

      Extremely complex and makes me all think about the cost, the economic weight if we don't in this country adapt new ways of really helping elderly and frail population. So, transitioning off what you said, Dr. Schreiber, I personally, I think about the cost and the challenges in my own little family, the sandwich generation.

      So, I have older parents, older in-laws, some have passed away recently, and we have young children in my family. So, my wife and I, my wife Janelle taking care of them all the time. So, how can you take care of two sets, children and parents, maintain a career, maintain your own health? We have a lot of challenges that are placed on families using mine as a little example here.

      So, I wanted to hear from your perspectives, what's the true cost to the United States here if we don't adapt a new model for taking care of elderly and frail populations? Considering that example and millions of other examples, what are we facing here? And how bad is it going to be if we fail? Dr. Schreiber, could we stick with you for this one?

      Dr. Rob Schreiber (26:25):
      It's a great question. I'm trying to remember the actual quoted number of how many hundreds of billions of dollars of caregiver time is spent that's uncompensated. The number is just huge estimated to be at least $600 billion. One of the other challenges we talked about was the caregiver burden, but also the lack of caregivers.

      So, with the aging demographic, we're not replacing the population and the number of caregivers as well as the number of people who are supporting social security and Medicare and Medicaid have dramatically decreased. So, not only is it impacting the older population, but as you said, it's going to also impact the younger population because who's going to be there to support you all, right?

      So, the true cost is, it is pretty, it's overwhelming actually. But I think, the thing is we actually have models that would work. And one of the things that I think PACE does do, because most people do want to stay in the community, and if you stay in the community, it's actually, there have been studies that have shown that people who stay in the community are actively engaged and they're productive. As much as they may need more help and support, they're interdependent, but they're still productive and they contribute.

      So, when you look at what they do, first what the cost is, it's a value proposition keeping them in the community. And most older adults, I think AARP had done a survey of where do people want to live? And about 80% want to live in the community. They do not want to be in an institutional setting.

      So, then the question is, okay, how do we do that? And what is the cost? So, if we don't figure this out, we know for a fact that with the way Medicare and Medicaid expenditures are, as well as social security, that if we don't bend, continue to bend this cost curve, there will be no more money left except for those programs, the National Debt Defense. 
      There may be one other thing that we can pay for, but any other type of funding will not exist.

      So, that's the issue. And so, then question is, do models like this make a difference? And in fact, it does make a difference. It dramatically lowers the cost of care by at least 20% to 30%. I would also say that the PACE model, as much as its evidence-based, we have ways to go. I really think that not only can the quality be improved, but the cost can be lowered.

      So, the value proposition of PACE and PACE like models have not been fully actuated such that if we build this in, so it becomes the way we do care, it is sustainable. It's sustainable for the individuals, it would be sustainable for families because there'd be more support for them. There'd be more access to these services.

      So, more people could access them as well as individuals would be in the community. There'd be more opportunities to do intergenerational support. I had talked about learning from older adults. I don't care how old they are, they can teach many of us lessons. And the value of that oftentimes doesn't even get acknowledged.

      So, I think there's a way to do it, but we really need to scale this fast because if we can bend that cost curve, then there are dollars that are saved that can be built in to help support not only the caregivers and the sandwich generation, but the younger generation as well.

      Brian Urban (30:16):
      And I want to get into how you're rapidly building out your team here to support this model. But Rhiannon, I know you got some good stats in that brain that I would love to hear going off of what Dr. Schreiber was saying in terms of what we got with 77, almost 80 million baby boomers. And of that, in the survey you had mentioned from AARP, about 80% of them adults 50 and older said they want to stay in their home. And how do we do that?

      So, I'm curious from your perspective, coming at it from a public health lens here, these are staggering numbers. And how do you begin to tackle this from staffing your team and the expertise that you need to have more partnerships? You made me think of actually Papa Health, Andrew Parker, future guest on the show, running a great socialization technology company, Papa Pals, and things like that.

      So, I'm wondering, are you starting to focus on staffing up your team, and then also building out these partnerships concurrently as how does that work? I guess, how you're tackling it based on some of these staggering statistics we talked about? I'm interested in that kind of perspective, Rhiannon.

      Rhiannon Iorio Perry (31:41):
      Yeah, definitely. I love how you knew I had a stat in my head. I definitely knew. Rob was talking about the number of aging adults. I think it's by 2060, we'll have 95 million people over the age of 65. And to Rob's point, about 80% wanting to stay in their homes. That is massive. That's so many people, right?

      And yeah, I mean, there's a lot that we need to consider here. I think on the staffing front is we think about wanting to do a few things. One, like we want to provide integrated care. So, as I mentioned, we need to think about the social piece. We need to think about the behavioral and the medical and the spiritual. There's so many different pieces that we need to consider.

      And so, when we're going to build a team, the interdisciplinary team really is the special sauce of PACE. You have your, of course, your providers. But you also might be leveraging your behavioral health workers, your dieticians, as I mentioned, your, of course, nursing. We have physical therapy, occupational therapy, recreational therapy for activities. We have drivers.

      So, we really need to think about, okay, what are all the different things that we want to do for our participants? What the transportation piece, which is having a transportation coordinator or the food with the dietician or the provider, as we think about all the medical needs. We need to be thinking about that upfront as we go to staff and designing our model and ensuring that if we're saying we're going to do something, we have the right people in place who can work collaboratively to bring the participants plan of care into action and to impact what matters most for them.

      And so, I think that's one big piece. I think that there's another piece here around just the populations that we serve and understanding that every population is unique. There's no blanket approach in healthcare to how we care for folks. And so, I think that we need to consider every time we go into a market, we need to listen to our participants and what they want and ensure that on a corporate side, and we're building our care model, thinking about what do participants want to see in their care, what activities resonate with them, what meals do they want to eat when they come to the center, what kind of books do they want to read and want to see in our centers when they come here?

      And then, I think there's another piece here around building trust in relationships in the communities that we serve. And that's really where we need to build strong partnerships with community-based organizations, who are very familiar with these populations and we have a lot to learn. And so, I think that there's a big piece here around us listening and us really investing and wanting to build that trusting and trust in relationship piece.

      And then, also on the other side of the teams, and what we can do from a care team perspective as we go into different populations is training around culturally competent care, for example, like death and dying looks so different in different populations. And we need to ensure that we're never making generalizations that we're always seeking to understand and making sure that the care we're delivering is truly meeting people's needs.

      Brian Urban (34:38):
      Yeah, I just love the two things you pulled out, Rhiannon, is amazing. One, you had mentioned that you're partnering with community-based organizations, you're learning from them, and also you're offering learnings to them. I didn't hear scaling them. And I think that's a challenge for a lot of other social care tech platform organizations that want to almost try and scale meals on wheels that are based on volunteers.

      For example, in central Pennsylvania, you get a lot of people making sandwiches and meals in a church basement. Unless you get a thousand volunteers, you're not going to really scale that. But there's different ways to partner in terms of how you identify the folks that are in need of these meals as an example, rather than to scaling. Because your example of partnership is far more realistic in terms of what the construct is for a lot of these community-based organizations today.

      So, thank you for sharing that. The other piece, the interdisciplinary team, I love it. It's like a preference sensitive care culture that you're taking to better serve the individuals that are older and frail populations and spiritually too. That's so important. If that's not there, then trust can't be built further up with the whole healthcare system.

      So, I wanted to highlight those two things you said for our listeners because those are two critical things that are missed historically in the US, within our healthcare society from my perspective. So, I love that you're addressing that. The tough thing a lot of people have been doing it for years to try and address those two things, but I love that that's a core piece of myPlace Health. So, thank you for saying that.

      Dr. Rob Schreiber (36:24):
      So, Brian, I wanted to just also, there was another thing that came to mind about the cost of how we make this sustainable. So, we talked about diversity and equity and be able to be inclusive is really critical, right? Because you're going to have the best model, but if you're not able to meet the local need and provide that care with people that understand that live in that community, you're not going to succeed.

      But it really comes down to what community is about. And the other opportunity in terms of bending this cost curve is keeping people in the community. But if you're going to have frail nursing home eligible, they're going to need a new type of support. They don't want to be in a nursing home, so what else is there?

      And so, there have been a number of programs, insurers as well have been built housing, supportive housing where you bring services into a housing building, they're small apartments, studios, but people can actually live in the environment. And we know for a fact that it's less costly than nursing home care. Matter of fact, in one of the PACE programs I worked with, we actually studied it per person keeping somebody in a supportive housing model with 24/7, 365 care.

      So, there was always somebody there with a one to six ratio. We were saving conservatively just from the cost of nursing home into supportive housing, $40,000 of hard green dollars per year. So, if you could take housing, develop supportive housing, affordable housing, low-income housing in communities that are accessible to services, connect that with the entire healthcare such as the IDT that has diversity and equity, and really is culturally competent.

      This is a way to make the healthcare system sustainable and not to break the bank. That is going to be the model. We have to combine both of those because that's... It's one thing to do the healthcare and the IDT, but if you can't stay in your home and you want to be in the community, what's your option? And they're very limited options unless you have significant income. And we know at least half of the baby boomers are not going to have that income in order to be in an assisted living or other type of supportive environment that costs dollars.

      Brian Urban (38:45):
      You bring up a great point, Dr. Schreiber. A lot of economic instability with this population as they continue to age a lot less liquid assets for them to utilize for paying for their services, for paying for where they live. So, housing definitely one of the most challenging SDOH domains to really tackle. And you brought me to a nice transition here naturally, I'm glad we're going this direction.

      So, obviously, the COVID-19 pandemic and the height of it in 2020 out through '21 really highlighted all inequities imaginable at a great stage through social media, through every community across the country, rural hinterlands, urban areas.

      When you think about addressing the social health barriers for elderly populations, what did you all see during the pandemic that maybe you're going to take into your model to ensure that you're addressing barriers? I mean, housing is one, but transportation and food are going to be critical to these populations. What's the consideration there? What have you learned and where are you planning to apply in that space? And Rhiannon, let's start with you because I'm biased towards public health lens. So, tell me what you all are thinking about.

      Rhiannon Iorio Perry (40:09):
      Yeah, so interestingly enough, so during the pandemic, PACE had a third of the deaths and hospitalizations compared to the nursing home population, which is really interesting. And I think a lot of this is attributed to what we've been talking about around the interdisciplinary team and coordinating care and giving access to services.

      And then, also meeting people where they're at, which we'll get to in a second. But I think that as we think about creating the care plan for folks like during the pandemic, we recognize the lack of access for transportation to appointments as an example. In PACE, you have to provide transportation. That's a huge focus. And you have team members who are deeply focused on doing that.

      And we're constantly checking in with participants around what are their needs, whether it be transportation, whether it be access to healthy food, and ensuring that our entire care team is aware of that in working with a participant to ensure that they have access to services by tapping into the different community-based organizations around, or for us even looking at our health plan sponsors and other programs that they've incubated as well and leveraging services from them.

      So, there's a huge opportunity there to think about what are the gaps that people are experiencing, and to bring that front and center to their care and ensure it connects to what matters most of them. And then, deploy the team around them to work together and collaboratively to be able to actually give them access. And then, the other piece is meeting people where they're at.

      So, as I mentioned earlier, a lot of folks in PACE might have felt social isolation or might have been home bound, don't want to leave their homes. And what we need to do, and what we plan to do at myPlace Health is to bring the care to them. So, that means, if they want to be in the center, they can, or if they want to be in the clinic, they can. But we can also go to their homes, our entire team can go there, and we can also provide care virtually.

      And that just really provides so much more access. So, they don't have to worry about leaving their homes to get an answer to a question or the caregiver doesn't have to worry about it either. We are at their fingertips and we're there when we need them. And I think that that's something like the pandemic showed and why that's so important and why you saw such a transition to virtual care.

      And we plan to keep that around. We've recognized the importance of that and we want to be able to build not only medical care delivered virtually, but the behavioral piece, the social piece, and also the recreational activities piece, as I mentioned earlier, of ways to engage folks at home in their PACE community to reduce any isolation.

      Brian Urban (42:35):
      I love that. So, from a CBO community-based organization approach, addressing SDOH barriers, from a caregiver helping their loved ones use technology or helping put in place remote patient monitoring devices. There's so many angles that I was feeling off of your response there.

      So, being able to put that in a sustainable model and through a teachable model is going to be a critical component too. But Dr. Schreiber, you looked like you had some thoughts. I wanted to make sure we captured what you were thinking here.

      Dr. Rob Schreiber (43:11):
      Yeah, just to add, it's fascinating. The COVID pandemic totally flipped everything in PACE because we were predominantly, pre-COVID, PACE programs were center-based. People came to the center, that's where you came to socialize. And literally, overnight, and I kid you not, it was overnight, it was over a weekend. We went from a center-based to a home-based model.

      Again Rhiannon brought up the outcomes. And a lot of it was not only going into the home, but able to do it safely. It made us realize though that there was a lot of value in the home that we were not leveraging. And now, post COVID, people have different preferences. There were a lot of losses that occur during COVID. I mean, the number of people that have died is astounding. One out of a hundred Americans have died or have been impacted by COVID.

      So, knowing that it's made us really think through things. But one of the barriers was, we talked about health equity, which PACE deals with, and I don't know if we mentioned this when we're talking about the model, the way it's paid for, it's bundle payment. So, it's total cost to care. We get Medicare, Medicaid dollars, we bundle them together and we got to live on that. That's the money we have.

      So, we have to be good stewards of that dollar. We have to make certain we're spending it right. We're not wasting it, it's not being abused. And again, we're audited very heavily to validate that. But with that in mind, part of it is that this population, oftentimes, they don't know how to use a smartphone. They've never had a smartphone. They don't have information technology. They don't have the internet.

      So, actually, this is the ability to bring equity around information technology to a population in need and be able to then it because it's like, "Oh, they can't use it. Well, no, they've never been given the opportunity to learn it." And it's amazing bringing that in opens up a whole different opportunity, as Rhiannon was talking about, of things that we can do in the home where they can do social interactions over the internet, rather than necessarily having to come in where they may not be feeling well that day, but they want to still be engaged.

      So, it's giving us a whole different approach where we're enabling the home and that becomes another place of care. And our goal is to elevate that, so that people can get care no matter where they are, that care coordination 24 hours, seven days a week, 365 is occurring. We have touchpoints and access to them to really meet not only where they are, but also to focus on what's important to them.

      Brian Urban (45:50):
      It brings off such a sense, Dr. Schreiber to me, that you all are rapidly learning and doing and applying as you go because you're not coming at it from, "Hey, let's just stick to what worked in the past." Clearly, that's not the case. You're rapidly learning, doing and applying. And I think maybe that's the culture that is going to continue to grow. And I hope it does at myPlace Health, and with your sponsors, SCAN and Commonwealth.

      Shout out to Sachin Jain for having that type of approach as well. Maybe, that's a cultural impact that's already happening before us here, but it's just so excited that you all aren't afraid to do this rapid learning and doing. So, I want to look ahead a little bit. I want to fast forward, going to bring us to a close here because we've had such a wonderful conversation. I feel maybe an episode two coming on, because we could just talk for days on this.

      But I'm interested, what are the top impacts you think myPlace Health is going to have in the elderly population in the US over the next three plus years? Rhiannon, let's shift back to you to start us off here.

      Rhiannon Iorio Perry (47:05):
      Yeah, I mean, I think that there's a cute, a few key things here. One is just for participants. So, it's really keeping frail and nursing home eligible older adults who have this complex social and medical needs living in their communities independently, living this life of meaning and purpose, a high-quality life that impacts not only them, but the people around them, that we talked about before, the caregivers, their sisters, aunts, uncles, everyone that's related to them.

      And then, of course, for the caregivers specifically, there's a huge impact here. They might not have to quit their jobs to care for their loved one or they might have some of the burnout they feel prevented because they feel wrapped around with the support and different resources, and a community that's really there to help them navigate healthcare and all the different challenges that we spoke about already today.

      And then, I think for the healthcare system, as of course, as we talked about, reducing total cost of care. So, reducing number of inpatients admits, and ED visits. And then, also just reducing the amount of complexity in a way of having to navigate all these different specialists as an older adult that can feel really confusing and challenging, and instead having that done in a very coordinated way.

      And then, I think just more broadly as we think about the healthcare system and the communities as a whole. This is a beacon of best-in-class care, an integration of social services that is going to impact the most vulnerable people in our communities. And we want to do this at scale, as we talked about before. And though it's the challenging piece, I think that's the part that is so motivating to be able to take what we're building today and impact.

      As I mentioned, all these different players in healthcare systems and ensure that people are able to live these amazing meaningful lives, high quality life that can really be provided across the country.

      Brian Urban (48:57):
      I love it. The lives that this population deserves to have afforded to them in challenging circumstances or normal circumstances. I love the mission. Thank you for pulling that through, Rhiannon. Dr. Schreiber, any final comments on what Rhiannon was saying in terms of the impacts that myPlace Health will have?

      Dr. Rob Schreiber (49:18):
      This is part of the reason why we're doing this is like, what's going to be different. And this is really, when we talk about scale, what does that truly mean? And that's really like, what do we want to see happen? And again, I think everything that Rhiannon said was critical.

      The two other things I would call out or three things would be the diversity and equity piece, really ensuring that we're meeting people, especially the vulnerable populations, which are oftentimes disenfranchised have been forgotten. And that includes people with significant behavioral health, serious mental illness and the population of people that are struggling with substance use is really critical. So, how do we build that in, bake that in, so it's normalized?

      The second thing is, how do we develop a community ecosystem? So, we really support the community so people can age in place, right? Because we can be successful, but we're touching a very small part. You have this whole bolus as we talked about, people that are coming downstream. How do we keep them in the community? So, what can we do preventively working with other organizations to keep people upstream because we know the numbers are going to be there?

      And then, the last thing really comes down to, how we truly engage a different model of care that's really preventive and that's really focused on what matters. It's really, how do we become age friendly and focus on those things that are important, how people want to live because it has, I think, been shown. And there is evidence that if you can focus on really what's important to people, their lives are better, the quality of care is better and the cost is dramatically less.

      And so, if we can do that, bring all that together, that is the step forward. I think myPlace Health in the next three, five years can be part of that foundation and support that movement, as we talked about before, to really change the way care is being delivered in a sustainable way, so that people can live a life of meaning and purpose, and also be part of the community. And have the community also be able to survive and thrive with this engaged older population that oftentimes has been forgotten about.

      Brian Urban (51:29):
      And we can't forget anymore and we need to address it head on. And I love what you said, your humble words and bold initiative that you're taking here to address how we provide dignity and care to our senior populations across the US.

      I thank you both from the bottom of my heart, Dr. Schreiber, and Rhiannon. I love the work you're doing, and I'm so excited to see myPlace Health grow. And for more insights and excerpts, please visit finthrive.com.

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