Ep 146 – Bringing an Integrated All-In-One Solution to American Healthcare, with Dr. Neil Wagle

This week on the Race to Value you will hear from Dr. Neil Wagle, the Chief Medical Officer at Devoted Health. This is a company we have been wanting to profile on the podcast for quite some time! Devoted Health is a healthcare company that designs Medicare Advantage plans for seniors; however, they are so much more than just a MA plan. Devoted Health has built a different model of care that starts with knowing their members on a personal level and earning their trust. By focusing on each member as a person and not as a chart, they are able to provide the best quality care for older Americans through an all-in-one healthcare solution combining the MA plan, access to high quality local providers alongside virtual and in-home care, and full-service guides—with world-class proprietary technology powering it all. This company is a leading innovator in value-based care.

Dr. Neil Wagle knows a thing or two about transforming healthcare. He is an internal-medicine physician by training, spent six years at Partners Healthcare (now Mass General Brigham) leading the health system’s efforts to improve the quality of care for patients. In 2017, he joined Devoted Health, a $12.7 billion health-insurance startup. As its chief medical officer, he’s spearheading the development of a model of care aimed at improving the health of older Americans by getting them the right care at the right time while saving costs for the US healthcare system.

In this episode, we discuss clinician burnout and moral injury, post-pandemic recalibration of the healthcare system, virtual care delivery, the benefits of a fully-integrated technology platform, health equity transformation, creating a virtual “Blue Zone”, patient-reported outcome measures, activation of chronically ill patients, and the importance of company culture in delivering relationship-based care.

Episode Bookmarks:

01:30 Introduction to Dr. Neil Wagle, the Chief Medical Officer at Devoted Health.

03:45 Dr. Wagle provides his background as a “synthesizer between medical-scientific world and the business world.”

04:15 Inspiration and mentorship from Dr. Tom Lee and being a part of Mass General Brigham’s first value-based contract.

04:45 “We’ll probably lose $70m in the first year, but we’re moving to value-based care because it is the right thing for patients.”

05:45 A chance coffee meeting with Ed Park led to the “ridiculously challenging” quest to build a system that could radically transform healthcare!

07:00 Provider burnout and moral injury is one of the major crises in healthcare (along with rising costs and inadequate care for aging Americans).

08:45 Dr. Wagle on how the pandemic has exacerbated moral injury and why we need to return to the altruistic underpinnings of medicine.

09:30 “The ability for physicians to connect with others has been decimated by overbooked 15-minute visits.”

09:45 How documentation requirements in fee-for-service medicine robs providers of “pajama time” with their families.

10:00 The Great Resignation in healthcare is being driven by the perpetuation of the fee-for-service business model.

10:30 Resolving the three crises of healthcare (i.e. Provider burnout, aging population, and rising healthcare costs) through care delivery transformation.

11:00 The good news in VBC: providers want to practice medicine in this way and patients actually have better outcomes with lower costs!

11:45 “You have to be able to monetize fewer hospitalizations. If you can’t, the value-based model of care won’t work financially.”

12:30 The emotional fuel of seeing better patient outcomes in VBC drives continual value-based care transformation.

13:00 The new wave of healthcare consumerism from the pandemic is causing a much-needed recalibration of care delivery.

14:00 “COVID exposed cracks in our fee-for-service model…”

15:45 “Value-based care is actually the ideal home for virtual care services because you don’t have to worry about over-utilization.”

16:00 Dr. Wagle describes how Devoted Health dramatically improves the health and wellbeing of Americans through person-centered care.

16:30 The “all-in-one healthcare” offering of Devoted Health as a virtual in-home medical group and MA plan, enabled by full-service guides and integrated technology.

17:30 Medicare Advantage patients receive this “all-in-one” care for free as part of their enrollment in the health plan.

17:45 Scaling a virtual care model further enhanced Devoted Health’s mission to treat members like family.

19:15 Overcoming the challenges of loss aversion in the perception of patients when adopting a virtual-first care delivery model.

20:00 The benefits of a virtual-first mentality when it comes to organizational scalability and culture.

21:30 Devoted Health has developed an end-to-end data and technology system that choreographs care delivery in a single, vertically integrated, tech-enabled model.

22:00 Dr. Wagle on the well-deserved skepticism of technology as a panacea…but how that is balanced with the practical vision of Ed and Todd Park.

22:45 Building a full-stack technology platform from the ground up was necessary (market-based solutions are based on FFS medicine and are incredibly fragmented).

23:00 Full-stack tech platform at Devoted does everything! (e.g. sales, enrollment, pharmacy, medical claims, prior authorizations, customer service, full EHR)

23:30 “Having a full-stack technology platform with all information in a single place allows us to deliver on the promise of complete, coordinated, and customized care.”

24:00 How human-centered technology design drives targeted population health interventions and personalized care delivery.

27:00 Human connection (relationship-based care) can be fostered with a full-stack technology platform because people don’t have to remember minute details.

28:00 Enabling tech-enabled rapid cycle innovation to deliver improved population health outcomes.

29:00 The challenges of defining “value-based care” and how health equity is changing how we understand value.

30:30 The historical debate about the adjustment of outcome measures to account for demographic factors.

31:00 “The world has moved to a different place where we have put a spotlight on health equity itself, rather than burying it in adjustment methodologies.”

31:45 How “Community Guides” at Devoted Health correlate the overcoming of SDOH with the Maslow Hierarchy of Needs to help members achieve full potential.

32:30 An example of how helping a member successfully enroll for public benefits can give them an extra $ 325/mo.

33:00 The development of a Health Equity Dashboard to measure their impact in closing equity gaps.

34:00 The product goal of Devoted Health is to be the world’s first virtual “blue zone” where people enjoy much longer, healthier lives than average.

35:00 “Longevity is not the ultimate goal. The first task of a health system is to make sure we treat people like family so they are happy and fulfilled.”

36:30 Dr. Wagle on what it really means to create a virtual Blue Zone at Devoted Health.

37:45 Creating the “Devoted Social Club” to help members overcome loneliness and social isolation through human connectedness and resilience tools.

39:30 Dr. Wagle on why the people and the culture is the foundation of Devoted Health.

41:30 “As we go out and look for new team members we look for experience, clinical acumen, and love in your heart.”

43:00 Caring for the clinician workforce so they can cultivate the love in their heart for the caring of others – it is a self-perpetuating phenomenon.

45:00 Keeping the mission as a “prime directive” by closing your eyes and imagining someone you love…than take action.

46:45 How Community Guides cultivate trusting relationships with members and help people overcome their mistrust of the healthcare system.

47:30 Spending time with members as an enabler of trust and empathy (e.g. a 90-minute phone call).

49:00 Trusting relationships are why Devoted Health has such a high net promoter score of 79 (higher than Apple, Netflix, and Amazon).

50:30 Starting with “Patient Priorities Care” in member engagement first…and then moving to data-enabled, rapid-cycle deployment of interventions.

51:30 Dr. Wagle discusses the importance of Patient-Reported Outcome Measures in value-based care.

54:00 6 in 10 adults have a chronic disease, and it is the leading driver of the nation’s $3.8T healthcare spend.

54:30 Dr. Wagle provides examples of how Devoted Health is making an impact in medication adherence and Hgb A1c reduction.

56:00 85% of diabetic members have their blood sugar under control, with an average A1c reduction of 2.3 within 100 days.

56:30 77% of hypertensive members now have their blood pressure under control, with an average reduction in systolic BP of 15.2 within 40 days.

57:00 Reduction of acute events related to Congestive Heart Failure by 50%.

57:45 Dr. Wagle shares an a research example of “learned helplessness” in dogs and how that behavioral pattern relates to most chronically ill patients managing their disease.

60:00 “We must relate clinical outcomes back to patient priorities. Those cycles are what capture momentum.”

61:30 Dr. Wagle discusses company growth and expansion and how Devoted Health is entering eight new states in 2023.

62:15 How will Devoted Health consistently replicate and scale as it enters into new markets at a national level?

64:00 Parting thoughts of appreciation from Dr. Wagle and how gratitude makes dreams come true in value-based care!

64:45 “Value-based care is more than possible…it is coming.  The arc of history is bending towards progress, and I am grateful to be a part of that journey.”