Ep 133 – Value as a Catalyst for COPD Care Delivery Innovation, with Geoff Matous and Dr. Abi Sundaramoorthy

Chronic Obstructive Pulmonary Disease (COPD) afflicts 24 million adult Americans and represents the 3rd leading cause of death. COPD is also the 5th most costly chronic disease in the US with attributable direct healthcare costs estimated at $49 billion! Given the edifice of fee-for-service payment in US healthcare, we have allowed the care of COPD patients to become fragmented and inconsistent.  We continue to see care of this chronically ill population wrought with poor clinical outcomes and a high economic burden. However, we are now seeing that value-based care is beginning to catalyze COPD care delivery innovation for a more promising future!

Our guests this week are Geoff Matous and Dr. Abi Sundaramoorthy of Wellinks – a digital health company offering the first-ever integrated, virtual chronic obstructive pulmonary disease management solution.  These two leaders are connecting the dots on COPD to create a constellation of care that includes pulmonary rehabilitation, personalized coaching and monitoring, and connected devices. Disruption in payment incentives have spawned care delivery innovation at Wellinks, and they are poised for further success of their platform with the promise of global capitation in ACO REACH and MA plans. Don’t miss out on the important conversation to learn how partnership and innovation can transform your healthcare organization’s COPD population health playbook strategy!

Episode Bookmarks:

01:30 Register today for the “Population Health Equity: The North Star for Value”(December 1, 2022)

03:00 COPD affects 24 million adults and represents the 3rd leading cause of death and the 5th most costly chronic disease in the US.

03:30 The direct healthcare costs of COPD is $49 billion (and growing!) with COPD-related hospital admissions costing upwards of $40k

04:00 Introduction to Geoff Matous and Dr. Abi Sundaramoorthy

05:00 November is National COPD Awareness Month

06:00 COPD is an Ambulatory Care Sensitive Condition (i.e. a chronic disease for which good outpatient care potentially prevent the need for hospitalization)

07:30 Balancing the population health management requirements for COPD (Coding and Documentation, Quality measures, and Cost Reduction)

08:30 Impacting patient behavioral change to impact COPD-related healthcare utilization

09:30 “COPD Total Cost of Care reduction is a significant opportunity in value-based care that has been left untouched for far too long.”

10:00 Why are we still in the early stages of COPD Care Delivery Innovation?

11:00 Employer-sponsored plans will not drive digital health innovation for improved COPD management – it must be driven by ACOs and MA plans.

12:00 Geoff speaks to the advantages of virtual-first COPD care in a risk-based payment model.

12:30 75% of the total direct COPD cost is tied to exacerbations — how can chronic care management programs work to more effectively manage COPD patients?  

14:00 Dr. Abi speaks about the challenges of health systems and ACOs developing a robust infrastructure for COPD virtual care.

15:30 43% of patients with COPD exacerbation will die within one-year of being discharged from hospital!

16:00 How the Wellinks Virtual COPD Management Solution approaches patient behavioral change.

17:30 The difference in approaches between “Pulmonary Health” and “Pulmonary Rehab” and how SDOH-based interventions can improve COPD management.

19:00 Health system attempts to help COPD patients self-manage their disease will fail if it is a “hero project” tied to temporary grant funding.

20:00 “Our call to action is to explore what can be done beyond the standard COPD care management playbook to improve patient outcomes and experience.”

21:00 99% of COPD patients have 1 comorbid condition, 87% have 3+ comorbidities!

22:00 Dr. Abi explains why COPD is a complex disease to manage and why addressing comorbidities alone will not be enough to reduce COPD exacerbations.

23:00 Behavioral health challenges associated with COPD patient management.

24:00 Optimizing clinical workflows to support a personalized and scalable COPD virtual care platform.

25:00 Taiwan implemented a nationwide COPD pay-for-performance program to align financial incentives for health care providers.

26:00 The limited success of the Hospital Readmissions Reduction Program (HRRP) in the US to address the misalignment of financial incentives that results in COPD exacerbation.

26:30 The United Kingdom has improved access to pulmonary rehabilitation

27:00 Why is value-based payment only focusing on COPD readmissions?  We need to get in front of the ED visits and the index admission as well.

28:00 “Financial toxicity leads to clinical toxicity.”

28:30 The promise of global capitation in ACO REACH and MA plans to provide realigned incentives for COPD preventive care models.

30:00 Applying lessons learned from BPCI Advanced and Kidney Care Choices programs to develop a targeted COPD value-based payment model.

31:00 Approximately 40% of COPD patients in the US have limited access to pulmonary rehab programs. There are 18K patients for every 1 pulmonary rehab facility in the U.S.

33:00 “Having only 4% access to pulmonary rehabilitation post-hospitalization of COPD is unacceptable.”

33:30 Referencing recent JAMA study showing that pulmonary rehabilitation after a COPD hospitalization is $5,700 net cost effective and adds Quality-Adjusted Life Years.

34:30 The workforce shortage of respiratory therapists to work in outpatient pulmonary rehab centers.

35:00 The impact of Social Determinants of Health in COPD disease progression in underserved communities.

37:00 Geoff discusses the vision of the Wellinks clinical model to improve COPD patient outcomes.

39:00 Dr. Abi discusses the artful design of their comprehensive COPD virtual care management platform.

42:00 How home-based COPD care management interventions create opportunities for personalization and customization.

43:00 The need for a continuous provider interaction in the COPD care continuum (and why we must overcome current care delivery fragmentation)

45:00 The available evidence of the contribution that patient activation makes to health outcomes, costs, and patient experience is significant.

46:00 “The major driver of COPD is behavior.” – Dr. Abi speaks about the importance of patient behavioral change outcomes in health coaching programs.

47:30 Training programs for health coaches in motivational interviewing.

48:00 Creating metrics for patient activation performance.

49:00 Findings from recent survey of COPD patients utilizing the Wellinks virtual platform.

50:00 Overcoming medical mistrust in minoritized communities in order to reach an effective level of patient activation.

52:00 Geoff speaks about the need for free market competition in “virtual first” provider models.

54:00 Lessons learned from prior partnerships to envision a more optimal patient care journey and data enablement strategy.

56:00 Information asymmetry in the patient care journey due to lack of health literacy and an overly complex health system.

57:30 Developing trusting relationships with patients through a “hub and spoke” care design model.

59:00 Recent mortality estimates suggest a growing socioeconomic divide with environmental risk factors for developing COPD.

60:00 Cell phone engagement with patients may often be the best starting point in working with patients in rural and underserved communities.

62:00 “Let’s all commit to bring the $49B COPD expense trendline down!”

63:30 Learn more about Wellinks and register for upcoming webinar with AHIP on November 30th.