LEDI 80 Dr. Julie | Oak Street Health

Julie Silverstein, MD Chief Medical Officer of Care Delivery at Oak Street Health is joining Leader Dialogue co-hosts Dr. Chuck Peck, Dr. Darin Vercillo, and Ben Sawyer on the August 9th, 2022, LeaderDialogue podcast.  The theme of the podcast is the Change Imperative, and the topic is Friction-Free Access

The LeaderDialogue co-hosts will be exploring with Dr. Silverstein the current challenges of coordinated primary care and coordinated patient access and management across the healthcare continuum. Oak Street Health focuses their practice on the Medicare patient population, leveraging the Medicare Advantage program primarily to address the comprehensive health needs of their patient population across 20 states, at over 140 clinics.  Julie will share her perspective and insights on these important topics, providing practical considerations from which all healthcare leaders and providers can benefit. 

Listen to the podcast here

Oak Street Health: Rebuilding A Value-Based Healthcare With Dr. Julie Silverstein

I’m honored to be joined by some friends of mine. Dr. Darin Vercillo and Mr. Ben Sawyer. Darin and Ben are both executives at ABOUT Healthcare. Guys, as always, it’s great to be with you.

It’s good to be here, Chuck.

A lot of our audience knows we started this show in the middle of COVID. For the first initial few months, we talked a lot about the challenges and opportunities coming both within and after COVID from an operational, financial and strategic point of view. We’ve also spent a few of our sessions talking about some of the leadership challenges we know you’re all facing. We transitioned into talking a little bit about some of the non-traditional models of healthcare.

We recognize that many of you in the audience are in healthcare systems and hospitals. Maybe some of you are in employed physician groups. We know, particularly, you’ve read and we’ve all heard about some of the non-traditional players like Amazon, who had historically been non-traditional, getting into the healthcare space as well.

We know Walgreens has been dabbling and is more involved in healthcare. We know CVS and Walgreens have been in healthcare for quite some time. We’ve also seen a lot more competitiveness in healthcare within the non-traditional side of the business. There also seems to be a renewed interest in primary care.

Primary care has been at the center of healthcare but there seems to be even more of an interest in primary care. As you all know, very few independent primary care and even specialty physicians are left out there. We’re excited because we have one of our alternative providers on board with us and that’s Oak Street Health.

I’m excited to introduce you to Dr. Julie Silverstein. She’s the Chief Medical Officer of Care Delivery at Oak Street Health, where she leads all of the provider teams nationally. Prior to being at Oak Street Health, for many years, Julie helped clinical leadership positions at Christiana Care Health System in Delaware, including Physician Service Line Leadership for Primary Care Community Medicine and was the Director of Performance Improvement and Patient Safety.

She also served as the Vice Chair of Ambulatory Medicine. Julie completed her residency and chief residency at CHA, Cambridge Hospital, a Harvard University affiliate. She’s an excellent person to have to talk a little bit about Oak Street and the Oak Street model. We also want to talk about some of the opportunities and challenges that Julie sees in terms of access for patients and a little bit about where the market is going. Julie, it’s great to have you here. Thanks a lot for joining.

LEDI 80 Dr. Julie | Oak Street Health
Oak Street Health: We deliver health care by investing upfront in our patients to keep people healthy and out of the hospital. We reassign the dollar to invest in primary care and provide the care that our communities deserve across the country.

Thanks for having me here.

Let’s start if you could take a minute to describe for our audience the Oak Street model. I’ll talk a little bit about the growth we’ve all read about and why you think it’s been a success thus far.

Oak Street Health is essentially a primary care practice that provides care for adults on Medicare. We are an organization that has changed the way we deliver health care by investing upfront in our patients to keep people healthy and out of the hospital. We reassign the dollar to invest in primary care and provide the care that our communities deserve across the country.

Could you talk a little bit about what kind of growth you have seen and where you see the market going, not just for Oak Street Health but also for primary care?

I’ve been a primary care physician for a long time, as you alluded to in your nice introduction. I trained back in the ‘80s when it was not cool to be in primary care. In the ‘90s, all of a sudden, that was important. I faded away and then came back again. We’re on a cycle in this country of figuring out how to do the right thing.

Doing the right thing in my mind is providing comprehensive, accessible primary care to everybody in the country. As you know and I think many people would agree, our health system leaves a lot to be desired. Our mission at Oak Street Health is to rebuild healthcare as it should be. We essentially use the Medicare model to be able to reassign the dollars to invest in patients upfront.

I’m hoping that as we progress, grow and other innovative companies also see primary care and access to primary care as important, we can begin to shift the waiver we provide care in the nation. I’m excited that it’s cool to be in primary care again. It didn’t matter to me all along the way. I’m a diehard general internist who believes that comprehensive and high-quality primary care is the way to keep people healthy. I’m happy to be working at an organization. That’s showing that to be true.

Comprehensive and high-quality primary care is the way to keep people healthy. Click To Tweet

Ben and Darin have some questions as it relates to your interaction and potential partnerships with hospitals. One thing I wanted to ask you about, from all the reading and understanding I have about Oak Street, is that one of your differentiators and this is an important one that I’d like you to talk about, is patient and physician satisfaction. A lot of our health system clients and the ones that I, Ben and Darin see have had a very difficult time with recruitment, particularly on the retention side.

As we get more into talking about patient access that Ben is going to ask you about, it also seems as though there’s a significant difficulty. There were access issues before. As Ben is always saying and I agree with him, hospitals and health systems wanted patients to come to see them or their doctors prior to COVID.

During COVID, they either directly or indirectly ask patients, unless they are sick with COVID, to stay away. The issue seems to be having patients come back. A lot of that has to do with satisfaction in those important groups, both the patient and physician. Could you spend a minute talking about how your model is a little bit different in that respect?

The points you hit on are very important. To provide adequate primary care, we need to create a longitudinal relationship, see people repeatedly, get to know them well and get to a place where the patient trusts the providers that they’re seeing so that they are part of the care plan and can take control of their health. Similarly, for the providers, we want providers to be engaged in the care, enjoy their work and want to do what they’re doing. In both situations, there are a couple of factors that are important and those are probably time and resources.

When it comes to patients, one of the reasons we have very high patient engagement scores and satisfaction is that we spend time with our patients because we are a value-based system. We can spend long periods with our patients. We carry smaller panels. We see patients much more frequently so not only is each visit longer but the frequency of visits is greater. We invest in that relationship upfront with the patients, which creates engagement and leads to the sense of trust that I mentioned.

On the flip side, for a provider to have time to get to know their patients, if they’re worth their weight as primary care providers, they want to spend time with their patients. They understand the importance of a comprehensive history, full evaluation and taking time, especially with older adults and complex medical care to consider all things that lead to improved health, better outcomes and better patient satisfaction.

We also provide resources both for the patients and the providers that help with satisfaction and retention. On the provider side, that looks like personal attention. Each care team comprises a clinical information specialist, also known as a scribe and a medical assistant, given time and resources where providers are not in that hectic frenzied environment of fee-for-service care, where we want to go as quickly as possible. On the patient’s side, we provide that important time and resources in that we have comprehensive care teams, which include social work, integrated behavioral health and others that help people feel grounded and engaged in healthcare.

LEDI 80 Dr. Julie | Oak Street Health
Oak Street Health: The proactive approach is the best way to address patient needs upfront and make sure that close connection and control of the situation are maintained because it’s really about intervening early and making sure that they’re getting the best attention they can.

It’s fascinating to hear about how you’re approaching care. Can you talk to the audience a little bit about the difference in the outcomes you’re experiencing because of your investment in time and resources compared to the norm in terms of patient satisfaction and quality of care?

The first thing to point out is that we care for highly complex individuals. We generally situate our centers in locations that are underserved by traditional medicine. Therefore, we have complex patients that are often dual eligible. They have very high numbers of 86% of multiple chronic conditions. They’re on more than seven medications. They are multiracial of many different types. We serve a diverse population and have a diverse provider group.

I’m happy to say I’m very proud of that as well. Close to half of our patients are dual eligible and more than 50% have problems that are related to food insecurity social isolation and other social factors that impact outcomes. Despite all of that, we still see a very large reduction, about 50%, in the use of the emergency room and about a 40% reduction in the hospitalization rate when patients engage in our model compared to traditional Medicare operating in the same communities we are in. Also, you were asking about a net promoter score. It is the likelihood of coming back and recommending our care, which is quite high. The average is 90% to 92%, which is far higher than your usual primary care practice.

Is all of your business on the value-based side? Do you have any fee-for-service businesses?

We do accept a fee-for-service Medicare. The majority of our patients are on Medicare Advantage. We provide resources to our patients, anyone who becomes a patient in our center, to help them understand their insurance and identify the best plan for them very often in the underserved community. Medicare Advantage serves people’s needs more comprehensively because there are multiple benefits and fewer out-of-pocket costs for those who aren’t purchasing supplemental Medicare plans.

I was looking you up before we got on the call and it’s a large organization. You have over 125 clinics across more than 20 cities. Do you also have partnerships with health systems in those areas to be able to provide coordinated care? How do you approach the care ecosystem for the patients?

To clarify, we’re up to 145 in 21 states. It’s far more than twenty cities because we’re scattered in several states. We have more than one city. We have relationships with the health systems that are in our communities but by far and away, we do not create primary relationships with health systems because we do try to accept as many payers as possible in given communities so that we can serve as comprehensive a population as possible. Therefore it’s incumbent on us to respect the networks that the people are in when they are in Medicare Advantage Plans. The health system relationships are very important in terms of helping us support the patients with their specialty care needs and certainly with hospitalizations. We remain open to those that are in the scope of the networks.

The health system relationships are very important in helping support patients with their specialty care needs and hospitalizations. Click To Tweet

I’m going to ask you one last question and then I’ll lateral to Darin because he’ll want to pick up on this. As the primary advocate of the patient, particularly for those patients that are underserved or may feel like they otherwise don’t have a voice, what are some of the obstacles that you all encounter as Oak Street positions in coordinating the care past your primary care? In other words, if they need specialty care surgery, hospitals gain access to those services or give the patient the same responsive attention that you all provide them. What are some of the challenges that you are experiencing? In that question, is it different post-pandemic than it was pre?

The biggest challenge is information. Information is key. At Oak Street, we are proud of the information systems that we built that enable us to take comprehensive care of patients. We’re gathering data and information from health systems as well as from insurers and past medical records. We integrate all of that into a homegrown system that delivers that information at the point of care.

With that said, many of our states, as you’re probably well aware, have underdeveloped health information exchange systems. Access to specific electronic medical records within health systems is complex and often requires different amounts of privileging and application. Often, when we first enter a new community, there are a lot of relationships and upfront work to be done to enable us to gather that data and information. One of the biggest issues is that we try to identify sources of specialty care that allow us access. We’re working with health systems interested in partnering with us in that situation.

Secondly, if we had our way, we would visit every single one of our patients when they’re in the hospital but while we have extensive resources, that’s challenging. We do visit some and have a very well-developed transition program to help people have the right care when they are leaving, either in a skilled nursing facility or the hospital. It’s simply not possible, especially because we don’t concentrate in one particular hospital to see them as much.

With regard to the second part of your question, have things changed since COVID, in some ways, we’ve been more able to access systems because people went to the telehealth route as we did for a very short period when it felt unsafe to see patients in the office. Access to information may have become slightly easier. On the flip side, whatever hospital visits we were doing, we became no longer able to visit the hospital during COVID. Some of our systems have evolved because of that. With those two exceptions, it’s probably not different than it was before.

Thank you for that. Darin, you’ve got several questions.

I appreciate everything that you’ve brought up. It’s been very much on point. Julie, you’re the model that you’ve built and the successes that you have been great to hear about. Coming from the flip side of the internal medicine work on the acute and critical care side of my practice, that handshake between great primary care ambulatory providers in the practice of being on the inpatient side has always been a joy to work with.

LEDI 80 Dr. Julie | Oak Street Health
Oak Street Health: The current cost of caring for a Medicare patient is quite high. So when we accept risk and get payment, we can reassign those dollars and invest in patients in different ways, rather than investing in expensive hospitalizations.

I’ve looked most highly, quite frankly, at those providers like the Salt Lake City area and those who focus on their patients, come and visit and are invested in their outcomes. It has been those that when we talk about that transition of care or the continuity of care has been something that’s been satisfying and feels safe as we pass those patients back to their primary care providers.

Along those lines, I wanted to ask you a quick question with respect to that. From the ABOUT Healthcare side, we largely focused on the genesis and the history of the company on the acute side of patient transfers. Those who are already critically ill are in hospitals but need to transfer to higher levels of care to get their issues addressed and taken care of.

Not long ago, interestingly enough, in many of the healthcare systems that we’re having conversations with, they’re very focused on this world of the investments that they’re making in their ACOs, value-based organizations and the partnerships they’ve had. Many of them are worried about, as they make those investments, being able to maintain a connection with those patients, especially as they transition in and out of different areas of care.

The question I wanted to ask you and it piggybacks a little bit on to what Ben said, was as your patients do go to ERs and into inpatient settings, as they move about and are at risk on the financial side to cover those expenses, how do you surveil for those patients? How do you repatriate them and take control in situations that might spin out of control from a care and financial perspective to make sure that not only do they get the best care but do so within the parameters you’re setting as an organization?

It’s hard to turn that question around but I’m going to turn it around. The vast majority of people don’t cycle through multiple institutions and go to lots of organizations. From the perspective of the health system, that’s what is seen. From our perspective, if we do our jobs well and we believe we do, we try to rapidly engage patients such that we avoid a large portion of what you’ve described. Most people have already identified what health system they use, their hospital and the place they want to go to. We find out who that is. We create relationships with those health systems in the communities where we’re delivering care.

Usually, it’s the place down the block that’s hyper-local. We use our information systems to be notified as quickly as possible of people being in the hospital. We have a transition care team that I mentioned before. Their centralized resource helps us gather the information on the same day and identify to the provider that a person has been in the emergency room or admitted to the hospital. Our team reviews that admission and tries to impact care immediately after that occurs.

While there are people who end up in the situation you described, it is the minority of folks if we do all the steps that we intend to enact along the way. If we do lose them, some people cycle, get very ill and are out of touch with us. We have developed a specialized piece of our workforce. That sole job is to contact those folks. We’ll even go to people’s homes to re-engage them in our care and make sure they know that we care about what’s happened to them and we’d like to see them back in the office. We try to prevent it and then pick up the pieces if we get in that situation.

Part of the proactive approach is empowering the patient, letting them know that we want to know about everything that occurs in their lives related to their health. Click To Tweet

That’s great that you take such a proactive approach. As we’ve always looked at that situation, we believe, similarly to how you’ve described, that a proactive approach is the best way to address those needs upfront and make sure that there is a close connection. For lack of a better term, control of the situation is maintained because it’s about staying in close contact with them, intervening early and making sure they’re getting the best attention they can. That’s great to hear. It’s a model to be followed.

Folks may know that we strengthened our relationship and acquired RubiconMD, a virtual specialist consultation network. We’ve been working with that group of physicians for many years. We have a closer relationship that’s allowed us to embed technology into our platform so that we can more easily access those specialists.

What we have done with the eConsult network is taken even greater control in the primary care space to access specialty information, keep the patients within our system and be well cared for to minimize the amount they need to go outside systems. That has helped us to improve our outcomes. Also, it helps a little bit with the sense that one needs to rely on a health system for multiple specialists and access to care. It decreases the risk of losing folks down a wandering path where folks are sent from one specialist to another.

It sounds like part of that proactive approach is to work with your patient population engagingly so they initiate contact back to you when there are issues and you’re not wondering in a black box with respect to the changes in their health status.

Part of that is empowering the patient and letting them know that we want to know about everything that occurs in their lives that’s related to their health.

Julie, I want to go back to something you said because I was chuckling a little bit to myself. It was your description of the rollercoaster ride that internal medicine and other primary care specialists have had. I want to point out to our audience that this is a very unique episode. We have three internists on the phone in one place at the same time. Ben may not be an internist but he stayed at a Holiday Inn.

I am a clinician. I’m a physical therapist by training, Julie. That’s how I started my career. I missed direct patient care. Once you’ve been a front-facing clinician, you always miss that.

LEDI 80 Dr. Julie | Oak Street Health
Oak Street Health: It’s important not to lump people together, particularly based on insurance type. We need to think about their needs and try to solve problems based on a specific population and attributes, and not try to be all things to all people.

I’m very interested in one thing. Other than the obvious, Oak Street provides high-quality, lower-cost care. We know companies like Amazon who purchased One Medical find your model attractive. I’m wondering whether there are other things you’re aware of that would have a company like Amazon and potentially others out there looking around. What do you think they’re looking for when they do something like purchase a One Medical or some of the big behemoths looking to get into healthcare and companies like that? What do you think they find attractive? What do you think they’re looking for?

I don’t think I’m capable of speculating about what they are looking for. What I do think is that when these things happen, it signals that there’s a problem. It means if a company like Amazon is interested in getting into healthcare, it helps us know that there’s something that we have to fix. Oak Street’s mission is to rebuild healthcare as it should be. We think we’ve got a good pulse on that. Others in the space are most likely looking to see how they can contribute to improving the health care space. I’m excited that many people are looking to solve the primary care problem in the United States.

Do you think that in terms of your business model, it’s the Medicare Advantage approach and the large number of Medicare Advantage patients that you see? Some of our health system audience is probably thinking about this. The revenue associated with that is part of the reason that you’re able to do a lot of the things that you’re doing. Is that a correct statement or not?

The cost of caring for a Medicare patient is quite high. When we accept risk and get the payment, we can re-assign those dollars and invest in patients in different ways, rather than investing in expensive hospitalizations. That’s always our preference. Many people need to use the hospital for various reasons that are quite appropriate but that is the goal.

As we close here before I turn it back over to Ben to talk about where we’re going in the future, are there any other things you think would be helpful for our audience to know about your model, Oak Street and how to relate to you? If they are in a community, where do you have offices? What can they do if they like what they’re reading?

That’s a great question. Thanks for asking it. There are many details but we are also very much a community-based organization. We try to hire from the local community. We have community rooms in our centers where folks gather. You don’t need to be patient to come. We have events. We try to combat the social isolation sometimes of the elder community by providing activities and engagement. We also grow very much with a grassroots approach to getting to know our community.

We have team members who go out into the community and be sure that people know that we’re there. In any city where we are, it’s fairly easy to be in touch with us because we have outreach team members who are responsible for making sure folks know about us. I’d be happy to link up with any providers or speak to any providers who might be interested in practicing with our model. Certainly, we’re open to patients in all of our 145 centers across the country.

In inner cities and underserved communities, variables like food and shelter and things even as basic as running water impact health far greater than any medicine we prescribe. Click To Tweet

Julie, we only have a few minutes left and as Chuck alluded to, we’ve been trying to talk about some of the global health issues. We did a whole series on the Payvider Movement, where the payers are moving into the provider space and trying to create an integrated offering. As you well know, the providers are moving into the payer space to provide the insured integrated offering. We’re phasing into what are the details of access, capacity and throughput.

Outside of the Medicare population, which you all are handling, it sounds extremely well. Do you have any recommendations to the audience for the non-Medicare patient that also is in a similar situation? In other words, they’re not getting comprehensive care and don’t necessarily have an advocate. It feels fragmented to them and access can be challenging. They’re on the lower income spectrum. They might be in an underserved area. What are some of the learnings that you all have had on the Medicare side that may be applicable to the larger general population?

I don’t know that I have a specific solution. One thing I’ve learned, having been in leadership in a general primary care space, which included pediatrics, family medicine and internal medicine is that it is very challenging to be all things to all people. One of the reasons we’re able to be successful is by looking at a specific population whose needs are varied but fall within a spectrum.

One of the challenges in commercial medicine is we try to, in the payer world, be all things to all people and it’s very challenging. I do know that there are many people trying to recreate the type of model that we have in the Medicaid space, for instance. It’s very important not to lump people together particularly based on insurance type. Think about their needs, try to solve problems based on specific population attributes and not try to be all things to all people.

Here’s a quick follow-up question. Health systems have been talking about moving from fee-for-service to fee-for-value or value-based care for a long time. Yet, it’s been difficult to do it because fee-for-service has been very profitable for them. You all have made that transition. You’re fully value-based with some exception of fee-for-service. It sounds like it’s working and going well. From that perspective, what would you say to the audience that hasn’t quite made that leap over and is thinking about what you said in terms of specific populations that we might want to be able to do this? What encouragement, advice or insight can you give those folks?

I’m not sure I have great amounts of encouragement in that space, to be honest, because there is a tension between the profitability of procedural medicine and hospital beds that is fraught with challenges for those who are also trying to create and use the value-based space. We’re talking about being proud of decreasing hospitalizations. Hospitals need a certain amount of that.

We’d probably have to take a step back, think about how we overall fund institutions and go bigger if we’re going to get into a space where it would be right for health systems to look into value-based care. With that said, many are doing it and I applaud them. It’s wonderful and it’s the right thing to do. We need to figure out how to keep ourselves afloat on the back end while keeping people healthy. It’s very challenging and it’s one of the things that led me to look into a model like Oak Street to be able to provide team-based care and the type of way that is the right way to provide care in general.

One last question. We didn’t emphasize it but it was an important part of your description and that was essentially the social work or the care management team that works adjacent to the primary care provider. The proportionality of their impact on the patient is higher than in a normal fee-for-service environment. How critical is it in a value-based world to have the navigator function or role that is making sure the patient gets what they need when they need it and the particulars of their current individual situation are taken into account?

It’s very crucial. Even more important than the actual navigator role, that plays a small part in our model. In the inner city and underserved communities, the impact of variables like food, shelter and even as basic as running water impact health is far greater than any medicine that I could prescribe. Having social workers and community health care workers who help assess and hopefully remediate some of those situations for our patients is hard to put a label on how valuable that is.

Julie, thank you so much for joining us. This has been an enlightening conversation. One of the things that I understood and got out of this was that despite what you may read about value-based care and fee-for-service medicine, value-based care in the right setting with the right group of physicians and other providers with adequate resources can work. Not just for patients but also the physician, the nurses and other providers. One of the things that Oak Street has proven is that it’s a very workable model when it’s done right in the right circumstances. I want to congratulate you and Oak Street for starting something that nobody thought was possible several years ago.

Your expansion and growth have been attributed to your sticktoitiveness and ability to see the future and make things work for patients and everyone else involved. Thank you so much. To our audience, thank you all for reading. We’ll be having additional episodes, as well as a webinar where we’ll be more deeply diving into some of the topics we discussed like the topic of value-based care, alternative providers and payviders. We look forward to seeing you all again during our next episode. Please look at the Baldrige Leader Dialogue website where the announcements relative to a future episode are at. If you have any questions, there are also some resources there. Please feel free to reach out to any of us.

Ben and Darin, we had a great conversation with Dr. Julie Silverstein, the Chief Medical Officer at Oak Street Health. Their value-based model of taking care of dual eligibles and Medicare Advantage patients was fascinating. The thing that I got out of it that was very impressive are two things. They’ve fully embraced the value-based care model and made it work for their patients.

They have one of the highest net promoter scores amongst patients that I’ve heard of in the industry, which is 92% to 93%. They have very high-quality scores, unbelievable patient experience and satisfaction. They’ve done it without formal relationships with hospitals and health systems in their communities and through informal relationships with hospitals and health systems located nearby their particular health centers.

That’s a great lesson that in the right circumstance and group of people, both providers and patients, you can make it work. The other thing and I hope I’m not going to steal Darin’s thunder grit that I found interesting was despite what I’ve been told, seen and heard in all my clients about needing continuity and a very close similarity between electronic medical records to make transitions of care and other things work, they’ve developed their primary care electronic medical record, which they seem to be able to make work with any health systems and other physician’s medical records. That’s the lesson to be learned. It isn’t that every single electronic medical record has to be the same. There are ways to make things work, integrate and get the information both to and from that you need. I found those two points interesting. Ben, what do you think?

I agree with all those. She emphasized two things that the audience will appreciate. Her providers have the opportunity of time and resources to do better. They have augmentation of scribes in social workers and others that are helping them manage the patient care experience. When we asked her about that at the end, she said one of the most important things is the social determinants and making sure that these elderly who can be socially isolated can contribute to their declining health because of things that are not directly physically related but more socially and community-related.

They’ve been very successful with that and have been able to serve the underserved in a lot of these states and cities where they’ve been successful. Being able to have success financially and from net promoter scores and those kinds of environments speak highly of Oak Street. It is a great model to listen to for our audience.

You’ve touched on some great things. As Ben mentioned, I don’t know why any primary care doctor wouldn’t be running to go work there if they got a scribe following them around doing all their notes for themselves. That’s a great thing for them but it was a great discussion with Julie. I applaud them for what they’re doing. It’s bold moves both clinically and financially if you look at their year-over-year growth, their financials and how they’re trying to make this whole thing work in a publicly treated environment. It’s great to see how we can stretch forward what we’re doing in healthcare in the US and make our model work here, especially in addressing the needs simultaneously of the underserved.

I applaud them and what they’re doing. She mentioned their attention to detail, the outreach to their patients, constant contact and relationships they’re building with their patients, which quite frankly, a lot of providers have shied away from. You see them when they’re there in the clinic. You have others who are seeing them regularly. They go to the hospital and are taken care of by a hospitalist. There’s a loss of continuity there. It sounds to me like they’re doing everything they possibly can and doing it right to maintain those relationships with their patients and build that trust with them. It’s a fantastic interview with Julie. I’m sure many people will enjoy it.

Here’s one other question I would add to this recap for the reader’s concern. When you’re talking about innovation and you hear about this to a population, the logical question you have to ask is what is so unique about the Medicare population that works there that it wouldn’t work in other populations? Darin, what you’ve alluded to is it could work in many populations because it’s a lot of attention to detail, developing relationships with your patients, following up, making sure that their needs are met, dealing with their community and/or personal isolation issues. That’s not unique to the Medicare population. That will be something we can leverage in our further discussions but it’s a good innovation question fundamentally to ask.

Ben, she even said they have a centralized office that’s taking care of them. They’ve been able to scale that for the needs of the whole organization. It’s a great point.

Thanks, Ben and Darin. We’ll look forward to the next conversation and episode.

That sounds great. Thanks, Chuck. I appreciate it.


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