EP409: 3 Really Cool Innovative Primary Care Bright Spots and a Few Notes for Policymakers and Payers, With Larry Bauer, MSW, MEd

In this healthcare podcast, we are talking about innovative primary care teams and, by way of Larry Bauer, my guest today, bringing you three inspiring case studies. Much can be inferred from these case studies, as much from how they are alike as how they are different. It is wildly important at the same time that it is wildly underappreciated how different local markets are. I love how Cody Coonradt put it on LinkedIn the other day. He wrote: "Healthcare is not a $4T market—it's 500 some-odd interconnected markets ranging in size from $1-50B. [It is] not a singular problem … each market [is driven] by unique third party payer incentives with unique patient cohorts. … "Before you figure out the next great idea—seek to understand the underlying health economic, revenue cycle, service provider contracting, and cash conversion processes that undergird it all. [That] is how to truly disrupt healthcare." Or, said another way, if you're part of the community, if you are already caring for patients in that community because you're a doctor or another clinician, you probably have the best shot at truly—and in meaningful ways—helping patients in that community. This whole statement is a really uncomfortable truth for many in private equity and anybody else who wants to find the easy button to fix healthcare with some big-ass, scalable, rapid-fire bulldozer approach. It's also a very uncomfortable truth for any national payer looking for one model or one point solution to roll out in a broad stroke to every one of these 500 some-odd interconnected markets that Cody mentioned. One size does not fit all here, and leveling up patient outcomes and care is hard grueling work that requires local market knowledge, being rooted in the community with relationships to succeed. You gotta get a little closer to the ground. Policymakers, please take some notes here. And you, too, self-insured employers, payers. So many universal lessons are embedded in these three examples that Larry Bauer, my guest, shares today. But bottom line—and round of applause required—you go, all you doctors and nurses and other clinicians or mission-oriented teams who take it upon yourselves to find ways to address the problem of human suffering in your local area. Stay tuned for an upcoming show with Jodilyn Owen, where we dig into this whole dynamic hard. I'm talking about the dynamic where some barbarian at the gate (ie, some venture-funded start-up) has gotten money—in some cases, lots of money—while there are community-based organizations out there who are doing amazing work really helping patients in the community improving outcomes and cutting costs and struggling, scrambling for every penny they can manage to get their hands on. So, that's in the future. Talking about today, though, we're gonna cover the bright spots when you get a really creative and committed PCP (primary care) team who is part of their own community and who wants to do better by patients locally and got some money to attain that goal. Today, as I said earlier, I am talking with Larry Bauer, who has been working with innovative PCPs and other docs for decades. All three of these case studies that Larry describes on the show today concern frail elderly adults, and this is on purpose (this using of the same patient population) for a couple of reasons. One of them is just to highlight that the same population in different geographies is not the same population and, therefore, the solution set is going to be different if we're gonna reach out and care for them. The second reason for selecting three solutions that all pertain to frail elders is that this group is notoriously expensive and care is notoriously poor. Everybody has a story about how their frail elderly family member or friend died a bad death or did not "finish well," as Larry Bauer puts it. It's a patient population at the mercy of this industry and unable, a lot of times, to advocate for themselves. So, solutions here solve, in a way, for the worst-case scenario and might be a great starting point for anybody contemplating how to help other patient populations, too. The three innovations we discuss today are: 1. Dan Hoefer, MD, and Suzie Johnson in their Transition Program in San Diego helping those at the end of their lives to "finish well." This is a capitated program. 2. Ken Coburn, MD, who, along with his team, created Health Quality Partners in Pennsylvania. This is a nurse navigator program, and it is paid for by a CMS grant. 3. Alan "Chip" Teel, MD, at Full Circle America with a program to wire up patient homes so that the clinical team could monitor what was going on in the home, intervene in case of emergencies, as well as organize community services. This program is paid for by the patient or the patient's family, but, point of note, it is 10 times cheaper than a nursing home. I do ask Larry Bauer, by the way, how to best walk the line between right-sized care and not enough care (ie, the whole death panel counterargument to some of this stuff). I think Larry's answer was elegant. You're gonna need to listen to the show to hear it. My guest today is Larry Bauer, as I have mentioned four to six times already. He is a social worker by training who has been at this, as he says, for a very long time. He created a not-for-profit called Family Medicine Education Consortium (FMEC) over 30 years ago, and it became a platform for bringing together very talented and capable family physicians and some general internists. This gang has been really redefining and re-creating primary care … which is a great way to sum up the three programs that Larry Bauer will talk about today.   You can learn more at the Family Medicine Education Consortium Web site or by emailing Larry at [email protected]. Larry wrote a "Bright Spot" report; check it out here.   Laurence Mahoney Bauer, MSW, MEd, served as chief executive officer of the Family Medicine Education Consortium, Inc., from 1994 to October 2021. The FMEC is a not-for-profit corporation designed to promote collaboration among the academic family medicine and primary care communities in the northeast region of the United States. He has also served as director of network development for the Center for Innovation in Family and Community Health in Dayton, Ohio, from January 2006. He is an associate clinical professor in the Wright State University School of Medicine, Department of Family Medicine, in Dayton. Previously, he served at The Ohio State University School of Medicine, Department of Family Medicine, for 4 years as director of organization and faculty development. He served as director of faculty development and behavioral science in the Department of Family and Community Medicine at the Pennsylvania State University School of Medicine in Hershey, Pennsylvania, for 13 years. Presently, he is an active consultant committed to the creation of a primary care–driven system in the United States. He lives in Hershey. He enjoys pickleball, basketball, and gardening.   06:53 In a brief overview, what does end-of-life care in America look like? 10:38 What are the three innovative systems and physicians Larry Bauer has worked with? 14:27 What does it mean to be in a capitated system? 19:14 What does the Health Quality Partners system look like? 22:13 Andreas Mang from Blackstone; look out for his episode in September. 22:50 What is a number one reason for hospital readmissions? 23:26 The third example of innovative primary care. 27:04 Why is comprehensive care at the community level so important and successful for end-of-life care? 28:03 "The number one goal is not cost containment; that's one of the outcomes." 28:26 What is the core issue for these three types of innovative care? 31:02 What does good policy to encourage this type of innovation look like? 33:22 EP326 with Rishi Wadhera, MD, MPP. 34:14 Why is it important to trust physicians and be present and partnered with physicians?   You can learn more at the Family Medicine Education Consortium Web site or by emailing Larry at [email protected]. Larry wrote a "Bright Spot" report; check it out here.     Larry Bauer of @FMEC_ discusses #innovation in #primarycare on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Vivek Garg (Summer Shorts 3), Dr Scott Conard (Summer Shorts 2), Brennan Bilberry (Summer Shorts 1), Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher