Today we hear a conversation between CHESS President Yates Lennon and community health expert Randy Jordan, who is the current Chief Advisor of Impact for Health at Next Stage Consulting. We listen as they discuss Managed Medicaid, funding the health safety net for the uninsured, and how different types of healthcare organizations can work together in a sustainable way.

Alright, Randy Jordan, welcome to the Chess Move to Value podcast. We're thrilled to have you here today. Look forward to our conversation.

Well, thank you, Yates. It's really good to be with you and with your audience today.

Awesome. So why don't you just start by telling us a little bit about yourself, what you do today, and then your journey through the healthcare maze to get to where we are today.

Be glad to starting with today's probably the easiest part because the rest is kind of a winding path. But today I'm working as a healthcare consultant with consulting practice out of Charlotte by the name of Next Stage. It's an interesting place to work. They have a great vision and mission for helping local communities and underserved populations and that's why I'm there. But prior to this current role, I had started out as a young man as a pharmacist practice pharmacy in the state of Florida come from a long line of pharmacists. So healthcare runs as a deep strain in my family history. After running a pharmacy, community pharmacy for a while, I ended up going to law school and decided to become a healthcare lawyer and that was a really interesting time in my life. I learned a lot from that experience and then moved on to become involved in nonprofit work and spent nearly 20 years working for an international faith-based charity out of Philadelphia by the name Hope Worldwide. And the last seven years I was that organization CEO. And then most recently, having moved to North Carolina eight years ago, I accepted the role as CEO of North Carolina's Free and Charitable Clinics Association. And that gave me a real great sense of the local flavor of North Carolina safety net. So that's how I got here today through that windy path. Always, always focused on healthcare, Always, as I look back, always focused on trying to help others.

OK, that's an interesting story. I know you spent a little bit of time in Cambodia. Can you tell us a little bit about what you did there and then we'll come back to that I think more a little bit later in our conversation, but really curious about what that was about and what you learned there.

Yeah, I, I actually never lived in Cambodia, but had a a strong period of work there. It started at the beginning of my time at the international charity, where I started as the general counsel, and the first assignment there was to put together a joint venture between Japanese Shinto priest, a journalist from Time magazine, and the CEO of our charity. And so that was an eclectic mix right there. But the purpose of that mix was to open up a free care hospital in Phnom Penh. Cambodia was named after the king and its purpose was to help people that didn't have access to healthcare. At the time, Cambodia was one of the poorest nations in Southeast Asia. They were spending about $2.50 per year on those that live there. They had undergone a horrible genocide through Pol Pot, and it was a very unique chance to get involved in that country. We brought up that first hospital in Phnom Penh. In the course of that work, there developed three free clinics in order to help support that hospital because some of the patients were able to pay a small amount and then finally open another hospital in the South of Cambodia in a little in a town by the name of Kempat. But all very formative experiences for our conversation today.

Wow, really interesting. So in your role as the CEO of the North Carolina Association of Free and...

Today, we're discussing Care Management in Managed Medicaid with Tammy Yount, CHESS Application System Analyst. We'll explore why it's essential for organizations to tailor their care management programs to fit their own unique needs, so they can holistically focus on the patient while optimizing value in healthcare.

Tammy Yount, welcome to the Move to Value podcast.

Thank you Thomas, for inviting me and I'm happy to be here.

So, Tammy, let's talk about care management in managed Medicaid. How does a care management program save money and healthcare?

I would say that saving money is one goal of a care management program. However, I would offer that the goals of a care management program should align with the triple aim that's born out of the 2001 Institution of Medicine report Crossing the Quality Chasm. So that report underscored 3 aims, if you will, one primary aim and two secondary aims. So the primary aim is to improve the health of populations with the secondary aims of improving the patient experience of care and at the same time reducing the per capita cost. So these are lofty aims given our current healthcare landscape and the payment models that we exist in. Not all organizations are the same. You have some large organizations that have a plethora of resources and smaller organizations with very limited resources. So each organization has its own unique structure and individual challenges and there's no one-size-fits-all care management program. So I would say there are many ways to build a care management program that will allow you to achieve the triple aim and organization needs to find the blueprint that works best for them. So when an organization's doing the right things, measuring the right things and focusing on improving the right things, the cost savings should follow. And I believe it was W Edward Demmings that said it best, you know, manage the cause, not the result. That's not to say that the organization doesn't need to have a clear understanding of the underlying processes, cost drivers, the population characteristics. He also said if you can't describe what you're doing as a process, you don't know what you're doing. And my favorite quote for him is in God we trust, and all other things bring data.

Tammy, tell me, how would a practice create a care management program?

So it's a bit of a chicken and egg conundrum when you're trying to create your care management program, you need many things in the least of which is data. I would say you need to start with the data, but few organizations have the data to inform their program design. Most organizations design their care management program backwards, meaning they design the program around the resources they have versus identifying the resources that they need based on the characteristics of the populations they're managing. So I would say the first thing you need to do is collect data and evaluate the data. So from the data that you've captured, then you would begin to develop your road map for how you're going to operationalize your care management program. And these would be very specific to each organization because each organization serves different patient populations, has different resources and different needs.

What are the keys to a successful care management program?

It's going to depend on who you ask. So I'm a data person, so in my world, all things starting in with data. But if you were to ask the payer, the nurse, the CEO, the CFO, the CIO, and most importantly, the patients, their families or caregivers, you're going to get a different response and varying perspectives. For a care management program to be successful, it's going to need to combine all of these perspectives. And critical to any successful program is having a mission, vision and values. And you'll need to operationalize your plan with those elements. And so...

It’s patient experience week here in the United States, and we have asked CHESS President Dr. Yates Lennon to share his story about how, as a practicing provider, he took the time to listen to feedback from his patients and implement changes which not only led to better patient experience scores but shed new light on the importance of value-based care.

Doctor Lennon, welcome to the Move to Value Podcast. Would you share your story about being a provider and how you came to realize the importance of the patient experience in health care?

So, my name is Yates Lennon and I am an ObGyn by training, practice, private practice, obstetrics and gynecology from 1993 to 1998 in Hot Springs, Arkansas and then in 1998 moved back to North Carolina, which was home, to practice in a small private practice in Asheboro, North Carolina. From 98 until 2008, we were a small independent group for physicians at at most. And in 2008, our group really saw the early, phases of value-based care coming. We saw, the landscape of regulatory requirements, changing quickly and, and understood that keeping up with that was going to be a significant challenge. We were one of the first ObGyn practices as a small group to go on to, electronic health records. So, we did that, and actually we did that in 2002, I believe. But then in 2008, as we really sort of started seeing the handwriting on the wall, we felt like we needed to join forces with a larger organization that could really help us keep up, stay abreast of what was happening while we continued to focus on delivering care to our patients.

So in 2008, we merged our practice into what was then Cornerstone Health Care, based in High Point, as we merged in and became a part of that organization around 2011, I had expressed an interest to the leadership at that time of becoming more involved in an administrative capacity of some sort, did not have a particular path in mind, but but knew that I had always enjoyed the administrative side of medicine and, and running a small practice. So, I was asked at that time if I would consider taking on an overhaul of the patient experience for the Cornerstone Group. So, we formed a multidisciplinary team, included, physicians, advanced practice providers, CMAs, nurse assistants, nurses, office managers, front desk staff. The throughout the whole organization, through all levels of the organization came together and formed a group, that later was named peak, patient expectations are key. And in the course of that, I really began to see, how important patient experience really was. And, and even though I had practiced for a long time, I never really thought that much about the patient experience of care. Fast forward another year or two. Cornerstone had begun the their first efforts at a patient experience survey, which was done online.

Prior to that, it was a paper survey, and it was handed out at the desk to patients. So not incredibly random. We employ a employed, a large provider that, did these online surveys. And I was actually very excited to see my first survey. I had a large patient panel, had a good reputation in the community, and was excited to see these first results. Unbeknownst to me, when they came in, our office manager took it upon herself to post them at the back door, and I came in and saw my scores and they were by far the worst of anyone in our practice, and I was devastated. I went through all of Kubler-Ross stages of grief in the span of about 15 minutes. But following that, I decided, you know what? There's a message here. So, what is that message? What What are my patients trying to tell me? are kind enough to fill out the surveys, tell me how I'm doing. I need to be wise enough to listen. So, I started assessing what a visit in my office actually looked like. I thought the the highest standard was efficiency, that if I was efficient and always on time, that that would be what made everyone happy....