CareDelivery_Kevin Green: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Manav Sevak:
Welcome to the Memora Health Care Delivery podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Manav Sevak:
Hey everybody! This is Manav from Memora Health. One of the founders and CEO, have a good friend on in Kevin Green today from Ochsner. Kevin, do you want to maybe just introduce yourself really quickly?
Kevin Green:
Yes, first, thanks, Manav, for having me on the podcast. I mean, I’m very excited to be able to share the work that we’re doing here at Ochsner Health when it comes to health equity and community health and social determinants and community engagement and you name it when it comes to our medically underserved population across Louisiana and even into Mississippi, I think these are somewhat exciting times on our end. For me, in my role, I am our vice president of community health here at Ochsner, which is not all-encompassing because when you reach out to the community, you start to care for them, they start to share with you all the concerns and challenges that they face. And you just, I think there’s a need and a drive to do more. So our work not only encompasses the clinical and mental and social care that’s needed, but also how we build those relationships, whether it be with local government and other organizations to further the environment and the people more completely. So that’s a bit about the work we’re doing here in Louisiana, and again, thanks for having me on.
Manav Sevak:
Yeah, absolutely, and it’s really just incredible work from the time that we’ve spent together and what I’ve gotten to know. What’s a little bit, just to share with everyone, what’s a little bit of your background and how did you end up in that role? Just because for what it’s worth, what I tell even other folks at Memora, what I’ve told other people that, when I told other people about our conversations, I stand that you have probably one of the coolest side hobbies, which, it’d be great if you can share that, but also just one of the most interesting backgrounds in healthcare.
Kevin Green:
Sure, of course. Well, I didn’t start in healthcare, I’m a 48-year-old executive and I began my work in the military. I’ve been a C-130 navigator for over 25 years, and I’ve done all sorts of things. I mean, you name it, just like me and my brothers and sisters that have served our country. I have been overseas, I’ve been to many locations that have been somewhat challenging, right, but I’ve had the privilege of serving as a flyer, as a navigator. And recently my role, and I say recently and I just marked how old I am because recently for me is like since 2007, I’ve been flying in the hurricanes and I even had the privilege of serving as the commander of the Hurricane Hunters for about two and a half years. So just about any tropical disturbance that’s occurred over the last 15 years almost, we have either had some hand in it. I’ve had the privilege of having some part in it, and it’s just been a really exciting career. As about, around 2013, a colleague of mine who was a reservist because we are reservist hurricane hunters, I told her that I was interested in trying something different, seeing a different part of the world and how else I might be able to serve, and she recommended that I reach out to Ochsner to find a role for me within healthcare. And I had never considered healthcare before that, not at all. If you had told me before October 2013, I think I started reaching out and showing interest around September. So in August, if someone had mentioned to me that I would be in healthcare today, I would have thought they had lost their minds. But I did have a transition, and it was a heck of a transition, because it’s been as though someone placed me in a foreign country with no understanding of culture, no understanding of language, no understanding of many of the simple things that I think we take for granted as we are, as we grow and develop within and within an industry, and I was just kind of dropped into healthcare. Now, granted, I sort that out, but it has been an amazing journey. I’ve done everything from access to care for our outpatient and inpatient services to transitioning patients from lower levels of care to higher levels of care. I’ve had the role of practice management when it comes to internal medicine, and in October of 2020, again, I was trying to understand how best to bring value in healthcare with my knowledge from aviation and operations and how to put processes and systems in place, and how do I line all of this with my individual purpose. We’ve spoken a lot about purpose in recent years and more so in recent weeks and months, and I think that my purpose as a person professionally and personally, is to protect others, to remove barriers, do things for others that were just a little bit help, allows them to be the person that they can be within this world, and realize their full potential. And I think that’s how I’ve been led to community health and health equity and kind of leading the work here within Ochsner.
Manav Sevak:
It’s an incredible story, and just so, it’s kind of fascinating to see the roller coaster that you’ve been through. And the concept of community health is not a new one, right? It’s something that has existed in healthcare for a long time. To some degree, community-based medicine was one of the first forms of medicine that was ever developed, but it’s starting to pick up a lot of traction again. And the concept of actually addressing all of these additional components of someone’s holistic health is something that’s top of mind across the country. What do you think has kind of changed in the time that you’ve been in healthcare that has made that a focus again for the industry? And what are kind of big trends that you’re seeing around health equity that are starting to appear?
Kevin Green:
I think, as far as what has changed and the trends that I’m seeing, I think in truth, COVID has been a catalyst. And when we have experienced COVID on such a grand scale, and by grand scale, I mean regardless of socioeconomic status, regardless of race, regardless of gender identification, however, someone might be identified as being in a different group, we were all faced with the challenge of COVID and equity and caring for ourselves and those that we love. And through that, I’ve seen an increased focus on ensuring that social determinants are mitigated, ensuring that health equity for all is a reality and that health disparities that have been within systems forward, I mean, since the inception of healthcare are removed that those barriers, those disparities are removed. And I think that the true difference today is our willingness to challenge our implicit biases to bring that forward. And then I think as a person, when someone does that and they see something that they morally or ethically cannot align with, there’s a drive to do something about it. And I believe we’re, where our minds are today, our great minds, as far as those that are on the forefront of technological changes, those are on the forefront of challenging the processes and methods within healthcare through which we’ve always taken care of patients are those the right ways and right methodologies going forward, they’re also focused on, and have seen the disparities and want to address them. So how do we take those advancements and apply them to this very incredibly complex problem that is no longer acceptable? Here in Louisiana, we have an initiative named, we coined this Healthy State, whereas we’re going from the 49th and 50th, our goal is 49th and 50th and transitioning to 40th by 2030. And there’s a simple reason we’re doing it is because it is no longer acceptable that our people are not cared for. They’re no longer acceptable that we have policies that are in the way strategic infrastructure, challenges that have not been met, educational requirements that have not been met, interventional opportunities as far as simple challenges of access to care that have not been addressed, and I think the same is true when it comes to health equity. We see that because an individual may not have access to transportation or there might be a perceived, an impression that an individual may not be willing to use technology, so therefore certain opportunities are not presented to them when it’s just not true. There are other challenges in place. And when it comes to trends, I believe that our growth in technology, when it comes to utilization of virtual digital as well as AI, is a trend that cannot be ignored. I think it’s one that we should embrace, absolutely, as we understand how best to care for these patients. Of course, I’m not clinical, yet I sit and I discuss this with our physician and APP partners quite often, and there’s a reluctance because there’s uncertainty around the safety and the connection and bond that we have with our patients, those things be challenged. Yet I think each day we prove that those are not insurmountable challenges, that we just have to want to be different. I think that another trend that I’m seeing and discussions I’ve had around the resiliency of our people, of our patients here in Louisiana and across the country, and how they are now demanding that we approach them differently. Today we have Amazon, for retail, I get anything I want from any retailer almost globally within 2 to 3 days, definitely within a week. And it’s just totally redesigned, I think, the way in which a customer, a patient in our circumstances expects to be cared for. So I think it’s an exciting time within healthcare for sure.
Manav Sevak:
100%, no, it’s helpful perspective. Bring that to life a little bit for me just because, you know, in all the time that I get to spend with CEOs of health systems and board members of health systems, health equity is a big priority for all of them. That being said, the number of people who are actively developing and scaling programs in that space is still really, really small. Just give me some examples of programs that you all have actually implemented and just some of the outcomes that you’ve seen from them. Just because in our, even our private discussions, I’ve had a chance to see just how incredible they are.
Kevin Green:
Sure, absolutely, so I’ll start with some of the outcomes and then I’ll back into how we attain those outcomes. We had a review very recently of our ED utilization data and the patients that are cared for within our health centers. So these are MRNs that are actively managed by our primary care physicians and pediatricians within the health centers. We’ve seen a 16% reduction in ED utilization, 16%. We’ve seen a 34% reduction in improper or avoidable admissions on the inpatient side. Readmissions, we’re still reviewing that data to ensure the accuracy, but we’re also seeing positive changes there as well. So from a health business perspective or health systems perspective, there are definitely advantages because when those EDs are utilized by these patients, we know that that is not the right place to care for them. We also know that limits our capacity to manage patients that have much more appropriate, they may have more appropriate emergent conditions. So that’s critical for health and health outcomes for all, as well as just the utilization of our resources. On our quality side, Ochsner has a challenge for ourselves internally on our metrics, whereas we target top decile when it comes to what we call the Big Seven. So screening such as colorectal, breast cancer screening, hypertension, diabetes management, etc. our community patients in Louisiana that are not actively managed by Ochsner, and I’ll put a plug in for our community health centers that are not internal to the federally qualified health centers, they do an outstanding job. They’re resource-limited in that they’re directly a primary care center without an integrated health system behind them. So this is definitely not an equal comparison as far as resource availability for them, but it is, and it is an explanation of what our outcomes are able to be considering the resources Ochsner has available. So on average, they’re at about the 50th percentile and we’re around the 71st and 80th percentile in many of the categories that we measure. So we’re seeing, for example, hypertension, we have a 20% more positive rate as far as hypertension management. We have a 25% better ability to manage diabetes. So in our patient, direct patient impact side, we’re seeing lives become better every day through our providers. We’re seeing better access to ED utilization and many challenges, social determinants challenges come with this patient population. For example, we’ve opened five health centers today in different parts of Louisiana. By the end of next year, we’ll have about 11 open. By the end of 2025, there’ll be 15, I imagine, more open across the state. We have just as many, we have pretty significant no-show rates, 25 to 30%, no-show rates, yet when we use our lift services, I’m seeing 7%, no-show rates. So as we look at our data and we say that people are challenged with transportation across states versus in our rural areas as well, it’s, there it is, black and white for all of us to see that if we mitigate these social determinants, it is not a will issue, it is also not potentially not an education issue, and at times they are, I don’t want to lessen that education challenges must be addressed, but if we can mitigate transportation, we go from 30 to 7% no-show rates. When it comes to access and the way we’re accessing patients, I think that we experience the quality outcomes we have because we use our digital medicine resources for hypertension and diabetes. We have a 25% virtual visit rate, nine community health centers, non-community health primary care clinics within our system have about a 12 to 15% virtual visit rate. Our patients need to be seen in a way that is conducive to their lives. And if there’s a patient that has to change, has to choose between an hourly wage or coming in to visit for a clinical visit, unfortunately, many times they have to choose hourly wage. Virtual visits allow us to mitigate that. Digital medicine allows us to have information pushed to us so we can have more consistent management of our patients. Online scheduling, I was told when I took this job that our patients did not want to utilize, this particular patient population may not want to utilize technology. Nothing could be further from the truth. Our online schedule is like 40% of our visits. It’s just been truly outstanding, the acceptance of technology, how we’re able to have much greater positive clinical outcomes because of it. Now we’ll say, we put a good bit of effort in our communication, our strategy to build trust, collaborate not only internally but externally in creating access for our patients, whether it’s through technology, whether it’s inpatient, whether it’s changing times, but we do that through creating interventions, through educating and to, and by implementing longer-term strategic, strategically impactful solutions. Those are the three ways in which we build that trust when we collaborate and create access. So our digital marketing approach or our traditional marketing approach is pretty robust, pretty substantial, but those resources are proven to drive the outcomes that we need to help these patients understand that the resources are available in a way that’s conducive to their lives. And the choices, those very difficult choices that they’ve had to make in the past are no longer necessary. So those are few of the outcomes that we’re experiencing. I think they’re just outstanding and I applaud our providers, and I appreciate, I have such a deep appreciation for our patients and their willingness to trust us because this has not been an easy road. Just last week, and I know this has been off the question, I’ve been going on for a moment here, but just last week I went to Lafayette, Louisiana. What I thought would be a simple clinic visit with maybe two or three patients turned out to be about 30 or 40 people waiting in the room to have an impromptu town hall to share with me and others, so leaders in Lafayette have been amazing in partnering in this journey, but to share with us some of the challenges that they face. And it was a very difficult conversation because one parent of a sickle cell patient who mentioned the difficulties around perceptions of drug addiction or speaking pain medications that that patient population experiences led a child at one point to not want to utilize any health system and to just rather be at home and in pain. The mother cried as she explained and shared the challenges that she’s experienced with us. And yet at the end of that meeting, there were so many social media posts, not by Ochsner, not by clinicians, but by those patients, because they experience so much hope and that we were being inclusive, we were listening, and we’re trying to solve their challenges by including them on the front end.
Manav Sevak:
It’s incredible, it’s incredible to hear and just, I think some of the community health work that you’ve done in this space, I would put at the top of the list on health equity initiatives that at least I’ve heard about that are being shepherded inside of health systems. If you think a little bit about, there are a handful of folks from other health systems that listen to this, if you think a little bit about what guidance you would give to other orgs as they think about standing up their own community-based efforts and investing more in health equity, how do they get started with that? And what are the big things that you all did and that you lobbied for inside the organization that they can as well?
Kevin Green:
I think in order to attain the same or better outcomes, they must do two things right from the beginning. That is to focus on building trust with our patients. We understand our patients, our physicians, our APPs, they understand their patients, they do. But this is a different experience because a person walks into, I walk into a clinic visit and I expect to share whatever my clinical concern is, whether it is physical or maybe something a lot more personal when it comes to maybe a mental health challenge. Yet I don’t expect to have to share that I can’t afford a proper diet because of my income and that I have to choose between keeping my electricity on or a proper diet, or that I have to choose between aftercare for my child and working or purchasing medication. So our social challenges, the social challenges we’re asking our patients to share with us are far more complex and not traditionally healthcare addressed through healthcare, yet we have to build the trust, we have to do that, that’s absolutely necessary. And to do that, we have to listen to the patients first. We have the experts, we know what’s going on, but to gain acceptance from our patients, I think the single most beneficial thing that we began was our patient advisory councils, where we allow patients to share with us their concerns. It was our market research, whereas we had conversations with many patients and each of the target areas, hear from them what their challenges are and how they would like us to address them, that goes a very long way. Because we can implement programs, of course, yes, please have transportation programs. We have community health workers that focus on housing insecurity and food insecurity, even legal assistance, all sorts of services that are needed. We address those, but I think what allows the patients to have the connection with us to walk through the doors and believe that we will take this journey with them is because we first listen to them and we’ve set up feedback loops to gain their, to understand their position on things, not simple surveys through patient experience. So I would say begin there with trust and listening. And then once you do that, build out the programs. You could, there are many sources that tell you what the social determinants challenges are. They are transportation, they are housing, they are food insecurity. Yes, we have ten boxes of food at each of the health centers so that when a patient comes in and need something today, we can offer it to them today. We also have community health workers that are there that will help enroll them into a state food assistance program, absolutely. Those are the interventions on a longer-term solutions that help those patients. As an organization, we’ve implemented economic and workforce development initiatives in each of the areas. That’s even more broad than our health centers in my scope of work, so those can’t be overstated, in my opinion. The internal collaboration, as I’ve just started to mention, being the second major area of, it’s not just a pre and street situation, physical, mental, social, but it’s also environmental. And if you are an anchor institution or can build a coalition of collaborators that can address economic challenges or address workforce development challenges, you start to sow seeds that have such just a truly remarkable return in the very near future with our patients. And then don’t be afraid to create access, I know many of these patients may be self-pay or payer classifications that may not be the most profitable, yet we’ve experienced in our EDs and in our inpatient admissions, avoidable admissions where our resources can be optimized for those patients that those points of care are more appropriate. We’ve experienced that, so it is a reality, it does happen. But don’t be afraid to first listen to them, and I think that is the most difficult and challenging part of this.
Manav Sevak:
Super, super helpful. Even just for me as, working at a healthcare technology company and building what Memora is and making sure we keep health equity in mind, and at the end of the day, doing what we want to do, most importantly and what our mission is of, meeting patients where they are and making sure that we’re doing everything we can to make sure patients get access to the right care at the right time. So really appreciate all of the perspective, Kevin, I feel like I always come away from conversation learning something from you, and would love to have you on again soon.
Kevin Green:
I really appreciate the opportunity to speak to everyone and share the work that we’re doing here. I am more than happy to coordinate with anyone, and if someone needs to reach out to me, please feel free to include my contact information with this podcast. I want to share the work that we’re doing. I think that our patients in Louisiana are better because of it, but of course, we’re learning to be better so that we can help them more.
Manav Sevak:
100%, Kevin, and really, really excited about all the time that we’re spending together as well. Thank you for coming on and we’ll have you on again soon.
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
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