Optimizing Population Health with High Tech and High Touch with Setu Vora, MD
Episode 479

Setu Vora MD, CMO Mashantucket Pequot Tribal Nation

Optimizing Population Health with High Tech and High Touch

Leveraging the power of telemedicine to improve population health

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Optimizing Population Health with High Tech and High Touch with Setu Vora, MD

Episode 479

Best Way to Contact Setu:

LinkedIn

Tribal Nation Link:

https://www.mptn-nsn.gov/default.aspx

Optimizing Population Health with High Tech and High Touch with Setu Vora, Chief Medical Officer at Mashantucket Pequot Tribal Nation transcript powered by Sonix—the best automated transcription service in 2020. Easily convert your audio to text with Sonix.

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Saul Marquez:
HP’s population health I.T. solutions are creating convenience and choice for providers and patients. Building on over 50 years in health and life sciences, HP is delivering end to end solutions for remote care and in-home monitoring. Supporting the transition to home chronic disease management, medication adherence, health education and remote clinical trial monitoring. HP Fit Solutions. Your single source for cost-effective technology-enabled remote-care solutions and financing services. If you’ll be at the HIMSS 2020 meeting, you can visit HP at Booth 1541. At the HIMSS 2020 meeting, visit HP at Booth 1541. Otherwise visit www.hp.com/go/healthcare. That’s www.hp.com/go/healthcare for more details.

Saul Marquez:
Welcome back to the podcast. And in today’s episode on Population Health, it’s a series of population health brought to you by HP. I’ve got the talented doctor Setu Vora. He is the inaugural chief medical officer for the Mashantucket Pequot Tribal Nation. He directs all Mashantucket health care initiatives, including oversight of the Tribal Health Service, Behavioral Health Service, Employee Health, Community Health Grants, Pequot Health Care and the stewardship of the tribe self-funded health plans where really they benefit coverage’s provided to Foxwoods Resort Casino and tribal government employees and a tribal member community. His goal is to assist the tribe with continuous improvement of clinical care, community health and company growth. Dr. Vora is leading the company in the adoption of performance improvement mindset, health technology, digital transformation and the use of data and design to help plans control costs and improve health outcomes. He’s a practicing physician with board certifications in internal medicine, pulmonary disease, critical care, medicine and sleep medicine. He trained at the University of Connecticut and subsequently at the New York Weill Cornell Medical Center. Prior to joining the Mashantucket Pequot Tribal Nation, he led quality improvement and patient safety movement initiatives at Hartford Health Care. In this episode, we dive into the use of technology, making sure that you include the human touch as well as all stakeholders to ensure that population health efforts lead to better outcomes, reduce costs and overall healthier patients.Join me in the discussion with Dr. Setu Vora on population health. Such a privilege to have you here. Thanks for joining me.

Setu Vora:
Thank you so much. I appreciate the opportunity.

Saul Marquez:
So tell me a little bit, Dr. Vora, what is it that inspires your work in health care? And tell us a little bit about your journey, about how you came to work with the Mashantucket Pequot Tribal Nation.

Setu Vora:
Certainly. You know, growing up in India, I was fascinated by the fictional character of Sherlock Holmes. And for those of you who know, you know the author is a physician. And a lot of the traits of the character Holmes, they’re based on deductive reasoning, diagnostics. So that really was one of my main driver of choosing healthcare in the first place. The deductive reasoning piece.

Saul Marquez:
Pretty cool.

Setu Vora:
Yeah. And then I, of course, came to US, trained in Connecticut and also in New York and had been a practicing physician in pulmonary critical care diseases, sleep medicine and internal medicine for the last almost 20 years plus. And the local Mashantucket Pequot Tribal Nation needed someone with a clinical background to assist the tribe reach its objective one. And that happens to be, you know, how maybe help the tribe’s members and community live a happier, healthier and longer life. And that’s their objective one. And that was a mission that really resonated with my own personal mission. So I signed up.

Saul Marquez:
That’s so great. And as we mentioned in today’s introduction, the topic is accessibility and telehealth reaching marginalized communities through virtual care. It’s an important piece of population health. I love to hear more about how you and the group there in the tribe are are working to add value to the population, the community, and maybe some unique things that you’re doing to help out the ecosystem.

Setu Vora:
Sure. If you look back at the history of telemedicine and adoption of that, the American Indian Alaska native tribes, especially Alaska Natives, one of the pioneers in really embracing telemedicine concept out of necessity. Right. I mean, you would imagine vast distances, long winter, lack of enough number of specialists to deliver care. They had to rely on emerging tech such as telemedicine. So I think what starts out as a constraint through an innovation in native community, now we see that those same lessons are applicable even in a more denser populated area such as the Northeast. Our tribe, Mashantucket Pequot Tribal Nation that I serve, is a federally recognized Native American tribe, one of the two in the state of Connecticut. And the tribal nations membership including its own community as well as employees and dependents, are served by the own tribe’s own self-funded, self-insured health plan. So it’s the right. confluence of not only population health management in a native community, but also what are the lessons that we can learn from our sister tribes in Alaska around adoption of telemedicine, even though distance may not be an issue for us. Because more and more folks, either by choice or by necessity, they still prefer to have a digital access, a digital doorway to reaching for care and then have the benefit and the luxury of having an onsite high touch clinical system that we already have in place, as well as a high-tech access point as in when the need for a variety of different reasons.And so in over overarching goal at Mashantucket Pequot Tribal Nation is to really strive toward that objective one and build humane trust-based system that is both high touch, which is in keeping with the native tradition of being with someone, right? And a lot about face to face, it’s a lot about actual hands on. At the same time, build a high tech component so that for disease states that are, you know, much more still of a stigma. Unfortunately, people can access behavioral health care, mental health care, they can access nutritional counseling, metabolic disease treatment reversals, smoking cessation, all those through either onsite clinic or we offer them a digital solution for the same. So our goal at MPTN is to really go back and connect with native practices and traditions as a preventive way of living, but at the same time utilize the ancient wisdom with modern medicine and build a system that is both a hybrid of high touch with high tech.

Saul Marquez:
So interesting and I really love the integration of that old way of doing things as well as as the introduction of both the high tech and high touch your comments around something that was driven by necessity because of the distance. But now something that ends up being preferred by a lot of people. So as you roll out this program and the other thing that’s fascinating is that the tribal nation is also self-funded, self-insured. It’s vertically integrated. And I think that it’s these vertically integrated payors, providers that end up doing a lot of the more innovative stuff. Tell us a little bit about some of the learnings that you’ve made as you’ve fulfilled some of the community’s needs that are both complex and also very interesting.

Setu Vora:
Yeah, no doubt. As with any change, focusing on where the specific needs of the people that we serve has been our our main starting point. And it was clear to us that metabolic diseases, overall mental health, well-being are high priority areas for all of us to focus on, which is not unique to just us here at MPTM. I think any any large organization or community is facing the exact same challenges. So we started out building a foundation of digital health solutions that were specifically tailored to address more of systemic chronic diseases and not necessarily catering to the varied wealth. Well, our goal was to reach more of the folks who are truly disengaged from the health care system at this time and offer them another option to engage with the system on their terms with privacy. So I think when any other digital deployment reaching out to the members who may benefit from it has always been a challenge explaining the value proposition to them, at the same time showing how it may benefit the tribe in general from both better health outcomes as well as return on investment. But if we had to make that clinical case first before the business case can follow, and I think that was a lesson learned fairly early on to bring in the community members early into the design phase, even before we decide whether we want to adopt this program adapted or abandon it, we had to have them onboard in the discovery phase as well.

Saul Marquez:
It’s fascinating. So having this involvement, being able to have really no attachment to the solution and being flexible feel like it has been a big part of the success you guys have had. So tell me a little bit more about maybe some of the impact and if you can share some of the metrics and improvements or even feel from the people that you guys have had been able to bring into the fold. Right.

Setu Vora:
Yeah. I think, you know, since I mentioned, you know, that the tribe we have our own healthcare management company that’s called the peak was healthcare. And actually the tribe founded healthcare management company even before its gaming enterprise.

Saul Marquez:
Is that right?

Setu Vora:
They had the foresight to invest in that, right.. So because of that, we have our own in-house independent third party administration system. So being self-funded, fully self-insured, we administer adjudicate all the medical claims and the pharmacy claims. We have our own onsite retail satellite pharmacies as well as mail order pharmacy. We are a federal pharmacy. We can supply pharmaceutical medications to other sister native tribes across US at a highly discounted federal supply scheduled rate. So we have that very data rich environment to look at deployment of a digital health solution and then look at previous historical claims experience both on the medical side as well as pharmacy side. And the only variable in that specific population happens to be, let’s say, for example, deployment of digital health solution that addresses metabolic health. Now we can track not only the members satisfaction, the net promoter score, the number of adoption, right. What matters to the members, the outcomes such as, you know, a reduction in their BMI or blood pressure control, their lipid profile as well as their, of course, the A1C besides tracking those outcome measures that really matter to the members, the people. We can also track outcome measures that define for health care system and the tribe in terms of how does this impact health care utilization from medical side. Are we seeing reduction in E.R. visits, hospitalization? Are we seeing a reduction in pharmacy spend because now they are off their injectable. So I think that’s where the beauty of having a full, like you said, fully integrated verticals in place allows us to really test these emerging solutions even more robustly. Besides what was obviously published in peer reviewed literature.

Saul Marquez:
That’s fascinating. So what role does technology play into everything that that you guys are doing there?

Setu Vora:
Yeah. So, of course, you would think of technology in terms of delivery of care with the use of EMR. For that, we use a national system that the Indian health service uses for onsite. For the travel members. It’s called our RPMS. But for our employee health, we have a different EMR system. And our goal is at some point to unify those. So from care delivery system, the EMR is the primary text deployment. But then we also deploy digital solutions to address unmet healthcare needs. For example, we know that our diabetes care measures, one of them, which was significantly lower, was screening for diabetic retinopathy. So now we have digital tele opthamologist program in place and we measure the adherence to annual diabetic retinopathy screening measure over time and share that data with our sister tribes at various national and regional forum to learn and share lessons about improvement. That’s just one example. We also use technology to engage with members how they want to be engaged. So we have deployed but compliant health grade text messaging platform where we can do bi directional communication and leverage some voice and also some emerging machine learning A.I. tools in guiding that dialogue, almost adding on a checkbox function to that engagement channel. And then of course, there are standalone digital platforms for smoking cessation or metabolic health, behavioral health that we have on site.

Saul Marquez:
I think it’s brilliant and just kind of the focus that you guys have in tackling some of the core issues, facilitating it with technology. As you’ve worked through some of the some of the challenges up front, what would you say has been one of the biggest setbacks you’ve experienced then? And what was the key learning that’s made you better?

Setu Vora:
I think one of the biggest setbacks is to realize that digital does not solve everything. So there are certain human conditions. Let’s say, for example, smoking cessation, nicotine addiction is so powerful that we offer not only the Onsite Freedom from Smoking program, which is the American Lung Association. It’s eight week program. We offer that. We also offer our members free nicotine replacement therapy, free Wellbutrin, free Veroniclin the Champix, if they so choose to use any of the medication assisted therapy for quitting smoking. Besides pharmaceutical counseling, we realize that in spite of having this, there are limitations.So we offered a digital health solution using a nifty first in the class carbon monoxide sensor and we had good adoption with the other pilot was 50 people. We had 50 sign ups within the first two months of launch. But it is hard. Yes, the pilot.

Saul Marquez:
Oh yeah, yeah. Yeah we had yeah we had them on the podcast not too long ago.

Setu Vora:
Yes. One of the early adopting site in the tribal nations across the US. And for that pilot we realized that adoption is good. Download engagement seems to be OK. The sentiment around readiness to quit improves. We also see that they drop their cigarette smoking rate from perhaps on an average 17 down to eleven a day, but really doesn’t lead to complete abstinence. And how do we really measure that has been a big challenge. And I think, you know, that’s where our learning is, that we still have to nurture the Real-Life community of these virtual digital health solutions to users and bring them on site together periodically to kind of share what could be done differently and iterate off of that.

Saul Marquez:
Yeah. You know, I certainly admire the things you guys are trying. I mean, it’s definitely inspiring to hear that you’ve tried programs like Pivot and you just sort of slowly iterating to get the best results. And so now you’ve brought people together and you’re trying this new sort of community based approach. And how’s that working?

Setu Vora:
I think it seems to work well when technology is almost invisible to some degree, where it becomes almost part of your natural clinical workflow. For example, you know, a few years back when I started at a tribe, the tribal health service, maintains a fleet of vehicles just to transport tribal members for their non-emergency medical visits. Right. And that’s fleet cost maintenance, insurance, fuel. And it also took the staff, highly trained clinical staff off line for those many hours when they were transporting patients for their imaging or their medical council for a specialist somewhere or dialysis. And so we implemented a digital solution to empower the clinical staff to book non-emergency medical transport as a health benefit. And we saw a drastic reduction in the need for taking our staff offline, allowed the members to access care on their time and schedule using partnership with Lyft through a platform called Circulation. And it says remarkable cost savings , besides, of course, connecting people with care, which is the main objective.

Saul Marquez:
That’s outstanding, Setu, and it’s wonderful to hear that there are different partnerships, through the innovativeness of the tribe and and some of your leadership, we’re improving access and also optimizing the way that the tribe can connect the dots and help the members.

Setu Vora:
Yeah. And the tribes goal is to stay as a sovereign, independent tribal nation and be sustainable. And to do that, it has to get better health outcomes at a much lower cost. And so our relentless focus is on better value help. And I think, you know, in the process, if we can use technology to keep some of those health care dollars that we spend within the community even better. So, for example, many of the Lyft drivers who provide these non-emergency medical transport happen to be tribal members. So the money stays within the community.

Saul Marquez:
That’s great.

Setu Vora:
And the circular economy almost.

Saul Marquez:
I was wondering about that. That’s really great.

Setu Vora:
At least that’s our intention to keep the quality, safety, patient experience to be highest possible. And the total cost of care to be low to drive that true high value health care in the tribal nation.

Saul Marquez:
So it’s as you think about us wrapping up here, we’ve got a couple more questions. But what are you most excited about today, Dr. Vora?

Setu Vora:
Just today, I’m just excited about the opportunity to speak with you and many like minded colleagues across your listenership, which is extensive, and perhaps connect with them and learn from them around their experience in trying to shape the healthcare for better. So that’s what I’m most excited about today.

Saul Marquez:
I appreciate that. And then you’re doing such a great job of of working to improve accessibility through the use of telehealth, but also through the use of so many different partnerships and empowering the community. So definitely want to want to congratulate you on the efforts that you and I and the Mashantucket what tribal nation are doing as the folks are engaged in this in this thought leadership series of population health. You know, I’m curious, what book would you recommend to them? Doesn’t necessarily have to be in population health, but curious what you believe would be a good read for the folks listening to the check out.

Setu Vora:
Yeah, I think, you know, if I had more time and more years to go back to school, I would certainly go back to community organizing as a prerequisite skill. That includes not only face to face organizing versus use up novel emerging media to engage with people, build communities to drive them to action. We cannot impose change. It has to come from within. And how may we become those catalysts to really empower the leadership that already exists in the community that we serve and just support them as a resource? I would love to go back and do that.

Saul Marquez:
Wow, that’s really interesting.

Setu Vora:
We already know what works.

Saul Marquez:
Yeah.

Setu Vora:
We know the science. We know it works. We just need to translate that into action.

Saul Marquez:
Wow. Yeah, that’s really insightful. And you know, as we all think about positively impacting the communities that we live in and health care, I think that’s something that we can all take away as a thought to be students of.

Setu Vora:
Students for life.

Saul Marquez:
I love that. So before we conclude, say, too, I just want to say thank you. I mean, just incredibly insightful work in telehealth. What closing thought would you leave the audience with and what would you say is the best place that they could interact with you after this conversation if something you said struck a chord with them and they wanted to continue the conversation with you?

Setu Vora:
Certainly. You know, in terms of some closing thoughts, I think if we just focus on the members or the patients we serve and keep that at the forefront and design interventions with their leadership and engagement. I think we’ll be better off. That’s one. And I would certainly love to love, love, love to learn more from our colleagues. And I can be reached at LinkedIn/SetuVoraMD S E T as in Tom U V O R A MD OR I can be reached by email as well at SVora at M as in Mary P S and Peter T as in Tom and Nancy Dot or org. I look forward to connecting with all of you.

Saul Marquez:
Setu, thank you so much. And we really appreciate you sharing your insights and the work you’re doing and telehealth and improving accessibility.

Saul Marquez:
Really appreciate it.

Setu Vora:
Thanks so much for your time.

Saul Marquez:
HP’s population health I.T. solutions are creating convenience and choice for providers and patients. Building on over 50 years in health and life sciences, HP is delivering end to end solutions for remote care and in-home monitoring. Supporting the transition to home. Chronic disease management. Medication adherence. Health, education and remote clinic. Trial monitoring HP Fit Solutions. Your single source for cost effective technology enabled remote care solutions and financing services. If you’ll be at the HIMMS 2020 meeting, you can visit HP at Booth 1541. At the HIMMS 2020 meeting Visit HP at Booth 1541. Otherwise visit www.hp.com/go/healthcare. That’s www.hp.com/go/healthcare. For more details.

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