The whole-member mindset

September 06, 2022 SmartBrief Season 2 Episode 5
The whole-member mindset
Show Notes Transcript

Health plans increasingly underscore the importance of whole-person care and a holistic approach to health. Susan Beaton of Wellframe and Dominick Bizzarro of MVP Health Care join us to explore the meaning of this idea and how health insurers can integrate a whole-member mindset into their plans to meet the physical, behavioral and experiential needs of members, wherever they are. 

Melissa Turner  00:03

Hello and welcome to Touchpoints, a conversation about care, connection and costs in the US health care system. I'm Melissa Turner. In addition to co-hosting Touchpoints, I'm also content director for health care and life sciences at SmartBrief. SmartBrief is a publisher of digital newsletters for professionals, and creator of this and other shows in our series of SmartPod podcasts.

Doug Harris  00:24
And I'm Doug Harris. I'm a custom content editor for health care and life sciences at SmartBrief, where I create content for payers, providers and other health care stakeholders. In addition to our work hosting Touchpoints and at SmartBrief, Melissa and I are of course also consumers of health care, just like those of you listening. Together in each Touchpoints episode, we'll explore the issues that make health care hard for all of us.

Melissa Turner  00:45
We'll also discuss how health plans, health care providers and their partners in the health care ecosystem can make it easier. Thank you for joining us on the Touchpoints podcast.

Doug Harris  01:08
Wellframe empowers health plans to become trusted advocates for members. Their team believes that health plans are in the best position to lead the charge into the world of digital health management. Let Wellframe be your partner in improving member engagement and outcomes. Learn more at

Melissa Turner  01:26

Welcome, I'm Melissa Turner, your host for today's episode of Touchpoints. Our topic today is whole-person care, and we have a great team with us here today to discuss this topic. Dominick Bizzarro is chief growth officer at MVP Health Care. In his role with MVP, a regional health plan serving more than 700,000 members in New York and Vermont, Dominick works to map his organization's course through the changing health care landscape. Welcome, Dominick.


Dominick Bizzarro 01:52

Thank you, Melissa. It's great to be here. Appreciate being invited to Touchpoints.


Melissa Turner  01:56

Glad to have you. I'd also like to welcome Susan Beaton, vice president of health plan strategy at Wellframe. Before joining Wellframe Susan worked for more than two decades in various roles at Blue Cross Blue Shield of Nebraska. She's also a registered nurse who practiced in pediatric critical care and trauma. Welcome, Susan.


Susan Beaton 02:15

Thank you, Melissa. Excited to have the conversation today.


Melissa Turner  02:18

Glad to have you back after you joined us last season. Let's go ahead and jump into our discussion. So whole-person care, I'm sure you both don't need me to tell you, but this has clearly been a bit of a buzz term in health care for the past couple years, maybe longer. Let’s just start by defining it. So could each of you just kind of take a stab at that? Let me know how you and your organization define it, Susan.


Susan Beaton 02:41

So I would say I'm just even from my background as a nurse that you mentioned, Melissa, we know that many people are influenced by and in their health care outside of the physician's office, and definitely outside of the purview of the health plan. So I think in order for health plans today to really engage members as a, as a whole person, they have to think about all the things that affect the members’ lives outside of just their medical condition. And a lot of times that might be their employment, as we were just kind of talking about a little bit earlier, or a status change and where they are working. And then, really, then the insights that you need to glean about a person about what challenges are they facing. So even though they may be working, they may also have food insecurity, they may not have access to the items they need. So if you have somebody who has diabetes, they definitely need healthy foods. And so all of those things that happen in their world, even at home or employment, also affect their health. And so whole person means looking at everything that they're that they're challenged with, that they need help on, in order to manage their condition. But in order to manage their life and be a little bit more successful, so they can in turn be successful in managing their health.


Melissa Turner  03:55

Absolutely. I'm sure that resonates with a lot of our listeners, Dominick, what would you add?


Dominick Bizzarro 03:59

Well, it certainly resonated with me. Maybe I'll try to boil it down and distill it. So I would say whole-person care is care in the context of a person's life. So it's customer-centric, for sure. And hopefully, it becomes relationship-centric. And it's definitely a pursuit. And the pursuit begins with first seeking to understand rather than only be understood, right? So you really have to kind of look at it from the outside in through the eyes of the person rather from the inside out, you know, from your product or your solution or your organization ,to them. I work with a physician CEO of an organization that offers really comprehensive integrated primary care. So primary care, urgent care, behavioral health care management. And we were riding in a car for an hour to visit a rural health center way up north in New York, almost to the Canadian border, so a really rural area. And he shared with me, he's been a family practitioner for over 20 years. And he said that, in the vast majority of cases, the diagnosis is pretty straightforward. The challenge is the care plan. And you have to select a care plan that can be implemented based on what the patient can understand, what their goals are, what their means are, their access to food, transportation supports, many of the things that Susan pointed out. So whole-person care is really care in the context of a person's life.


Melissa Turner  05:33

That's really interesting. And I wonder, Susan, in your clinical history, if you if you kind of look back on that and see some of those themes of, you know, presenting a care plan is great, but it has to be one that works for the patient. Does that take you back?


Susan Beaton 05:49

It does. And to Dominick's point, is, you can give them a condition, it might be a new one. But you have to get them to engage then, right? It's easy to tell somebody, “Maybe you have diabetes,” but how do you get them to engage in their health? And a lot of times, especially when they're in front of their medical professionals, their doctor or even their nurse, they try to put on a really good front. And they try -- they don't want to disappoint. And so they want to share that they're doing all the things that you prescribe them, like Dominick said, you have a care plan. But are they really doing them? So in order to really understand the member and understand that whole person, then get them to engage and actually openly share about what they're struggling with.


Melissa Turner  06:28

Yeah, absolutely. We will pick up lots of these themes throughout this conversation, including how do you develop that understanding. And how do you engage? But I want to just step back for a moment and ask your take on why there is so much emphasis on whole-person care now. Dominick, do you want to pick that up?


Dominick Bizzarro 06:45

Yeah, I think as a country, our outcomes aren't all where we want them to be. Whole-person care affects those outcomes. And it can do it quite positively, whether you're looking at access costs, quality, satisfaction, both at the individual person level and the population level. And certainly the pandemic exacerbated the, I think, for those in health care the clear, existing disparities in health care in terms of access and understanding and trust and how cost affects all that. But it became clear that those disparities are affecting the overall health of the US population relative to other countries. You know, Commonwealth Fund has studied this for many, many years. And the life expectancy in 2019 in the US for a newborn is 78.8 years. And for neighboring Canada, it's 82.3 years, and it's nearly higher in all other high-income countries. So I think that's kind of shined a light on it. And those are pre-pandemic numbers. And it only got worse after the pandemic. So we have an aging country, and we need to adjust what we offer people in our communities. And what we do on an individual level in dealing with that individual person just adds up to the health of a population overall.


Melissa Turner  08:12

Yeah, absolutely. Susan, do you want to comment on this?


Susan Beaton 08:14

Dominick made a really good point. I think it just became exponentially exposed during the pandemic the needs that people have. And I think it really exacerbated the factors that were affecting their health that maybe we didn't have insights. So you know, so my next point is the health care system got really busy with COVID. And that meant people were still kind of doctoring themselves at home. In the meantime, if it was an emergency, and their providers or nurses might even have been then contacting them at home, sometimes by video conferencing or telehealth. And now you're getting a view also into their surroundings. And so I think what we're seeing is, then, that factors, that social determinants of health that we talked about earlier, whether it's employment, maybe there was loss of employment during COVID, or now I can't afford my medication. And then you have isolation happening. So now you potentially have a mental health issue on top of that. And so, you know, some of the things that we heard directly that you can pick up by having that engagement and kind of two-way live communication is that 51% of people were sharing that they had difficulty paying their household expenses during COVID. Or 1 in 10 households suffered from food insufficiency. So people that might have gotten access to resources through work, or their children through school, now didn't have that and there were true bouts of suffering going on. Outside of what we just see people normally in the health care system, have a medical condition. And then you tie that with that social isolation. And to Dominick's point, now you're going to increase morbidity, mortality. You add that behavioral health piece on to it, depression, high, high rates of depression or anxiety. And that all just relates to more risk. And so whole person is looking now, not just one touchpoint that you talked about with somebody about a condition or when I saw somebody come into the hospital or whatever we check off, right, a box of here's all your history, here's all your systems, your heart, your lungs, your bones, and we check them off. But what did we really do outside of that, to really, uh, you know, that whole person? And I think, you know, Dominick said it well with some of the statistics that he shared, that yes, it is an aging population. Right now I think 4 in 10 adults have two or more chronic diseases. And by 2025, chronic diseases will impact 49% of our US population. So if you had two people in a room, in a couple years one of you is going to be experiencing some life-changing events, and what are we gonna do about that? And how are we going to engage people in that?


Melissa Turner  10:50

Well, clearly, this is a timely conversation, I want to just kind of try to paint a picture of whole-person care, maybe walking through the member journey. Using whole-person care as a lens, could each of you kind of walk me through your vision for what it should look like? Susan?


Susan Beaton 11:07

It’s really interesting. Back in my days at the health plan, we used a lot of predictive modeling tools to identify members that we thought were in need. And we have lots of claims data. We know lots of things about folks. But you don't have the other things that are the wraparound things that we just talked about that put somebody on that list. And so when my nurses would reach out, and maybe they'd reach out to a person that that showed up on the list, maybe they had diabetes, and maybe they had some ER visits because their blood sugar was out of control. And we thought, you know, you qualify for some care-management intervention. And what was interesting to hear back was they didn't think of themselves as being sick, or needing care management, because they did take their medication. It might not be every day, but they took it and they filled it. And they thought they were using the health care system, whether they're going to the emergency room or to their doctor. And so I think that that was an interesting aha moment, is, we have to put that condition aside because our members or patients don't see themselves as a condition. And they just want to go out and go to work and provide for their family and live their best daily life. And so I think that's something that we've seen, you know, through our platform, as well, working with health plans, and the nurses and even my nurses, was, there is an opportunity for those health plan nurses to play a key role in empowering their members to engage in their health. And it's not just that condition, and that gets back to know me -- know me as a person, know me as a member. And I think that's the piece that that we kind of sometimes don't focus on. And, you know, we always hear every year when they do the job evaluations that nurses, doctors, they're No. 1, No. 2 as the most trusted resource. And most members don't know that their health plans have them available. And so what a huge opportunity or missed opportunity if you're not extending your resources, which are your nurses, and they're your secret sauce because they can build those relationships to solve that whole-person problem or the things that are affecting their daily lives outside of that condition. And knowing that it's hard enough living with, you know, diabetes, and then on top of your daily life, is how do you help them better manage it or stay on track, because nobody can be perfect. And I think we sometimes think they should be, like, do all these things in that care plan that we talked about earlier that that you should be doing. But we know that like, half of them, almost half, missed a step in their daily care plan daily or weekly. Maybe a quarter of them forget to take their medication. And, you know, we have a fourth missed their doctor's appointment. But are we asking why? So yeah, they show up on a gap and care list. But are you actually helping them truly be that whole person and solving for the issues that they're having in their daily lives, and I think with the right service, and then you extend the reach of that nurse, and then you extend it into their daily lives, because where they are is where their cellphone is. If you can engage them when it matters, and have earlier insights into how they're living, I think would definitely help, especially those that need acute assistance in a chronic disease like diabetes.


Melissa Turner  14:21

Susan, can you say a little more about what that those nurse touchpoints should look like? You know, somebody's got their phone, are you talking? Texting? Are you talking calls? An app?


Susan Beaton 14:30

I use both, right? So knowing that health care can be complex that there's times that you need just to be able to quickly chat with somebody. You have a question, and you don't have, want to have to wait between 8 and 5 p.m. Because that's not, that's not how we operate in our lives, right? Like you're going to a kid’s soccer game, or maybe I work third shift. And just because somebody's 8 to 5 doesn't mean I shouldn't be able to connect very quickly or wait on hold or I don't want people to know my personal business. So if I'm going to have to say it out loud, I'm not going to share it. But then knowing that in the support of the times that things are complex because claims can be complex appointments, all of that stuff is. How do you then schedule a time that's convenient for them? And you could do that by chat and then schedule a longer call if you need to. To hear a voice, sometimes they need that, and maybe your empathy. But in the meantime, how do you fill those gaps? And, if you really want to know that person, then you have to fill in those gaps. And if you get earlier insights, you can provide earlier intervention. You don't need to wait for a claim to come in, it's too late. And so what do you do in the meantime? And I think there's a variety of ways, and digital is one of them. Apps is one of them. But I think what we've seen and what I've heard personally is they want to know there's a person on the other end, not just like maybe a chatbot is, especially if it's complex and personal. So I think there's a variety of ways to engage members, because they all they all learn differently and interact differently.


Melissa Turner  15:53

Absolutely. Dominick, I want to ask if you want to kind of walk us through the member journey through a whole-person lens.


Dominick Bizzarro 16:00

Sure. Well, let's look at a Medicare Advantage member that has, let's say, congestive heart failure. But just quickly before that, I just want to touch on what we as a health plan needed to do as an organization to make that member journey more meaningful, right? So we had to come to some self-realizations. About three years ago, we took a real look in the mirror and said, there's three mindsets we’ve got to emphasize at MVP Health Care. One is to be customer-centric, and begin with a clear definition of who the customer is. And that is that person, that is that member, that's our customer, that's who we serve. The second piece was to embrace a growth mindset, emphasizing curiosity and humility and the importance of understanding customers’ unmet needs, right? And then the third was, when you look at those needs, whether it's selecting a health insurance plan, but addressing new health issues, or preventing their health from declining, you start to recognize you can't do it all. But it all needs to be done. So partnership becomes really important, right? So we implemented a framework to really understand customer needs. And so we started with understanding what they're struggling with. And we use a jobs-to-be-done framework was put forth by Clay Christensen, we implemented it as our innovation methodology, and we call it evidence-based innovation. So what we did in this is we surveyed many consumers around things that they were struggling with, and really got it from their perspective, right? Because we want to think more like a health services company than a health insurance company. So let's go back to our Medicare Advantage member with congestive heart failure. So treating a condition like congestive heart failure, and I, I also share a clinical background, not a nurse but a pharmacist from way back when. When people call me and ask me about drug interactions and stuff, I do have to admit I haven't practiced for a while. So I am pulling up some apps to look at it. But I can still give good advice. But so when you're treating congestive heart failure through a whole-person care lens, you really got to understand it from their perspective and really kind of coordinate and harness the collective energies not just of the health plan, but the providers and the community-based organizations and all the supports, they need to connect the dots for the customer. So one of the biggest challenges is not with the chronic condition itself, but with the other aspect of their lives, as Susan pointed out, that kind of impact their condition, so it really requires partnership. So along the lines of partnership, we partnered with the University of Vermont Health Network, and we co-created a new Medicare Advantage plan last year, and it was called UVM Health Advantage. So we teamed up to create this Medicare Advantage offering because our collective expertise and willingness to share that expertise and learn from each other for the benefit of Vermonters and northern New Yorkers. We analyzed data, we did surveys, tested about 200 or 300 outcomes through statements for about 1,000 health care consumers in Vermont and northern New York, to understand their needs. And in those surveys, and we also surveyed other parts of the country, and when we looked in those surveys, Vermonters and northern New Yorkers were particularly concerned about cardiac disease. And it makes sense because heart disease is the leading cause of death in Vermont and northern New York. So the UVM HN doctors provided input to define an initial focus on congestive heart failure. And the teams work together to design benefits that had care kits, personal health guides, wellness programs, and looked at its external factors that contributed to heart disease, like poor diet, lack of transportation, medical, follow-up medical appointments and so forth. So if you're a UVM Health Advantage member with congestive heart failure, your journey begins with a personalized welcome call from a care guide to create a connection and understand you as a person. So think of a care guide as like a personal concierge working at the intersection of the patient, the customer, the doctor and the health plan to improve the experience managing health conditions and ensure that you as a member are getting the most from your benefits. So we begin that conversation. We ask about concerns, barriers, levels of understanding as they're trying to address new health issues, as they're trying to improve their health or prevent their health from declining. And we'll ask about recent discharges, we'll ask if there's concern about disruption of services. Because they're new to the plan, they may have had things approved before. And now they're gonna go through new formularies. And, you know, well, is this visit approved, is this procedure still approved, now that I'm changing plans. So we'll let them know, or will try to understand from them what their concerns are, and then serve as a resource to remove those barriers. We’ll let them know, if you were just recently discharged from the hospital with CHF, you can get three months of free medically tailored meals delivered to your house. If you have transportation challenges, that you can have 36 free rides to and from medical appointments. So don't let that get in the way. We can get you there and back. We'll send you a care kit with a digital blood pressure cuff and pulse oximeter. So you can measure where you're at in your care and share it with your doctor, or someone that's working with you can do that. We offer cardiac rehab services, right? So not all patients are in different kinds of stages of health when it comes to congestive heart failure. And that can involve, you know, memberships, to cardiac rehab centers so that you can exercise, you can maintain your health. And so we go through the benefits and get, help them understand it. But more importantly, create the connection, right? So one of our care guides recently worked with a member who was just discharged from the hospital. And he had previously lost his wife, he hadn't been eating well, he was losing weight, which wasn't good for his post-hospital recovery. And she said that upon learning about his home situation, I was able to send them meals and a congestive heart failure care kit that allowed his physician team at UVM to better track his recovery, while ensuring he had access to healthy food. So that type of coordination truly makes a difference in the lives of members. And when you establish that relationship and that trust, you know, you have that nurse who's connecting with that patient, you know, recognizing that this patient just recently lost his wife, there may be a need and a cause for additional conversations to really understand what could be getting in the way of that person returning to health. So I think that the journey has to be very specific to where the individual is in their life, again, care in the context of their life, and then lay out a plan and a means to engage and connect to ensure that they can stay on track, and recognizing what their goals are in the process.


Doug Harris  23:31

Wellframe empowers health plans to become trusted advocates for members. They believe health plans have the knowledge and resources to support more people across more touchpoints in their health care journey. Wellframe’s solutions for digital care management and digital customer service empower members and health plan staff to achieve their best in the most wonderfully human way possible. Make sure your members feel confident cared for and supported by their health plan. Don't miss this moment. See how a digital health management strategy would benefit your plan at


Melissa Turner  24:01

Yeah, absolutely. And thank you for painting that picture. Really interesting, and I think the care we would all want for people we love. Listening to you talk I was just sort of stunned by, you know, kind of the complexity of connecting all those dots and making sure all those things happen. And so clearly, there's got to be a role for technology here. Can you talk about that, Dominick?


Dominick Bizzarro 24:23

Sure. I mean, I think broadly, having spent half my life kind of on the vendor side and in health care technology, I think there's a lot of different paths to go down, right? But technology is simply a tool. So I kind of split it into, like, there's technology to enable delivery. There are devices for remote monitoring and understanding if there's an event that we should be caring about, you know, that's happening with the patient that we otherwise wouldn't know about. And then there's the sheer collection of the data. So it's a pretty broad topic, but I'm going to focus on delivery right now. So part of this shift to say, OK, access is a real issue. Do we need to be customer-centric? We need to have deeper relationships with our customers. We knew that during the course of the pandemic, care was changing. how care was delivered was changing quite a bit. So we implemented part of this delivery change for a digital platform called Gia, and it provides customers with virtual care, but virtual care that extends beyond urgent or emergent treatment and encompasses everything from primary care to mental health and psychiatry, at-home lab, which we're finding is incredibly popular, and for some populations, incredibly needed, to be frank. And certainly at-home COVID testing and, you know, even connecting our customers to in-person care nearby. So, at the outset of the pandemic, for instance, we launched a virtual emergency department function in partnership with UCM Digital Health. And we did that in three weeks, right? So it's amazing what a health plan, which you typically think of as a fairly bureaucratic organization, and maybe not moving at 80 miles an hour, you know, more like 25 miles an hour, but we moved at 80, right? Because not only were emergency departments kind of getting flooded with COVID patients, but you really had to do stronger triage upfront to say, who should be going to the emergency department, because that might not have been the safest place at the outset of the pandemic. But that really became kind of a triage service over time. So we still have that in place. And we added that to the portfolio. Another partnership we did with a company called Galileo to give MVP members access to virtual comprehensive care, right? So virtual primary care. So our entire membership can use Galileo to do this. But we actually, in our surveys, we found that one of the outcomes that popped the most across populations was, minimize the time to determine if a new health issue requires a face-to-face visit. It was ranked as highly important and poorly satisfied, right? So when we look at that, and we split it across our populations, we saw that in our New York state Medicaid member population, we had many who were not affiliated with a primary care physician. We went to New York state, which previously had a regulation that said, you know, you can only affiliate with an in-person PCP. So we applied for an exception. And they agreed. And so now we have a virtual primary care offering for our Medicare members through Galileo where they can establish that relationship. And as Susan said, we meet them where they are. That could be texting, could be chat, or it could be phone, it could be video conference, any number of means. And back to the behavioral health piece. Obviously, we saw a huge uptick during the course of the pandemic. But that's sustaining, right, those type of, the delivery of services, and many times it does start with, well, I'm only comfortable texting, then maybe when I trust the provider more. I'll talk on the phone. And then I'll be able to, you know, kind of get to the point where I can have a telehealth visit. Because it's very rich, right? I mean, I know they say, what is it, 50% of communication is nonverbal. I think it's much higher. And you know, in those types of settings, that becomes incredibly important. So I think, on the delivery side, technologies help, but I know Susan's got a lot of experience in this area and could, could probably wax eloquently about it. So I'll turn it over to her.


Melissa Turner  28:36

Yeah, absolutely. Susan, we want to hear your thoughts on the role of technology and delivery of whole-person care.


Susan Beaton 28:41

Well, I think Dominick actually kind of hit it right on the head. Um, the right technology, that's the key. It has to be the right technology to close that gap. We, you know, between health care encounters, and help people get the support that they need at home. That it has to meet, I think, as Dominick said, some, some key capabilities to make it an attractive way for members to want to engage. So you know, we talked about a combination of phone calls and messaging, so meeting their needs in the moment, which can change as well. And then you have to meet both their clinical and their social health care needs, as we said earlier in our conversation that, you know, you have to be able to support them comprehensively. You have to avoid treating them just independently as a disease and really looking at all the socioeconomic pieces that are going on, you know, in their lives. And how do you make it personalized? You know, they see it as personalized when they're in front of their doctor, they get a few moments of their time. Outside of that, what are we doing to really personalize their experience at the same time so that they too want to engage? To Dominick's point that they want to come back, and I really thought it was interesting that you know, Dominick's you know, example of the Medicare Advantage and the senior population. I think that's a, that's a key one is, is you know, to his point is, yes, we know that they have chronic diseases as they age. But 3 in 4 older Americans, they want to stay in their home, and they want to age in place. And technology, that's the fun way to look at technology, right, that technology can actually allow them to maybe do that. And we know now that over 75% of people over age 60, they actually have smartphones, they're texting with their grandkids, they're on Facebook, they're doing recipes on Pinterest. And so you’ve got to bring health care into that somehow. So we know they'll do it. And we know they have access. And, you know, I think even misconceptions about those seniors that may have even, you know, some of the socioeconomic, you know, things that we talked about, even income lower than $30,000. We know that actually, almost 71% of Americans have some type of smartphone, even if they share it amongst, you know, their family. And so how do we tap into that in a way, you know, we've talked about this in the market the last couple years how COVID did, you know, shoot up telemedicine over 340%? So how do you capture some of that engagement? And maybe that's the beginning with their physician, to Dominick's point. That, you know, they've now built that relationship, they feel comfortable with that, and maybe even feeling comfortable using that telemedicine and technology to do that? Where can we look to ask the members and patients? Where else would they be willing to use technology with us? And I think those are the things that, you know, help them not be afraid of it and use it and incorporate it into their daily lives. And I think we'll see the access and the increased utilization naturally come with that.


Melissa Turner  31:30

Very interesting stuff. And clearly, the pandemic has accelerated everything that we've talked about here today. This is probably a question that is evolving, and we're still learning the answers. But I wanted to ask you to comment on the kinds of patient outcomes we can expect to see under the kinds of care models that we're talking about today. Susan?


Susan Beaton 31:49

Yeah. You know, there's different types of ways I think outcomes that we look at. As a nurse, I had more outcomes about engagement, satisfaction, interactions and learnings. And then as a health plan executive, you still had, you know, you still looked at those pieces of it. But you now have, also, ROIs to look at your employer groups -- all of those things, take a look at all of it. But in order to eventually get an ROI, you have to look at engagement. And that's still making sure you're knowing about the member and personalize it and doing that whole-person care so that you can have that united front with a member. And knowing that when they do engage with you, when you have their best intentions at heart. And then you're going to see the outcomes come because you gotta teach in the moment. They need help. And sometimes they won't ask for it. So how do you teach it? And nurses are, are keen on that. And so I think then that's when, what will come, you'll see a reduction in an emergency room or readmission from the hospital. If they now can ask questions in real time about what were my discharge instructions, I threw that piece of paper away, you know, many times when, as a home health nurse, they'd come back with their bag from the hospital of all their belongings. And then they'd have their discharge instructions in there, and they'd put it with everything else and cast it aside and not go back to it. So that means they're not following everything that the doctor sent them home with. And so I think you have to look at different ways then to engage them. And they're just happy to be home and relaxing in their chair, getting to feel better. And they're not even thinking about that doctor visit in 10 days, or how do I get there, I don't have a ride. And so unless you remove those barriers, all of those things will come in. The savings will come. Also a reduction in ER readmissions and increased compliance. And to Dominick's point, a pharmacist, taking their medications, which we know then lend, you know, lend their ear to an ER visit potentially if they miss it. So there's a lot of ways to engage that that truly turn into meaningful cost savings on the end.


Melissa Turner  33:47

Absolutely. Dominick, what are you thinking about outcomes? How are you thinking about outcomes?


Dominick Bizzarro 33:51

What she's describing is real engagement. You’ve got to be careful not to chase vanity metrics, right? So you’ve got engagement -- like, you know, how many people signed up for our app or something like that. And there's nothing wrong with that. But you know, that's just on the way to what you're actually trying to accomplish. So I like hearing about, you know, those metrics that matter. You know, engagement, that that matters. So you have the traditional metrics that we're all trying to improve. I think NPS, you know, Net Promoter Score is a very good one, right? Because you're only asking, you know, the customer, and you're not kind of guiding them in a particular area, just say, you know, based on your experience, would you recommend us to a friend or a relative? So we track that, we track that by different product lines, we track that by those that use different services, and we can understand the impact of that because every organization kind of has constrained resources, and we want to put more energy behind things that are working or not working. So NPS is important. I think quality is incredibly important. I used to be on a hospital board and I chaired the quality committee there. But you know, quality means different things to different people. So we, we have definitions of quality that are incredibly important, you know, from a medical perspective, but patients have different goals that they're trying to achieve and different aspects of what quality is to them. Convenience and access and, you know, not causing hassles for my neighbor, who takes me to the grocery store twice a week. So I want to make sure that I can get all of my services like on a medical campus, perhaps, you know, versus having to ask that neighbor to take me three or four times, you know, to the same place. So these, some of these things are, are interesting. And so I think quality of care is meaningful. But I think quality of life is defining, you know? And that's really what whole-person care is about. So traditional metrics matter, but maybe it's time for creating some new ones as well. So I truly believe quality of care is very, very meaningful. I'm a clinician, but I think quality of life is defining.


Melissa Turner  36:01

I want to close today by asking you to share a bit of advice for your colleagues. We know a lot of health plans are working to deliver and enhance whole-person care. For those that are on the earlier side of this journey, what would you say is most important? Dominick?


Dominick Bizzarro 36:16

You know, you can't do it all. But much needs to be done, right? I'm speaking to health plan colleagues. It's almost, I think it was the Theodore Levitt quote that said, you know, the railroads thought they were in the railroad business, when in fact, they are in the transportation business, right? So I think we need to understand that. What is our role? Yes, we offer health insurance products and programs and services, but it's really about, you know, the health of the people that we serve. So I think it's definitely about success, and not perfection. So, trying things and experimenting, and using the scientific method, is incredibly important. But when you find out what people are struggling with, their unmet needs, things that are important to them, but are poorly satisfied at the time, you'll find that there's a broad array. Right now, if you ask them, you can narrow the target a little bit, but you're still going to end up with 10 or 12 different aspects of care in the context of their lives that they're struggling with. So you quickly come to the conclusion that you need to work with partners, you need to collaborate, you need to coordinate, you need to integrate. So I think partnership is critical to success, because if you can provide more of a platform to that individual and deliver it in a coordinated way, where you're kind of harnessing all the capabilities that need to be brought together, and that need to work together to solve more customer needs, then I think you're going to reach the goals that you want. And all of the metrics will follow, of that. So I would, first and foremost, say it's about success, not perfection. I think partnership is critical to success. And, you know, creating a culture amongst payers and providers, and certainly vendors and community-based organizations, that's marked more with collaboration, and integrated excellence is some new goals that we have. So we have to kind of get outside of our organizations and look at the larger whole and say, how can we best serve this patient?


Melissa Turner  38:29

Great message. Susan, what would you share?


Susan Beaton 38:31

I would say this, and knowing that I just did this and did a digital transformation back in 2015 with the health plan is that digital's here. It's not coming. It's actually here. And what they should look at, though, is I think sometimes they forget they've done it in a way already. When I think about paper claims, right? Then you have a huge claims processing system, and you had medical records that you scanned and filmed. And now you have imaging machines, and you have print mail machines. So digital, you know, they've adopted it in different ways. It may have not always been member-facing. Maybe it was inside for their staff and efficiencies first, but I think, you know, then they need to look at it from the member side. It's not a radical transformation. And it's nothing to really kind of sit back and wait on. So I think as Dominick noted, it's the approach that you have to take, it's, as I always said, is build, measure, learn, repeat, because it's not going to be perfect. But in health care and as clinicians, you know, whether you're a nurse, a doctor or a pharmacist, like Dominick, as well, is we were kind of taught to be perfect, right? You don't make mistakes. And so you just have to realize you have to start, and you have to start somewhere. Thinking about that is there's ways to, to really as a health plan, to organize your resources a little bit differently. It's not just taking a digital tool or a digital engagement and sitting in it alongside your current processes. That just won't work. You're adding just one more piece to the mix. So there's a, you know, opportunity then to have a redesign -- even have, you know, their staff inside and their resources. Because I think a lot of times we focus on, you know, even back to the examples Dominick and I had on the conversations, whether it's diabetes or high blood pressure or congestive heart failure, we would focus on one disease at a time, one process. But members aren't that. Patients aren't that. One in 4 people have multiple conditions. And so there's a way to then kind of take the opportunity as you do digital technology, it's also looking at your staff. So how do you build, measure, learn, repeat from even your current workflows, because that's what I think the members are expecting you to be able to do, is to kind of pivot along with the times, and then be able to offer them multiple resources. So you know, they still want to talk on the phone, but they also want to engage digitally or talk with, chat with somebody on an app or, you know, look at a telehealth tool that you have, or a wearable device. So there's lots of ways to take that approach to just start on using that technology. And I would say to Dominick's point is there's things that a health plan should focus on, and what's core business to them. And engagement is one of them -- customer service, clinical pain claims. But sometimes you have to, as Dominick said, partner, then, to get that, you know, and get that next set of things ready in a timeframe that your consumers want them. And you just can't take two or three years at a time. And so how do you get it, all the information that you have? How do you get those fantastic resources like your nurses in the hands of your member sooner and better in a way that they want to? So I think there's huge opportunity to just start and move forward. So …


Dominick Bizzarro 41:35

I have to just kind of pick up on that theme. I read a quote the other day from James Clear, the author of “Atomic Habits.” And, exactly to Susan's point, nearly everything awesome takes longer than you think. Get started, and don't worry about the clock.


Susan Beaton 41:54

That’s right.


Dominick Bizzarro 41:55

Don't let the start stop you, right? I mean, you've got to get started.


Melissa Turner  41:59

Well, that is a wonderful message to close on. Fascinating discussion, and a wonderful vision for health care. Really exciting to see where you both take this concept in the future. Susan Beaton of Wellframe, Dominick Bizzarro of MVP Health Care, thank you both for joining us.


Dominick Bizzarro 42:15

Thank you.


Susan Beaton 42:16

Appreciate it. Thanks for the great conversation.


Melissa Turner  42:20

Thank you for listening. We hope you enjoyed today's conversation and learned something, too. You can check out SmartBrief’s health care newsletters by going to and hitting the blue subscribe button. Be sure to spread the word and subscribe to the Touchpoints podcast. Finally, a huge shout-out to our friends at the Shift.Health Content Network. We'll be back here in a couple of weeks for another episode of Touchpoints.


Doug Harris  42:48

Wellframe empowers health plans to become trusted advocates for members. They believe health plans have the knowledge and resources to support more people across more touchpoints in their health care journey. Wellframe's solutions for digital care management and digital customer service empower members and health plan staff to achieve their best in the most wonderful human way possible. Make sure your members feel confident, cared for and supported by their health plan. Don't miss this moment. See how a digital health management strategy would benefit your plan at