Olivia Banyon, Senior Vice President Commercialization Solutions, UnitedHealth Group, and Sean McCabe, Vice President, Inflammatory Bowel Disease Franchise Head, Takeda 

Banyon: Hello, I am Olivia Banyan, and I lead our cross-Optum clinical engagement team within UnitedHealth Group. I work within the UnitedHealth Group growth and innovation platform. We work to drive innovation across both UnitedHealth Care and Optum, specifically partnering with life sciences organizations. 

I have a background in epidemiology but have worked in large pharma for most of my career, specifically within innovation and digital solutions. This includes population health with Sanofi, quality improvement across the portfolio with Pfizer, and Merck-Medco as a PBM in disease management. And along the way, I worked on a few startup companies around things like interoperability and meaningful use, all driving toward improved outcomes. 

McCabe: Hi, I’m Sean McCabe. I have the honor and privilege of leading the inflammatory bowel disease franchise within Takeda. It sits within the gastrointestinal business unit along with the GI Rare franchise. We support IBD, not only from a therapeutic perspective but also with disease management and life cycle innovation overall. Historically, I've been oriented around the commercial side of the organization within health care, a series of different organizations and therapeutic areas all leading into my current role today.

Interviewer: Can both of you detail what you envision as an established, strong, successful value-based care model? 

Banyon: I'm going to give a perspective on the value-based care model as it relates to partnering with a life science organization. Within the patient journey, within the disease focus that we're speaking about, we can identify where there is an opportunity to improve outcomes or address an unmet need. We first must find out where there is an opportunity to define how to improve care and then do that together. That could be in improving diagnosis or improving timeliness of treatment, timeliness of assessment. It could be around optimizing treatment. It could be around other types of assessments around patient satisfaction, quality of life, other types of patient-reported outcomes that we could put into place, and other measures of cost. 

We all talk about value-based care as it relates to providing the best care at the best cost but what I want to reframe. Cost is not one dimensional. We are looking at how patients access health care, all dimensions of health care, how providers provide health care, and how they make decisions. How they use the resources, the data, and the technology that we as health systems provide to them to enable providers to do the best care. And we are looking at where there are other ways to get the best value. All kinds of thinking about evidence-based medicine or other types of best practices where there is no well-documented evidence, but there are other types of, it could be best practices and other types of analyses that we may have been able to evaluate within our own populations.

When we look at patterns of care, when we look at the way our providers are treating our populations and we see the best outcomes, we're going to see what got us to those best outcomes. And we're going to try to replicate that. When speaking about value-based care together with this IBD collaboration, we must identify where we can focus to improve the patient journey for IBD.

McCabe: First, I think this is about a shared understanding of consistent goals in terms of what requires a solution and based on the insights and the experience we have in our respective domains. There are a lot of self or industry-imposed constraints on the patient and even provider journey. I think this is about how do you identify those and then start creating co-solutions around those as an organization. I think that's what great looks like. But ultimately, it's about how you're driving change with those insights and your ability to intervene at the appropriate moments.

Interviewer: I remember when I was sitting in the session, you introduced a circular diagram. In the middle, it said the priorities are patient- and provider-centered. And when we think about value-based care, especially in the theme of Asembia sessions that I've gone to personally, a lot of folks are focused on the payer and what the payer can do. But in your session, a lot of the conversation was mainly on the patient, which I'm sure we can all agree that's how the conversation should start. It should be patient focused. And as you said, Olivia, focusing on that patient journey and figuring out we're in the journey that we can step in and give support to help their quality of life.

Banyon: Leading up to Asembia, we talked quite a bit about being patient-centered. But for us to be patient-centered, we need to enable providers to do that. We must think about clinicians’ well-being. We must focus on provider abrasion. We can't continue to put extra work into the system. We must allow providers to provide care. Whenever we’re working toward a collaboration, we must think about how we can focus on clinician well-being as key to being patient-centered. 

Interviewer: In a session I attended, folks revealed some statistics that I believe recently came out from the American Medical College. By about 2056, we're going to have significantly reduced numbers of newly graduated physicians. And the system is already pretty clogged up now. 

Even in my own experience, I'm trying to make an appointment with my pulmonologist and it's like 4months out. What you're saying about focusing on the physician burden is important because we can have these tools but if the physician is swamped, we can't even use them. 

McCabe: Yeah. And those are, dare I say, almost self-imposed constraints that the system is putting on that create challenges with capacity. And we've seen that even in this disease area, much of the initial stages of the patient journey are impacted by those basic elements of how much time it takes to get in and be seen by a provider, how much time some of the procedures are taking to be able to be implemented. A lot of these are just constraints that feel like you don't require a tremendous amount of investment and capital or anything to be able to hopefully alleviate some of those. 

Interviewer: This leads to our next question as we focus on the quality of life for patients. Besides what you have discussed already, how can payers change their workflows to also ensure the quality of life for patients in a value-based care collaboration model? 

Banyon: One of the things that we're doing at Optum is designing a new value-based care system. We're looking at a clinical transformation platform that anticipates the needs of consumers and anticipates the needs of patients. That's system wide. When we think about this, and I'm speaking about Optum Health right now as an example, Optum Health consists of all our Optum care delivery organizations, as well as other Optum health services that we provide to different providers and payers. From a population health standpoint and so forth. And in this clinical transformation effort, we're looking at how to partner between a payer, United Health Care, and Optum Health, our provider group. The two come together to coordinate every single aspect of patient care that's necessary using data and technology to allow us to do more timely decision-making for patients, to allow us to focus on the patient experience. In a way that is when that patient is in the office, when that patient is getting prepared to go to the office, when that patient is getting discharged from a test or a procedure or an inpatient, another inpatient type of visit or experience. How do we anticipate those needs? It can include social determinants of health. Can it include transportation to or from the visit, can it include other needs that that patient might have? Can it include a follow-up to ensure after a new diagnosis the patient fully understands, or the caregiver fully understands, what that diagnosis is and what the management requirements are? Because oftentimes, patients are overwhelmed by that first experience. Connecting with that patient at every step requires a multidisciplinary team. And that is what we put under this rubric of transformation that we want to bring to life with our data and technology teams. 

Interviewer: One of the themes in the session is identifying the patient gaps. And from what I recall, besides the social determinants of health aspects you mentioned, the other factors are how we get high-quality, personalized care. If we're working toward achieving these goals of filling the patient gaps, how do the payers and the providers benefit from that? 

Banyon: Oh, in many ways, if it's done right. First, patient satisfaction is very important to us because from that we derive retention. Our NPS scores are incredibly important to the organization. But there's also the benefit of, from a clinical perspective, you can expect better adherence and adherence to an overall treatment plan. That includes following the instructions for the management of the condition, but also taking medication. 

Improved adherence also leads to better outcomes long term. It also reduces waste. Especially with complex conditions or rare diseases where patients often face this diagnostic odyssey. They aren't accessing the right diagnosis and they're seeing a lot of different providers and they're getting tests and that is a lot of money. It does affect their satisfaction with their care if they are not getting the answer that they need or deserve. By having these systems in place where we can better direct patients to the right care pathway so that we can get the answers or get them on the right treatment plan, it does improve their overall satisfaction with care, with the goal being to have them get to the point of getting better outcomes, which has an economic impact. Getting the diagnosis, getting the treatment, and getting them on the right path ultimately leads to a better total cost of care outcome.

Interviewer:  And the other thing is if we treat the patient and the patient is getting those better outcomes, that's fewer ER visits or fewer office visits, reducing the burden on the system that's already under pressure due to staffing shortages. Because it's not just doctors, there's a nursing shortage going on right now. If all these parties and stakeholders got together and collaborated in the model that you described in your session and described during this interview, it could help address and combat those staffing shortage issues that we have going on right now. 

Banyon: I think we're in the spirit of efficiency for sure. We're also trying to supplement and broaden the care team. We are looking at other allied health professionals. We're looking at increasing the role of the clinical pharmacist, which has historically been underutilized, increasing our already large case management team. Many, many payers do. But the question is, what is their role? What has it been? What can it be? From a patient management perspective, oftentimes there is a very big need for care coordination.

And it's always this hierarchy, this balance of clinical needs, social care needs, logistical needs, and administrative needs. We must understand what the primary need for that patient is that must be addressed first. What is the most urgent need? Oftentimes we can use a personal interaction with a patient, but sometimes data can tell us that too so that we can align and assign the right care team to that patient. It's not that they're not going to see everyone on the care team, but it's who they're going to see when on that journey who can make sure their needs are addressed. And then I think one of the things that we're trying to address, and there are a lot of payers who struggle with this, is the single point of contact. Especially in a big system. Optum has many different points of contact. We give one point of contact throughout your journey, one phone number, this is what we're aspiring to around the experience.

McCabe: I think the disease that you're trying to support or augment is critical as well in terms of the type. In this instance, this is a progressive disease. Any of the constraints, suboptimal decisions, treatment, and disease management that occur earlier will ultimately lead to increased cost intervention and requirements later. The particular disease and its course in terms of how you address the earlier stages of it are important because those are in aggregate. A lot of the increased cost creates those capacity constraints downstream, and some of these practices when left mismanaged overall. 

Interviewer: Especially with inflammatory bowel disease, that's such a complex array of conditions, and the amount of testing and appointments and everything like that is absolutely a lot for any one patient, but also a provider to deal with. Can you share some details about the pilot program discussed during the session and how it can benefit the patient? 

McCabe: From a pilot perspective, there's a variety of different constraints along the journey. And it was referenced that indexed suspicion for the disease, the differential diagnosis, there's a lot of costs associated with that by nature of all the testing, almost ruling out other potential diseases. And then ultimately the requirements for the diagnosis still require quite a bit of intervention. There's opportunity there. And what you have is, I would say, still a pretty uninformed HCP universe outside of those strong centers of excellence that support IBD overall in terms of determining what that appropriate treatment algorithm might be and the like. But it's not just treatment. This is also about an understanding of what was referenced as the broader disease management where there is still a need for some of the social support, nutrition support, even I would say even pharmacist support just to understand which types of treatments are available overall.

The goal for this pilot, first off, is to identify post-diagnosis what a suboptimal disease journey looks like. With data overall, you can look at treatment or utilization of what's deemed to be probably more the suboptimal treatments along the journey. And that sets up an intervention point because what's probably underlying that is disease progression that will at some point in time increase complexity for the patient, diminish quality of life, and certainly add cost to the system overall.

Setting up that intervention point is an opportunity first to engage with the patient, understand initiatives or interventions are going to be required to optimize the journey for those who are just initiating it as well. It's exciting. Especially with all the unknowns surrounding IBD, having something hyper-focused on such a complex disease can open the door for other complex diseases. While people can recognize the symptoms, it takes some time to get to that diagnosis.
I think this is a good model for future use for other disease states. Ultimately, if left unmanaged or sub-optimally treated, this is a disease course that will add a high degree of burden for those who weren't optimized. I think it's about the identification of those diseases when they're progressive and how critical those intervention steps and the optimization of the early stage of the journey are. 

Interviewer: What is one key highlight that you were excited to share at your Asembia session this year? 

Banyon: We talked about value-based care a lot, but our other focus was around collaboration. The core attributes of collaboration and the importance that Takeda and Optum came together with a very well-aligned desire to learn through this collaboration and to ask novel questions together to commit the long term to change the course of the patient journey like we've been talking about and hopefully get to the point where we can start to see how we can improve, improve outcomes for this population and get to the point where we can do something meaningful in a larger scale. It is important to choose the right partner and being well aligned with our core objectives and understanding that this is the real world. This is a clinical trial setting. And this is something that we're both going in, rolling up our sleeves, and saying we're ready. We're in it together.

McCabe: I would say what was most exciting from my perspective is the novel aspect of it. I think now in health care when you think of manufacturer or payer, you think of opposing ends of the value chain in some respects. And I think coming into this, it's a very novel partnership. It comes with a mutual degree of respect in terms of what level of expertise, what level of intent, and then ultimately how we can contribute to a collective solution is established. And I think that's exciting and speaks to a level of appreciation and understanding of where our roles are in the ecosystem. When you can combine and partner you can optimize someone's journey, not only through disease, but the journey through life.