The time has come to explore the intersection of value-based care innovations and advocacy for patients with chronic conditions.
In this episode of Bite the Orange, Juby George-Vaze, CEO and Chief Innovation Officer at Globex Health, discusses the evolution of value-based care, highlighting its goal of shifting risk from insurance companies to providers and patients. Juby emphasizes how this model empowers patients, improves healthcare outcomes, and contains costs but acknowledges the challenges of maintaining long-term improvements. She touches on her involvement in addressing Long COVID and her efforts to raise awareness, collaborate with healthcare professionals, and advocate for proper documentation and reimbursement for patients with it. Looking to the future, Juby also anticipates a healthcare landscape marked by patient empowerment, AI integration, regulatory changes, and financial incentives driving innovation in healthcare models and programs.
Tune in to join Juby George-Vaze on a compelling journey through the evolving landscape of value-based care and her advocacy for long COVID patients!
FULL EPISODE
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Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange. And today we have a very special guest. If you know her, that's incredible. If you don't know, then you're about to meet the very interesting and fascinating person that I met recently in New York City at a med start-up event, and she has a pretty unique background. This is no other than Juby George-Vaze. Welcome to the show, Juby.
Juby George-Vaze:
Thank you, Manny. I'm very happy to be here. Thank you for inviting me.
Emmanuel Fombu:
Thank you, so when we first met, that we had like a brief initial discussion, I found your background pretty interesting. So, for those who don't know you, so tell us, who is Juby George-Vaze?
Juby George-Vaze:
I'm a mom, a daughter, and a nurse who's been a nurse for almost 30 years, which is hard for people to understand when they look at me, but that is what is true, and I'm an advocate for chronic conditions and living successfully with multiple chronic conditions, which I personally do, therefore, I have a passion for that, and I started in the world of healthcare a long time ago when things were starting to transform. So I just have a long-standing, longitudinal perspective about many things, which includes working for the insurance company, looking at financial background, because I have an MBA in health systems management in addition to being a nurse, and I'm a certified case manager who understands that intersection of technology compliance and regulatory money, navigation and funding, and also just clinical side. And I just look at it, and I see this, at this time in our society, that convergence of all of that, and I look forward to being part of it and have some innovations that we are helping many people improve their quality of health while containing the cost.
Emmanuel Fombu:
Which is quite interesting, and I like such stories, especially when I built my personal kind of angle. I know before we start recording, you mentioned a story that I talk about, usually, when I give a talk or in my book and other stories, about my story of my grandmother and diabetes, right? And how that kind of pushed me to be very interested in this world of predictive medicine and how we can leverage AI and other technologies to improve healthcare going forward. So what is that story? What is your why? What got you so interested in and fascinated and passionate about this particular field of healthcare, especially future healthcare?
Juby George-Vaze:
So yeah, so I just watched, and being part of that things that work and that does not work in healthcare. And then, I grew up in India, I was partially raised by my grandparents. My parents were already in this country, so I was with my grandparents for a few years, and both of them, my grandparents, were diabetic, but they were diabetic, and they managed it very well. In addition to mainstream, they incorporated Ayurveda, which usually bittermelon many other things, so a way of living as, food as medicine, and other things as part of it. So, that greatly influenced me, and they both lived late into their 80s, my grandfather lived into his 90s. You can have multiple conditions and still live a very healthy quality life. So, that perspective influenced me tremendously as I was given the ability, resources, and position to influence large scale in this country, when I was part of the health insurance world, to design complex disease management programs and also help these to kind of impact people. So, insurance companies are the ones who can drive changes, but they piggyback into the healthcare systems because they control the money. Obviously, we have a triad or pyramid system, and the insurance company, ... the payer, have the ability to drive a lot using the tools they have. And so I was able to implement design and implement some of that, especially in the area of diabetes, cancer, and many other complex chronic conditions that cost anywhere from $80,000 to $2 to $3 million a year per person per year.
Emmanuel Fombu:
Which is quite interesting. What I find quite interesting about you is actually the angle that you set it, right, like the background perspective around value-based care. You have a very unique perspective about value-based care, like immediate kind of experience, especially when it comes from the payer side, like even as a patient, right? So I think you have a kind of complete circular view, a 360-view, of what happens around value-based care. So, with that being said, please help us define what you think as value-based care for those that don't know what value-based care is and tell us why that value-based care is important, and some of the work you've done around making sure that value-based care is a reality.
Juby George-Vaze:
So value-based care started out as almost like a theory. I want to say underlying influence was somewhere in the 2005, '06, which is a new product designed, and I was part of the pilot, was called Consumer Director Health Plan, CDHP, and that was pilot by my employer. So, as employees and self-insured, we were the pilots, the employees, and that was 2006. So the design expanded, and somewhere in 2009, 2010 was the beginning of value-based payment model being deployed as a pilot into the industry which I was part of, and that was started with a patient-centered medical home. Then the ... a bit of digital payments inside that, and then it switched over to full-fledged contracts and value-based payment model, which is shifting. So, in my ..., healthcare economics way is shifting the risk more to the provider and to the patient from the insurance company's ... value-based care does. That's the goal. That is what it is. But now, how it's coming and presented as is a way to engage patient, provider, and the whole ecosystem so that the patient is empowered, and the provider, the doctor, or the hospital is empowered to proactively intervene. So, a patient that is costing $80,000 a year, if we can drop the insurance companies' perspective, who designed this, it's dropped down to like $60,000 or $40,000. That's 50% savings. So what if you shift upfront resources, provide $5000 or $10,000 in resources to the doctor and the patient ecosystem? In doing so, you're still saving money, but you're enabling the provider and the patient to do more. So that is where you know, and underlying is, when you look at it, it's risk metrics. Usually, there's a patient population attribution. Then, just like if you have a credit score, we have a health score. We, usually, it's designed by certain companies such as Johns Hopkins and a few others. I was part of a group that helped design early ones in the 2008, '09, time frame. And so your credit score, you can improve or make it worse. So same thing, so the doctors, and the, and the patient, everybody is enabled to improve that health risk score and bring that to down to better. But the challenge is, me, I'm a diabetic, I'm a very well-controlled diabetic, so it was maybe about ten years ago I went through a journey of adjusting and adapting. It took me about a year and a half to two years to get straightened out on my diabetes. So, if I was part of a value-based payment model program, then the doctor and the hospital may get some additional money the first year or the second year that I did improve from my A-1c brought down from 7 to 5.4, which is normal. So there's additional revenue or money to be made by the doctor providing me maybe patient education, dietician counseling, many other resources. But after two years, I plateaued. I'm based, I'm good, I don't have any other improvements that significant, but a lot of the measurement that's built into the value-based system is for, you know, it's usually 5 to 7-year contract; year three, if you are not improving, again, on those credit score, the health score of the patient, then as they calculate all these complex measurements to say if you did something to improve the condition, I'm showing us, I didn't do any improvement, no improvement on year three because everything was done on year one and two. So that causes a problem to the system, which is the doctor and the hospital who put in a lot of resources thinking that they will improve and keep making money, so money, these bonus monies. In return, what the insurance company is getting is, wow, I'm compliant, I'm not costing any more money. I could be going down from a 40,000-a-year patient to maybe 20,000, and I'm still good. So this is a very interesting issue that there's a lot of benefit, but inside, there's also some systemic issue that creates, so that incentives are not aligned with the long-term outcome.
Emmanuel Fombu:
Which is quite interesting. And I really like this approach of value-based medicine, and, because if you look at every stakeholder, if you look at the patient, the provider, if you look at the pharma company, if you look at the payer, like all the pieces, all the stakeholders, so in this particular space, it just kind of model, everyone benefits. The patient benefits, in this particular case, in diabetes, in your case, your blood sugar levels become nicely controlled, and I'm very proud of how you did your A-1c piece. That's quite fascinating. And for those that don't know, A-1c basically gives you like a 30-day average of what your blood sugars are, right? So if you do like a finger stick of your blood sugar piece in the morning. So, for example, if you have like a cup of juice or you're fasting, that affects the blood sugar levels. But A-1c levels are a way to catch people if they want to cheat, right? So to have that A-1c dropped the level that you just talked about, I mean, let's just be consistent, right? It's a good way to have a good insight peak over a long period of time ... what she had to do to try and correct it, which is valuable to her because then a quality of life improves, right? Her diabetes case has improved for her and her family and caregivers around her. That's one. He also, great, because the position of a physician society, physician is very happy, right? That they have a patient that is well, controlled, well-behaved on that side. Of course, on the ... side piece, of course, you're taking therapy, adherence is also great, right? Other lifestyle modifications that come from therapy are also going great. On the payer side, it's also great because now you're being controlled, right? Which means that they have better outcomes. So this is the beauty of value-based care that you have everyone connected, and everyone in a particular relationship is actually having a great outcome. So this is not something that only benefits one player. From that story that Juby just said, you could see how every single person around that value chain has significantly improved. And this is not only about diabetes, right? You can take this and apply it across multiple other areas. I know you, you're also involved, and we've done some work or passion around the post-COVID-19 syndrome. I know COVID came as a piece, right? It's not a chronic condition that's affecting people. ... Talk about that a little bit because I know COVID has been here, a lot of people probably have been affected by this and the insights you share with us.
Juby George-Vaze:
But yes, the post-COVID, our paths, and also called Long COVID is something that I have a special interest in, and that, my interest is influenced by the fact that we are in New York metro area, and we were earlier impacted by COVID, and we were able to see all the impact. And the second part underlying was, which I did not consciously realize was happening, is I am also a 9/11 survivor. I worked on, at One World Trade Center for Empire BlueCross BlueShield at the time, my office was on the 24th floor. That being one of the biggest insurer in New York City, and having been part of the medical management, means you have access to a lot of the people who were hurt at that time. Then, later on, people who develop various types of cancers. So I had a longitudinal, maybe a 20-year perspective on this, and somehow the long COVID started to see aspects of it. And that's when my company, Globex Health, our former regional CEO of Empire Blue Cross, was also medical director, is the head chief medical officer for my company. She was also part of the 9/11 survivors, she actually worked on the 25th floor, and both of us recognized a pattern early on. And we had a group of doctors, about 30-plus, that we were meeting weekly and having this large, long three-hour Zoom session to share knowledge at that time. So all of us noticed that the same time, so this is a convergence of 30-plus physicians, researchers, and experts in the industry, all of a sudden, we are seeing this pattern, and this is May-June of 2020, so very early. And then several long COVID was out of New Jersey and New York. So, we started putting the data together to show certain agencies in the government. So, in order for us to understand how healthcare system works, it's very intricate and interconnected. So you need to go to the top, who can make the changes? We were already part of a group that is helping this change Medicare in a more community-based care and a large-scale program run by CMS or AMC under ... who manages it. So we have already had access to all the right people, so we actually requested a meeting, and set myself a series of meetings, two, three meetings, to accomplish this, show them what's going on, what needs to be done. They already had American Medical Association representing their high level. So we were who actually designs ICD ten codes and CPT codes and Medicare CMS is the one who allocates reimbursement. And my medical director has always had fiduciary rights within Medicare. She was one of the people who were given permission to give Medicare rights to do non-traditional. She approved that while still working at Empire Blue Cross. So between all these things, somehow, we were able to showcase the issue, understand the potential long-term $10 to $20 billion disability issue downstream that's coming down the pike, and they were able to create some protocols and reimbursement evade to capture inside ICD ten. Because everybody runs analytics, it's the electronic medical record system, unless it's somewhere documented that person has long COVID, as they go through multiple doctors in the system, there's no way to identify and treat appropriately, and something is novel and has no priors to kind of justify. So that was something we helped create and also presented at high-level in different parts of the government and healthcare structure, which includes HL7, to put in some sort of process. Then it transferred over to the healthcare financial management organization that I'm part of that represents a lot of the high-level CFOs in the finance side in healthcare, showing them there's a reimbursement kind of pivoted them to create these post-COVID clinic centers. And so that started popping up a lot of hospitals when they were there, ambulatory surgery and all these places were closed, and not being able to generate revenue. This was a new revenue generation process for them. So I was able to utilize a lot of other areas of code, you know, for the organization, and because we were still under that COVID emergency mandate, so long COVID was at that time mandatory to be reimbursed by the insurance, and that makes a big deal. Everybody was running in the red at that time, hospitals, and this was also a significant saving. And I want to say, I believe a lot needs to be done in that area because there's still a large gap. We are also, part of the ..., National Translational Science has a large COVID conclave that has a special area that is working on researching and earning analytics on long COVID.
Emmanuel Fombu:
I'm quite fascinated by all their work.
Juby George-Vaze:
So, I was invited by the Government of India in the early 2021, I want to say, I don't remember, to be one of the speaker for their World Healthcare Organization-sponsored events supported by the Ministry of Health. But they had representatives from Malaysia, Indonesia, many Asian countries, and Russia, and a few others, and we were able to share what we are seeing and what needs to be done to an international body in a way where they are all able to take that and disseminate. Because we saw this issue earlier in New York metro area and created some things that other countries were able to also start to cut up, piggyback, and adapt.
Emmanuel Fombu:
Now, which is quite fascinating. And I think anyone listening today, I think they got a very solid kind of background or foundation, at least on value-based care, right? And some of the great use cases that you've mentioned, I think you mentioned also being a survivor of 9/11, I think that's always, always honored to have someone like that, that went through such an experience, right? And I think there's a lot more associated with it. And it's an honor and pleasure, of course, definitely, to meet you. So with all the work that's been done so far, Juby, in value-based care, from all the time you've been involved in this particular field and all the experience you have, right? Also a great international, well-known speaker as a subject matter expert in this space. So what have we accomplished so far, and what are some of the gaps that still exist, and where do you see us going, and how do we go about solving this in the near future?
Juby George-Vaze:
So I think there's a convergence happening right now with the AI technology and some of the regulatory. And this pandemic really opened up our eyes to how fragmented our healthcare system is, and certain aspects are broken. So I see it's starting to get a little bit more, I guess, turbocharged effort to mitigate that. You and I are part of those ecosystem. We are trying to also help facilitate change and support those change agents, especially innovation, is what I see; that includes AI, big data. And value-based, in my opinion, is similar to, and healthcare goes through these pendulums, it's about 7 to 10 years; having that endless three decades, I've watched through these pendulums. We are going to see in the next 2 to 5 years a shift again, because value-based really started in 2010, '11, '12. That's when it started getting deployed, and we're are seeing this ten years later. So we're going to start to see new models again. I believe that employers are starting to take a bit more ownership to say we need this, we need that. The convergence of technology makes it so that now we see hospitals become health insurance. For example, in where we are, in New York metro area, in New Jersey, there's a healthcare consortium of hospitals, and they all offer their own insurance, health insurance. So there's going to be a shift on that triad, I call it a triad, and the power will be distributed a bit more so that the patient becomes the driver. That means patient has a financial incentive, maybe through the employer, some sort of methodology that would have it, because we saw early on that pay for compliance. So, right now, value-based is called, is a different underlying is called pay-for-performance, P-for-P. We're going to see patients and employers taking more empowerment on it and saying, okay, I'm a self-insured employer, I will be paying for all these extra things, which I love. Because, you know, I use food as medicine, I use supplements, I use alternative like acupuncture, many others. Now we're seeing that getting incorporated because if it's self-insured, or if it's a part of an ACO for value-based, they, then they are looking for the result, not the pathway. The result may be paying for a meal delivery plan that's a healthier meal that costs maybe $30 to $100 versus $2000 or $10,000 for a hospitalization. So they're going to be a shift in how it's going to be approached because of that incentive from the value-based model. But it's going to change also because of the AI and some of the regulations that's coming down the pike, which includes something called TEFCA, which is a blockchain-based regulatory. There are some changes coming down the pike which where the data and how information is shared, which is called the US Data Core. I think version four is going to be the one that's going to be getting applied in the next year. It's going to be mandatory application, so all healthcare organizations, it's like HITECH, HIPAA, it's going to be that new thing that everybody has to be confined to. And then the last piece is financial incentives. So value-based, for example, inside the Medicare world, we saw CJR joint replacement in 2016. That was the first beginning wave of that large-scale value-based by Medicare. Medicare has scheduled many other innovations, the latest one you're going to see is the hospital-at-home program. So that itself is going to be incorporated in some sort of value-based model, that means every hospital, every telehealth program, every remote health program have a place where patient is managed at home, but they're getting paid at a higher reimbursement rate for managing that patients at home. It's a win-win because Medicare or the insurance company do not have to pay every day, hospital day, hospital night rate, they pay less. And it's great for the patient because they don't have to disrupt their life fully and end up in a hospital, but they get the best of the both worlds. The convergence of the technology and the AI and the reimbursement regulatory, that's what's happening, but it's influenced by that value-based model.
Emmanuel Fombu:
I think that's quite fascinating, and thanks a lot, Juby, for coming to share. I would love to definitely bring you back another episode of this. I think, for anyone listening today, I think you see the focus here and the knowledge that you shared with us about value-based care, her experience in it, and some real-world examples of how it could benefit patients, not only patients, but other stakeholders in healthcare, ... Juby herself will be a great use case example. Like I mentioned earlier, my grandmother too also had diabetes and it was great to have this chronic condition that we could manage and actually get good outcomes in it. So, once again, thanks a lot, Juby, for joining us on this show. I would love to hopefully to get you back another episode. We we'll pick another fascinating, interesting topic that we can share with our audience. So, thank you for joining us today, Juby.
Juby George-Vaze:
You're welcome. Thank you for inviting me. Thank you, everybody. Have a good day.
Emmanuel Fombu:
Thank you too.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com, or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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Juby George-Vaze:
Juby George-Vaze is a seasoned healthcare professional with over two decades of experience. She is a nurse, innovator, and healthcare leader with a passion for improving the lives of those with chronic illnesses while reducing healthcare costs.
Juby's expertise spans clinical, compliance, finance, pharma, biotech, and technology. She has a remarkable track record of designing and implementing large-scale healthcare programs, including one that reduced total healthcare spending by $200 billion.
Her tech-savvy approach is evident in her early involvement in healthcare coding, pioneering electronic medical records, and embracing cutting-edge technologies like AI and blockchain for healthcare. Juby's contributions have earned her recognition, including the 2019 AI/VOICE Innovation Award for Chronic Disease Management.
Juby is not only an industry trailblazer but also a mentor to startups, sharing her deep knowledge and passion for transforming the healthcare landscape.
Things You’ll Learn:
Value-based care has evolved from a theoretical concept to a significant healthcare model, aiming to shift risk from insurers to providers and patients.
Sustaining long-term improvements in value-based care models presents challenges, emphasizing the need for ongoing innovation and adaptation.
The future of healthcare is expected to feature patient empowerment, increased use of AI and technology, regulatory changes, and innovative healthcare models.
Financial incentives, including employer involvement, are poised to play a more significant role in shaping healthcare practices.
Collaboration among healthcare professionals and advocacy efforts are instrumental in driving positive changes within the healthcare system.