How Better Patient Experiences Drive Better Outcomes in Value-Based Care

Stewart Gandolf (Healthcare Success): Hello again, everyone, to the Healthcare Success Podcast. It's my pleasure today to introduce Michele Paige, who is Chief Growth Officer for Strive Health. Welcome, Michele.

Michele Paige (Strive Health): Thank you. I'm really happy to be here today.

Stewart Gandolf (Healthcare Success): Glad to have you as well. So before we get started, it would be really helpful to our listeners to tell them who is Strive Health, your background, what you do there, and we can get started from there.

Michele Paige (Strive Health): Excellent. So Strive Health is a national leader in value-based kidney care. We partner with health plans and providers and improve outcomes and lower costs for people living with chronic kidney disease.

We focus on whole-person care because kidney disease rarely exists in isolation. Our model combines technology, predictive analytics, and we leverage multidisciplinary clinical teams to identify patients with CKD, close gaps in care, and coordinate care across what could be a fragmented system. So we help patients navigate everything from specialist appointments, connections with PCPs, and their medications, as well as provide other services like transportation arrangements, nutrition counseling, and care planning.

Our approach is patient first. In fact, we recently performed patient segmentation and persona research to get an even deeper view into what patients living with chronic kidney disease may need from their care teams, depending on where they are in their journey, how complex their clinical profile is, and other demographic and cultural variables. Ultimately, our goal is to help patients stay healthier longer and avoid unnecessary hospitalizations and basically just make healthcare easier to navigate.

Stewart Gandolf (Healthcare Success): Great. So when we work with or in this space with chronic kidney disease, you have a lot of challenges, right? You have some patients who are poor, less educated, as you mentioned, multiple complications with their healthcare. Talk more about the patient personas and how that's helping you figure out how to work with them because it's such an overwhelming disease and they may be older, they may have caregivers helping as well. So it's pretty complex. So let me know what you've found out.

Michele Paige (Strive Health): Absolutely. So one of the biggest lessons was that our patients' challenges extend far beyond kidney disease itself, like you were mentioning. Across these cohorts of patients, we saw a wide range of barriers from behavioral health challenges and feelings of being overwhelmed to transportation issues, food insecurity, financial strain, and housing instability. The common thread is that every patient's situation is different, which means the way that we speak with our patients, get to know them and understand them, and engage them cannot be one-size-fits-all.

In fact, we revealed three main cohorts of patients: those who are curious, concerned, or simply overwhelmed. A curious patient is one who may be earlier in their diagnosis of chronic kidney disease and have other comorbidities they were already focused on, like diabetes or heart failure. They want to gain better control of their health, and they want the education and specific information that gives them that control to do that. They're very engaged in their care plan, and in fact, nutrition at that point in their diagnosis has a great impact on their health. So they need personalized diet, nutrition support, lifestyle management, and all of the information that empowers them.

Conversely, there's another segment of patients that may just be concerned, and what this means is they're further along in their kidney disease, and they've reached a point where they're experiencing more complications, especially aligned with other diseases or comorbidities. They're declining, and they need immediate support to help stabilize them and avoid hospitalization. But they can't go it alone. Many have other issues that impact them, like affordability and transportation, and they need to stay adherent on their care path. So they need the hand-holding every step of the way.

And then you have patients who are just overwhelmed. They need a step-by-step, day-by-day approach to their care. They need an advocate, a friend, and small steps to manage their health. It's all about understanding what small goals are and how to motivate them to achieve them and help them handle that every single day. So regardless of where people are in their journey, we have to remember that this is a very emotional time in their lives. It's critical to establish trust through active listening, understanding, and a lot of empathy.

Stewart Gandolf (Healthcare Success): Got it. So healthcare has traditionally been designed around systems and providers, which is something we talk about a lot here, right? I've shared anecdotes, for example, my mother, when she fell and broke her hip and they lined her up on a gurney outside of radiology because it was probably convenient for the hospital. And I'm sure there are many reasons why, but it wasn't great for her. So building the system around patients is relatively a new idea. Why has the old model persisted for so long, and why is it becoming unsustainable when we're talking about value-based care?

Michele Paige (Strive Health): I think that the system has traditionally been designed around claims, reimbursement, operational workflows, benefits, and provider reimbursement in particular, not necessarily with a consumer-first design in mind. But over the last 10 years, I would say, or a little more, companies have really transitioned to more consumer-first or customer-first solutions, and affordability has become really important in order to access care.

So I would say with advancements in technology, data sharing, and really giving the patient more access to information online, benefits access, and cost transparency, it's been shifting. But it's still an imperfect system. It's really critical to design patient access across medical benefits, care delivery, care management, and pharmacy access to create that continuity. All of that data sharing across plans, providers, and pharmacy is critical to a better patient experience and outcomes.

Cost transparency, in particular, across medications and medical services, is critical, especially in pharmacy costs where a lot of the patients that have kidney disease and other comorbidities need to leverage specialty medications or other high-cost traditional medications that may require manufacturer coupons or copay assistance. So it's really important to connect them to the pharmacy access points as well as other benefit navigation points so that they don't have these barriers to care.

Consumers demand a healthcare experience that's just as easy and convenient as other consumer services. We have to be accountable to that, to make it easy in order to keep them engaged and get better outcomes.

Stewart Gandolf (Healthcare Success): Got it. And so I guess I'm going to ask you another question. In terms of value-based care, and we have a healthcare audience that understands the idea, but why is value-based care so important with kidney disease? Because the cost can, of course, spiral. I'll just talk maybe a little bit about this, and then you tell me what you think.

Oftentimes the idea with value-based care is to keep the patient stable and to help them stay out of the hospital and also to keep the cost in check and incent better outcomes versus just racking up fees. Do you feel like value-based care is critical in kidney care? Is it a model that we're likely to see more of in the future? Just help me understand that a little bit.

Michele Paige (Strive Health): I would say that value-based care is really important to the healthcare system. It enables us to move upstream in the patient engagement continuum by attributing these lives to us as a company and being able to take some of the prohibitive costs out of the plan and to manage it more directly with patient engagement, adherence, and connecting those patients to care.

What we also do is create collaborative relationships across specialists and PCPs and have incentive-based contracts with them so that we can, in a P4P-type arrangement, make sure that we're working as a team to approach patient care, keep folks on their care path, and get better outcomes. This is really critical. It creates almost like a high-performing, high-value network within a plan's network. So it optimizes the approach to patient care.

Stewart Gandolf (Healthcare Success): Got it. Okay. So going back to the idea of consumer-first healthcare, you alluded to consumers wanting an experience like that. Of course, that has become much more prevalent. What does that actually mean in the real world, in practice, especially for patients that have these chronic and complex conditions?

Michele Paige (Strive Health): Consumer first is really grounded in patient-centered design, and it's making sure that when we are looking to engage a patient, everything that we do puts the patient at the center, understanding their preferences so that we're reaching out to them in a way that they're going to be most responsive from an omnichannel perspective, whether digital first is their preference or web-based virtual visits with a nurse or even in-home.

It's really critical that we're designing this experience to the needs of the patient based on preferences, based on situation, and where they are in their care journey. It also means that we're reducing friction. A lot of the fragmentation is really about the overwhelming and emotional situation that our patients are going through, and it's really hard to be so rational about figuring out what doctor should I visit, when should I visit, do I need a specialist, what do I do next?

We take all of that mystery out, all of the surprises, and we take care of that patient by guiding them through their care journey every step of the way. It means arranging for their doctor's visits. It means connecting them to the care that they need if they don't have a PCP or haven't seen someone in 12 months or if they need a nephrologist at this point.

It's about helping people transition from the hospital and knowing where to go next to manage their kidney disease. Do they need to start dialysis? Where would they go for that? So it's really about designing the better patient experience from the very first journey touchpoint all the way through adherence to their care plan and making sure that they get what they need when they need it.

Stewart Gandolf (Healthcare Success): So when it comes to, you mentioned accessibility earlier, how do you do that? Do you have a patient navigator or advocate that helps them on a one-on-one basis to navigate through this very complex system and care?

Michele Paige (Strive Health): Yes, we do. So the first thing we do is outreach the patient with an enrollment specialist, and we help them understand who Strive is, what we do, and how we've been asked on behalf of their health plan to help them navigate through their kidney disease care path.

The first thing we do is say, "Hey, how can we add value for you today?" Does that mean arranging transportation? Does that mean helping you with your financial stability or housing stability? Whatever it is, we will have a care navigator who will help them understand what to do next.

Then we will connect them to a visit with one of our NPs, who will really understand and take them through what their labs are indicating, what it means, and what stage they've been diagnosed with for CKD. We help them understand and close certain gaps in care so that they start on the journey in a really comprehensive way, and then we will follow up depending on what those needs are.

A community social worker may contact them to really understand how to remove those barriers for transportation and community services. We will connect them with a behavioral health specialist who can really help them navigate some of those feelings of being overwhelmed or depression that's related, oftentimes, to this chronic disease. Then we will also connect them to a registered dietitian or nutritionist who can help them understand the right foods for them.

We do this all by wrapping this care team around the patient's needs and then also connecting them with their providers in the network. So it's really all about consumer-first health.

Stewart Gandolf (Healthcare Success): Yeah, I can see that. The idea, I guess, that's striking me is just trying to be empathetic with the patients or their family. This is a life-changing thing we're talking about here, and not in a positive way.

Having helped my sister when she was chronically ill with cancer, in her particular case there really wasn't a clear quarterback. So I had to become her quarterback, which is not something I'm an expert at doing. So it's nice to know that that system can help.

What are some examples of the smaller but high-impact changes from this model that can help reduce friction and make care feel more coordinated for patients? What are some of the findings we can talk about here?

Michele Paige (Strive Health): I would say small but high-impact changes organizations can make is, first of all, understanding that health literacy really varies across different patient segments. We have to simplify our communications and not talk so much in healthcare speak, speaking at a fifth-grade or sixth-grade level in easy-to-understand layman's terms, and also starting with understanding what the patient's lifestyle is today.

Do they have a caregiver? Do they need help? In what way? We need to fit, or retrofit, our healthcare system around that specific individualized patient need.

We need to be proactive instead of waiting for patients to contact us and say, "Hey, we just hit the hospital," or, "Hey, I need help." We can see from the data and clinical insights and predictive modeling what patients are going to need us most and when. So leveraging that data and proactively outreaching is going to help us coordinate that support around their practical needs as well as the care path that's appropriate for them.

Then we have to make sure that we are collaborating through connected care. Sharing information seamlessly across providers, specialists, and the extended care team is really important. We don't want to make patients repeat their story every single time a different provider or care team member outreaches to them. It's very frustrating. It's very personal. And we have to make sure that we are earning the trust of those patients.

Stewart Gandolf (Healthcare Success): Got it. Let's talk about accessibility. What role does accessibility play when it comes to creating a better experience?

Michele Paige (Strive Health): So accessibility means not just technology, but the way that we communicate with patients, as well as what's really convenient for them.

When some people think about accessibility, it's really about convenience. For example, some patients are more digitally savvy than others. I've heard patients say, "I don't use my mobile phone. I don't use apps, but I do use my computer." So we need to make sure we have a patient portal so they can perform web-based virtual visits. Or some are not digitally savvy at all, so maybe a home visit is more appropriate.

But regardless of the modality, we need to be able to provide the right access channel based on that patient's preference. We also need to provide flexibility. Sometimes patients are able to meet with their provider off hours, or maybe only during the day they have nothing to do.

By the way, a lot of Medicare-eligible individuals, that connection point is probably, in some cases, the only interaction they may have. So they're really looking for connection and also for removing barriers. A lot of Medicare-eligible individuals who could be duals or lower-income folks need services. They need community support and connection.

Accessibility is not just about affordability and connecting them with care. It's also about facilitating the ways that patients engage in their care and how to make their lives easier. It's very hard to deal with a chronic condition like kidney disease. It is life-changing. It alters your lifestyle completely. That's why we have to personalize the support that we provide by providing access, lower costs, and support is really the formula for success.

Stewart Gandolf (Healthcare Success): So what lessons can other healthcare organizations take if they're truly trying to make consumer-centered care? Where should they even start? What are the resources, systems, teams, when they're all busy and they're stretched thin? What, in your experience, is a good place to start?

Michele Paige (Strive Health): The first place to start is with the rich data and actual insights that every organization has. Between eligibility data, claims, labs, diagnoses, and where individuals are accessing care or not, these rich data insights can help create the right approach or the right care path for a patient, as well as understanding where they are in their journey, their lifestyle, their demographics, and their psychographics. All of that helps us personalize an experience.

Also, there isn't one organization right now that doesn't need to reduce costs or administrative burden and streamline workflows. This is a great opportunity right now for patient-centered design. We can leverage AI to perform outreach calls and automate those.

In fact, we put in a process whereby, before every weekend, for an individual who has high-risk CKD and CHF, we can perform an AI-based voice agent triage call that just checks in and says, "Hey, how are you doing? How are you feeling? How are your symptoms going into the weekend? Do you need any help?" This reduces unnecessary hospitalizations. If the individual is indicating that they have symptoms and they need help, it immediately drives a nurse outreach call so we can address that personally.

There are so many ways that we can streamline our workflows, leveraging AI and personalizing those experiences right now so that we can definitely create better workflows and better outcomes.

I think we also need to anticipate those barriers. It also means identifying challenges ahead of time. If we know that there is a transportation issue with this patient and we can make that arrangement on an ongoing basis to ensure adherence to dialysis visits, the more proactive we are and the more we can swim upstream to anticipate patient needs, the better outcomes we're going to get. The patient will have a much better experience overall.

I would say that adopting a patient-centered design approach and mindset is really the key to success. When the patient is enjoying their experience because they know that there's support, they have someone to talk to, and they have someone to help, they're going to stay on their care path. When they do that, we get better outcomes. When we get better outcomes, it translates into lower costs as well as the value that we're all looking for so that we can continue to build additional services, again, to make patients' lives easier.

Stewart Gandolf (Healthcare Success): Great. As we wrap up here, as you look ahead, what do you think about the future of patient experience, specifically in value-based care? What do you think will happen? What needs to change for us to get there?

Michele Paige (Strive Health): You know, I always say this, but when you create value-based experiences, that's how you have the value of value-based care. It's critical that we're engaging folks in that care plan.

I would say the future of patient experience is all about simplicity. Patients shouldn't have to navigate on their own. They should know exactly who to call when they need us, automatically be outreached to see how they're doing, and have the right access to care and resources available to them.

The future of value-based care is highly individualized, and it's more about reflecting the individual, not just their diagnosis. This is a really great opportunity right now, and between AI, data, provider collaboration, and a patient-centered experience, we're definitely going to be able to drive better outcomes and lower the total cost of care.

Stewart Gandolf (Healthcare Success): Great. Well, I'm glad that, like I said, I'm not endorsing Strive necessarily, but I love the idea behind what you guys are doing there. I think it's great. It must be very rewarding to help patients navigate such a terrible place, especially at the beginning.

I've had friends of mine who were on dialysis, and it's funny, there's a lot to understand about the feelings that people go through and the social aspect. Some people don't want to do home dialysis, for example. They like being around other people. So I think it's a really important category.

The idea of delivering a good patient experience while at the same time making the cost not spiral out of hand and helping keep people out of the hospital is a really good idea. So thank you, Michele.

Michele Paige (Strive Health): Thank you.