This episode discusses quality and value in healthcare and how the BPCI program, designed to lower costs and enhance care quality, particularly in the post-acute phase, did not demonstrate notable positive impacts on HF-related measures. What does this mean for the larger health quality landscape?
The GameChanger
Quality in healthcare is rapidly evolving. There are pressures at the population level that evaluate how we do things; the quality always needs to be safety focused.
Host
Jake Galdo, PharmD, MBA, BCPS, BCGP
CEO
Seguridad
Reference
Article:
Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure
https://jamanetwork.com/journals/jamacardiology/article-abstract/2813066
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE Information
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Define quality in healthcare.
2. Review outcomes of hospitals participating in the BPCI program.
0.05 CEU/0.5 Hr
UAN: 0107-0000-24-133-H04-P
Initial release date: 04/01/2024
Expiration date: 04/01/2025
Additional CPE details can be found here.
This episode discusses quality and value in healthcare and how the BPCI program, designed to lower costs and enhance care quality, particularly in the post-acute phase, did not demonstrate notable positive impacts on HF-related measures. What does this mean for the larger health quality landscape?
The GameChanger
Quality in healthcare is rapidly evolving. There are pressures at the population level that evaluate how we do things; the quality always needs to be safety focused.
Host
Jake Galdo, PharmD, MBA, BCPS, BCGP
CEO
Seguridad
Reference
Article:
Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure
https://jamanetwork.com/journals/jamacardiology/article-abstract/2813066
Pharmacist Members, REDEEM YOUR CPE HERE!
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)
CPE Information
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Define quality in healthcare.
2. Review outcomes of hospitals participating in the BPCI program.
0.05 CEU/0.5 Hr
UAN: 0107-0000-24-133-H04-P
Initial release date: 04/01/2024
Expiration date: 04/01/2025
Additional CPE details can be found here.
Hey, ce Plan members From CE Impact, this is Game Changers. I think you're gonna love our conversation today. It covers health equity, healthcare quality, heart failure management and we circle back to the Health Equity Index to tie it all together. Buckle up, we move fast, address a lot of opportunity for pharmacy and identify the real game changer in all of this patient health outcomes. Let's get into it. I'm Jen Moulton and with me today is Jake Galdo. He is a regular contributor on this podcast so I know a lot of you have heard from him before. He is the CEO of Seguridad and also the managing network facilitator for CPSN Health Equity. Welcome, jake.
Speaker 2:Thanks, Jen. It's actually really fun to be on this side of the conversation with you, so I'm excited for this topic.
Speaker 1:I bet it is. I don't know which side is more stressful, that side or this side.
Speaker 2:We'll flip a coin at the end of the podcast. Okay, I guess we'll find out.
Speaker 1:You can tell me what you think. So today we are talking about a really important topic. It has been getting so much, we have been talking so much about this in healthcare as well, as you know just kind of in the world, but it is so important for health outcomes and that is healthcare equity. So I'd like to start today by just what talk to me about what you think is, or what you know is, because we have some research to back that up what is quality in healthcare? What does that mean?
Speaker 2:Yeah and so. So what's really interesting, jen, is like you have this over embodiment, like health equity, and health equity is really identifying disparities in care, and disparities of care is something that we measure. Like you know, as a woman, how is your pain treated differently than me as a man, right? And so we would evaluate your level of care, the medications that you receive, the therapy that you get, your access to providers, right, and that's a type of measure, and we could say that, as a woman, you are making this number up right. So this is fake data. This is not real data.
Speaker 2:As a woman, you only get treated for pain when your pain management is eight out of 10. But as a man, I get treated with pain management when my pain is a two out of 10. So, all of a sudden, there's a difference right in how you're getting treated versus how I'm getting treated, and so the goal of health equity is to remove that, so that we are all treated equally. And so we start to look at the places that we live, the air that we breathe, the houses that we have, the friends that we know, and how that affects our health outcomes, and how do we address those social and clinical aspects of our care. That's the health equity kind of embodiment and that's evaluated oftentimes through quality. And quality is that measure where we identify that you only get care at an 8 out of 10, but I get care at a 2 out of 10. So quality is just a measure, it's a numerator because that's top. It's a numerator over a denominator. It's just a number, just it's a measure, it's a denominator, it's a numerator over a denominator.
Speaker 1:It's just a number and it's our way to standardize and for the loving word of this, objectify healthcare, so that we kind of know what's going on Right right, because quality in my mind might be different than quality in your mind, but when we're talking about it in terms of healthcare, there has to be a standardization of that right.
Speaker 2:Exactly right. We have to speak the same language.
Speaker 1:So what is so when we talk about quality, and then there's also the value that is related to the quality? So what's the definition of value as it relates to that?
Speaker 2:Yeah, so value is really fun to me, because everybody in healthcare talks about value-based arrangements, value as it relates to that yeah, so value is really fun to me, because everybody in healthcare talks about value-based arrangements, value-based purchasing, value-based, value-based, value-based right. But the definition of value is quality over cost, right? It's a math problem Value is the quality of care divided by the cost of care. And so when we talk about value, we can play with either factor, right. We can make quality go up, which makes value go up, because the quality is the numerator statement. We can make value go up because we can make costs go down. At the same time, value can go up by spending more money, but in proportion having better quality.
Speaker 2:Right, because it's all about that relationship of value, equaling quality over cost. And when I say over, I mean divide, right, it's quality divided by cost. That's our value statement. And so when we think about healthcare and we think about value-based arrangements, everybody wants to get more bang for the proverbial buck, which means I need to standardize the quality or the evaluation of the quality and then evaluate it off of a cost to talk about value.
Speaker 1:Right. So that requires a measurement system. So that is a little bit of what we're going to talk about, and that is really a lot of your world these days, lot of your world these days. So talk to us about that. And what are the issues in healthcare?
Speaker 2:related to a measurement system of quality and a value. Yeah, awesome. And so to kind of define this idea of a measurement system you know that's a weird phrase, but like it's a whole domain within healthcare science is measurement science, right, and so our measurement system is the overarching scoring system of quality for something, right, and that's a really great definition where I use the word something and of things and like it's very, very abstract. So let's kind of think about it. If you walk into any restaurant in the US, you know the safety of that restaurant, right, it's literally on the front door and it says A, b, c, d, f, so we as a consumer can just look at that and know it Well.
Speaker 2:that, effectively, is a measurement system. That scoring system why is it an A, why is it a B, why is it a C is derived off of a variety of measures. Are there cockroaches in flower? Which is a real thing that happened down here in Alabama, right, Because that's why you read these types of things. You know cockroaches in flour, cleanliness of the floors. Do we take the rag?
Speaker 1:that washed the bathrooms and use that to wash the dishes. Those are measures.
Speaker 2:Those are bad examples Jake, yeah, but those are measures.
Speaker 1:The visuals are terrible.
Speaker 2:They're making us think about it which adds up to a measurement system, and so we can take that idea of a food safety score at a restaurant and apply that to all health care. And so, using my bad examples that I just gave you, one of my favorite quality measures is actually in the CMS Hospital Compare Measurement System. So it's the rating system for hospitals from the lens of CMS, and one of the measures is cleanliness of bathrooms. There's an actual measure in a health system to tell you how clean the bathroom is. I don't know about you, but like I kind of read that before I go to a hospital, so I know.
Speaker 1:It's the barometer for what you measure. Everything else right.
Speaker 2:Right, it is Like you know. It's really funny because there's often medication centric measures as well and and I'm very fortunate that I'm a pharmacist, so I'm biased in that if somebody failed the pharmacy measures, but they did well on the bathroom cleanliness, you know what I feel okay going there because I'll be my own advocate for medicine and I put more. I personally put more weight in the cleanliness of the bathroom versus the medication measures, but that could be different for somebody else. And that's the beauty of measurement systems and we have them for all facets of healthcare health plans, which is the proverbial star rating hospitals, like we talked about, physicians, pharmacies, so they're all over the place and they help us understand the quality of healthcare so that we can start to understand the value of healthcare.
Speaker 1:Which also relates, then, to the safety.
Speaker 2:Which relates to the safety, because there often is a safety component for these. When you look at a measurement system, they're constructed and designed with a specific endpoint in mind what's the ROI, if you will, what's the clinical incomes, what's the safety? And so, from like the health system perspective, you have the leapfrog group, which is a safety hospital score, and all of their measures are safety focused. From community pharmacy we have Choose my Pharmacy, again a safety focused measurement system of the pharmacy.
Speaker 1:So has there been and this is you know how we'll get into the topic today like, talk about the research in this area and how you know it's great to talk about it, but then how does it really relate to practice and to patient outcomes and to patient safety? Because you know, all of those things are the end game, right, like we can do all this, like is the bathroom clean, is that, you know? But is the quality of care there? And so what you know, let's get into the topic for today about the research that pulls all that together.
Speaker 2:Yeah, so the article that we found was actually published January 3rd of 2024, so earlier this year and it's entitled Bundled Payments for Care Improvement and Quality of Care and Outcomes in Heart Failure. And unfortunately this does not have a pippy little name because they decided to just throw every noun in there and, like all good research articles, there's probably like 30 different researchers on here. I'll note that the primary investigator is from Yale School of Medicine and also works at the Beth Israel Medical Center in Boston, and what's interesting is like so we have this article and what the question was posed is in Medicare, so we have CMS, which is our largest single payer, but not the largest segment of health care payment. In CMS you have Medicare or Medicaid Medicare. So the elderly they are starting to look at bundled payments for care improvement, entitled BPCI, bundled payments for care improvement, and it's a model implemented in hospitals and so this research was looking at that bundled payment care improvement. So almost a value construction payment model specific towards heart failure. And the reason this is happening is that, you know, in the larger measurement system not the narrow view of just heart failure, but in the larger measurement system we're starting to see up to a 3% payment penalty on health systems on their ability to perform well. On that measurement system that CMS hospital compares. So that's the looming umbrella, right. You have a measurement system for the health system and that measurement system says you perform well, or you're going to have a 3% penalty for readmissions. So that's the proverbial stick. And so the research question was well, let's take the entire thing and just look at heart failure and see what happens. And so the BPCI program. It was developed by CMS and through the CMS Innovation Center and it's focused on lowering costs, improving quality and aligning incentives for care coordination. And it really looks at this acute heart failure patient, so acute decompensated heart failure, and then the post-acute discharge within 30, 60, 90 days.
Speaker 2:And this study was a. This is where we're going to get very jargony from looking at the study itself and I apologize to all of our listeners, this is the proverbial fun part of our dialogue. This is a cross-sectional study using a difference-in-difference approach to evaluate data collected by the American Heart Association. Get with the guidelines, heart failure registry, so this is a healthcare registry data set and using CMS claims data. So this is build events, which I think is also interesting. There were 23 hospitals using the BPCI program versus 224 hospitals not using that program. So you had 23 hospitals in like a value-based arrangement and you had 224 hospitals not in a value-based arrangement of heart failure.
Speaker 2:I cannot overemphasize my little asterisk or caveat that I'm saying of heart failure and this data was from November 1st 2008 to August 31st of 2018. So it's about a decade long and I'm going to spoiler a little bit because I know I'm talking about methods, but a spoiler a little bit. This research was a decade long. There was a lot of things that happened in healthcare in a decade, particularly in that decade, and so I feel like that's an overriding theme that's going to happen as we talk about it. Their primary endpoint was to evaluate the seven quality of care measures focused on heart failure and then look at nine outcomes and you're like, well, what's the difference between quality and outcome? Like kind of saying a measure is a measure, numerator over denominator measure is a measure.
Speaker 2:In measurement science, we sometimes categorize our quality measures as structure, process, outcome, as just a way to talk about what they're evaluating for the system. So your outcome is 30-day readmissions. Your process is did I get a beta blocker for the person with? So your outcome is 30-day readmissions. Your process is did I get a beta blocker for the person with a heart attack? Your structure is did I have an electronic medical record? And so each one is vital to how we have the construction of a measurement system. Our goal are the outcomes, but we often have to build upon structure and process to get those outcome measures.
Speaker 2:This was a decade ago. We're getting on close to 15 years ago for this research, which means healthcare quality at that time was more structure-based. Do you have an EMR? Not outcome-based 30-day readmissions, and that's one of the nuances that's really important when we think about the study design being so long when looking at this type of information. Now the scary part. So what are the results? What happened and why did this make the news earlier this year? The overall study found that the bundled payment hospital patients versus the non-bundled payment hospital patients, which was a difference of 8,000 versus 94,000. So there's a huge huge difference.
Speaker 1:So the bundled payment was 8,000?.
Speaker 2:Yeah, the one that we're kind of looking at. Our intervention arm was 8,000 patients. The other kind of control arm was 94,000 patients, which honestly it's really big to look at. And so they looked at like, is there a difference? And ultimately no, there was no difference in the quality of care, which kind of shocked everybody. We're gonna pay you for quality. We would anticipate quality to get better, for you to get better payment. But we saw that in this bundled payment, the BPCI participation was not associated with a significant improvement of, or likelihood of improvement in, process of care measures at all. The only one that they saw improvement upon was beta blocker at discharge, which, interestingly, is the quality measure that ended up getting retired because everyone did so well on it and so there was right.
Speaker 2:So the one area was significant is the measure that we retired. So there was no difference. And at discharge, receiving an ace or an arb. At discharge receiving an angiotensin receptor or nephros and inhibitor. So that's our new, uh, heart failure specific therapy, which is kind of fascinating because I don't think it was on the market in 2008, right? Uh, the sagittarial valsartan that came out in I don't know, 2013, 2014. I'm ballparking here.
Speaker 2:I didn't, I didn't actually look up when it was but it definitely was not on the market, right, so like it wasn't even there, but that's what we're saying was not an improvement.
Speaker 2:There was no, you know, cardiac resynchronization therapy, crt, pacemaker, uh of discharge and there was no 60-minute heart failure education within seven days. That last one is also interesting 60 minutes of heart failure education within seven days of discharge is actually a transition of care billable code that did not come to the market until about 2012, 2013. So, again, halfway through the study, a new billing CPT code emerged which is specific to what they were treating and evaluating here. Right, so it's just, there's a lot of things in the paradigm of how we manage hard failure that shifted in that decade for this kind of bundle payment to come out and say it didn't work, it didn't do anything. Yet we did see that discharge to skilled nursing facilities significantly declined in the BPCI hospitals versus non-BPCI hospitals. So again, study design, empiric validity, intrinsic validity of the study, internal, external validity. I'm just wondering how much in the paradigm of heart failure has changed in this decade that really changed this.
Speaker 1:Which is ultimately the goal, right, you want to study it and you want to promote those quality activities to the point where they just become the norm and there's no differentiation between care, no matter where you go. So that tells me that the education and all of the things that go into changing care happen within that timeframe, and you could deduce that right Correct, which means at a population health level, it was doing what it was supposed to do, right, exactly.
Speaker 2:So it's fun to see that play out.
Speaker 1:I mean even though it maybe impacted the study.
Speaker 2:You see how impactful that can be, exactly, and I think that that's why we wanted to start today's conversation talking about what is quality, what is a measurement system, because it plays into this. Sometimes our research is way behind what is happening in practice, and I think that this is an interesting commentary on that. And so the study authors said, in conclusion hospitals participating in this bundled program did not have improvement in process of care quality measures, nor 30-day or 90-day risk-adjusted all-cause, all cause mortality or admissions fair. But is that because our whole industry changed and everyone started to actually perform better?
Speaker 1:yeah, yeah, which again is the goal right of measuring quality. You want to put something in place so that everybody starts to do that, and then it it just rate, it continues to raise the bar. So you see it work and so, yeah, I love how you're like looking back at the study and saying, like this is what it did.
Speaker 2:And it helps us kind of understand the literature and how we react to the literature. It also helps us understand ideally we're going to cross our fingers and say that we're prosthetic, right, we're thinking to the future, right. And this gets into some of the other dialogue that we've been having recently, which is that health equity index, which is how you started today's conversation what's going on with health equity? And so there's been this big push in healthcare to start to address social determinants of health. Right, and there's data within how we care for patients and document SDOH. So if I say that you're food insecure, I don't say you're food insecure. It doesn't matter what screening tool I did, I can document it as a Z code, and that Z code is an ICD-10 subtype that says food insecurity. So there is a way in the data to say that you, jen, have food insecurity.
Speaker 2:What's really sad is that in claims data, only 1% of patients are expressing Z codes. I know there is more health inequities happening right now. Right, our active military in the US. One in five are food insecure. So you can't tell me that there's only 1% of the general population expressing a Z code, which is a social determinant of health or health related to social needs that's identified and documented. If that's at 1% but we know the military is at 20%, just food insecure then we're clearly not documenting data, which is why CMS is pushing for the health equity index, which is this plus or minus 40% payment modifier that goes into effect in two years, using data from this year. So all of a sudden we have this like complete overhaul, just like we saw in this 10-year study in heart failure, where how we're changing payment based on our ability to track and identify and resolve health inequities in the outpatient and inpatient settings.
Speaker 1:Right, so the issue there is, we're not asking the question.
Speaker 2:Right, we're not asking the questions and you can almost say that we don't have the right measurement system. That are evaluating us?
Speaker 1:Right, Because we're not incentivized to ask the question we don't even know to ask. But we don't know what we don't know.
Speaker 2:Yep, and so that's a lot of work that we've been doing. You know, when we advocate towards, say, the National Council of Prescription Drug Programs or NCPDP, to say, can we codify Z codes as a separate type of data element outside of the overarching ICD-10, so we can start to capture social determinants of health information? Right, because we need to capture it, to identify it, to then make interventions to resolve it. Because there was a Deloitte white paper that said if we don't do something about health inequities, it's going to cost the healthcare system a trillion dollars in the next five years. So we've got to change, and we've got to change now. And that goes back to this idea of having really good interoperability within data at every level of healthcare, where, if I identify food insecurity at a community pharmacy, I can share that with the payer, I can share that with the hospital, I can share that with the community-based organization that's addressing the food insecurity for me. And we need to have measurement systems that are evaluating our ability to do that.
Speaker 2:What's interesting in the community pharmacy landscape is, you know, there's been a lot of DIR fees. Dir fees are the bane of community pharmacy right now. Right, we're in the DIR hangover cliff, occurring in this kind of calendar year, and those DIR fees are plan level measures applied to pharmacies inappropriately. And so, again, it's just this how do we start to describe the quality at the pharmacy? How do we describe the quality at the health system? How do we describe the quality at the payer and make it all vertically integrated? So we're all aiming towards the same goal, which is inclusive of addressing health-related social needs.
Speaker 1:Jake, I think this is such a good conversation on so many levels and I don't want to take us off track, but I think I'd be remiss in not saying that. You know, I think so often, especially in healthcare, we think, oh, we have to document, document, document, like they need all this data. We have to do one. You know we're required to do one more thing and it can get really exhausting and frustrating and it's like why, you know why, all this extra admin work.
Speaker 1:And I think this point is so well, you know, you make it so well, like, you know, stepping back and really taking a look at why we do these things.
Speaker 1:Because we need to make changes in practice that impact the health outcomes and in order to do that, we have to document this and we have to meet a quality measure and we have to put those bars out there for us to keep pushing forward, because we might think we're doing that in our individual practice, but until it's really done at kind of the system level, which is what you're talking about, we can't say that it's making an impact and we can't see it making an impact and then there's not payment for it because it hasn't been sort of proven. So I know I just got back from the APHA meeting last week and there's so much talk about how many more studies do we need to do or how much more do we need to document to show our worth, and you know, I think we can get caught up in that. But if we look at the big picture, that is also critical in moving practice and moving payment and moving quality and moving health equity and moving outcomes along outcomes along.
Speaker 2:I think that's really well put and I think we should call out our colleague and friend Randy, who's president-elect of APHA and he's on a mission and his mission is to make every encounter count. His mission is to make us in the community pharmacy be interventionalists right, and it goes back to this idea of structured process outcome. So let's think about a quality measure in the community pharmacy setting pediatric weights right. Does the pharmacy document the child's weight, yes or no? Right? That's your numerator denominator. It's a really straightforward measure. But performance is actually terrible. It's not 100% like we would all hope. It's closer to 30% nationally. That's really, really bad.
Speaker 2:And in some pharmacy management systems there isn't even a field to document weight, so I can't even collect it to record it. If it's sent over to me from a prescriber, it gets deleted as opposed to being documented. So there's just a lot of issues around it. And to your point, does that really matter? No, I actually don't care if I had the child's weight. What I care about is if the dose is correct. But I can't make sure the dose of that antibiotic, that is 25 to 50 milligrams per kilogram. I can't know if that's correct if I don't know weight right. So the structure is do you have weight? The process is did you do something with it? To Randy's point, and the outcome is good antimicrobial stewardship, better kids getting healthier parents, not having to take off sick days, less cost of healthcare system. So there's a rhyme and a reason to a lot of this in quality that it's more than a check the box.
Speaker 1:Yeah, well, and even just clinically, like, is the antibiotic working? Do you have enough? You know, in most, probably in most cases with antibiotics, is there enough being given to? You know, help them feel better and be better and rid of the infection? Or, you know, is it too much in, you know, in a negative situation? So I think that is you know. Having worked with you for a couple of years, like that is something that I had not given much thought about. But how many medications are weight-based at a pediatric level? I mean, what's the percentage?
Speaker 1:Probably all right, I mean truly probably all but are we really clinically focused on that, particularly in the community? I think in the hospital it's different. A lot of that's IV and you know. So there's different situations there that you know sort of catch that. But that was a real you know. I think so often we don't know what we don't know, and that was a real example of that. And I think I think a lot of people that I give that example to cause I think it's a very basic one they're like oh yeah, no, we don't. And then to your point, like if they do, it's being deleted or it's not looked at again or it's not updated. Every time a pediatric patient is gaining weight, every time you know they come in the pharmacy at that age, so it's just it's, you know, it just cycles, I guess, around that. So it's such a great example.
Speaker 2:Thank you and I think you know, going back to this idea, I'm not advocating that payment should be based off that one measure right, because that's bad.
Speaker 1:That's an example.
Speaker 2:Just like what we saw in this study. Payment shouldn't just be based off of heart failure. You look at the whole picture. You look at the entire measurement system for the pharmacy. You look at the entire measurement system of the health system of the payer and your payment modifiers are based off of that. So when we say that value is quality over cost, quality is not pediatric weight measurement. Your quality is the pharmacy's quality score, the health system's quality score. What have you divided by the cost of the overarching care?
Speaker 1:Yeah, but it's a signal to the way that that pharmacy and pharmacists in that practice practice, because if they're doing that, clearly they're paying attention to other things and it's a clinically based they, you know they are making every encounter count because they're asking the patient has you know, have they gained weight, what is their weight, and you know, relating it back to that. So it's just a whole cyclical. That's just one measure, just one of one indication, I guess not even measure, but one indication of the way the rest of the practice is, is going to back to your point about the bathroom.
Speaker 1:If there's a clean bathroom in a hospital likely then everything kind of follows suit.
Speaker 2:Right, or you know, everything's great except for the cleanliness of the bathroom, and I still don't want to go there.
Speaker 1:Yeah Right, Good point. You might be a little more particular about that than other people but, to me. I think it shows To each their own.
Speaker 2:That's what's so fun about it. To each their own. You can look at the measures and pick what matters to you. I have a two-year-old? You do not, unless you haven't told me something, Jen.
Speaker 1:No thank goodness no no, okay, then they're done that day.
Speaker 2:Yeah, so I'm looking at the pharmacies that do well in pediatric measures, and you might say that's not for me at my walk of life right now, which is perfectly fine.
Speaker 1:Well, but I mean, I think about the quote that the way you do one thing is the way you do everything. So you know to that point, if it is clean, then everything is going to follow suit.
Speaker 2:So it does matter.
Speaker 1:Okay, so this is a great discussion.
Speaker 2:no-transcript very biopic in our viewpoint and we can just say what are the takeaways of this study? That this payment model over a decade didn't do anything different on outcomes. But I think that that's very myopic and we're just looking at the study itself. I think that the game changer is that quality in healthcare is rapidly evolving and that there are pressures at the population level be it the health equity index, payment modifiers within CMS for re-emission rates, new therapies coming to market that evaluate how we do things, and that we need to focus on quality of care, recognizing that the definition of quality goes to these metrics.
Speaker 2:And the underlying aspect for me this is my personal opinion is that that quality always needs to be safety focused, right. We're never going to get into a position where we say, oh, you prioritize safety, shame on you. Because, honestly, if somebody tells me, shame on you for focusing on safety, I don't want to partner with you, I don't want to go to your practice, I don't want to be there. So, the more that we can emphasize quality based off of safety and using that for the care that we deliver, I think is the overarching kind of game changer. And how that impacts payment at a national level impacts payment at a national level.
Speaker 1:Yeah, yeah, absolutely. And I would say, you know, as we wrap up here today, that and this is a plug but we, for our CE plan members, we did a live panel discussion a couple of weeks ago that you led on the health equity index. So if it is something that you're interested in learning more about, which everyone should be interested in learning more about, because it will impact all of our practices, no matter if you're in a hospital or community long-term care, everything it impacts, that is a great CE and it is available on demand for CE plan members on that learning management system. But maybe you could just kind of wrap that up quickly, because I thought that was a really great, really great intro to the Health Equity Index and what's to come, and also a call to action, because even though it won't be in place for two years, all that data you know, just like this study, it's looking in retrospect and so what you do today is really going to impact those payments made on the Health Equity Index in two years.
Speaker 2:Yeah, no, I think that's a good call. And when we say Health Equity Index, this is really a payment modifier within the Medicare space, right, but at the same time there's a Health Equity Joint Commission standard that went into effect last year for all Joint Commission accredited entities, so ambulatory care clinics, hospitals and so forth, and so health equity is everywhere in healthcare. That panel is us, with some leading experts across the nation from CPS and health equity that are pharmacies that specialize in integrating community health workers and social determinantsants, health experts, and are getting payment for delivering services around health inequities and addressing those health inequities. And so you hear from experts from the entire US Like we had people from Georgia, new York City, iowa, missouri, california, literally everywhere talking about the services that they deliver in their local communities that change the lives, that are then positioning them to do well in that health equity index and get paid differently for the services that they deliver.
Speaker 1:Right, right. So lots of mixed. Like you said, the index isn't necessarily the payment model, but there are things that are looking at that index that will pay that. So great point. There's a lot going on in this space, and I think that's another reason to really listen to the CE. It was an hour, right Again, talk about this all day, but it was a 60 minute quick recap and I would really encourage everyone who wants to understand this at a little bit deeper level to watch that, because it was really, really informative. So thank you for doing that. Okay, well, is there anything else that we didn't touch on? I feel like we kind of briefly touched on a lot of different things, didn't dig deep, but there's more to come in all of this space Is there?
Speaker 2:anything. Yeah, I think the only other takeaway I might share is that as we get into health equity, as we get into value-based models of care, you know a lot of that is workforce development and making sure that your team is equipped to addressing all of these things, and I know that a lot of the work that we do at CPSN Health Equity is partnering with CE Impact and the integration of community health workers into our practices, which has been a game changer.
Speaker 1:Ah, I heard that. Yeah, game changer, you're right, jake. And the community health worker course that we do, and it's a big course. I mean it's a certificate, so it's definitely for somebody who wants to go all in on it, but it is, I would say, one of the most impactful things I have ever done or been a part of, because I'm not even doing it. You're doing most of the work, as well as others that that teach that course and facilitate it, which is so great.
Speaker 1:But what we see from that is pharmacy technicians having such a rewarding career and it is such an amazing career path for them. Like you said to the workforce development piece, because I know it's really hard to get technicians right now and this is a really great, great thing. But, as you know, what we hear about these technicians and the lives that they're impacting is just so amazing. Like it just warms my heart every time I hear some of these, some. You know the impact that they're having in their communities and, again, this is going to come back to payment eventually. So it's not just you know the soft, you know feel good about what you're doing in practice. It really has an impact on adherence and the healthcare that people are able to get, and there will be payment related to it in the future. So it's if you don't know much about community health worker, I really encourage you to find out more about that as well.
Speaker 2:So thanks for bringing that in.
Speaker 1:Thank you for having me have this conversation. I love this information, so it's always fun to talk about it. Yeah, yeah, absolutely Well. Thank you, jake. I appreciate you being with us this week. You do so much in this space, and so from CE Impact, thank you. But also as a pharmacist, thank you. I think we're making huge strides and health outcomes will improve because of it, so I appreciate that. That's it for this week. So if you are a CE plan member, be sure to check out some of those other courses, but also claim your CE for this episode and all the episodes at CEimpactcom and, as always, have a great week and keep learning. Thank you.