Dr Vivian Lee on HEOR Integration Amid COVID-19, Implications for Value-Based Care Transition

Vivian Lee, MD, PhD, MBA, is the president of Health Platforms at Verily Life Sciences.

Transcript

As COVID-19 has laid bare many significant gaps within the health care system, can you speak on how health economics and outcomes research (HEOR) has been leveraged in the real-world setting during this time?

I can give you a lot of examples. Maybe the one that comes to mind first is in our digital health platform called Onduo. So, when Onduo was started a few years back, it was a program to help people with type 2 diabetes manage their condition, help them keep their blood sugar under control. It included a device—the sensor for measuring their blood sugar—as well as the ability to do telehealth chatting, video conferencing, for example, with coaches and with clinicians. Then, of course, it expanded. So, there's weight loss programs, there's hypertension, there's mental well-being, depression, and so on.

When COVID-19 struck, it was clear that we really had an important role to play as a digital health technology with our members. For one thing, just simply access to information, we know people were really scared and as you will remember, people with diabetes were in that high-risk group. So, people wanted to ask questions, so they could reach out to their coaches, and they could reach out to those clinicians and ask them about COVID-19 too—the impact of COVID-19 on their diabetes and just COVID-19 questions more generally.

In that environment, HEOR has actually proven to be really high-impact in terms of thinking about our business model in Onduo. So, if you think about some of the shortcomings of our nondigital, traditional health care model in this country, which is predominantly still fee-for-service (FFS), if we thought about those same shortcomings or that same sort of what I think is a very limited approach, if we apply that to the digital health space, we would just have pay-per-click—instead of paying for every visit, you pay every time you click something on your on your app or do a televisit.

Instead, really what we've been doing working with our HEOR colleagues within Onduo and within Verily, has been creating a novel payment model where we are paid for better outcomes, better health. And so for example, our payment is conditional on people's blood sugar getting better or blood pressure going down—it's really pay for performance.

I think that's how it should be, I think we are going to be disrupting the payment model of health care if we were able to do that from the digital side. And it requires data that employers aren't really accustomed to providing, new economic models to figure out what is the right pricing, what is our risk, what is the employers’ risk or the insurers’ risk, and what are the benefits of those interventions. So, maybe that's one example.

How do you foresee the role of HEOR for health care systems in the near future, and what are some opportunities for growth?
I write about that question a lot in my book, The Long Fix, which came out just last year. In The Long Fix, it's really a collection of stories from all over the country of health care systems, communities, [and] medical groups about how to rethink—reimagine, really—the way in which our health care system should function. And as you can imagine, it very much has an angle to moving from FFS, what I call paying for action, and instead paying for outcomes, which is another way of thinking about value-based care.

So, thinking about it from the perspective of the health care system, which from my own experience having been the CEO of a health care system, I really think about what is it that would enable health care leaders to take that risk, to take the leap into this value-based world? What tools can they be equipped with to feel that they're going to be successful, to feel optimistic and to really embrace this change?

Well, they need to be able to measure their outcomes, they need to be able to measure cost of care, they need to have methods to manage both of them more successfully. And some of that may include price transparency tools for their clinicians and their patients or digital health apps like the one I just told you about.

So, we have been building a whole suite of those tools at Verily designed for health systems to support them. When I was the CEO at the University of Utah Health, we were faced with this challenge all the time and so I know what it's like—it's difficult to move health systems. But in my view, HEOR is absolutely critical because it's about building the tools and the evidence that can enable health systems to succeed.

When I was in Utah, we were able to succeed not only in the quality side, but financially. Healthier patients for the system actually led to more than doubling of our margins because they had fewer complications, fewer readmissions, shorter lengths of stay, which on the inpatient side, where we’re paid prospectively, meant that we actually had more fall into our bottom line.

So, we more than doubled our margin, and I believe that those lessons can definitely be extended to systems across the country and maybe even across the world.