Powering Personalized Senior Care at Home w/ Dr. Jeffrey Kang

Whole-person care is the gold standard for treating elderly patients by delivering care where they need it when they need it, but traditional healthcare models make it tough to scale.

Can value-based care and home-based medicine change that?

In this episode of CareTalk, host John Driscoll speaks with Jeffrey Kang, CEO of WellBe, to explore the challenges and opportunities of geriatric care, the evolution of Medicare risk adjustment, and why integrating whole-person care into value-based models is key to keeping vulnerable patients healthier.

🎙️⚕️ABOUT CARETALK
CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy.

🎙️⚕️ABOUT JEFFERY KANG
Dr. Jeffrey Kang, the founder of WellBe, was inspired by his personal experience caring for his mother during her battle with cancer. As both a physician and a son, he witnessed firsthand the importance of having a trusted medical guide to help navigate complex treatments and decisions. This experience led him to create WellBe, a service dedicated to providing personalized, compassionate care whenever and wherever patients need it. Under Dr. Kang’s leadership, WellBe is driven by the belief that everyone deserves access to a trusted doctor who understands their needs, supports them through every step of their health journey, and ensures they receive the best possible care.

🎙️⚕️ABOUT WELLBE
WellBe Senior Medical is transforming healthcare by delivering expert medical and mental health services directly to patients' homes, ensuring compassionate, personalized care at low or no cost. Collaborating with existing healthcare providers, WellBe's dedicated team offers in-home medical care, 24/7 provider access through a nurse hotline, and mental health support via telehealth and home visits. Currently serving patients across 10 states, WellBe continues to expand its reach, partnering with health plans nationwide to keep individuals healthy and comfortable in their own homes.

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Transcript

John: 0:07

Welcome to CareTalk, America's home for incisive debate about healthcare, business, and policy. I'm John Driscoll, the chairman of the UConn Health System. Welcome, Jeff. Jeff is the CEO of WellBe, a longtime friend and really an expert in the field of whole person care. So today we're going to go through a little bit of his clinical journey, the journey of sort of a managed care executive, a public servant, a successful big company bureaucrat, now an entrepreneur. So welcome,

Jeffrey: 0:43

Jeff. Good morning, John. Looking forward to it. And we have a lot of commonalities. You're a big company bureaucrat also, so. I'm sure

John: 0:55

I was very successful. I enjoy the entrepreneurial role a lot more. So Jeff, tell me, how did you get interested in medicine? How did you become a doc in the first place?

Jeffrey: 1:04

Yeah, you know, that's a, I don't want to digress too much, but it was really interesting. When I was growing up, I had the opportunity to visit my grandparents in China for the first time. 25 years. Cause you know, there was communist China and, um, you know, of course you'd go and visit them and first time, you know, and they, they, they ask you, what are you going to do in your life? You know, then I was whatever, 20 years old or something like that. I said, I was going to be a lawyer. And they said, why do you want to be a lawyer? That's the epitome of American capitalism. That's the, there was, we're talking communist China. Sure. Why don't you be a doctor, the human body is the same around the world and you can always come back and serve the motherland, you know, and I, I stepped back and I thought about it and you know, when you think about medicine, you're caring for everyone, regardless of race, you know, religion, political affiliation, you're contributing to society and you got skills that work around the world. So I switched selves. And so

John: 2:18

you, you become a doctor. Talk to me a little bit about that early academic journey because I believe you, you've got a, you specialized in geriatrics, which although an exploding category really doesn't have that many practitioners, what got you interested in geriatrics?

Jeffrey: 2:34

Yeah, so So once I made the switch to medicine, then I was really all about, you know, caring for people that need me, you know, when you think about family practice, you're fundamentally or pediatrics, you're fundamentally dealing with healthy kids, right? Uh, adult medicine, a lot of it's prevention wellness stuff. But when you really get into the geriatrics, you're talking about very complicated illnesses, people who are disadvantaged. I mean, I'm sure you've had a loved one, you can kind of picture it, you know, 90 years old, frail, can't get out of the house, six or seven diseases, 20 medications. What do those people do? You know, I'm sure you've had a loved one like that. And it's incredibly frustrating.

John: 3:24

It's, it's, it's, it's, and, and it, and unfortunately, because medicine is so transactional now. So broken into silos, that whole notion of whole person care, particularly for someone who's got, you know, multiple comorbidities. No, my mother's, my mother turned 91 on, on, on Friday and it is, it's extremely tricky and we don't really, as a healthcare system, we aren't really well set up for that. And then, and then you, you, you train geriatrics. How did you end up? Getting to CMS of all

Jeffrey: 3:57

places. Well, before I get there, I just wanted to, you know, you're absolutely right. Medicine's transactional, but so what happened was geriatrics, geriatrics. I actually, we discovered that the best thing for your mother, people like your mother, very frail. The best thing to do was to actually care for them at home. And the dirty secret of medicine is about 95 percent of what a doctor does in his or her primary care office. It can be done at home. Take a history, do a physical, draw bloods, do an EKG, you can do practically everything at home. The only reason why we do it in a doctor's office is because the transactional reasons you point out. You can see 20 to 30 people a day in the office versus in the home, which is the right thing to do. You still, maybe only four or five people a day. And that was the challenge that I had. Every time we, this is like 30 years ago, we as geriatricians, we'd see a patient in the home. We'd lose money because you only need maybe four, you know, four or five a day. You lost, we weren't paid enough, you know, you lose money. And so now you do the right thing, but it's just not financially

John: 5:17

sustainable. But geriatrics, the other thing about geriatrics is it really does work. I mean, geriatricians actually, the view, you look at the satisfaction of patients who were seeing geriatric doctors, doctors who have an orientation towards frail elderly, multiple comorbidities. The outcomes are actually very, very strong. You're building your, your clinical background. How did you end up as a, in, in public policy at the Center for Medicare and Medicaid Services?

Jeffrey: 5:47

So it turned out what we learned 30 years ago is you could not support this kind of care. It's called geriatric in home care in a transactional fee for service system. So we actually started the initial pilots. See, it worked in many of the initial CMS pilots. That back then it was called HICFA. Now you and I are old enough, remember healthcare financing administration, but yes, we started in the initial demonstrations. One was the PACE program, you know, which was originally off Onlock. And then another one was called, um, institutionalized SNIP, which was basically care for nursing home patients.

John: 6:24

Just contextually there, Onlock was one of the great successes of the healthcare program. It's a, all of your care was in one place. It was community based. And honestly, Jeff, it was the Chinese American community or Vietnamese American community. It's

Jeffrey: 6:41

Chinese American in San

John: 6:42

Francisco. But it was, but it was comprehensive care in one place and was the model for community based care and PACE because all of the care was provided, whole person care in one place also was incredibly successful keeping people healthy and kind of happy. As they aged in place. I mean, they're, they're extraordinarily successful models. We talk a lot about what doesn't work in government, but both of those were great examples of what did work.

Jeffrey: 7:12

Yeah. And sat to your point, status cash, you know, it was high, but it really, they're really value based care. And the way you can economically sustain the program was you did the right thing for patients. You took care of it at home in the community based model. You lowered costs, and that's actually how you made your money, not through more and more visits. It was economically viable because you really, it's true value based care. And when people hear value based

John: 7:41

care, Jeff, they often think about, well, there's some private sector incentive and there's businesses involved. You know, there's just to this morning, there's a lot of, there's a lot of news about the United Health Care potentially gaming the system. Uh, and I think probably others have gamed the system as well, although they're, they appear to be in the crosshairs. Yeah. You're really talking about the healthcare. I think you're talking about more of the healthcare impact of the incremental invested hour or dollar. Is that the right way to think about it?

Jeffrey: 8:15

Yeah. Um, another way of thinking about it is, is since the true value based care, you are both the provider and the payer. You're financially responsible for. The hospital payments, the specialist payments. So if you can do the right thing and keep people healthy and out of the hospital or out of the emergency room, you actually make more money that way. You know, which from a patient's perspective, it kind of the aligned incentives. You know, I'd rather you take good care of me and do prevention and community based care in the home and keep me out of the hospital. Was it acknowledged it at Heckman CMS that this. Made sense. So the PACE program is very successful, but really only covered maybe back then 5, 000 people nationwide. Uh, uh, ISNIP program, same thing, maybe 5, 000. So I actually went to CMS. Because what I really wanted to do was create the conditions where programs like this could continue to thrive and move beyond just little small pilots. Uh, so one of the things that we did at CMS, uh, you, we're risk adjustment, you know, we're the 28 of risk adjustment. You just kind of, there are some abuses there. But the good in it is we developed the one of the risk adjustment and the good of that was for those providers or payers that really took on sick patients, they got adequate reimbursement versus, you know, 30 years ago, if you were a payer, you got paid the same for everyone. Your goal was to just skim the healthy, right? And you remember that back then, right?

John: 10:06

Yeah. And we're, yeah, I know. And there are all these horrible stories, but we're talking about The managed care programs and the differences, whether you paid the same amount for every patient, where unfortunately some of the health plans actually only enrolled healthy patients and shifted to a place where the risk adjuster, where you're, you were supposed to be compensated more for caring for more, uh, for patients with, with, with more needs and hence took more time to give them the right care. The risk adjuster program, gosh, the concept was right, Jeff, where did it go wrong? And then let's get back to what you're up to because you're, you're kind of an expert in this area.

Jeffrey: 10:48

Yeah. So, and now, and I do want to spend at CMS a few minutes, a few minutes on the STARS program, which is really important, but no, I think the concept's great. And you actually saw a tremendous uptake of providers going into, like, uh, I used to be the president of ChenMed. They deliberately put their clinics in a low income neighborhood. You know, if you were like fee for service, you wouldn't do that, right? But the risk adjustment really does allow for people to kind of take on pretty sick people. You know, where, what wrong, quite frankly, is, is there's a difference in incentives when it comes down to coding in the managed care world, the Medicare Vantage world, you're incented to collect diagnoses and record diagnoses in the fee for service world, which, which is what, how CMS does is they compare. I

John: 12:00

think what you're saying, Jeff, is there are perverse incentives in both fee for service, regular Medicare, and in managed care around risk adjustment.

Jeffrey: 12:08

That's correct. And if you had similar incentives. to collect the right diagnoses, then everyone would be on a level playing field. But right now, it's, it's different in the two programs.

John: 12:21

Mm hmm. And do you want to talk a little bit about how CMS tried to fix some of the, those incentives with the STARS program? Because again, and we're really very much focused on the managed care because, you know, now 54 percent of all Medicare eligibles are actually enrolled in Medicare Advantage or the managed care part of the Medicare program.

Jeffrey: 12:44

Yeah, I, I would actually argue that that is the reason why, because when we started back then, this was way back in the Clinton administration, it was maybe about 10%. So now we're up to 54, 50%, uh, A was risk adjustment, but B it was a STARS program. The other take, if you recall, the other knock on managed care 30 years ago was You're just denying care, you're not improving quality of care. So the second thing we did at CMS is we created Medicare HEDIS, Medicaid HEDIS, the CAPS, you know, the Member Satisfaction Survey. Those eventually became the STARS program. Just so folks can

John: 13:28

track this, the HEDIS programs are really clinical measures of progress. And the caps are really consumer satisfaction, if you will, just crudely stated. And so by both looking at both how the Medicare eligibles felt about their care and how then mathematically taking, you know, standard clinical outcomes, were you making progress? And those foundational blocks that you helped create, uh, ended up creating something called the STARS program, which is. I honestly, the, it, it really drives or drove the profitability of Medicare managed care companies into some of the fastest growing and most profitable businesses in America over the last five, six years.

Jeffrey: 14:10

Well, as you're aware, John, you know, you're a four star above the CMS would actually pay a 5 percent higher premium, right?

John: 14:18

And it, this is, this is a business where 3 to 5 percent is the profit margin.

Jeffrey: 14:22

That, that's correct. But you see, from a public policy perspective, the way we thought about it back then was you do a risk adjustment, so you get adequate payment for sick people, and you do the STARS program, so you actually create incentives to improve care. Improved member satisfaction and if you actually, you know, I mean, this is historical, but if you 20, let's say 2025 years ago, if you asked in the C suite of a managed care program, how much time they talked about quality and member satisfaction, it was zero. Now you ask the question in the C suite, how much, you're talking about it like 60, 70%. It's all the time. But that's really good.

John: 15:09

We've gotten the incentives right. So where do you, yeah, I don't want to get too far off a field, but there is a fair amount of, you know, interest right now on the federal level. The Department of Justice is going after UnitedHealthcare around the way they may have gamed the system according to the Department of Justice invest, the premise of the investigation. Do you think the, the, the program is wrong or some of the competitors might be wrong?

Jeffrey: 15:37

Yeah. I think it's as with everything, I think there are a couple of companies, I don't know. I don't want to comment on United, but there are people that's who, who let's call it abuse, you know, the program. But I would not throw out the program from a public policy perspective. It's the right direction to go. Um, you know, even in traditional Medicare and traditional fee for service, there are people who abuse the system, you know, they're up coding. And

John: 16:03

in fact, if you look at the history of managed care, when managed care came in, inpatient days went down in Medicare and emergency room visits went down. So actually people were getting. Better care on balance. So I, I think that's exactly right. So you, you're, you, you're at CMS laying the building blocks of this, of these systems, and then you end up coming out and, and, and, and joining the evil empire of managed care. So what, how did you then make the transition to wellbeing?

Jeffrey: 16:40

Yeah. So look, I don't, um, I went to the payer side that's called the, you know, it's a Cigna for nine years. I think they're my goal. Was to try to take some of these same Medicare managed care principles and move it into commercial health insurance. It's really tough in commercial health insurance. And I think one of the biggest challenges quite frankly, is, is the health plan in the commercial health insurance world is really not the payer. They're a third party administrator. It's really the employer that's the payer. And that, I think that's one of the fundamental structural issues. Uh, but yeah, no, I mean, there, so then I got. Um, you know, there was only so much you could do on the payer side in commercial. So then I went to your former employees, Walgreens, you know, uh, uh, there, I wanted to learn retail health, you know, or consumer health, that was kind of, that was an interesting experience in a nutshell, I would say, I don't know how you felt about it, but, um, I think in a nutshell, there's only so much that consumerism will do. I

John: 17:48

think, you know, the other thing, the other challenge Jeff is for people like you and I. Walgreens is such a strong traditional retail pharmacy culture that they have a very hard time reimagining, you know, interestingly, even with its, its boots was much more flexible than, than remarkably within even older history in England around clinical care than Walgreens was in the U. S. And I just think cultures, cultures and leadership can be funny. And I think both of you and I were trying to do the right things. We made some progress, but I just think it's a, um, and I think it's also hard when the core business boots was actually doing well on its own. Um, whereas I think the core retail franchise has really suffered because of the PBMs and getting your head around that correctly. It's harder to actually do anything novel in healthcare that's meaningful and substantial, but I know you made, you did make some progress, but it's. You know, Walgreens, you know, has its, has had, had its hands full on the other side.

Jeffrey: 18:53

No, it's very hard. You know, it's interesting. You mentioned boots because boots in an odd way, because it's in single payer countries. There was no PBM. So the payment rate was the same. So when you think about it, Boots was then, okay, how do I improve satisfaction? How do I add value to the patient? So I get more retail sales, right? I mean, that's kind of Walgreens. And they

John: 19:19

found a way to actually get the NHS to pay. I mean, yes. It's much easier to do convenient care at a Boots than it is to add another primary care doc. Got it. Yeah. So then what, what, what, where did you go after? Did you go to ChenMed after? Yeah, I went to ChenMed. Yep. Yep. As their president. That just seems like a great model. Um, you want to talk a little bit about their model of care? Cause that's also whole person care.

Jeffrey: 19:43

Yeah. So the way I like to think about this, John is, it's, I've came full circle, you know, provider side, then the CMS, then the payer, then like big retail, now back to provider. I ended up concluding that if you really want to add value, it really is on the provider side, in particular primary care. And then the other theme in my career was like serving the underserved. And I really liked the Chen, they deliberately put their clinics in low income neighborhoods, you know. I mean, it's, you know, it's really funny. I mean, you and I are old enough, 20 years ago, we used to talk about the biggest problem in healthcare was access to care, you know, and now we've moved down, but we hadn't solved access to care, you know. So the way I think about 10 Med is they put their clinics in Harlem or, you know, South side of Chicago, you're trying to solve access to care, pretty simple. And, and, and see what trues you to well being. So similar. So let's call it, you can put yourself in low income neighborhoods. That's the one that, or you can focus on, you know, what we were talking about, the frail elderly patient, like your mother, and then you solve their access to care by delivering care in the home, but it's a similar principle. It's just, at the end of the day, care in the home for a very sick population is, is the right thing to do. What we were able to do that I, we had a very hard time making it work 30 years ago in that fee for service system. The one big difference is now Wellbe Senior Medical, we're a value based provider. So we're both financially at risk for all the hospital care. And then we're basically supplying geriatric care or the equivalent of primary care.

John: 21:36

And your, and your, your customer is first the health plan that's taking risk in Medicare, and secondly, the patient. So how do you, so how's it going?

Jeffrey: 21:47

Yeah, so the, uh, the way it works is the health plan finds these really sick people and then assigns them to us, and then we care for them. Even if they have a primary care physician, we're, think about us as the geriatric specialists. caring for the patient, you know, and patient gets to keep their primary care doctor. And we're the geriatric specialists. Uh, it's going quite well. I mean, you know, um, we're currently about 170, 000 lives in nine states. I love

John: 22:16

it. Are you finding that the doctors, the patient's current doctors are threatened at all by what you're doing or nervous about what you're doing?

Jeffrey: 22:27

Yeah. So I would say the majority or not, because the majority, you know, when you talk about what patients were caring for, they would say, Oh yeah, this Mrs. Jones or Mr. Seuss, they really need help. And I can't see him at home and you know, I'm glad to have some help. Now I can still see him in the office periodically. Great. Okay. Appreciate it. But I'm glad to have the help. It's, I mean, think about it as a primary care doc. Let's say you have a patient with bad end stage congestive heart failure. They're glad to have the cardiologist help them, you know. So, uh, the majority are fine. Now there's a couple where it's threatening, but that's, you saw that like in the retail clinics at Walgreens, right? Absolutely. Yeah. Absolutely. Jeff, you

John: 23:16

and I profoundly agree that this geriatric care and care in the home Delivering care where people want to get it, allowing them to live independently is the right way to do it. I mean, obviously I'm a believer because of care centrics and I know it works because it's, and it's the only way actually to do whole patient, whole person care is to see people in situ. You know, it's, I don't know whether it's, they're more honest or things are just more transparent when you're actually in the home with, with patients who are vulnerable, but I've seen it. You've seen it. You know, the folks that devoted see it when they're doing their, their work. Different help plans that really have gotten it right. Um, why don't you think everybody's, why doesn't everybody flock to the Wellbe model? The CareCentric model? What do you I, I mean, I certainly found it frustrating that I had to sell something that just made so much sense. What do, what do you think, what do you think the, the challenges are to actually convincing people? That the WellBe model is the better model, the Geriatric model is the holistic model and that for these most vulnerable, most expensive patients, we can

Jeffrey: 24:19

actually keep them healthier. So the, the whole sector is growing now. Uh, there are a lot of new companies in this space. I think the plan are beginning to get very focused on this, especially since last year, they had a lot of medical cost headwinds. And then when they do the analysis. They look at, wow, it was really these sick people, right? So I think the plans are coming around. I actually think the biggest barrier to why this model doesn't just completely take off is it really there's, it's very hard from a provider perspective to take risk, it really is hard. I mean, you need financial backing and you need a lot of expertise and doctors really, at the end of the day, aren't trained for this. You know, let's call it the business side of medicine, right? So,

John: 25:12

well, and, and even more so the risk side, I mean, it's not just getting your bills paid. Um, so one, one final question, Jeff, I guess if you had one thing to change in healthcare that would make this the wellbeing model. Um, easier to execute. What would it be? It could be on the regulatory side. It could be on the insurance care side. Ooh, that's a good

Jeffrey: 25:33

question. One thing to change. I think the regs are probably from a regulatory standpoint are a pretty good place. So probably on the plan side, I think that the plans get a little confused around this and because they're approached by so many different other, what I would call point solutions. Um, you know, that split up the whole person, you'll have like a diabetes program and a prevention program and a palliative care program and everything. So probably it would be clarity on the health plan side where they really, it's in their interest to find whole soup, you know, whole person solutions. That's what the member wants, but then it gets them out of the business of, of trying to manage all these little point solutions. So I think it's. I think it's the plans kind of coming to a strategy, which really is a little more around whole person solutions than rather than point solutions. That makes sense. I, it does. And I think that's a great way to leave it, Jeff. Thank you so much. Thanks for, thanks for joining us today. John, I've really enjoyed it. I'm sorry we didn't get a chance to spend more time on your. on your experience at Walgreens and CareCentrics. Next time, we'll have to flip the order here. We can, uh,

John: 26:57

happy to do it. I think we've had a lot of fun and some success at covering some of the same territory. So, if you liked what you heard or you didn't, we'd love you to subscribe on your favorite service to our wonderful podcast. Thanks so much, Jeff.