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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About William Winkenwerder, MD: Dr. Bill Winkenwerder is Chairman of CitiusTech, a global health information technology services firm. He is Chairman and CEO of Winkenwerder Strategies LLC, a US-based healthcare advisory firm. As one of the most influential and recognized leaders in health care, with broad experience in medical care delivery, population health, healthcare finance, and health insurance, Dr. Winkenwerder is a respected expert on leading large scale organizational change and innovative health information technologies. Currently he works with global private equity firms, and in addition to CitiusTech, serves as director or advisor for healthcare firms – Net Health, Confluent Health, WPS Health Solutions, Elation Health and RxRevu. Dr. Winkenwerder is a Fellow of the American College of Physicians, and a Board Certified Physician who has practiced primary care medicine at top medical institutions. He has been widely recognized for his outstanding contributions. Charitable work includes service with the Executive Advisory Board of the Leonard Davis Institute of Health Economics, the CEO Roundtable on Cancer, The Board of Trustees of Davidson College, and The Bob Woodruff Foundation. Dr. Winkenwerder has been an advisor to US Presidents, Presidential Candidates, and many large corporations. He has been a contributor to various national news and media outlets. A graduate of Davidson College, and The University of North Carolina School of Medicine, Dr. Winkenwerder, a board certified physician, received his Masters in Business Administration from The Wharton School and completed a fellowship at The University of Pennsylvania.

COVID-19 Updates with Dr. William Winkenwerder

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Advancing NEMT with Ride Sharing — featuring Megan Callahan of Lyft Business

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President and CEO of the Clinical Effectiveness Business

The massive pivot to virtual care during the pandemic not only showed the potential for disruption, but it also served as a dry run for widespread adoption of new modes of care delivery and enabling technologies.  According to a recent AMA report, <a href="https://www.ama-assn.org/system/files/ama-return-on-health-report.pdf" target="_blank">Return on Health: Moving Beyond Dollars and Cents in Realizing the Value of Virtual Care,</a> “This evolution to digitally enabled care will fundamentally transform the value equation for health care professionals and payers…the attention will shift to how we can use innovative technologies to enhance overall episodes of care, blending a virtual and in-person experience in ways that improve access and experience for some patients while maintaining or improving quality and reducing long-term costs.” Virtual care affects consumers whether they’re engaging with their PCP over video or with their insurer. Regardless of who initiates the engagement, providers, payers, regulators, and other stakeholders must ensure a strong supporting infrastructure exists. The stakes, from the impacts on consumer health to safety, satisfaction, and cost, are too high to ignore.  For its part, my organization, Wolters Kluwer is providing valuable access to trusted clinically valid, expert-vetted content and tools to those driving this massive shift in care, both providers and payers. For more than 30 years, through UpToDate and other deeply entrenched healthcare platforms, we have provided healthcare professionals in traditional settings with evidence-based technologies to ensure they can confidently treat patients and answer even the most complex clinical questions.  Moving forward, all members of the healthcare ecosystem might reasonably expect that care, whether onsite, virtual, or preventative, is guided by the same evidence. With a validated base of evidence – one that is organized and accessible – we can eliminate variability across a consumer’s health journey, reduce diagnostic and treatment errors, create alignment with preventative care, and lower costs.  This is why Wolters Kluwer is expanding access to our trusted content and tools beyond traditional care settings, where its benefits are already proven. We now provide unprecedented access to these resources through two new solutions: one for virtual care vendors who are developing tools for providers and patients and one for payers who seek to engage more frequently and effectively with their members. Opportunity and Support for Virtual Care Vendors Virtual care is a rapidly evolving, quarter trillion-dollar market, and players must move quickly to meet consumer demand. A <a href="https://www.businesswire.com/news/home/20221101005204/en/Nearly-Four-in-Five-Americans-Who-Have-Used-Virtual-Primary-Care-Say-It-Helped-Them-Take-Charge-of-Their-Health" target="_blank">recent Harris poll </a>of 5,000 consumers, commissioned by Elevance Health, found that more than half of respondents (52%) say they would use virtual primary care in addition to the care they receive from their current primary healthcare provider within the next year.  Our Digital Health Architect platform is a content-as-a-service solution that lets virtual care vendors build, customize, and deliver their own digital health solutions. Our first suite of content, aimed at Consumer Education, includes hundreds of multimedia programs, drug information, and articles.  Virtual care vendors will rely on more than technology and usability alone. New applications must link to dynamic content and tools that have measurable impact on health, are safe for consumers, and reduce costs. Starting from scratch is costly, time-consuming, and likely to introduce more variability in care, which negatively impacts patient outcomes. We’ve created a solution for perhaps the most time-consuming and costly aspect of delivering virtual care at scale, reliably and without compromise: API-enabled access to dynamic expert healthcare content that already guides patient encounters across more than two thirds of U.S. hospital systems. Saving time and costs for virtual care developers while ensuring content is always reliable is good for them and fulfills our mission to help ensure best care everywhere. Helping Payers Increase Engagement and Improve Outcomes For insurers, engagement is critical to financial success and, more important, a driver of better health outcomes. In <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/supercharging-the-roi-of-your-care-management-programs" target="_blank">“Supercharging the ROI of your care management programs,”</a> McKinsey authors estimated that “payer care management can leave 90% or more of potential value ‘on the table’ because payers are not able to engage the vast majority of members they identify for care management.” EmmiGuide is a member engagement solution that helps payers improve outcomes by influencing positive health behaviors through compelling content and guidance based on sound behavior science. By sharing accurate, evidence–based content that is already widely used, plans not only build trust with members, but also help them gain confidence managing their health.  EmmiGuide provides access to disease treatment plans, drug information, and industry-leading patient engagement, communication, and education materials. It’s fully configurable for diverse populations and rapidly scalable across platforms – email, portal, or interactive voice response. Studies show that Emmi, the foundation for EmmiGuide, works: 83% of individuals using Emmi through their provider say it motivated them to take new actions to improve health. For payers, this is strong evidence for future ROI. <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/the-untapped-potential-of-payer-care-management" target="_blank">McKinsey advocates</a> for payer care management as well, estimating that “payers may be able to generate more than two-to-one (2:1+) ROI, meaning that for every $1 invested there may be a $2 return, while also ensuring a better, healthier experience for members.” Conclusion: Go Virtual, Stay Grounded Virtual care will continue to evolve and improve. We know now that healthcare is about more than inpatient visits; it involves a constellation of smaller interactions away from a physician’s office or hospital. These interactions will increasingly be initiated by payers as well, with members receiving targeted support to improve adherence to everything from medications to diet and exercise.  Virtual care, including prevention through care management by payers, has an important place in our healthcare and wellness futures, but the evidence and insights that have sustained us for centuries at physical points of care must guide virtual engagement too. By expanding access to our trusted, clinically valid, expert vetted content and tools beyond traditional care settings, we can be the same catalyst for best care everywhere in the virtual world as we’ve been at traditional points of care for decades.

All Virtual Care and Care Management Must be Grounded in Evidence

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Chief of the Office for Provider Advancement

The number of older adults in the United States is expected to surpass 80 million by 2040. Among them, elderly women are more likely to be widowed, live alone and experience higher medical costs, along with wage losses later in life. Hispanic and Black women are even more likely to face these challenges.1  Economically, many elderly women rely on what they have available in income and savings, but women, particularly those of color, experience deep disparities related to work, housing, the economy and health care systems throughout their lives. Taken together over a lifetime, these inequities limit their opportunities for economic security and often result in older women facing impossible choices between affording rent, groceries, medicine and other basic necessities.  Gender pay disparities and inequitable distribution of childcare responsibilities accumulate for women in the calculation of Social Security benefits, which are based on the individual’s highest earning years. While the average Social Security retirement and survivor benefit for men in 2019 (excluding disability benefits) was $1,612, women received only $1,283 — only 79 cents to the dollar as compared with men.2  On top of having a lower standard of living and fewer social supports, elderly women face increased health complications. Hypertension in women of color, for example, becomes more frequent in older age due to the long-term effects of microvascular inflammation and mental stress. Research shows that the prevalence of hypertension in this population of women is in part due to the impact of accumulated microaggressions, racism and anxiety—another example of the way that inequities add up to unjust health vulnerabilities. Adding to that stress, women may have had the extra burden of serving as primary caretakers or of working multiple jobs.  Older women additionally face higher costs due to longer life expectancy and management of chronic conditions tied to older age and gender. Women are more likely than men to have a chronic condition and more likely to have more than one chronic condition.1 In general, medication usage among women increases with age. Seventy-two percent of women ages 50-64 take at least one medication regularly compared with only 42% of women ages 18-49.1 This greater risk of health issues, combined with lack of economic opportunity that forces women to pay out of pocket, pressures many aging women to forgo healthcare altogether. Or worse, to choose between paying for healthcare or utility bills.  So, what can health leaders do to address the increased health risks among the rising number of senior women in their populations? One way is to educate care teams to be aware of the full set of challenges that aging women face. Raising such awareness removes blind spots, making way for screening and history-taking that can lead to the provision of supportive services. Collecting data on race, ethnicity, language, gender and other factors specific to this population that affect health equity can help, especially when it comes to chronic conditions that impact the fulfillment of the quintuple aim. To earn their trust, health professionals must gain an understanding of what is important to elderly women and how they prefer to connect. For these women, bearing in mind the cornerstones of patient experience is essential. They want providers to get to know them, and they desire empathy, compassion, and a simple, warm and welcoming approach.  Increasing a health workforce’s competence for understanding each community and culture they care for can make a significant difference in outcomes for elderly women.  Involving elderly female patients through a patient advisory council is another method for gaining powerful ideas for improving patient experience and other measures of quality care. Doing so will aid in designing quality care programs that include cultural, social and caregiver support.  Care coordination is another key aspect of connecting the dots across the health system, so that older women don’t fall off the radar in terms of quality care. Care coordination can start with the primary care provider, a mental health specialist, subspecialists, and especially a hospital care team if an individual ends up in the hospital. Taking advantage of digital health tools may allow for facilitation and access to care for patients.  Providers, health plans and government leaders can invest in reducing social determinants of health and improving health equity as a true component of a clinical model of care excellence. Recognizing the impacts that economic insecurity, race and culture preferences have on outcomes for elderly women is vital. Identifying ways to streamline access to social services and benefits is beneficial for elderly women. In addition, expanding access to Medicaid and the benefits of Medicare coverage can ensure that lower-income women who are not currently eligible for Medicaid can access care. This entails including coverage for oral health, vision and hearing, which help to eliminate high out-of-pocket medical expenses. Women — and particularly minorities — are more likely to be in the low-income bracket and unable to access these services.1  Advocating for expansion of other federal and state benefits — such as Social Security, Supplemental Security Income, the Supplemental Nutrition Assistance Program, refundable tax credits, and housing assistance programs for low-income, older adults — would also free up critical financial resources, providing some alleviation for ‘heat, treat or eat’ decision making.  Working with family or community organizations, such as churches or centers for aging, can also be supportive in addressing health needs. Helping older women make social connections to the community through friends, family and even pets are ways in which leaders may bring innovation to the existing clinical care model in support of health and wellbeing. Healthcare Effectiveness Data and Information Set (HEDIS) measures and Medicare Star outcome metrics help in assessing the effectiveness of healthcare interventions in closing quality care gaps, covering the level of support the patient and member received related to medication adherence, cardiovascular care, diabetes and renal care, and 30-day readmission rates.   Sharpening a focus on the needs of older women — our mothers, aunts, grandmothers and neighbors — will help them access the high-quality care they need to thrive at every age.  Sources: <ol><li>National Women’s Law Center. Supporting the Economic Security and Health of Older Women of Color. Sept. 29, 2021. Accessed August 2022. https://nwlc.org/resource/supporting-the-economic-security-and-health-of-older-women-of-color/. </li><li>Social Security Administration Annual Statistical Supplement, 2020, accessed August 2022. https://www.ssa.gov/policy/docs/statcomps/supplement/2020/5a.html.</li></ol>

Supporting older women facing increased health risks: Considerations for health leaders supporting senior women as they age

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