Video
Watch: Caring for clinicians
NEJM Catalyst and Dr. Conway discuss reducing burnout.
Caring for clinicians
Edward Prewitt, MPP, with Patrick Conway, MD, Chief Executive Officer for Care Solutions at Optum
Speaker 1:
We are here today to talk about how Optum works on wellness. And I’m very pleased to be here with Patrick Conway, CEO of care solutions at Optum. Patrick, as a practicing pediatrician yourself, and as a leader with oversight of tens of thousands of physicians and other clinicians, how do you view the problem of burnout?
Speaker 2:
We at Optum are thinking about burnout in the following ways. How do we remove stress from the environment? How do we support our physicians and other clinicians? All in, at Optum, our burnout rates are about 10% lower than average, but they’re still way too high. So we’re actively working on that. Let me share a story from my residency. It was before work hours. So, I did Q3 call in the pediatric ICU. I had more than 10 patients die during that month. Actually, driving home one day, I fell asleep, ran into a tree, totaled my car. Luckily, I walked away from the accident. When I look back on that, I was burnt out, overtired, and almost had a horrible outcome. What we want to prevent in our clinicians is, how do we support them? How do we support their mental health, their well-being? How do we support their work environment so they can be productive and generate the results we want for our patient? Another data point — there’s good evidence when clinicians and physicians are burnt out, the outcomes for patients are worse — both in terms of experience and clinical outcomes. So, we view this as a safety issue, both for our providers, for our clinicians, our physicians, but also for our patients … that we create an environment where you have clinicians that aren't burnt out — are the opposite, hopefully — that are productive, excited members of the team coming to work every day.
Speaker 1:
Well, those are some very good reasons to work on wellness. Let’s talk about the inverse of burnout. What motivates and satisfies clinicians?
Speaker 2:
At the end of the day, for most physicians and clinicians, I think it’s, you know, similar to me and other people you know, you went into medicine because it’s a calling — you wanted to help people. As you mentioned, I still practice. I’ve been a volunteer attending on weekends for free for more than a decade now, which sometimes surprises my residents and medical students. But, I do that because I love it. I love patient care. I love the interaction with the patients and families. I work as a pediatric hospitalist, mainly for kids with multiple chronic conditions who generally get better and get to go home. You know, no matter what your specialty is, you generally went into medicine or nursing or other clinical fields to help people. So, our goal, at the end of the day, is to support them so they can help the patients, the people, the families they serve. And if we support them in that environment, that's what clinicians want to do. Whether it’s a therapist or a physician or a nurse, that’s why they come to work every day. And that's what we're trying to enable.
Speaker 1:
So, “clinicians” covers a lot of different types of licenses — not only physicians. Let's talk about nurses, physical therapists, social workers …
Speaker 2:
Yeah. I'll talk a little bit about that and also weave in a couple stories here. So, on the nurses, if you look at our [PN1] Nava health team, we basically hire a lot of nurses, therapists and others that manage post-acute care. And they come work for us because they wanted a different environment where they got to manage in a full-risk way that manages physical, mental and social needs. And we support them in that — from hospitals to nursing homes, to other environments.
Let me give you a physician example as well — a landmark physician I just went around on a visit with. So, these are physicians who have chosen to take care of patients in their home — physical, mental, social needs. She was a geriatrician, used to work in an office environment, you know, 15-minute or [less] visits. She talked about how that burned her out. And now, she gets to drive around, see a handful of patients a day, take extended time with them meeting their physical, mental, and social needs.
When we walked into a home with her … and this 91-year-old woman gave her a huge hug, said, “This doctor changed my life.” And then as we exit, she talks about how it changed her life as a physician — being able to care for elderly, sick people in their home in a holistic way. So, at the end of the day, that’s what we’re trying to do.
Sorry. I’m gonna share one more story if it’s all right, because I’m going to meet with this team tomorrow. You may not know this, but Optum now has almost 6,000 psychiatrists, social workers, therapists, in mental and behavioral health. So I’m gonna meet with that team tomorrow. They talk a lot about how COVID and its aftermath — and this started before COVID … but it exacerbated it — that they just can’t keep up. The mental health need is just overwhelming. So, how do we support them? How do we support them in that journey? How do we not overschedule them? How do we make sure they have time to take care of themselves so they can take care of patients as a licensed therapist as well? So, hopefully those mixture of stories and data helps.
Speaker 1:
Yeah. This is something we’ve been hearing about and publishing about quite a bit at NEJM Catalyst and is a real theme of today’s show, you know — a comprehensive approach to mental health at health systems, not only for patients, but also for the clinicians. So, let’s talk about, tactically, some key ways to support physicians and all clinicians.
Speaker 2:
Yeah. So, I’ll call out three, and we can probably dive deeper in each of these. I think one is administrative burden and complexity, and we should talk a little bit more about that. Two, I’d say, the clinical workflow and, particularly, the electronic health record. But, overall clinical workflow, we think about a lot. And then lastly, what you started to touch on: We’d love to talk more with you about mental health and well-being and how we support that and clinicians.
Speaker 1:
Well, let’s talk about each of those in turn. First, reducing administrative burden and complexity, which, with NEJM Catalyst research reports, we’ve been hearing about this for years.
Speaker 2:
Yeah, yeah, yeah. So, let me tell you a few things we do. We are often managing patients in a risk-based environment. So, we’ve taken a percent of premium from the payer, whether it’s UnitedHealthcare or another payer. That often allows us to eliminate prior authorization, meaning, now that we’re providing full care and you’ve taken that risk from the payer, the payer turns off prior authorization. I did that, by the way, when I was CEO of Blue Cross, North Carolina as well — so, I’ve seen this from different sides of the equation. Eliminating prior auth is a major reduction of administrative burden. When you can’t eliminate prior authorization, how do you make it easier? So if you want an image, how do you make it easier? How do you make it electronic? How do you have not endless phone calls or other things?
The other aspect that I would talk about that we do is really decision support, which we’ll probably talk more about in the electronic health record, but if you’re making referrals into specialty care, how do we make that easy? If you have questions about diabetes, renal, mental and behavioral health, how do we answer your questions within the clinical workflow or easily connect you and your patient to who they need? So, once again, you don’t have yourself or back office staff sort of constantly trying to find in-home care or specialty care. So, that’s a few examples in the administrative areas.
Speaker 1:
So, you mentioned the EHR — it’s both burden and it’s also care delivery process, as you mentioned. And how are you making delivering care easier, including the EHR?
Speaker 2:
Yeah, this is major. So, I mentioned I still practice. I will tell you the biggest challenge in every new hospital I go to is the electronic health record and learning it. You know, if you've seen one instance, you've seen one instance. So, I feel this acutely in my own practice. We're trying to do a few things. I think one is, across our care system — which, as you said is tens of thousands clinicians — how do we, as much as possible, have an interoperable electronic health record environment? So, we try to track Mrs. Jones or whoever the patient is across time and space. So that clinician has the information they need at the point of care. We're not perfect on that, but we get better each and every day. So they know, you know, how Mrs. Jones was cared for in our clinics and our ambulatory surgical centers, maybe by therapists and all that information is connected or, and by the payer. The other thing, just to dive a little deeper on decision support — we've invested a lot in artificial intelligence, advanced data analytics, et cetera, so that we are able to analyze data and easily get the clinician the right information at the point of care, point of care assist within their workflow.
Once again, the physician, the clinician is driving the clinical decisions, but how do you get that information at their fingertips in an easy way? How do you create defaults that help them in their care delivery? Same in in-home care — we’ve got a home-built electronic health record that we use for all our risk-based care in the home. But it’s tailor-made to really support, for example, an elderly geriatric, often dual eligible population where things like social determinants and addressing those is a key part of the electronic health record.
Speaker 1:
Very good. So let’s talk about mental health and well-being. We touched on it before. How does Optum work on those?
Speaker 2:
Yeah. In a number of ways. I’ll start, you know, I’ve experienced — like many people — the mental health system as a person, as a family member and as a practicing physician. We have to do better. Like many clinicians, every weekend I work in the hospital, I’ll have, usually adolescents in my case, that are sitting in the hospital waiting for effective care. So, we need to fix the care system for everyone. Then, how do you address it for physicians and clinicians? One, I still think we have work to do, to reduce the stigma. So, I purposely try to talk about that, you know, in town halls with our clinicians. I’ll tell you, in one, I said something as simple as, “It’s okay not to be okay. And here’s the resources we have for you.” I can’t tell you how much feedback I got on that — in a positive way. So — reduce the stigma.
Two, make sure they actually have the resources. So, people seek help for depression, for substance use for other things. How do we support them in that? I don’t wanna dive deep on this, in this call, but also I think there’s some things from a policy perspective — I was a policy maker in my former life — that we could do to support physicians and clinicians. I think people still worry about disclosing … and what could be the ramifications of that. So, how do we really support them so they get the help they need? And then, we’re actually actively providing that. I mentioned we have 6,000 behavioral clinicians, so, we’re utilizing our own behavioral clinicians and our network of behavioral clinicians to really get people — whether it’s depression, substance use, other anxiety — how do we get them the help they need? How do we give them time off to get the help they need?
How do we enable telehealth, which we’re seeing huge uptake where, if you’re a busy physician or clinician, you can’t take off from 8 to 5. So, you might see somebody at 7 o’clock at night via telehealth. So how do we enable that? It’s not a single-bullet solution. This is a complex problem that is physicians’ and clinicians’ experience. And actually probably at higher rates than the general population, unfortunately. But how do we support people in their mental health and well-being? Sorry, I’m gonna say one more thing, because I said this recently and people were like, look, this has been a journey for me as well. I now meditate, exercise regularly, sleep more than I used to. I've made personal changes in my life. It made a difference. I'm a healthier, better person for it. You know, there's never out enough hours in the day to do any of our jobs.
We need to give ourselves the time and space to do self-care. I think we're sometimes taught as physicians that it’s bad, it’s selfish. It’s, in fact, not selfish. We need to provide ourselves self-care and our families care, becasue that will enable us to be better physicians, better clinicians — to actually care better for our patients. It’s, in fact, the opposite of selfish. It allows us to be the people we need to be to provide the care that the people we serve need. So that’s the environment, the ecosystem, we’re trying to build for our physicians and clinicians.
Speaker 1:
That’s a great point. Let me end with a two-part question. Yeah. So, you know, as we said at the outset, burnout has been an issue in health care among physicians and nurses for a very long time — clearly a complex endemic problem. It’s not an easy fix. How have you seen things change, particularly over the last couple of years with the pandemic, and how have you seen the responses change over time?
Speaker 2:
I think, yeah. A couple thoughts. That’s a great question. I think, one, you know, COVID. And we saw this in our system, I’m sure others did. People were so focused on delivering care to patients. You know, they stopped providing self-care because it was … there was a huge need, and that’s how physician and clinicians, including our own, responded. And, on many levels, I’m incredibly proud of that. I’m proud of the work we did, as — I’m sure — hospitals, health systems, people across the country are. I think it exacerbated what was an underlying set of mental health, well-being and burnout issues. So, I think our job going forward, which we’re trying to do — and I know others are — how we build a system that really supports people in their everyday life. So they can be as productive, as successful, as holistically healthy as possible.
Once again, same as we do for our patients’ physical, mental and social well-being. We need to provide that same level of care to our physicians and clinicians. You know, I mentioned this, we at Optum are better than average on burnout, you know, standardized burnout measures, but we’re not done. We’ve got a ton of work to do. And I also think the national dialogue has shifted. I will say, when I was a resident, I didn’t get the impression it was okay to talk about these kinds of things, to be honest. Maybe that was just me. But I think that, at that point, it was not something that has the focus it does now. And I think that’s a good thing. The fact that policymakers, payers, providers, doctors, nurses, et cetera, are focused on reducing burnout and supporting mental health and well-being, I think it’s better for our health system, better for the physicians and clinicians, and ultimately, better for the patients we serve.
Speaker 1:
Yeah. A psychiatrist who was publishing an article with any NEJM Catalyst said to me that the COVID 19 pandemic has made mental health issues okay to talk about, as you said. So, Patrick, this has been a great conversation. Thank you for sharing your personal stories as well as these tactics from Optum on how to really work towards wellness.
Speaker 2:
Thanks. Well, I appreciate your time. Thanks for having me.