Moving Healthcare Forward Means Looking Back

Ashley Kent (00:00): Hello, I am Ashley Kent with Growth DX, joined today by Jenn Kerfoot, president and COO of Duos, and someone who has spent her career deep inside Medicare Advantage, value-based care, benefits, policy, and member experience. in fact, Jenn and I actually met on a boat in Miami at a rides conference about

Jenn Kerfoot (00:22): Yes, that so long ago.

Ashley Kent (00:25): so long ago. I'm like,

Ashley Kent (00:26): Was it two, three, four years ago? I don't even know what this

Jenn Kerfoot (00:28): Yeah, it

Jenn Kerfoot (00:28): was definitely before I was at Duo, so it's over, it's like, this is probably like maybe four years ago, about plus or minus, Farmbox RX, yeah.

Ashley Kent (00:34): Were you what was it? Farm box? Farmbo

Ashley Kent (00:37): yeah. You were at Farm Box. that was truly one of the most fun brand activations I've ever done with one of our clients. It was hilarious. We were we were looking at budgets and of booths

Jenn Kerfoot (00:41): Yeah, it was something. Definitely. Yeah.

Ashley Kent (00:46): and all this, and then you know, the idea got thrown. I was like, Well, we're in Miami. What if we got a boat? So we had the whole thing, forget

Jenn Kerfoot (00:51): Right?

Ashley Kent (00:51): a booth, we got a boat. and so

Jenn Kerfoot (00:53): It was

Jenn Kerfoot (00:53): definitely fun.

Ashley Kent (00:54): Yeah, we got trapped on a boat together for two hours. and then here we are on a podcast

Jenn Kerfoot (00:56): Super great. Here we are.

Ashley Kent (01:00): together three, four years later in completely

Jenn Kerfoot (01:02): Right?

Ashley Kent (01:02): different roles. So there you go. Excited to have you.

Jenn Kerfoot (01:06): Thank you so much for having me.

Ashley Kent (01:07): Well, would love for you to kick us off by just bringing us up to speed, even bring me up to speed on what you've been up to over the last few years and specifically within your role now. as we

Jenn Kerfoot (01:18): Yeah.

Ashley Kent (01:19): tee ourselves up headed into our discussion.

Jenn Kerfoot (01:21): Definitely. Well, since you saw me last, have moved like three cities. So I think when you met me, I was in Nashville, went from Nashville to Denver, Colorado, and now I'm in Chicago, Illinois. So I've been moving a lot, but, you know, all good things getting engaged and getting married in twenty twenty eight. Like I was telling you earlier before we got on. But, you know, when you met me, I was at Farmbox Rx after leaving Farmbox Rx. I joined a company called Duos.

Jenn Kerfoot (01:47): where today I am the president and COO. you know, for the entirety of my career, I've really sat at the intersection between, you know, health plans, you know, how do we serve their members and really looking at overall, how do we improve health outcomes and deliver on the promise of value-based care, but also working with, you know, solution partners to, you know, bring innovation and technology as well as, you know, better kind of orchestrated coordination.

Jenn Kerfoot (02:14): for health plans and their members. And so like, I'm really passionate about the work that we're doing at Duo's and what we've been building over the last three and a half years, which is wild to me because it feels like just yesterday was my first day here. It's kind of the relativity of time, I like to say. But, know, at our core, we're an AI-powered member experience and performance platform that really solves what I like to call the healthcare's final mile problem.

Jenn Kerfoot (02:40): So like ensuring members don't just learn about their benefits or learn or, you know, become aware that they need to get appointment, but really ensuring that in the end, they're kind of ushered through the various different steps in that care coordination and delivery journey, and also breaking down barriers to care and getting access to care. And so what we do at Duo is

Jenn Kerfoot (03:03): is guide these Medicare Advantage members through high value actions that directly impact plan performance. So things like helping them retain coverage through Medicaid determination, which I know is a big hot button topic coming out of HR1, the One Big Beautiful Bill Act, but also helping members schedule annual wellness visits and connecting them to in-network providers and looking at how can we leverage AI and technology to one...

Jenn Kerfoot (03:28): know, create a better member experience, but also inform our teams

Ashley Kent (03:31): Yeah.

Jenn Kerfoot (03:32): and our data in the reporting that we're delivering back to our health plan partners.

Ashley Kent (03:36): I mean, you guys tackling just one of the largest gaps

Ashley Kent (03:39): that are happening within here and I mean and especially with your background and experience, you know, I think that

Ashley Kent (03:45): Even just over the last three years, the landscape of what it's looked like to work with a health plan and to sell into a health plan has just dramatically evolved. and then with the big beautiful bill, there's so many new things that have been coming up that are just redistributing priorities, where people are investing. And you know, from the, you know, service provider perspective who's trying to work with the health plans, I mean, it is

Jenn Kerfoot (04:04): Absolutely.

Ashley Kent (04:05): the wild, wild west trying to figure out where the priorities are gonna be and who you need to speak to. And then every plan is different too. They're not

Jenn Kerfoot (04:07): Well, definitely. So different.

Ashley Kent (04:12): the same in any way, like your strategy for one can't be the same for the other.

Jenn Kerfoot (04:16): Absolutely.

Ashley Kent (04:17): so you guys y'all have your work cut out for you, but you guys are killing it and solving such an incredible need within the space.

Jenn Kerfoot (04:23): Definitely. I think

Jenn Kerfoot (04:25): like one of the things that is like, you know, not to be cliche, like change is definitely the only constant. I would say amending or building on that statement that it's been a really interesting, you know, three, four, five years to your point that, you know, not every health plan is the same. I will say the one thing that I'm seeing across the entire industry is one, how do we do more with less? And two,

Jenn Kerfoot (04:50): How are we looking at not just solving problems for a star ratings department or risk adjustment department, or what our product and growth teams are building to launch and market, especially as we march towards AEP, but what is the intersection of the work being done, the communications going out to members, and where are there overlaps in ways that you can have better cross-functional interdepartmental collaboration for initiatives like this? But what's more is like where might

Jenn Kerfoot (05:19): we have with those handshakes and handoffs, kind of some seams and chasms where we're actually missing a significant part of the member experience in the journey where we might have an opportunity to address some problems as a plan. I think it's a, know, diamonds are made under pressure. So I think we're, you it's going to be a real sparkly year hopefully, but it definitely is a tumultuous landscape that I think that even health plans are trying to grapple with, you know, as we look at October.

Jenn Kerfoot (05:45): and getting the new star ratings with all the lawsuits, what is gonna be the future of the program and how are plans supposed to make a strategic three, four, five year plan when the rule book or kind of that goalpost seemingly feels like it's getting moved.

Ashley Kent (06:01): Yeah. Well, I actually just had a conversation with someone the other week and we talked about do you let policy dictate your growth strategy and,

Jenn Kerfoot (06:08): Mm.

Ashley Kent (06:08): her answer was so great of kind of like what do you latch on to and it's like what are the policies that have stood this test of time? And we'll continue to and it actually kind of brings us to a really good point that you brought up here

Ashley Kent (06:20): about how healthcare can tend to forget its own history. and it can continue to evolve. And you know, we've taken ideas that we've tried 20 years ago and we we might rebrand them, give them a new name, better technology, slap a new label on them, call them innovation, but somehow we seem to continue to make the same mistakes over and over again. And exactly with what we're saying, it just seems super relevant right now as we're making really big decisions around this next era of what

Ashley Kent (06:47): healthcare looks like and specifically in your world within the payer landscape. I'm curious, you know, with that framing in mind, what should we be doing as we move forward? And how should we think about this little bit differently?

Jenn Kerfoot (06:58): I think that's a loaded question. think like one, you know, I go back to the beginning of my career and like one of the reasons why I think I've been able to be so successful in my career is because at the beginning of it, I had a lot of really great mentors and leaders within the value-based care community that really invested in me understanding foundationally where the program started so that I could understand how it's ended up where we are now.

Jenn Kerfoot (07:25): and I think first and foremost, you can't go to school. You can go to school and get a degree in healthcare administration or, obviously doctors go to medical school and then they then become medical directors. But it, you know, you can go to school to get that the technical understanding and knowledge of like maybe one kind of vein or vertical of the discipline of like, is broadly value based care, but you can't go to school and no one goes to school or says, when I grew up, I want to work at a Medicare Advantage health.

Jenn Kerfoot (07:54): Like if there's someone out there, one of your listeners that has said that genuinely, I would like to meet them. But everyone ends up here in an interesting, you know, random or unrandom chain of events. And so like, you know, some folks I've talked to, like I started my career in a call center and then I understood how it worked at that level. And then I got promoted and I kept moving up and expanding kind of where I went within that health plan. Some folks come from, you know, financial sector.

Jenn Kerfoot (08:20): private equity, technology, what have you. And then they bring that, contextual experience and then they learn kind of how to run a health plan on top of that. And so I think it's important to start kind of and understand the beginning of the program and how we get to where we are today. And so, for example, my mom's a history teacher. And so to make her proud, I always like to say, you know, we want to go back to 1965 where Lyndon B. Johnson signs, what I believe is one of the most

Jenn Kerfoot (08:48): consequential promises to the American public that has ever been made. which is Medicare says really grow old with dignity and Medicaid says poverty shouldn't be a death sentence. And then every step that iterates on that, we end up having, that was the Social Security Act and amendments. And then you get to what's called TEFRA and then Balanced Budget Act (BBA) and Medicare Modernization Act, which was in 2003. And then of course the Affordable Care Act, which we get under the Obama administration in 2010.

Jenn Kerfoot (09:16): in the Bipartisan Budget Act in 2018 and then now HR1. So knowing kind of each program builds on top of the other, kind of in a plus or minus way, it's take a little bit of this out, you know, add something on there, but it's important to know why something exists. You know, CMS doesn't ever do it, anything for their own health and just cause they felt like it. And that was the vibe that day. So I think by knowing that programmatic history, even if you don't know the technical nuance of, you know,

Jenn Kerfoot (09:45): What was the difference? When did we transition from like RAPS to EDPs? Like, you you understand the why and that contextualizes how to ask better informed questions to your broader leadership team or your colleagues or your peers, no matter what organization you're

Ashley Kent (10:00): I'm curious with the just, you know, stepping stones over time that have been building do you feel this is personal perspective as well, but do you feel like we are actually truly building towards what we were, you know, setting out to do Or have we kind of is it taking two steps forward, few steps back, loaded question, but

Jenn Kerfoot (10:17): It is a

Jenn Kerfoot (10:17): loaded question, but I think, you know, let's go back in the way back to 1965. folks were not living as long as they are now. So we think about it in 1965, the average age of an individual on the program versus, you know, as recent as, you know, the other day when I was curious, like, you know, what's the oldest member that we serve at Duos? They're 103 years old. Folks weren't living to 103. Very few people were living to 103, very few centurions.

Jenn Kerfoot (10:44): in 1965. And one of my favorite things is that, you know, President Johnson kind of predicted this when he signed that bill, which was like, we're going to face the new challenge next of what are we going to do within our economy to adjust ourselves to a lifespan in a work span where the average man or woman is 100 years old. And I'm paraphrasing a little, but he actually put that in there when he signed it initially saying like, we probably want to solve for this later, friends, because

Jenn Kerfoot (11:09): You know, it's what comes next that matter. It's not just, you know, when you sign the bill, it's, know, it was never supposed to be a static thing. We were always supposed to, you know, learn, grow, innovate and build a more efficient, you know, program. And at Duos, I talk a lot to our team members and tell them, you know, we're the architects of what we get to inherit. every time you get a paycheck, you look at the lines, you got social security and got Medicare coming out of it.

Jenn Kerfoot (11:34): And it's not going into an invisible bank account for you and I, it's funding the people on the program now. And so with less workers, and obviously if we look at and chart the birth rate in this country right now, we're gonna have to be solving some complex problems of how we can optimize and make the system more efficient so that when you and I age into the program, there's a dollar left for us. Otherwise, we're in big trouble when we get to that day.

Ashley Kent (12:01): I think that's something that thinking that many steps ahead there's just so much to even just grapple with with what's happening today. and how do you solve for those? And I'm I'm I'm curious too with with DOUS specifically, you guys span so many different areas in

Jenn Kerfoot (12:13): Mm-hmm.

Ashley Kent (12:14): helping bridge a lot of these gaps. How do you guys balance that of, you know, how for

Ashley Kent (12:18): thinking, are you guys working versus, you know, solving the problem in hand right now? 'Cause you

Jenn Kerfoot (12:23): Yeah.

Ashley Kent (12:23): know, there's a lot of things on fire today. and those that'll be on fire in a few years.

Jenn Kerfoot (12:29): You know, I tell our team a lot, like, you know, you don't have to always, you know, build and solve and staff for a fire brigade if you're putting in a good sprinkler system. So one of the good things and why I really like working in government programs in general is we get a little bit of, for the most part, you know, a notice.

Jenn Kerfoot (12:47): of when something's gonna happen. That's the Administrative Procedures Act. CMS, before they change something about the program, it has to go through notice and comment period. And if they don't and they violate the Administrative Procedures Act, that's when we start seeing some of these lawsuits happen. But when we're looking at what are we doing now with our products in market? What are we doing in terms of providing value to our clients? There comes a conversation of, okay, do we continue?

Jenn Kerfoot (13:14): adding on net new products or do we continue kind of expanding and growing and enhancing the products that we have? And one of the first things that we do and what I own within my role is that commercialization function and also looking at net new product development. So the first thing I'm always doing is I'm hitting the books. I know everyone loves AI, but let me tell you, Claude, Gemini, GPT, all of them still can't tell me what measurement year I'm in. So I feel good for job security on that front. AI is not taking my job at least today, but I always go and read.

Jenn Kerfoot (13:41): you know, every time we get an advance notice, every time we get, you know, the final rule, et cetera. I'm reading that because CMS is giving us clues to what they might be thinking about in the future. When CMS, and I encourage everyone listening, if CMS says we are soliciting feedback for, you know, we're relevant, don't just, you know, come and say, like, I don't like you. I don't know why it's like this, you know. But like, actually, like, give them feedback because they're in, I believe, earnestly trying to figure out is this something we should do? You know, how much upheaval will this cause?

Jenn Kerfoot (14:08): know, comparatively to the benefit that we believe that it will generate. And so like one of the things that we do at Duos is we look at that and say, okay, well, what might be coming, you know, down the hill and hitting health plans so that we can proactively start building towards that to offer to plans on the day it, you know, arrives at their doorstep and is codified by CMS. And I think, you know, not all things always go through and get codified by CMS, but I will say, knock on wood.

Jenn Kerfoot (14:35): We've been pretty spot on and at reading those tea leaves. So it's a little bit of our little bit of science and also just, you know knowing kind of the rate and pace at which this industry will move because you know, again understanding the history of the program like obviously if CMS put out tomorrow like we are soliciting feedback on completely redesigning the entire program I'd be like, yeah, let's not not build new product for that because it's probably gonna be enough

Ashley Kent (15:01): Mm-hmm.

Jenn Kerfoot (15:01): But when CMS says, we are looking to change the way that SSBCI benefits are going to be not only adjudicated, but the requirements for plans on how they'll be reporting this data to come back. I'm looking at MedPAC, I'm looking at kind of BMA, I'm looking at the various different lobbyist publications, as well as overall kind of what CMS has said over the last, four or five years about that program. And saying, is this something that I think that's gonna kind of go cross the line and get codified? And the answer is yes. And so then we started actually

Jenn Kerfoot (15:31): two years in advance iterating on that program and that product so that when final rule came out, which would go live for 2027, I get to proactively tell our teams, go tell our clients, we have a nice new shiny tool for them, as opposed to waiting for our clients to ask us, hey, this thing is here, do you have anything for us? So it's kind of like a nice

Ashley Kent (15:49): Mm-hmm.

Jenn Kerfoot (15:49): little symbiotic relationship that takes it from being like a vendor to more of like a solutioning partner with the plans.

Ashley Kent (15:56): I mean you've got this superpower. I think it this is a good tip for anyone. Go follow you

Jenn Kerfoot (16:00): Yeah.

Ashley Kent (16:01): to see where you're thinking and where things are headed. because you're thinking about ten steps ahead everyone else. I'm gonna move us into, you know, you brought up AI, our jobs are secure, you know, all those different things, but you know, this is just the era, I mean everyone is slapping AI.

Ashley Kent (16:18): We the whole reason everyone says they get into healthcare is to fix a broken system. And so I'm curious too, from that perspective, you know, if we are throwing AI, we're accelerating something that is actually inherently broken at the core, are we actually fixing something or are we just at risk of making a bad process happen faster?

Jenn Kerfoot (16:39): think it's just one first grounding ourselves in what does efficiency look like? What is a good versus a bad process of doing things to answer that question first and define that clearly within the organization of is it financially good for the overall business? I would say also in addition, and this isn't ranked in any way, but things that I consider in that is does this provide a tangible good for members and not just kind of like, you know.

Jenn Kerfoot (17:07): a coat of paint or some marketing, you know, buzzword to tell members about. Also, is it overall improving health outcomes, which is at its core the promise of value based carry that will save the overall federal government money comparatively to the fee for service program. And once you kind of get kind of those dimensions of how that two by two, four by four matrix of how you're kind of thinking about, then you can start thinking about the time to value and kind of internal like upheaval, I call it like the.

Jenn Kerfoot (17:35): you're going to do a new software, a new process. Or like, for example, I told our IT team one year, I'm going to change their ticketing system. And you would have thought I told them that Santa didn't exist. like knowing like, is the, what is the tangible value this will provide relative to kind of the work and you know, maybe the consternation that it will create, how much dust you'll kick up. And then also thinking about, we have, you know, ethical and you know, compliant guardrails built around that?

Jenn Kerfoot (18:01): AI process that will ensure that we're not kind of staring off into the wrong direction. So favorite quote of all time, know, Jurassic Park, everyone thought if they could, they never thought if they should. So making sure you have like, you know, that little bit of a pause when you're thinking about something like that to say, like, let's pause and make sure that who are we serving? Are we leaving anyone out? Are, you know, there's a difference between intuition and a difference between bias and making sure we're not confusing the two.

Jenn Kerfoot (18:28): And I think those are really important considerations when determining, you know, how do you sequence adding on efficiency without to your point of just, you know, increasing the time to time horizon where you're executing, getting from point A to point Z of a bad process.

Ashley Kent (18:44): Mm. I saw it happen so much. I mean, like when V twenty eight was coming out and you saw all of these risk adjustment tools that were popping up and, you know, really it was just getting into gamification of the system that was in there when, you know, ultimately I I get what they were doing with V twenty eight to try and get a w around that, but you know, it was just something that how do you when your value based care is here for the reason of what you stated in, you know

Ashley Kent (19:06): somehow in healthcare we find a way to game our way around the legislation that's in place and, you know, I think that also

Jenn Kerfoot (19:13): Hmm.

Ashley Kent (19:13): too from what you were saying as well, it

Ashley Kent (19:16): It's where the payers are also going mentally. They're not looking for the point solutions that are just gonna be, you know, trying to

Jenn Kerfoot (19:20): Mm-hmm.

Ashley Kent (19:21): solve one specific problem. They're looking for a holistic solution that is within there. And when you go back into the could and should, I think that can be a good litmus test for, you know, how do we start to expand beyond just one specific issue to help a broader population and the broader issue at hand

Jenn Kerfoot (19:36): definitely.

Ashley Kent (19:37): of what you're trying to solve versus just this one very specific thing that is timely right now and today and you're

Jenn Kerfoot (19:41): Yeah.

Ashley Kent (19:42): gonna have, you know, longevity in your company.

Jenn Kerfoot (19:44): Definitely. I think like, you know, if we look back to COVID, think, you know, COVID was a really interesting moment if we, and myself included, it's really hard to pause in where you are right now and be kind of introspective and look backwards in time. Cause you're moving everything in, you know, innovative innovation, know, technology, everything says forward momentum. Don't look backward. We're not going that way. But it's, so it's hard, especially at the executive level to pause and say like, like, like let's take a beat and think backward, but like,

Jenn Kerfoot (20:13): For your listeners, COVID's an interesting time that I like to use when talking to health plans. It's unprecedented. So I was at a health plan at the time. We've never experienced a global pandemic before. Everyone's kind of learning as we go, but health plans, and I can use my own experience on a dime, from one day to another. I stayed at the office that night. I slept in my office chair. We stood up, a telehealth program.

Jenn Kerfoot (20:37): We figured out all the providers we needed to call to ensure we could keep members at home. Like, you know, as a country, we did, you know, just, we were able to turn the ship that moves typically very slowly, very, very quickly. So I'm like, so don't tell me it can never get done. There was a urgency and a forcing factor that facilitated for that, you know, that really speedy turn. But I think looking back at, you know, the period of COVID and, you know, the things that we learned, I think it's important to like, you know,

Jenn Kerfoot (21:06): tease out, you know, why were we able to make those decisions and like break it down to like, what is the risk? And it made it very clear for us, you know, it was a no brainer, you know, ECMO, you know, that was the number one fear of a lot of our providers. it, you know, it's hundreds of thousand dollars just to have an ECMO team. It's very, very expensive. There's a lot of risk. There's no guarantee with it. And so the sickest of the sick folks, and if you have watched the pit, Robbie's mentor in the pit.

Jenn Kerfoot (21:33): what you see him on all those tubes and machines that is an ECMO machine. You know, we're trying to say and balance out, know, should we get these members and use a lot of these flexibilities CMS gave us to just give them food, give them anything that they possibly need to stay at home and be safe versus how expensive at the worst case scenario ECMO costs. And that was a no brainer for us. And so when you take out all of the noise, like it's always about the smoke versus the fire, we took out all the noise. We were able to make very

Jenn Kerfoot (21:59): clearly aligned decisions that all of us confidently stood behind. was no, you know, the kind of like, you know, interdepartmental, like this initiative is more important than your initiative. There was one initiative. And I think sometimes,

Ashley Kent (22:09): Right.

Jenn Kerfoot (22:11): you know, in our day to day post COVID life, it's like, no, now we're managing costs. Well, how do you manage costs? But also make sure that's not hurting you on your access to care or then hurts you on your star ratings that accounts for really, you know.

Jenn Kerfoot (22:24): in a lot of, I think I saw a recent report saying the only way for profitability and to hit the shareholder expectations is around star ratings. Okay, well, if we're talking about utilization and all this other stuff against star ratings, okay, well, which one wins? I sometimes ask, well, who's the bigger bear? Who's deciding this? Because now neither of you are making a decision and that you end up being kind of like a Solomon's baby situation. Where's the real mom? And we were able to do that during COVID. There was no question

Ashley Kent (22:51): Mm-hmm.

Jenn Kerfoot (22:51): in anybody's mind and

Jenn Kerfoot (22:53): folks that I would passionately disagree with in the office, we had no disagreement in that moment. We knew what we needed to do and everyone went off and did it. And so sometimes you gotta, you know, kind of go backwards to move forward.

Ashley Kent (23:07): I mean it goes all the way back to our original, you know, discussion of what we're talking about, forgetting our own history. I mean, this is just six years ago and you know, some

Jenn Kerfoot (23:14): Yeah, it's wild.

Ashley Kent (23:16): and with that though, it's amazing how quickly we fall back into the same patterns that we had.

Jenn Kerfoot (23:21): Mmm.

Ashley Kent (23:21): Prior to COVID, and start to find,

Jenn Kerfoot (23:23): Definitely.

Ashley Kent (23:23): you know, like it starts slowing down back again. And you know, when you didn't have that urgency, you come back into comfortability and you know, you start moving at that slower pace and back to how things are done. And, you know, why are we not learning? And or have you have you seen where people have taken, you know, that level of agility that we had in healthcare at the time and translated it to how, you know, specifically health plans, I mean, they're so known for moving

Jenn Kerfoot (23:45): Mm.

Ashley Kent (23:46): so slow when it comes to innovation. And so have you seen them take any of

Ashley Kent (23:50): those qualities of how they were within COVID or have we gotten comfortable again and, you know, gotten back to all right, well, you know, let's argue this side, this side, we're gonna take eighteen months to figure

Jenn Kerfoot (24:01): Yeah,

Ashley Kent (24:01): out what's next.

Jenn Kerfoot (24:02): I would say no. I'm trying to think like I'm indexing it in my head. I would say no. And I would say like we get a couple of things coming out of COVID. Like one, COVID occurs, we also in that time period, shortly after year one and two, I'd have to look up the exact number. We cross what I call the tipping point. know, Medicare Advantage now accounts for over 50 % of all Medicare beneficiaries. So we, the question is like, you know, was the Medicare...

Jenn Kerfoot (24:26): advantage program designed to house this many people. So that's the question. Are we getting too big for the, know, the, you know, the ranch style house and maybe we need to add on another floor. That's one question. So you had that, that makes it compound. The other thing is, you know, we have a lot of money for lack of a better term rain from the sky for a lot of plans to make sure members can be safe, stay at home and, know, not die during COVID. You know, I say to folks a lot, you know,

Jenn Kerfoot (24:53): The only thing worse than not hitting four stars is losing four stars. The same is true for kind of money when it comes from the federal government. You know, it was never the expectation outright that this money would keep flowing, you know, post pandemic. But when the spigot gets turned off, it's a little like, ooh,

Ashley Kent (25:09): Yeah.

Jenn Kerfoot (25:10): like, oof, like that was that was hard. That's a hard pill to swallow. So I think you compound with that with, you know, everything else I've said in addition to V24 to V28 star changes.

Jenn Kerfoot (25:22): the Inflation Reduction Act, the Part D redesign. So then you like, and I think so like saying, have plans taken and adopted some of that framework like they did in COVID to today? I would say no, but also they have a bunch of compounding external forces kind of putting that downward pressure on them. But also I think it's hard to be intentional in thinking about what worked well during this time period and how can we take that and scale it.

Jenn Kerfoot (25:50): for when we're not in a pandemic and be that intentional. Like I think intentionality is sometimes predicated around a situation that drives that urgency and that relevance.

Ashley Kent (25:59): Super interesting. I mean, you know, maybe we will start learning from our mistakes, maybe we will start, you know, evolving over time. But it takes innovators like yourself and you know, and partners to the health plans as well, to be able to get to that point. And w which brings me to another question that I've

Ashley Kent (26:16): been thinking about and as I I'm watching health plans and I'm looking at how they're investing in you know innovative solutions. So whether it's you know an enterprise investment that they're making in a company or they're actually you know working with them through an enterprise contract or they're building it out in-house. I'm curious from the payer side, how do you think about those things when it comes to investing in innovation? and the different strategies behind that.

Jenn Kerfoot (26:39): Yeah,

Jenn Kerfoot (26:41): I think, you know, one, you want to have, and this is true for health plans, this is true for if you're running a medical group, IPA, a technology solution, et cetera, which is you want to know what your North Star is as a plan. Underneath that, that North Star should guide all of your departmental goals that ladder up underneath it in your individual directives for, you know, your directly responsible individuals. Now,

Jenn Kerfoot (27:04): When I think about how I would and how I have evaluated solutions at a plan, is I first think about, am I in a growth year or I'm not in a growth year? Because the answer is in the name, it's called managed care. If you can't manage the care, you probably shouldn't be in that service area and I don't wanna grow in that area. I wanna be growing in certain areas. think it's strategic growth is what underpins all of this. no, more so what this entire system is predicated on is retention.

Jenn Kerfoot (27:28): And so like first and foremost, I'm thinking like, I don't want to add like a testing learn and use my members as a guinea pigs, essentially like their returns. If I don't think I'm going to be there later. And that's the Jenn kind of philosophy because I think, you know, members, I might know that is a benefit that I put in my bid. And if I change something, I can only change it so much. I'm not allowed to have these massive changes year over year. And if I do make those iterative changes to my benefits, I have to put it in my annual notice of change.

Jenn Kerfoot (27:56): Members don't read that a lot of times. So, and the member doesn't know that that's the process. So when, you know, they, as a member get anything from their health plan, for cost or not for cost, you know, if you take it away, they're like, hey, why'd you take that away from me? And there's a host of reasons why that might've happened. We don't, as an industry, always, you know, transparently communicate that to members, but I don't want to, you know, cause abrasion by, you know, testing something and then...

Jenn Kerfoot (28:22): pulling the rug back. So I want to make sure I am making an informed decision that's not built on a short horizon. The other thing I think I look at is, you never can really look at longitudinally, at least like in its truest sense with a Medicare Advantage population, because every single year they get the opportunity to leave you, which is why I think, you know, when we look at the studies around VBID, the program, the design itself, it iterated on a handful of times.

Jenn Kerfoot (28:47): but also like members were moving in and out of plans. And so I always, you know, would say to CMS like, well, if this was a, you an actual, like if I was in college setting up a case and study design, this probably wouldn't have gotten me an A, but I said it a lot nicer than that, but that was what I said in summary. But I think like, you know, thinking about like really being willing and having the patience to wait, because when you are testing something with a population, you're not going to see an ROI in year one. Full stop. Why?

Jenn Kerfoot (29:16): because if it's for stars, I'm in measurement year 26, 27 caps, gives me my 28 stars and then my 29 payment year. So it's a long time horizon for stars. If I'm looking at risk adjustment lens, I'm thinking, okay, well, if I can get the member in and accurately and timely risk adjusted before June 30th, that sets my initial payment as long as the member stays with my plan. So like, I think that like, if you're expecting for like testing innovation and having like eight.

Jenn Kerfoot (29:45): boom, one year, six months, three months ROI, you're not going to have that. So you probably shouldn't even be entertaining the conversation because you don't have the appetite to launch it. And it's actually going to kind of salt the earth ahead when you want to actually do it. And you are in a place to do it because someone's going to say, well, you tried it that one time and it didn't work out and you really decided to scrap the whole thing. So making sure that there's like, you know, a reason and a season, I'd say. The other thing that I would say is making sure that

Jenn Kerfoot (30:13): you're evaluating innovation from not just a cost perspective, but also from the ROI ratio or multiplier perspective, but also from is it significant? sometimes payers actually do the inverse of that. They say, I'm looking for statistical significance. Does it have a P value that's less than zero? For what? But my out of the box comment to that is usually, you

Jenn Kerfoot (30:37): It is statistically significant that if I give people a hundred dollar bills on the corner of my block, they're going to give me a high five. That does not mean that generates an ROI. Ideally you want to have both. And where I see a lot and I've actually sat in on purchasing committees at a plan and also advising plans where they're like, first, let's look at their pricing. And I usually push back and say, we should talk about value. Is every person in this room aligned on the value that it must provide us, how we are going to measure it? And that's one of the things that

Jenn Kerfoot (31:05): you know, I lead at Duos and we're very, very much value focused, not pricing focused, because once you have value alignment, then pricing is a byproduct of that exercise because you want to make sure you square your pricing to your value. When we start talking specifically about, want your best and final offer and I want you exactly at this price. Well, then I'm negotiating outcomes based on essentially how expensive are that solution partner, that innovation partners cogs. and, that's, that's

Jenn Kerfoot (31:33): not what you're solving for in value-based care, you're solving for outcomes,

Jenn Kerfoot (48:31): Thank