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https://youtube.com/clip/UgxCoxfiD1Vh7U4b-FJ4AaABCQ

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    WOMAN 1: So we task this design team

    with the challenge of addressing
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    the lack of sufficient diversity
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    in the HSR workforce,
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    which often results in the field

    overlooking crucial research
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    questions and perspectives.

    In the empathize and defined stages of the process,
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    the team gained a deeper understanding of the issue
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    and they defined their challenge, more specifically,
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    as addressing diversity, equity,
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    inclusion, and belonging
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    for populations that have been
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    historically marginalized
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    as a result of gender, gender identity
    gender expression, race, ethnicity,
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    disability status, socioeconomic status,
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    sexual orientation, age, and any other factor
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    that is unrelated to ability.
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    They then brainstormed potential solutions
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    that incorporated levers
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    that came up in their empathy work.
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    So the importance of
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    consistent messages of value,
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    the role of leadership at setting the tone
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    for the culture of an institution,
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    and the need for a holistic approach
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    to address the challenge.
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    For our initial prototypes,
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    we created videos that tell people stories
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    of discrimination and exclusion in their workplaces.
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    We paired these with related data
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    about the composition
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    of the health services research workforce,
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    and we've also adapted questions and resources
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    from various self-assessments,
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    to provide a menu of options
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    for actions that our audience can take next.
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    So since the summer, this team has gone through
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    more than six rounds of prototyping,
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    and they've gained feedback along the way,
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    from researchers, professors, university leadership,
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    funding organization leadership.
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    And the testing feedback has really ranged
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    from input on how best to produce the videos,
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    to big questions about the potential
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    for long-term impact.
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    Our testers have told us
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    that the stories themselves are really
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    powerful statements, they make them question
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    their own capacity to affect change.
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    Other feedback has included mixed opinions
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    on who the right messenger or storyteller is,
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    to make the story most compelling.
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    And we also found that some individuals reported
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    their awareness of this issue in the field overall,
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    but haven't seen it play out
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    in their own workplaces as much.
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    Along the way, the learning community and staff,
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    have reflected on the experience of learning
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    and applying human-centered design.
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    So, one challenge that we have identified as part of
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    this process, has been soliciting people's feedback
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    without reintroducing any trauma that they have
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    experienced related to the challenge.
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    And that's been especially relevant
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    for the team that I just described.
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    Another challenge is due
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    simply to the project structure
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    of relying on volunteers who have busy careers
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    and busy lives, and that is just sustaining momentum.
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    So, because human-centered design is a team sport,
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    it can be difficult to move forward sometimes
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    when gathering people together
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    is not as feasible.
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    At the same time,
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    our learning community members and staff
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    ultimately see the value of human-centered design
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    as the bold approach that we needed
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    to address the complex problems
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    facing the field.
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    So people have said that it takes you
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    out of your comfort zone,
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    and can generate solutions
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    that are sometimes surprising in their creativity.
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    It also democratizes the process by forcing
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    everyone to check their expertise at the door.
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    We often start our design sessions
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    with warm-up exercises
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    that can feel like silly ice breakers
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    or mental games, but these help people focus
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    on the process, instead of people's titles.
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    And that allows fresh ideas
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    to bubble up naturally.
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    Taking a step back,
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    human-centered design
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    can also be a useful tool in our toolkit
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    for health services research
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    and for public health, more broadly.
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    Schools of engineering and schools of business
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    have been quicker
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    to bring human-centered design
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    into their curriculum,
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    but there are now RFPs in our field
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    that calls for these skills.
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    We also know that diverse teams
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    tend to do better than homogeneous teams
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    in solving problems and generating sustainable solutions.
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    And that really brings us back
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    to the importance of humility and empathy
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    for the people we are designing for.
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    We found that humility and empathy
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    is really key to tackling these challenges
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    in a way that improves health care
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    for everyone.
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    So, thank you for listening.
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    That's it from me today.
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    I'm happy to answer any questions.
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    My email address is here,
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    as well as the url
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    to learn more about the paradigm project.
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    You can also sign up on that page,
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    be part of our reactor panel.
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    Which is a group
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    that provides feedback to the project.
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    The email polls and other channels, periodically.
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    Thank you again.
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    WOMAN 2: Thank you, Danielle,
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    for your excellent presentation.
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    So we have about 20 minutes remaining
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    in the session, and we see there are
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    multiple questions.
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    Before we hand it to our co-host
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    Dr. Abigail Silva,
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    we wanted to make sure
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    that we get to questions
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    that actually are for all presenters.
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    If there're multiple questions for one presenter
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    then we kind of hold them back
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    and kind of address each question
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    to each presenter first,
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    and then come back for the remaining questions
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    to the same presenters.
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    So over to you,
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    Abigail.
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    DR ABIGAIL: Sure.
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    We could start with Dr. Tak.
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    How was the unplanned readmission defined?
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    And did you adjust for severity?
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    Dr. Tak.
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    DR TAK: Can you please allow me
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    to share the screen.
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    DR ABIGAIL: Sure.
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    DR TAK: Yeah,
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    Actually, I went over the questions for me
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    and I made a very short Q&A slides.
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    So I would go over them
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    and answer through the questions.
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    So, the first question was
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    whether my data was on
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    national level or state level
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    So, for our study,
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    the initial study population included
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    1 million randomly selected Medicare patients in nation.
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    So this is on national level data
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    rather than state level data.
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    And the second question was,
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    how we defined index admission.
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    So we defined index admission
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    following the instructions of centers
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    for Medicare and Medicaid services.
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    So, index admission
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    is usually the first admission
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    during the initial observation period.
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    At CNS hospital readmission reduction program
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    requires to exclude the following cases
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    from index admission.
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    So first, if the primary diagnosis was
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    medical treatment of cancer
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    readmission was psychiatric in nature.
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    We excluded and from index admission.
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    Second, if the discharge status
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    was dead in hospital,
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    left hospital against medical providers advice,
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    or transferred to another acute care facility,
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    they were excluded from index admission.
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    Lastly, if the patients unenrolled in Medicare
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    fee for service plans or died within 30 days
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    of discharge, we exclude them from index admission.
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    And, a patient could have multiple index admissions
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    if the admission accured after 30 days
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    of discharge from index admission
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    and new admission meet the
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    eligibility criteria stated above.
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    And the next question
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    was that how I defined
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    unplanned 30-day readmission.
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    Unplanned 30-day readmission
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    is defined only after the index admission.
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    And, if the inpatient was readmitted
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    within 30 days of discharge from index admission
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    it was not planned.
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    It's unplanned 30-day readmission.
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    And when inpatient were readmitted
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    multiple times within 30 days of discharge
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    from index admission
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    only the first readmission was counted
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    per CNS criteria.
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    And another question was that
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    for readmission, we did not consider
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    whether inpatients migrated or not.
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    because we focused on index admission.
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    And for severity,
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    I think that means health severity.
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    So we did not measure them directly
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    but in our multi-variable regression analysis,
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    we (INAUDIBLE) 20 more (INAUDIBLE)
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    observed diagnosis.
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    (INAUDIBLE)
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    Do you have any other questions?
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    DR ABIGAIL: No, I think you covered those.
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    Thank you.
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    The next question would be for Dr. Pourat.
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    Was the P for P
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    based on a global improvement
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    or for specific metrics?
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    And did you see greater difference for metrics,
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    where there was a performance payment attached?
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    DR POURAT: OK, so the P for P
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    was per metric.
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    It was not for global improvements
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    in this case.
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    There were some other forms of
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    payment incorporated into the program,
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    but we haven't really studied those yet,
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    because the majority of the funds
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    for each project were distributed
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    under the P for P, or P for R.
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    Could you repeat the second one please.
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    DR ABIGAIL: Sure.
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    Did you see a greater difference for metrics
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    where there was a performance payment attached?
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    DR POURAT: If I understand the question.
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    So, every single payment
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    was either pay for reporting
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    or pay for performance.
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    So pay for reporting means
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    you just have to report your findings
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    but you're not penalized,
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    and there is no target.
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    But everything else is P for P.
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    In other words,
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    you have to show an improvement
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    over your previous performance or baseline.
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    So yes, everything was pay for performance,
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    pretty much after the first year.
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    DR ABIGAIL: OK.
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    Thank you.
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    The next one will be for Dr. Glron.
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    Did any of these plants that you presented,
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    participate in the health home program?
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    DR GLRON: That one threw me.
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    Yes.
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    A couple of the plants
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    who we spoke to did mention
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    participating in health homes
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    as part of their either investments
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    that they were making,
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    especially when they were talking
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    about housing and housing instability,
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    they would often list that
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    if they were participating, as one example.
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    Or just had a general (UNKNOWN)
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    that they were aware they were participating,
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    even if they didn't necessarily
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    count it as an investment.
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    But, it did emerge
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    among those who were participating.
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    A common example of the housing-related investment.
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    DR ABIGAIL: OK
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    Great, thank you.
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    And, Danielle DeCosta.
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    How can someone in the field share their
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    ideas or feedback to the design teams?
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    What would you suggest, or recommend.
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    WOMAN 1: Sure.
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    So I would say that we are trying to
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    get the information about the project.
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    out there.
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    So doing things like today's presentation is
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    one part of our strategy.
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    And everyone who's sitting here listening
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    is someone that we would
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    want to hear from,
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    somebody who has experience
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    conducting research themselves,
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    translating that research for an audience
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    at a conference or for policymakers,
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    other decision-makers.
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    So, we have brought in volunteers
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    to hop on a 30 minute
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    or a 45 minute zoom call,
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    and look at a team's prototype
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    and give us their feedback
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    just based on their experience
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    in the field,
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    and over their education and career.
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    So, we want to hear from
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    as many people who are interested
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    in contributing to the project in that way.
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    And so, I would suggest
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    going to the Web site
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    or emailing me directly
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    and we'd be happy to use your input.
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    DR ABIGAIL: Thank you.
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    And Dr. Pourat,
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    I have posted a three part question
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    for you, in the chat.
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    Can you clarify the alignment
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    between value-based performance
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    and value-based.
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    Value-based performance
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    and what does this mean.
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    DR POURAT: So I actually read this
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    and I'm not quite sure
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    what the question is,
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    because both of it...
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    What is the difference
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    between value-based performance
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    and value-based performance?
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    I think that must be a typo there.
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    WOMAN 2: Yeah, let me clarify that.
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    Sorry, I asked that question.
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    Sorry for interjecting
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    but I wanted to clarify that question.
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    I'm wondering if you can clarify
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    for our audience, the difference
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    between value-based payments
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    and value-based performance,
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    and whether they're aligned
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    in this program.
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    DR POURAT: Right.
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    So the the value-base...
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    We're talking about the same thing, really.
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    So, what you are interested in
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    is changing the behavior
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    of whoever it is,
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    in this case, was the hospitals.
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    And you want to make sure
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    that they actually change
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    how they deliver care
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    or whether they are actually able
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    to change the outcome.
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    So that's the performance part of it.
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    And then the payment
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    is associated with that performance.
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    So, it's kind of one and the same thing,
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    in this context.
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    And then the second question is
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    to the critics of Medicaid expansion
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    for California's Medical.
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    Whether it is sustainable.
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    This is a broader question
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    than my presentation
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    but, you know, is Medicaid expansion
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    in California, sustainable
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    if you're talking about the expansion
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    to additional populations that were
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    not previously included before the ACA.
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    You know, of course the state is
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    heavily dependent on the federal share
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    which is much higher
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    for the expansion population.
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    So whether if this if ACA goes away
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    can California sustain it?
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    I would say, it would be very difficult.
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    I assume that was the question.
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    For, has there been any increase or decrease
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    in uptake of utilization for primary care
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    versus emergency care?
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    What I didn't present was information
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    on emergency department visits
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    during this program.
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    We are doing that.
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    We are also looking at inpatient admissions.
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    In the interim though,
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    we are doing the evaluation.
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    These metrics
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    were not going in the right direction,
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    and you really needed more time
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    to understand exactly what's happening.
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    So we did not present
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    any of those results.
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    It was, in essence, premature
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    because when you are doing these kinds of
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    significant changes to care delivery,
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    you don't expect immediate results.
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    You have to wait to see
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    overtime, as you're providing as you...
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    Let's say you're improving cancer screening,
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    you're changing primary care, redesign,
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    to make sure the patients...
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    There's this proactive style of medicine,
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    you don't expect that patients
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    (INAUDIBLE) change
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    In our past evaluations,
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    we have seen the results change
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    maybe in the second year or a third year
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    where all of that effort,
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    that is, all the investment in the beginning
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    actually pays off.
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    DR ABIGAIL: Thank you for that.
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    Thank you for that.
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    The next one is for Nicole Glron.
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    You've mentioned that plants reported
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    investing mostly in their members.
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    Did any pants mention
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    making investments
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    that benefited the community at large?
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    DR GLRON: Yeah, that's a great question.
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    Whoever post that, thank you.
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    Yes.
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    So the findings that I summarize,
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    mostly focused on
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    the individual member-level investments,
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    because that's ,mostly what plants
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    are focusing on,
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    but we did ask plants to tell us
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    if they were making any community-level investments
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    and if so, what those would look like.
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    And we actually found that
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    in our survey about 0.67 of plants
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    told us that they were making
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    community-level investment.
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    So these are investments that
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    don't necessarily just target members
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    but actually, go beyond members.
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    And when we interviewed plant leaders
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    to learn more about these
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    community-level investments
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    that they were making, we actually
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    found that many of the investments
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    that they were considering
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    to be community-level,
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    were still somewhat focused on members
  • Nesincronizat
    and expanding some of the
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    secondary benefits to members,
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    or for example, a health plan
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    may have listed that they were investing
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    in supportive housing within the community
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    but a percentage of those housing units
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    were earmarked for their members.
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    So some of the strategies
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    for community-level investments
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    we're still always to stay
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    focused on ensuring that benefits
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    came back to members.
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    However, there were some plans
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    that talked about
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    making investments that truly were based in
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    the community, open to anyone,
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    not just their members.
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    And some of those common investments
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    took the form of community resource centers,
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    or grants for education within the community.
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    And we found that plans who were operating
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    in communities where there was a very
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    large Medical population,
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    definitely were more aware of
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    and making some of these investments
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    that were community-level
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    for none members.
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    Because they just had a larger incentive
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    to do so.
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    A lotof their community was Medical.
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    So, yes, thank you for asking that.
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    DR ABIGAIL: That's great.
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    Thank you so much.
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    And Danielle De Costa.
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    So, working with the design team,
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    you know when someone's
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    thinking about doing this,
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    what's the best way
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    to, sort of, engagement...
  • Nesincronizat
    To engage them?
  • Nesincronizat
    And then, what does that mean
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    for the process as a whole?
  • Nesincronizat
    Like, you know, should investigators
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    or program developers,
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    implement sort of
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    a longer timeline, for example,
  • Nesincronizat
    in their planning?
  • Nesincronizat
    So what do you suggest about that.
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    WOMAN 1: So I think, if I'm understanding,
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    the question is, are we asking
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    about engaging the members of
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    the learning community
  • Nesincronizat
    that these design teams themselves
  • Nesincronizat
    are volunteers, through this process?
  • Nesincronizat
    DR ABIGAIL: Yeah, (INAUDIBLE)
  • Nesincronizat
    Yeah, engaging
  • Nesincronizat
    the design team members themselves.
  • Nesincronizat
    WOMAN 1: Right.
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    We've had a lot of lessons learned
  • Nesincronizat
    about this over the past year,
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    and we've played around
  • Nesincronizat
    with a few different strategies.
  • Nesincronizat
    So, we meet with the teams monthly currently,
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    and we share information with
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    the learning community, as a whole,
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    on a monthly basis as well.
  • Nesincronizat
    Before the pandemic,
  • Nesincronizat
    we had planned on convening everyone in person
  • Nesincronizat
    twice per year,
  • Nesincronizat
    but, of course, that has now changed.
  • Nesincronizat
    And so some of the things that we've learned
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    is that, especially with volunteers,
  • Nesincronizat
    being able to convene people together for
  • Nesincronizat
    maybe a more concentrated period of time,
  • Nesincronizat
    to do the hands-on design (INAUDIBLE).
  • Nesincronizat
    might have been a more efficient way to do it.
  • Nesincronizat
    So, as we look to the future
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    and maybe, you know,
  • Nesincronizat
    bringing together new teams,
  • Nesincronizat
    addressing new challenges.
  • Nesincronizat
    I mean, the 17 challenge statements
  • Nesincronizat
    that we identified
  • Nesincronizat
    for our first round here,
  • Nesincronizat
    don't encompass everything
  • Nesincronizat
    within the field.
  • Nesincronizat
    So, maybe we would do more
  • Nesincronizat
    of abbreviated design sprint
  • Nesincronizat
    over a few weeks, or a month.
  • Nesincronizat
    Where we would bring in volunteers
  • Nesincronizat
    for a concentrated number of hours
  • Nesincronizat
    per day/per week,
  • Nesincronizat
    where they could really do that hands-on work,
  • Nesincronizat
    and then go back to their regular jobs
  • Nesincronizat
    after that.
  • Nesincronizat
    So, that's one of the things
  • Nesincronizat
    that we learned.
  • Nesincronizat
    I would say the timeline
  • Nesincronizat
    could be as stretched out
  • Nesincronizat
    or as condensed as would work for you,
  • Nesincronizat
    but design thinking does lend
  • Nesincronizat
    itself well to those quick
  • Nesincronizat
    prototyping and testing cycles,
  • Nesincronizat
    so you can rapidly experiment, and learn,
  • Nesincronizat
    and generate new ideas
  • Nesincronizat
    that could be even better
  • Nesincronizat
    and more creative than the ones you had before.
  • Nesincronizat
    DR ABIGAIL: That's great.
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    Thank you so much.
  • Nesincronizat
    I think we've run out of time,
  • Nesincronizat
    and I wanna give the mic back
  • Nesincronizat
    to our moderator.
  • Nesincronizat
    WOMAN 2: So, we just wanted to thank
  • Nesincronizat
    all the presenters.
  • Nesincronizat
    Thank you for your excellent presentations,
  • Nesincronizat
    thank you for staying for the Q and A session,
  • Nesincronizat
    thank you to all the attendees, to APHA
  • Nesincronizat
    and to the medic medical care section.
  • Nesincronizat
    Thank you as well, to our co-host,
  • Nesincronizat
    for doing a awesome job
  • Nesincronizat
    picking all the questions.
  • Nesincronizat
    So, have a good rest of the conference.
  • Nesincronizat
    WOMAN: Bye everyone.
  • Nesincronizat
    Thank you, bye.
  • Nesincronizat
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https://youtube.com/clip/UgxCoxfiD1Vh7U4b-FJ4AaABCQ
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