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Trevor Hayes: A Medical Director’s Perspective on Healthcare

Trevor Hayes shares a medical director’s perspective on healthcare as he talks with Rob Oliver on the Perspectives on Healthcare Podcast. A member of Generation X, Trevor joined the podcast from California. He has experience as a hospitalist, family doctor and palliative care team leader. His group is turning back the clock on how medicine is delivered.

Here are 3 things that stood out as Trevor shared the medical director’s perspective on healthcare:

· The viewpoint on what is “quality healthcare” depends on where you are in the healthcare system
· Noncompliant patients may have unseen reasons why they are not carrying out their plan of care
· A lot of patients are not aware of the full extent of the benefits that they have

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Here  is the transcript of “Trevor Hayes: A Medical Director’s Perspective on Healthcare”:

Rob Oliver: Thank you for being with me today. I appreciate you coming and listening. Today’s perspective comes from Trevor Hayes. He is a medical director and palliative care lead out in California. He is a member of Generation X. Trevor, thanks for being here.

Trevor Hayes: Absolutely. Rob, thanks for having me.

Rob Oliver: You bet. Tell me a little bit about yourself and your role in health care.

Trevor Hayes: Sure. So my role as a family practice position hasn’t necessarily been the most traditional one. I basically was a hospitalist for about ten years and got into the current type of practice that I’m in now, basically because I saw sort of a lot of gaps in what we’re doing in our hospitals work. I enjoyed being a hospitalist. I enjoyed sort of the camaraderie and working with specialists, but I felt like some of our high risk patients were definitely getting great care in the hospital. But to be able to transport that care back home and actually put wheels on the care plans that we have designed, it wasn’t working, and the reasons necessarily weren’t so much that they were medical deficiencies in our plan. But they were actually psychosocial. And so I think this is what I enjoy with what I do now is not only do we Hone in on the medical aspect of the care, but the psychosocial and all the other determinants of health.

Rob Oliver: Excellent. So it’s very interesting that you say that we had Milind Awale on who is a hospitalist, and he was talking about basically the hospitalist takes over for the family physician, your general practitioner, while you’re in the hospital and you’re saying you’re looking at it from the opposite direction to say, okay, I was in the hospital and I’m seeing that when they go home, the care that they’re getting is not fulfilling their needs. Can you talk a little bit about the way that care is delivered in your current system because it’s unique and different if I’m understanding it correctly.

Trevor Hayes: Yeah. Sure. So we try to make the care very seamless. So, for instance, when you’re in the hospital, that’s like one silo where the care is being delivered, it’s delivered when you have the condition where you’re in acute phase of illness and typically you get stabilized. And then there is the transfer back of that care to the primary care provider or to the specialist, which in itself is sort of its own little silo. And then in between is what happens in the home or in the nursing facility or the custodial care facility. And I think what our group is trying to do is to sort of walk the care from the hospital back to the primary care provider back to the specialist and also to determine why patients might be coming back into the hospital and a rotating frequent basis. So it’s a little bit different mindset. It’s trying to make the care kind of seamless.

Rob Oliver: Okay. What does quality healthcare mean to you?

Trevor Hayes: Yeah. So there’s a lot of different perspectives on what quality is, and it really, I think kind of focuses on where you’re at in the health care ecosystem. I think if you’re a health plan, quality health care kind of means HCC codes, which I know you’re going to ask me to explain these acronyms, but basically it’s a scoring about how ill a patient is, which then determines about how much money gets forwarded or basically given to the health plan for the care of that particular patient for a specific amount of time. There’s also quality metrics. So, for instance, if you’re a diabetic, the hemoglobin ANC is something that they look at and they want to make sure that they’re at a certain goal, which then to the health plan basically says that this patient is under control or getting managed. Well, so that’s from the health plan perspective, very, very business, very operational, heavy in terms of the quality looking to make things inefficient excuse me, efficient. Sometimes it seems inefficient a little bit of a Freudian slip there. But but basically that’s from the perspective of the health plan, I think for the patient, which is what I’m most focused on, I think obviously we should all be focused on is really understanding what their own personal goals are for their care and sort of trying to meet those needs. And I think that that was pretty powerfully demonstrated to me when I started working with my current group, when I started working with the few homeless patients that we have. So for them, quality care isn’t so much getting to the best specialists in Beverly Hills per se. But it’s really making sure that they have a place to stay and that they have a place to eat. And it isn’t until we sort of address those needs, that then we can start focusing on their insulin and how much it costs and and their access to it. And how are they taking it? And it’s surprising when I was a hospitalist how much I would dump on a patient and expect them to understand and expect them to learn and even the basic things like using an inhaler you’re a COPD patient or being able to understand the patient is actually giving themselves insulin correctly is a big thing. And another thing that we don’t really think about is sort of needle phobia. So people are quite afraid of needles. So understanding the anxiety that goes behind checking your blood sugar. And unfortunately, a lot of these patients get labeled as, quote, unquote non compliant, which really we haven’t sort of explored kind of why they’re not taking their insulin, because there’s usually reasons that they’re not going to tell you. So quality for patients, I think, really focuses on their own personal goals of care. If you have a cancer patient basically who has stage four illness a lot of times, their goals of care really isn’t to do aggressive therapies or to be in and out of the hospital at the last three months of their lives. They really want to be with their family. They really want to be able to walk their daughter down the aisle at their wedding. So understanding those goals, I think, really helps us to provide goals of care and quality care for patients. And I think the last thing I would say is one of the things I had a difficult time early on in my career. Reconciling is the fact that you have to have a good business model that makes sense and a good operational model to be able to deliver that care. But you also have to balance that with the patient themselves. Like, what are they really interested in? What are their goals for care, what is most important to them? And really you can’t have one about the other, so I can’t deliver good care if I don’t have a good business model, that’s sustainable or that business model is not going to work. If I’m not understanding what’s important to the patient and how I can give them the best care possible.

Rob Oliver: Excellent. You’ve already answered this question in some ways, but it’s on the list. Can you give me an example of quality health care? And you’ve given me a couple of examples. And if you care to elaborate on those or give me other examples, whichever way you go, I appreciate it.

Trevor Hayes: Sure. Well, I think in my current position, what we’re doing a lot is trying to maximize the benefits that patients already have. So we work with some large medical groups and insurance companies out here in California, and a lot of patients are not really aware of the benefits that they have through their insurance company. And so that’s where we come in to try to educate them on those benefits and to maximize the benefits that they already have. So a concrete example might be a dialysis patient who has dialysis three times a week. They live maybe in south central Los Angeles, which is maybe resource for. And they don’t realize that they actually have transportation benefits to the dialysis center. And so getting our social worker in there and getting them to understand that they do have benefits. And if they can go to dialysis really helps to keep them out of the hospital. And I think it gives them a sense of control over their particular sense clinical situation. So that’s just maybe a small example. But it’s really just bridging the gap.

Rob Oliver: Yeah. It makes so much sense, because what you’re talking about is as those benefits, the insurance company is much happier to pay off pay for small benefits, like getting someone to dialysis, getting and getting them quality care in that way, as opposed to saving money by not paying for that transportation and eventually having to pay for advanced treatment for kidney failure. Okay. What do you wish people understood about your role in healthcare?

Trevor Hayes: Yeah, that’s a great question. Health care has become so incredibly complex with so many different layers, so many nuances that it’s really hard to understand everybody’s role. I will say that I’m also coming from a place of not understanding some of the other roles in health care. But I think what is important for or I wish that maybe the primary care providers or the IPA groups in our area sort of understood is sort of what we’re trying to do. So we really are trying to drive the patient back into the primary care provider’s office rather than take these patients away from them. So sometimes there can be a little bit of a turf war that’s perceived. But I do think that once they understand that we are actually trying to increase the touches that they have with patients and trying to sort of take them from that place of despair where they think they can’t get any help and they’re not going to reach out to their specialist or their primary care and start getting them plugged back in. I think that that is something that it’s a perception that we’d like to change, and there’s many that I could go on. But I know you don’t have unlimited amount of time here.

Rob Oliver: No worries at all. And that really I appreciate you sharing that, because one of the goals of the podcast is for medical professionals to have a greater understanding of their colleagues and a greater appreciation for the work that their colleagues do and how they can work together. And I think that you being willing to share that it’s spot on, and I appreciate it. What excites you about the future of healthcare?

Trevor Hayes: Yeah. I mean, actually, I’m quite excited about health care. I do speak to physicians a lot and other health care providers that are a little bit pessimistic about the health care that we have. I think, you know, we do have excellent care here. I think in the United States, I think our issue really is making it portable and getting it to everybody and being able to get each entity within health care to talk to each other and to be able to work together. What I’m really excited about is I’m going to use a term that I’m not sure out there, but I think it gets the point across. But as we Amazon, Ize everything is everything gets brought to the home. I think you’re going to see health care come more and more into the home. There’s a lot of things that we are able to do. We’re doing X rays, we’re doing IV fluids in the home, even in our group. We’re doing EKGs in the home we do have the dream at some point, and other companies do as well to somehow get dialysis into the home, which would be a major game changer for people. I think there’s going to be a lot more things available for patients that our cancer patients undergoing therapy. There’s going to be a lot more ways that we can sort of keep them in the home, keep them away from places like the hospital, where there’s a lot of possible serious illnesses that they can contract whether undergoing therapy. And so I just see really health care kind of moving back to the older days, where the house call becomes the top and the clinic just becomes more of a side thing rather than the clinic kind of being the primary place where care is delivered.

Rob Oliver: Very interesting. Maybe if you don’t mind commenting on you mentioned earlier the psychosocial aspect of medical care and what do you see as the psychosocial implications of people receiving care in their homes as opposed to having to go out to the clinic for that?

Trevor Hayes: Yeah. I mean, I think there is something that has become very real to me as I’ve been with current company for three and a half years. Is people feel respected instead of myself as a provider triaging and saying, I need to tell you when you can come into the clinic, we’re flipping on on head and the patient is saying, I need to see you, and I need your help and understanding that I don’t no longer have to tell a patient that I’m going to see you in October when really you want and need to be seen now, the cynical provider can say and snicker that, hey, this patients just anxious, but really anxiety is what drives people into the home when they feel sorry. It’s the hospital when they feel like they are out of control and really just holding the hand of somebody who has asthma and maybe give them a treatment even so they can give them the treatment, give the treatment themselves, but also just reassuring them by checking their pulse oximeter, checking their blood pressure, the rest of their vital signs saying, Listen, I know you’re going through a bad time, but I think we can take care of this and I know we can take care of this in the home and the nurse calls the next day to find out how things go or or going. I think it sort of gives patients a little bit more control rather than saying, okay, I can only see you three months from now because I’m backed up. It’s very interesting. I think that what you bring up in some ways. I think this pandemic has really brought to the for the fact that this is not just about the physical aspects of what COVID does to the body physically, and that is definitely an issue. But there’s also the the psychological impact of the anxiety that goes with the fear of getting COVID, and then when you have the anxiety of how is this going to affect me long term, how does this affect my employment? How do all of those things? It becomes a much more holistic approach to understand it’s not just the physical nature of it, all of it all together.

Rob Oliver: What is one thing medical professionals can start doing today to improve the quality of health care?

Trevor Hayes: That’s a great question. And I think that people I think most medical providers are quite comfortable in delivering the actual hard clinical medicine. I don’t think there’s really an issue in sort of understanding what are the best evidence based guidelines for diabetes, for instance, or congestive heart failure? That’s really not the hard part of medicine. But I think if providers can understand that that particular illness throws the complete mental status. Ification out of control, where people who are going to work in earning a living for their families everyday, they’re going through the routine, they’re raising their families, they’re paying their taxes suddenly have this sort of chronic illness or medical event thrust into their lives. And I think understanding the fallout from that really sometimes helps to contain the whole illness for the patient. And I think probably has better clinical outcomes. When you’re less anxious, you’re able to actually focus and look at the illness for what it is and to be able to address it appropriately rather than sort of reacting. And I think when people feel a sense of control, which when you’re ill, you feel completely out of control. When people get more of a sense of control, they tend to make better decisions. So I think for medical professionals understanding that not only is there the mental aspect of someone’s illness, but and there’s also the social aspect as well, where someone who has a list of 50, not 50, but maybe 25 medications on their list, and they’re not sure what to take or when to take and sprinkle a little bit of dementia in there. They really need a caregiver who’s neutral maybe in the family who can help to administer those medications and really help to decrease the amount of time that they’re in the hospital.

Rob Oliver: Very interesting. When I’m doing keynotes, I have stressed to medical professionals the fact that the medical profession exists to allow people to live their life as fully as possible. And it either allows people to get back to what they were doing if they’re experiencing an illness or if they’re experiencing some kind of limitation. It allows people to continue as fully as possible. But whatever it is, the medical profession is there to facilitate people living their lives, which is great. Trevor, thank you so much for joining me today. I really appreciate you sharing your perspective on health care.

Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.

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