In 2024 Healthcare Innovation interviewed Deepak Sadagopan when he was chief operating officer of Population Health Management at the Providence health system about integrating value-based care into the mainstream delivery system. This week we spoke with him about his focus on a similar mission in his current role serving as business lead of the value-based platform at Risant, the nonprofit Kaiser Permanente subsidiary that in 2024 purchased Pennsylvania-based Geisinger Health and North Carolina-based Cone Health. Risant execs have said other health systems will be added over the next few years. 

Healthcare Innovation: You had an influential position at Providence. What intrigued you about coming to Risant?

Sadagopan: As part of the work with Providence, we were able to expand the adoption of value-based care, creating a pathway to success, and aligning economics between multiple payers, and creating the right pathways to assuming risk. As Kaiser Permanente was creating Risant to expand the access to value-based care, what appealed to me is that Kaiser as an institution is dedicated to the practice of value-based care. That's what they have built their entire care model on. They are expanding the care model to areas like Pennsylvania and North Carolina that are not traditional Kaiser Permanente markets — they more closely resemble what we had at Providence than what Kaiser did in California with an integrated delivery system. What was exciting to me is learning from Kaiser Permanente the care model that has been made successful, but also using my background and experience to help adapt some of this in a multi-payer environment, and in other geographies, and getting to things that you couldn't normally get to in a traditional healthcare delivery system outside Kaiser Permanente. It involves getting all primary care groups to adopt similar evidence-based approaches to treating conditions — things that have made Kaiser Permanente who they are in their practice of medicine. Having the opportunity to replicate that is what appealed to me.

HCI: Does it involve taking Kaiser's care model and overlaying it on these other health systems or is it more nuanced than that?

Sadagopan: It is using the Kaiser Permanente model as one of the best-practice inputs. There are cases where Geisinger excels at a practice or where Cone does an amazing job. The goal here is to create a system of functions that is accumulating best practices in value-based care and replicating them across the Risant ecosystem. 

It does start with the Kaiser Permanente model. One of the examples is value-based care guides, which are a form of evidence that's made available to the primary primary care provider. Evidence being made available to the primary care provider is nothing radically new. What makes Kaiser Permanente's model different is that each care guide for over 500 conditions most commonly accounted for in primary care has been distilled and incorporates how providers have actually treated this condition, whether it's diabetes or psoriasis. How do you manage that condition in primary care to the maximum extent possible? What evidence base can you use to do that? At what point do you pull in a specialist to assist with the problem? 

There is a very intentional consultation and interaction between the primary care and the specialist for every type of care guide. The care guide itself functions as a form of agreement between primary care and specialty on how this condition will be treated. That process of collaboration, functioning as an integrated system and using a common rule base as the basis to guide care — that is what uniquely differentiates how Kaiser functions internally. It's one example, but it illustrates how the whole system is put together.

HCI: That sounds like it would take strong primary care leadership in those organizations, if it involves a cultural change or a change in how they approach that evidence base….

Sadagopan: You hit the nail on the head. This is about strong primary care leadership. This is about strong system leadership leaning in and saying, "Hey, this is not just about deploying a piece of technology and saying that everybody should adopt it. This is about enabling primary care and specialty to work with each other — primary care being more empowered and strengthening the primary care system. In fact, the value-based platform, which is my primary responsibility as part of my role here at Risant, consists of a system of of three or of four different value streams comprised of products that we integrate and are seeking to pull together in every system that we work with.

The first involves the value-based care guides I mentioned. They are part of  the value-based platform that we call Evidence-Based Care Everywhere. The goal is to make sure the right information is available to support a care delivery person no matter where the care is delivered, whether it's at home, whether it's in the primary care office, whether it's in a virtual setting.

Second, the care itself is smart. This is where the contextualization comes in. It's not just blanket evidence that worked in KP that we're seeking to air drop in. It is more like understanding who the patient is, understanding what the patient's insurance is if the guide recommends a medication. Before deploying the guide, we actually work with the local primary care and the specialties to make sure that the choice of medication is actually contextualized to the insurance systems that are  prevailing in the market. 

The second part is what I would call Care Without Delay, which is when the patient does need acute care services or or does need to be in touch with the broader health system. How do you make the care available to them with the least friction possible? It does not matter in the Kaiser Permanente world, for example, whether it is midnight or whether it's a weekend. If a patient needs a particular care process or diagnostic or treatment, that will happen. If the patient needs to be discharged over the weekend and is ready to be discharged, then they will be discharged over the weekend. We're not going to wait until Monday or Tuesday when the next set of available providers are present. No patient leaves the hospital in Care Without Delay, as an example, without getting a primary care follow-up appointment. We make sure there is availability before the patient checks out of the hospital. 

Similarly, we have a third area that we call the Right Place, Right Time, which involves a patient-facing set of solutions that gives them access to multiple modes of care, virtually or through other types of care appointments. The goal is to expand the capacity of primary care through virtual care visits, so the patient doesn't feel compelled to go to an urgent care or an emergency department to get their care needs met.

Another pillar that we have is what we call Physician Simplicity, which involves making the right thing to do the easiest thing to do. For example, in the Kaiser Permanente model, accessing the value-based care guides involves going and searching for the right care guide and pulling it up. It's a proactive pull. What Risant has been able to do is to make that easily accessible, making it AI-native, so the right care guide is actually presented to the provider without much administrative effort on their end. And we will expand that to voice modality and other ways in which you can access the evidence in a way that is not as effort-intensive for the provider. 

HCI: Are some of these tools and platforms things that have been developed in house at Risant or are they built in partnership with some tech vendors?

Sadagopan: It's a hybrid. There are pieces that we build internally. We have a strong point of view that any capability that faces a provider is closely embedded with how we make decisions about which care is appropriate at which place and how it integrates into a process. We’re going to anchor toward building some of that stuff internally. But when it comes to leveraging innovation and technology and how to surface evidence to different points of care, whether it's ambient, whether it is using other forms of technology to be able to interact with the patient, we are working with an ecosystem of partners who contribute to the innovation that we are able to bring.

HCI: When I interviewed you for Providence, I asked what it takes to succeed in value-based care, and you told me that healthcare delivery systems don't have the functions and the processes and the systems to actually manage risk. You said that the provider side needed to learn to think like a payer. So are Cone and Geisinger going to have those tools to manage risk?

Sadagopan: Well, all the tools that I’ve been talking about help bring some of that administrative and management capability within the walls of the healthcare delivery system and replicate it at scale. It takes a certain type of healthcare system to align with Risant, and part of the criteria would be systems that have already shown a commitment toward value-based care and that have actually progressed a little bit along that journey. We've seen with Geisinger and Cone that they have already made progress through their health plan — or multi-payer risk through a clinically integrated network as part of Cone. They've already developed some of these capabilities internally from an administrative standpoint. What Risant is doing is helping accelerate that journey through additional tools that we can make available once you do have the risk, and, in fact, even expanding beyond populations who are covered under risk arrangements to everybody served by these health systems.

HCI: Are there certain types of data that perhaps they didn't have access to previously or an analytics platform that Risant offers them?

Sadagopan: Part of the work that we do at Risant is to put together an analytic function that supports analysis of which care models have had the best outcomes and identifying potential areas where managing total cost of care continues to be an opportunity. And it's not just total cost of care; it is the ability to drive quality-of-care outcomes with our populations as well. The analytics platform enables identification of these opportunities, and then we use the capabilities that I described and align them toward solving those issues.

HCI: Risant has been working with Geisinger a little bit longer than Cone. Are they a little farther along in the journey?

Sadagopan: Geisinger and Cone both joined Risant in 2024 at different points. We have been working with Geisinger a bit longer, but even with Geisinger it's still only been a two-year journey. As you know, with value-based care, these investments take time to materialize. But even in these early days, there's been really promising progress. I'll use value-based care guides as an example. Almost 70% of Geisinger's PCPs are using them on a daily basis. And as a result of this, over the past two years — and some of the analytics we put in place enables us to measure this — we have avoided approximately 500 referral visits to specialty per month because those care needs are being addressed in primary care.

That does two things. One, it allows primary care to function at the top of their license, which they've always wanted to do, and not just punt to a specialty every time they come across a specialty condition. Second, it increases capacity in specialty. How many times have you called a dermatologist or an orthopedic specialist, and it takes three or four months to see them? What it has allowed us to do in these markets is decrease the time needed to see a specialist. It’s very exciting to see. 

At full or at-capacity hospitals, they board patients in the emergency department waiting for a bed. As we put in Care Without Delay, we've seen our emergency department boarding hours decrease by almost 40% consistently from the baseline period, which is a pretty significant decrease. 

At Cone, when we first deployed Care Without Delay, we had a significant number of patients who were on extended lengths of stay, who've been at the hospital 200 days or more, perhaps because they needed complex condition management that was not available in the post-acute facility. There were not the right partnerships to be able to enable those post-discharge functions. We’ve been able to reduce that census by more than 50% over the past couple of months. There has been consistent impact on the length of stay across both these groups since we've deployed these solutions, and we've seen more integration between the hospital and the post-acute facilities. So there's more fluid conversation and consistent establishment of relationships between the hospital and these post-acute environments. We're starting to pivot to looking at chronic conditions that are leading to avoidable hospital visits. That’s our next area of focus.

HCI: Are Geisinger and Cone in MSSP ACOs or other alternative payment models where we could see the impact of these deployments on their results in those programs?

Sadagopan: Yes, I think you could. Geisinger is in MSSP in the enhanced track. Cone has been in ACO REACH and I think they're going to transition into LEAD. I expect that as these programs take shape, we will start to see the impact in some of the results that come out. We don't deploy them wholesale every single time. We target deployment at specific populations, test them to make sure they're working, and then we deploy wholesale. So as these solutions start to gain scale within these local environments, the effects will be seen in in these programs.

HCI: Risant announced recently that Dr. Jaewon Ru was leaving his position as CEO. It seems like he did a lot of work the past few years in setting up this infrastructure and the team to make this work. What are some of your impressions of what he accomplished as the inaugural CEO there?

Sadagopan: I feel a huge amount of gratitude for the time that Jaewon and I have spent working together and standing up the value-based platform, creating the structures to execute, getting the initial systems together, and driving this body of work that is showing promising results in these initial days. I wish him the very best as he transitions to spending more time with his family.

HCI: Dale Maxwell is coming in as an interim CEO. He worked at New Mexico-based Presbyterian Health Services, which is an integrated health system. So perhaps it has a similar flavor to what you might see at Cone or Geisinger. He has a lot of experience working in that type of organization…

Sadagopan: Yes, we’re excited about the background he brings, and we are very optimistic about continuing the journey that we have embarked on. As [Kaiser Permanente CEO] Greg Adams mentioned in the press release, Risant has a long-term strategy, not only for Kaiser Permanente or for Risant itself. I think it's a long-term strategy for our healthcare delivery system as a whole to be able to show that a care model transformation that is deployed intentionally can actually help in the reduction of total cost of care and improve quality and outcomes across our populations, and that journey continues.

HCI: Is there anything else you'd want to mention that's been the most interesting or rewarding about this work so far? Any surprises?

Sadagopan: No surprises come to mind. But I have been so excited and filled with gratitude to work closely with folks at Geisinger, Cone and Kaiser Permanente, who all in their own ways are equally passionate about this work and are leaning in enthusiastically to be able to accelerate and support deployment of the value-based platform and the work that the platform is intended to serve. So it’s involved a lot of learnings for me personally in these early days across Kaiser Permanente and these markets, and a lot of exciting opportunity to be able to use a combination of technology and best practices to create the outcomes that we've got.