Q&A with Aetna's Chief Medical Officer Dr. Kyu Rhee on creating a 'values-based system'

Kyu Rhee, MD, is a senior vice president at CVS Health and chief medical officer at Aetna. He sat down with Becker's to discuss ongoing trends across the healthcare industry and how he is working to create a "values-based" care system through opportunities offered by a global pandemic.

Dr. Rhee's background as a primary care physician working with underserved communities has influenced how he views the roles CVS and Aetna will play in the rapid transformation of public health, primary and virtual care.

Editor's note: Responses were edited lightly for clarity and brevity.

Question: CVS has publicly discussed its intentions to expand more into in-home care. What opportunities do you believe home health offers Aetna members?

Dr. Kyu Rhee: My background started in primary care in predominantly underserved communities in Washington D.C. and Baltimore as an internist and pediatrician. I remember very fondly the CVS across the street playing a very important role in the health that was delivered to my patients in Washington, D.C. — that was Upper Cardozo Health Center, a part of Unity Health Care. 

This pandemic has accelerated transformation in health and healthcare, and CVS Health has played a very important part of the COVID-19 pandemic response and hopefully what I would call what's evolving to recovery. But there are other infectious diseases like monkeypox and other conditions. People have deferred a lot of their vaccinations during this time and there's a chronic disease curve, which has gotten worse for many of us as we've avoided traditional primary care and preventive services. And then there's mental illness, which has gotten a lot worse during this pandemic, along with inequities. 

Where we think we can play is where we're a trusted part of the community because we've got amazing capabilities and assets that are both in-person and virtual. Those virtual services can be extended into the home. People want their care when they need it and where they want it — home health, virtual and telehealth are important frontiers in which we deliver that. 

Q: The CVS Health Virtual Primary Care program will start to be offered to Aetna plans in 2023. How do you expect this new offering to play into the company's broader strategy of growing in-home care abilities?

KR: As a primary care physician in D.C. with my panel of 2,000 patients, I saw the value of in-person and the importance of the team we had that included the pharmacist across the street, social workers, behavioral health specialists, nurse practitioners and physician assistants. 

If you think about access in rural communities and even in urban communities, this opportunity that we've leveraged to have the whole team — which includes a pharmacist, behavioral health specialist, physician and the nurse practitioners in our Minute Clinics — is exciting because it'll improve access. 

To me, primary care is so foundational because it improves health outcomes. You typically need that primary care clinician and that whole team to address your holistic needs in the context of that community. What's powerful about our virtual primary care solution is it integrates a transparent team and integrates with our in-person capabilities. That collaboration and hybrid approach is really what we believe customers and clients want in this next chapter of the pandemic.

Q: Amazon plans to buy primary care network One Medical for $3.9 billion. What does this acquisition mean for healthcare and primary care delivery? 

KR: There's no question that tech, and healthcare tech particularly, appreciates the importance and the value of leveraging data analytics and even artificial intelligence to address one of the most important challenges in our society — health and healthcare. When you look at Amazon, Apple, Google, IBM or Microsoft, it's clear that companies understand the value of data and the value of health and healthcare as a value proposition.

We're proud at CVS Health and Aetna to leverage data scientists as part of our team that delivers care. I believe it's now over 900 data scientists who play a very important role in assuring that the analytics and the nudges we give to our members, providers and clients improve health outcomes and reduce waste. We live in an age now that data scientists are a part of the team, so whether it's Amazon or Apple, I'm proud of the fact that we've recognized it for a long time and have been leveraging data scientists in the work we do already.

Q: CVS is looking to place a bid on home health company Signify Health. How do you think an acquisition would help members care outcomes?

KR: We're always looking for important partners and collaborators. As a payer, we aim to be the partner of choice for all providers and health systems, so as we explore these opportunities, we're excited to see many providers integrating home health and telehealth into their thinking and strategy. We already have trusted value-based care arrangements with providers where we're thinking about health outcomes, impact and improving access to primary care and home health. 

Q: We're seeing Medicare Advantage offerings grow rapidly across the country and it's a key part of CVS' growth strategy. What innovative care or payment models is Aetna implementing or considering to improve senior care outcomes?

KR: One innovative approach is supplemental benefits. We've got an extraordinary group of over 500 physicians at Aetna that I'm proud to lead. Our physician experts play an important role in looking at the care that we deliver and the priorities we give as we look at the data and the gaps that often exist. Supplemental benefits take a total approach to health, such as our partnership with Papa and their adult companions. 

I worry about my own mom and her ability to have companionship, especially during this pandemic. When we think about our strategy, we're thinking about how we support seniors with things like house chores assistance or providing remote companionship.

Through the Papa program in 2021, 62 percent of Aetna PPO and 52 percent of Aetna D-SNP plan members reported feeling less lonely after using Papa. There's so many other areas where we can innovate, and I often reflect on my own experience as a primary care provider and also by asking what I can do from a population health level to help the millions of lives we have the honor of serving.

Q: Aetna is currently one of six healthcare companies participating in the NCQA's digital quality solutions pilot to help develop the next generation of HEDIS measures. What do you believe are some of the biggest outstanding issues with HEDIS measurements and how does this new pilot work to resolve those?

KR: When I worked in the federal government, I helped lead the national quality strategy for the country as part of a committee under the Affordable Care Act, and I was fascinated to see all the measures we track in our healthcare system.

To me, we have enough measures to do what's right and improve the health system, but there are areas like equity where we do need more measures. I'm proud of the fact that the NCQA now has a health equity accreditation, and we're partnering with them on that.

We have to use the measures we have because frankly, those are the measures we use in our value-based contracts. Many times those are the basis for our star ratings with Medicare and Medicaid. But we also have to question in the system, what are the measures we want if we treasure equity, if we treasure mental health and if we treasure prevention?

We should have measures that reduce disparities, and we should expect that — whether it's rural, race, ethnicity or gender disparities. If we treasure mental health, we should be looking at depression screenings as a measure that we expect people to get tracked on in the same way that I look at breast, colon and cervical cancer screenings. We do often track primary care preventions, but how much are we talking about that, especially during this pandemic? We've seen many people avoid healthcare visits and as a result, certain vaccinations have reduced. 

We have these measures and if we treasure certain values, we need to make sure that the measures we target in our value-based contracts align with those values.

Q: Many payers say they don't know the race or ethnicity of most of their members and if they do, it's hard data to get. How have you prioritized this type of data collection at Aetna in order to find care disparities and gaps?

KR: We were the first major health plan around 2003 to begin collecting race and ethnicity data from our members directly in recognition that health disparities exist. 

In my mind, the future of health equity and health disparities reduction is about trust. The employer-sponsored insurance system is half of our health system and HR departments have that data. We need to make sure we can get that data and use that to show what I would call equity dashboards, where people can see a known inequity in mortality rates, for example.

We have to show that equity is a key measure and value that we believe in and then challenge the system in our role to do better because we expect better. I see the future of this in value-based contracts, where you will not only measure readmission rates, but also the stratification based on race and why certain groups are twice as likely to be readmitted than other groups. 

The definition of TechQuity is four different areas: One is making sure your workforce is diverse and represents the people you serve. Number two is collecting the data and having the trust with your members to collect the data, including race, ethnicity and more granularity around sexual orientation, gender identity, disability status, veteran status and other key metrics. The third area is equity dashboards. Equity hasn't been given its due and it needs to, especially in this pandemic moment. The fourth area is AI.  With the nudges we give using those data scientists — we have to be very careful that we're not inadvertently worsening disparities, and promulgating the current disparities that exist. Thinking about equitable, ethical and transparent AI is really important.

Q: Aetna said in March that it would partner with Grow Therapy to offer mental healthcare benefits to every member. How else is Aetna investing in better mental healthcare access for its members?

KR: I would argue the majority of mental health is served in primary care settings, so this is where it connects to the primary care mission that we have. But it's also important to know that behavioral specialists are part of the team, whether they be a psychologist, social worker, psychiatrist and even pharmacist. Our strategy is very transdisciplinary.

Many people with comorbidities typically have mental illness and this pandemic has nearly tripled the amount of mental health or illness burdens that people have in the areas of depression, anxiety and substance abuse. We're committed to making sure primary and virtual care are key components.

As we look at our provider networks for mental health, we want access virtually, and primary care clinicians have an important role in addressing it. To me, mental health should be a part of everyone's responsibility: primary care clinicians, payers, providers, and patients and family members. Looking at the opportunities we have, it's really important that mental health is part of anything and everything we do.

Q: Aetna cut ties with Cerebral in June and CVS also said it would stop filling certain prescriptions for their patients. In the age of widespread telehealth, do we need better scrutiny of virtual providers prescribing controlled substances?

KR: We need to always keep looking at information data and make the right decisions on behalf of our members to promote health and prevent disease. We're always committed to looking at our provider networks and asking what's best for members based on data and science. What you're referencing is a part of what we've evolved to assure as our commitment. This new age of the pandemic has provided many opportunities, but also potential risks, and we have to be cognizant of that.

Q: What went into the decision for Aetna to make sure its employees and members who live in states with restricted abortion access are able to travel to other states for reproductive care? 

KR: We have a long standing commitment to women's health and reproductive health and we've been talking to our members and our clients about this. We are definitely looking at the laws and looking at ways in which we can address women's and reproductive health in this critical moment.

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