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Alan Weil interviews Eric Roberts from the University of Pittsburgh School of Public Health to discuss his and colleagues recent research comparing the experiences of dual eligibles enrolled in D-SNPs with those enrolled in Medicare Advantage and traditional Medicare.
Each week, Health Affairs' Rob Lott brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
00;00;00;01 - 00;00;27;26
Alan Weil
Hello and welcome to A Health Podyssey. I'm your host, Alan Weil. About 12 million people are what are often called dual eligibles, people enrolled in both Medicaid and Medicare. The group includes frail elders and people with a wide range of disabilities. Now, since Medicaid eligibility is tied to having a low income, this population often has significant unmet social needs.
00;00;28;05 - 00;00;54;20
Alan Weil
In addition to their need for medical care, almost a third of dual eligibles are enrolled in what are called D-SNPs: dual eligible special needs plans. The SNP designation was created in 2006 and was designed to improve care for people enrolled in both Medicare and Medicaid, specifically by improving integration between these two programs that actually function in quite different ways.
00;00;55;16 - 00;01;35;15
Alan Weil
Are D-SNPs providing better care than other options for people who are dually eligible? That's the question we'll discuss in today's episode of A Health Podyssey. I'm here with Eric Roberts, Assistant Professor in the Department of Health Policy and Management at the University of Pittsburgh School of Public Health. Dr. Roberts and his coauthor, Jennifer Mellor, published a paper in the September 2022 issue of Health Affairs comparing the experiences of dual eligibles enrolled in D-SNPs with those enrolled in Medicare Advantage and traditional Medicare. They found some positive results for people in D-SNPs, but not uniformly for all populations.
00;01;35;22 - 00;01;42;02
Alan Weil
We'll discuss these findings in more detail during today's episode. Dr. Roberts, welcome to the program.
00;01;42;10 - 00;01;43;16
Eric T. Roberts
Thanks so much for having me.
00;01;44;04 - 00;02;02;23
Alan Weil
I'm looking forward to this conversation about dual eligibles, a term that people often use sort of loosely or, you know, we all know, yeah, they're in both programs. But can you say a little bit more? This is 12 million people. Tell us a little bit about them and particularly their health and social needs.
00;02;03;05 - 00;02;25;25
Eric T. Roberts
Sure. And this is a fairly heterogeneous group of people, even though we tend to think of them as all medically and socially vulnerable. So to describe the duals, it's first helpful to just define how people get to be duals. To qualify for Medicare individuals have to be at least 65 years old, have a disabling condition or end stage renal disease.
00;02;26;06 - 00;02;53;18
Eric T. Roberts
And to qualify for Medicaid, as you alluded to, they have to have low incomes and limited assets. So this makes the dual eligible population high need, both in terms of its medical complexity and its health related social needs. Within the dual population, there's a high prevalence of co-morbidities, including diabetes and hypertension. About two in five dual eligibles have behavioral health disorders like depression, schizophrenia or bipolar disorder.
00;02;54;19 - 00;03;20;06
Eric T. Roberts
40% of duals got on Medicare because of a disability. And as a consequence of this, many have difficulties performing activities of daily living. Things like eating, bathing or dressing. Some also have intellectual and developmental disabilities and co-occurring behavioral and physical health co-morbidities. So as a consequence, this population's health care needs are complex, overlapping and heterogeneous, depending on what subset of duals we're looking at.
00;03;20;26 - 00;03;42;18
Eric T. Roberts
Many duals have needs for long term services and supports to help them perform activities of daily living. They often have substantial behavioral health care needs, chronic condition management needs, and most importantly, needs for care coordination across this range of services. And one size does often not fit all for this population because of the varied medical and social risks within it.
00;03;43;07 - 00;04;04;18
Eric T. Roberts
I want to also just emphasize quickly that Medicare and Medicaid are each filling different needs for care in this population. And this also contributes to a fair amount of complexity. Medicare is the main payer for inpatient and outpatient care and prescription drugs. While Medicaid will pay for long-term services and supports and some behavioral health care. Medicaid will also pay for Medicare's premiums and cost sharing.
00;04;04;28 - 00;04;16;13
Eric T. Roberts
And it's this kind of bifurcated structure that often makes it hard to coordinate care for very complex patients. And that's part of the intent of these SNPs, is to resolve some of those care coordination challenges.
00;04;17;02 - 00;04;40;07
Alan Weil
Yeah. So let's go a little deeper into that. That was an excellent overview. And if you take the need for coordination and the heterogeneity, we've had Medicare Advantage for a while. You have a capitated payment to a plan to take care of the broad needs of someone on Medicare. What makes a D-SNP different from traditional Medicare Advantage?
00;04;40;28 - 00;05;13;18
Eric T. Roberts
Yeah. So D-SNPs are Medicare Advantage plans that exclusively serve dual eligibles. Other Medicare Advantage plans are not restricted in who they enroll, but Medicare Advantage plans must only enroll dual eligibles. In principle, this gives a D-SNP the opportunity to specialize. To kind of tailor its model of care, it's provider networks, and it's supplemental benefits to the health care needs of its enrollees. Rather than addressing sort of the needs of an average Medicare beneficiary a D-SNP can specialize in the populations it's intended to serve.
00;05;14;17 - 00;05;40;08
Eric T. Roberts
Another feature of D-SNPs that sort of differentiate them from other Medicare Advantage plans are that all D-SNPs are required to have contracts with state Medicaid programs. And these contracts specify the plan's responsibilities for coordinating care with Medicaid. Most of these contracts only require D-SNPs to engage in a fairly limited amount of care coordination. For example, notifying Medicaid of when a beneficiary is admitted to the hospital.
00;05;41;00 - 00;06;02;14
Eric T. Roberts
But some contracts require D-SNPs to attain higher levels of what we'll call Medicare and Medicaid integration. And this can take on a variety of flavors, but it could range from greater administrative alignment, so greater care coordination across Medicare and Medicaid, managed care, to feature as extensive as covering Medicare and Medicaid spending for the same enrollees.
00;06;03;01 - 00;06;18;18
Eric T. Roberts
This is still relatively rare, but these contracts are a focus of policymaking because this is where we think that there may be an opportunity to attain greater integration between D-SNPs and Medicaid and to really realize the full potential of D-SNPs to kind of enhance and customized care for duals.
00;06;19;14 - 00;06;42;15
Alan Weil
Well, this notion of what the potential is from integration is something I want to explore with you in more detail. Before we get there, we ought to at least cover the findings of the paper. You have, after all, done an analysis looking at certain outcomes for people enrolled in D-SNPs, comparing them to people in Medicare Advantage or in traditional fee-for-service Medicare.
00;06;42;26 - 00;06;50;25
Alan Weil
So before we describe integration, is there evidence that it benefits the enrollees if it's through a D-SNP?
00;06;51;25 - 00;07;16;24
Eric T. Roberts
The evidence is that it's rather limited. So just as a brief overview of the findings, we looked at how dual eligibles, self-reported access to care, use of care, and satisfaction with care differed across D-SNPs. Other Medicare Advantage plans that don't exclusively serve dual eligibles and traditional Medicare. And we did this in five years of the Medicare community current beneficiaries survey, which is a survey of Medicare beneficiaries.
00;07;17;02 - 00;07;42;26
Eric T. Roberts
We had about 10,000 individuals in the survey. What we found was that D-SNPs and regular Medicare Advantage plans both tended to outperform traditional Medicare in certain areas of access, preventive service use and satisfaction with care. But D-SNPs did not perform better than regular Medicare Advantage plans in many of these areas. D-SNPs only performed better than regular Medicare Advantage and a few areas of satisfaction.
00;07;42;29 - 00;08;08;04
Eric T. Roberts
For example, out-of-pocket costs and the ability to get care from specialists and inpatient reported access to dental care. But D-SNPs did not perform better in these and other crucial areas that may reflect the extent of care coordination that D-SNPs are intended to attain with Medicaid. So this really suggests that D-SNPs as a whole have not provided better care to dual eligibles than other Medicare Advantage plans.
00;08;08;13 - 00;08;13;25
Eric T. Roberts
And this is consistent with some other evidence out there that performed similar comparisons using patient surveys.
00;08;14;14 - 00;08;41;07
Alan Weil
Now, we're always want to be careful not to over read one result here, but the notion that it's similar to a regular MA plan suggests to me that there may be certain benefits, particularly with respect to access and coverage, for moving from traditional Medicare into an MA plan. But this whole notion of integration with Medicaid, a whole separate program, that was the reason for creating D-SNPs.
00;08;41;07 - 00;08;50;01
Alan Weil
And as I read your paper, not much evidence that that part of what the goal of creating D-SNPs was has played out just yet.
00;08;51;04 - 00;09;15;09
Eric T. Roberts
I think that's a fair assessment, but I should say that this partly reflects that D-SNPs operationally have achieved a fairly low level of integration with Medicaid. The potential for integration exists. These contracts with state Medicaid programs do provide opportunities for Medicaid to really coordinate care with Medicaid managed care programs and provide a more unified range of benefits that are integrated within a managed care plan.
00;09;15;18 - 00;09;35;03
Eric T. Roberts
But I should say that most enrollees in D-SNPs are not in those types of highly integrated products. Most of them still see a D-SNPs as a separate plan from their Medicaid coverage and their navigating two separate insurance programs. So we're seeing evidence that D-SNPs are not that much better than regular Medicare Advantage plans because D-SNPs are not that differentiated still,
00;09;35;03 - 00;09;54;28
Eric T. Roberts
from regular Medicare Advantage plans in these areas of integration where I think there's a real need to improve the delivery of Medicare and Medicaid services for duals. So on the one hand, this shows that there's some unfulfilled potential. On the other hand, I think we have to sort of stress that the possibility for integration has not been fully realized.
00;09;54;28 - 00;09;59;03
Eric T. Roberts
And so this is an area where policymakers are really intent on making some changes.
00;09;59;12 - 00;10;25;19
Alan Weil
Well, you know, that's what we like to talk about at Health Affairs. Before we talk about those policy changes, anyone interested in health equity should pay particular attention to duals. And I wonder if you could say a little bit about both the demographic profile of people who are duals and the findings in your paper that show different results by race and ethnicity?
00;10;26;06 - 00;10;49;03
Eric T. Roberts
Sure. I think one of the key demographic features of the dual population to understand is that duals are disproportionately Black, Hispanic, or other people of color. Nearly one half of duals are people of color, and nearly two thirds of D-SNP enrollees are people of color. And by the way, this is kind of consistent with the fact that Medicare Advantage plans disproportionately serve Medicare beneficiaries of color.
00;10;49;11 - 00;11;11;21
Eric T. Roberts
D-SNPs are not that different in that respect, but they serve many of these enrollees. So whether D-SNPs provide relatively better care than other types of Medicare coverage for dual eligibles is critical for health equity. What we found in this paper was somewhat concerning in the few areas where D-SNPs performed better than regular Medicare Advantage plans overall.
00;11;11;27 - 00;11;39;03
Eric T. Roberts
For example, access to dental care, satisfaction with availability of care from specialists. Only non-Hispanic white duals reported getting better care in D-SNPs than in other Medicare Advantage plans. So this suggests that some of the benefits of D-SNPs, while limited, don't seem to be realized equitably among racial and ethnic groups enrolled in the program. And, you know, this is a critical concern and something that policymakers have been attentive to.
00;11;39;04 - 00;12;07;02
Eric T. Roberts
I'll say that MACPAC and its most recent report to Congress highlighted health equity as a key goal of policymaking in D-SNPs and the need to make equity an explicit goal of integration policy. As policymakers contemplate reforms to the distant model moving forward. So this result really, I think, resonates with those recommendations and underscores a better need for evaluating health equity among D-SNP enrollees and pushing plans to address remaining inequities.
00;12;07;26 - 00;12;40;16
Alan Weil
Well, I'm concerned that the findings show that integration hasn't really happened. But I take from you that the efforts to integrate are still pretty young. And so I want to talk to you about sort of what integration would look like, what some of the potential is. And as you said, what some of the policy questions are or policy opportunities are for making integration more likely.
00;12;41;01 - 00;13;29;11
Alan Weil
We'll cover those topics after we take a short break. And we're back. I'm speaking with Dr. Eric Roberts about whether or not people enrolled in D-SNPs, dual eligible special need plans, are having a better experience than those in traditional Medicare or in Medicare Advantage. Before the break, we talked a lot about the findings, but as you describe to our listeners, efforts in integration are still pretty basic.
00;13;30;09 - 00;14;02;10
Alan Weil
So I want to ask your help in sort of painting a picture here. You noted earlier on that Medicare and Medicaid actually pay for fairly different services. They play, as you said, different roles for this population. You also noted that the population itself is quite heterogeneous. So I wonder if you can give us a little clinical lens here into what it looks like to care for these patients or this population or some subset of them.
00;14;02;20 - 00;14;09;03
Alan Weil
And what not integrated care would look like and how that might differ from what integrated care would look like.
00;14;09;29 - 00;14;41;22
Eric T. Roberts
Sure. And just one example, that kind of comes to mind are duals with behavioral health conditions, which, you know, who are over represented among duals compared to other Medicare beneficiaries. And particularly in the non-elderly disabled dual population, which is quite unique. So individuals with behavioral health conditions like schizophrenia, bipolar disorder, depression often don't just have those conditions. They have a much higher rate of physical health co-morbidities, for example, obesity, diabetes and hypertension.
00;14;42;04 - 00;15;12;15
Eric T. Roberts
And yet, from the payer's perspective, Medicare is the primary payer for the physical health care services. Medicaid will pay for some of the behavioral health care services. And then if those individuals have long term care needs, that's primarily covered by Medicaid. And so that from a clinical perspective, these kind of conditions are not separable. Right? They sort of co-occur and there's this sort of two way relationship between sort of, you know, mental health conditions and physical health.
00;15;12;25 - 00;15;40;21
Eric T. Roberts
Yet we've kind of created this arbitrary bifurcation of payment systems. So the conceptual argument in favor of integration is that one payer would be responsible for the full range of services that duals use. And the question is, how do we get there? D-SNPs are intended to be a platform for getting there, but they have not gotten us there yet in a complete sense, because D-SNPs are still, by and large, separately administered and financed from Medicaid.
00;15;41;09 - 00;16;14;17
Eric T. Roberts
So from the patient's perspective, they're navigating two separate benefits that are covering these separate but complementary health services to address their range of health care needs. So where we're going from, D-SNPs is in sort of more integrated breeds of D-SNPs, where one managed care plan will cover the Medicare and Medicaid spending for the same patients. Now, this has not been sort of standardized yet, and there is variation in these plans and whether they will cover both behavioral health and long-term care or just one or the other.
00;16;15;11 - 00;16;38;29
Eric T. Roberts
And so where we're at with policymaking is figuring out how to design these plans in a way that covers an appropriate range of services, while recognizing the fact that the administrative process of integrating coverage is still really complex. And it involves this sort of interaction between a state Medicaid program and Medicare to figure out how to actually affect integration.
00;16;39;19 - 00;17;05;21
Eric T. Roberts
And so the goal is to sort of make this arbitrary distinction between what Medicare and Medicaid covers go away, but how we get there is still relatively new, and it has not been formalized or standardized yet. And this has big implications for the sort of vulnerable subgroups of dual eligibles, those with behavioral health conditions or developmental disabilities, where I think we have yet to match the model to the patient.
00;17;06;21 - 00;17;22;25
Eric T. Roberts
And so it's the next step in really thinking about this is how to design these models in a way that better coordinate care across the programs, but is attentive to the varied needs of different subpopulations of duals. And the evidence to guide those policy changes is almost nonexistent at this point.
00;17;23;27 - 00;17;48;25
Alan Weil
Well, you know, decades ago, literally when I ran the Medicaid program in Colorado, I would always talk to colleagues in Medicaid who said, you know, where we pay to meet social needs, the savings accrue to Medicare. And so we knew from the perspective of the patient, the enrollee, that it was a good thing to do. But if we were arguing for resources, it was hard to get them.
00;17;50;00 - 00;18;18;28
Alan Weil
And it never seemed to make a lot of sense. We knew we weren't doing best by the patient. So this notion of financial integration has always been out there as the ideal way to optimize resource allocation. But until you're there, the examples you gave, I have to say earlier on, in integration, like letting someone know when they've been admitted to the hospital that sounds pretty basic to me.
00;18;19;07 - 00;18;28;26
Alan Weil
It's hard for me to imagine that that's really fundamentally going to change people's experience of care, although you certainly prefer they notify than not.
00;18;29;24 - 00;18;49;29
Eric T. Roberts
Well, that's true. So a couple of remarks to your points there. This this idea of sort of Medicare and Medicaid having conflicting financial incentives has long been recognized by policymakers. It's probably one of many examples of what I'll call the wrong pocket problem in health care. You know, I do something that saves money, but the savings accrue to someone else.
00;18;49;29 - 00;19;23;18
Eric T. Roberts
And so that blunts the incentive to do the good thing. And so, you know, the dual eligibles are one example of many cases where this occurs in health care. Now, the idea is maybe if we put the, you know, financing of these programs together, we would actually effect clinical integration or we would achieve clinical integration. I think that there is still and it will do more than simply notify Medicaid of when a patient is admitted to the hospital that there will be within the plan, sort of a real focus on coordinating care across the range of services that duals use.
00;19;24;03 - 00;19;43;29
Eric T. Roberts
What that looks like and how the elements of a successfully, clinically integrated plan could be disseminated, I think aren't very well known and it's a bit of a black box. And frankly, this is the challenge where it's sort of theory and practice have this chasm between them because we have this idea that financial integration will resolve all these conflicts.
00;19;44;09 - 00;20;05;21
Eric T. Roberts
But how that looks in practice, how that gets customized to different populations, is it, you know, housing services or unstable house duals? What types of home and community based services? We tend to think of those as one homogeneous group of services, but it's quite varied. What types of behavioral health care? I think all of that is not well understood.
00;20;05;21 - 00;20;20;01
Eric T. Roberts
And so it leaves states and plans which have a great deal of, you know, have sort of significant influence over how integration actually gets implemented with a lot of uncertainty about how to do this in an effective way.
00;20;20;24 - 00;20;47;25
Alan Weil
You know that your notion of a chasm between theory and practice, it seems just right. And policymakers looking at sort of this tool of financial integration think if we just did that, everything would fall into place. And what you're saying and it's certainly the experience I've had around this topic, is we don't actually know how to translate the aligned financial incentives into appropriate care.
00;20;47;25 - 00;21;20;28
Alan Weil
And you talked about clinical integration, but this is really clinical integration and clinical social integration both. And we need to learn. And the only people who learn are people actually do it. Actual people enrolled in systems that are trying to figure this out and this very vulnerable population. So when the financial integration models were first proposed, there's a lot of pushback on the speed with which states were asking to do this integration, and the numbers were cut way back.
00;21;21;10 - 00;21;29;27
Alan Weil
It sounds like we are still very much on a learning curve. And although we'd like to learn faster, maybe we just have to accept that that's where we are.
00;21;30;12 - 00;21;57;06
Eric T. Roberts
I think CMS is, a couple of thoughts there, CMS is definitely pushing us in a learning direction. They are formalizing some integration standards that different plans have to attain. There is clearly an opportunity to learn as these models are implemented. So some of this will be learning through doing, you know, on pushing states too fast or pushing plans too fast.
00;21;57;19 - 00;22;25;19
Eric T. Roberts
I think a bigger concern for me actually is and this came up in the Financial Alignment Initiative and just to set the context, this was these were demonstration programs to attain integration that were authorized under the Affordable Care Act. On of the big push backs came from the beneficiary community and the provider community over concern that what it meant to be in an integrated product, whether people could maintain continuity of access to their primary care providers, was not adequately explained.
00;22;26;06 - 00;22;54;18
Eric T. Roberts
And there's some evidence that it was particularly poorly explained for non-English speakers and racial ethnic minorities who opted out of these integrated models at even higher rates than white individuals. And even Health Affairs has published some of this evidence in Health Affairs Forefront. So part of this will be sort of, you know, advancing the evidence through incremental policymaking and part of this will be also getting the integrated models sort of better translated to their end users.
00;22;55;15 - 00;23;12;13
Eric T. Roberts
Otherwise, we're not going to have beneficiary experience to study and learn from and I really think that these things go hand in hand. We can talk about sort of what integration means in the abstract or even in a clinical sense. But I think, you know, in many cases from the beneficiaries perspective, this is not adequately explained at all.
00;23;12;23 - 00;23;39;03
Eric T. Roberts
And in fact, my study and others raised some concerns that this may be particularly inadequately described for a vulnerable subgroups of duals. And so if we're going to move the needle forward, we need to both sort of engage in some policy trial and error evaluation, but also really keep in mind the end user and better translate what this means for the beneficiary and adapt to the beneficiaries needs.
00;23;39;12 - 00;23;43;16
Eric T. Roberts
And I think that that is an area where the financial alignment initiative was a bit flatfooted.
00;23;44;14 - 00;24;05;11
Alan Weil
That's very, it seems like the right balance to strike. So let's just ask sort of a big question here. Given what you found, given the pace of change, is it that the D-SNP designation or model is sort of not really the right one? Or is it that we're a little too early and we need to give it more time?
00;24;05;11 - 00;24;13;14
Alan Weil
Or do we need to have higher expectations for them? Where are we in the D-SNP experiment in your mind?
00;24;15;00 - 00;24;40;02
Eric T. Roberts
Well, I would say to begin, I think that the D-SNP model is here to stay and is an important chassé to build off of. D-SNPs are the largest permanently authorized managed care model to do this work of integration. Now whether they've achieved it is as we've discussed of concern and remains an area for growth. Congress permanently authorized D-SNPs in 2018.
00;24;40;02 - 00;25;10;24
Eric T. Roberts
So this is likely to be the most sort of scalable, realistic way of moving forward. But there is a fair amount of heterogeneity among D-SNPs in the level of integration that they've attained. And there's a lot more to do to kind of standardize, both to learn from what D-SNPs are doing, to identify elements of D-SNPs that actually do improve care and advance health equity for duals, and figure out how to then tailor those to different populations and disseminate them.
00;25;11;03 - 00;25;30;27
Eric T. Roberts
And we are not at that stage yet. So I am not inclined to say that we should scrap this model, but I am inclined to say that we need to improve upon it. And where we can improve upon it is by figuring out what elements of integrated plan design work and for whom, and then for sharing that evidence with states and plans.
00;25;30;27 - 00;25;46;03
Eric T. Roberts
Because there's a menu of options that everyone has on the table within this D-SNP kind of idea. What does integration mean? How does it get applied in individual plans and a real need for better evidence on how this can actually get effectuated?
00;25;46;18 - 00;25;57;23
Alan Weil
Well, as we come to a close, I wonder if you could say what slice of that is on your research agenda. It's a big, complicated topic. Where are you focused right now?
00;25;58;08 - 00;26;23;16
Eric T. Roberts
So I am very excited about this. I am submitting a grant to look at the effects of different Medicare, Medicaid integration models and D-SNPs. And we're really going to look at two of these newer varieties of D-SNPs that CMS formalized through recent regulatory changes. They're called highly integrated, D-SNPs or HIDE SNPs and fully integrated dual eligible SNPs or FIDE SNPs.
00;26;23;26 - 00;26;50;28
Eric T. Roberts
And I promise when all this gets cleaned up, we'll have tidy SNPs. And really trying to understand, okay, what are the key distinctions among these models? Which ones perform better and for whom? Recognizing the fact that the dual eligible population is heterogeneous. So the effects of a model for duals with behavioral health conditions may be different from the effects of the model for duals with other chronic health conditions, physical health conditions.
00;26;51;11 - 00;27;17;14
Eric T. Roberts
So really understanding that heterogeneity and then doing a fair amount of work to understand the variation at the plan and state level and how this notion of an integrated SNP actually gets operationalized. My hope is that by looking under the hood, we will start to drill down into the key elements of D-SNP design that actually can achieve what policymakers have hoped for these plans, but have yet to have been realized.
00;27;18;03 - 00;27;50;24
Alan Weil
Well, Dr. Roberts, I thank you for the paper and for focusing on a very high risk, high need population. And that has not been particularly served well. We have these two exceptionally important programs for them, but they weren't designed to work together. And we've been trying to figure this out for a long time. I appreciate your commitment to doing your part to help solve this thorny health policy problem and today, I also thank you for being my guest on A Health Podyssey.
00;27;51;07 - 00;27;52;05
Eric T. Roberts
Thank you. It was a pleasure.
00;27;52;19 - 00;27;59;27
Alan Weil
Thanks for listening. If you enjoyed today's episode, I hope you'll tell a friend about A Health Podyssey.
00;28;02;13 - 00;28;34;11
Jeff Byers
A Health Podyssey is produced by Health Affairs, the leading journal for Health Policy research. The team behind the show includes Patti Sweet, Jeff Byers, Julia Vivalo, Sarah Kolk and Sue Ducat. Like the show? Subscribe to A Health Podyssey on Apple Podcasts, Spotify, Stitcher, Google, or wherever you listen to your favorite podcasts. Thanks for listening and have a great morning, day or evening.