Bringing value-based care to life in New Mexico
Advancing value-based care
As Teresa Mitts sits across Dr. Jaren Trost in the living room of her home, she wipes tears from her eyes while discussing an extremely challenging year filled with health complications.
Teresa, who shares that she’s hardly mobile these days while she recovers from surgery and adjusts to life with a colostomy bag, takes a deep breath.
“This has not been fun,” she says through tears. “I hate it that I have to take all this medication. I hate it that I’m not active. It’s been so long and it’s just been a long, strange trip.”
Dr. Trost gently reaches out and grasps her hands in his own.
“I’m going to take care of you, OK?” he says. “I’m going to help you get back to better health.”
Teresa isn’t all that different from the patients Dr. Trost, senior medical director within Optum Health, is used to seeing. In fact, it’s why he began this journey back in 2022 — he noticed that some of his sickest patients were getting sicker. They weren’t coming back to the clinic. They weren’t returning phone calls or filling their prescriptions and he didn’t understand why. He asked his team to make a list of his sickest patients — and then, he went to go see them.
Changing the approach
Dr. Trost, who grew up in New Mexico, hopped in his bright blue Honda Civic to see what was happening. What he found was eye-opening, to say the least.
“(One) patient was really struggling. He was connected to oxygen 24 hours a day so he wasn’t able to leave his room. He couldn’t even get up to go to the bathroom,” he recalled. “His house was extremely dirty. If that patient was able to get to my office, I would’ve never seen that side of it. I wouldn’t have seen how he lives day to day.”
He saw homes without running water. Dirt floors. Empty cupboards and barriers to transportation. Patients who were barely able to get themselves out of bed, let alone make it across town to a clinic. In one case, a patient on their list had passed away a year ago but the family was too distraught and never updated their records.
It forced him to take a step back and think through the lens of, “what are the challenges facing these patients day to day,” the social drivers of health that create barriers to better outcomes?
“I wanted to make more of a difference,” he said. “When I first started, I went out with my medical assistant, we drove and all I had was my stethoscope. You see these people and all you want to do is help.”
Dr. Trost knew he had to change his approach. Leading with a value-based care model, Dr. Trost expanded to home care to help his patients improve their holistic health outcomes through a focus on quality care, trust and human connection.
Improving health outcomes
Creating a healthier community, especially in a state like New Mexico with underserved populations, has to start with removing barriers.
“There’s really a lot of need there when you think about folks that need to get care and access care — they’re not really getting the tools and resources they would otherwise, especially in the rural communities,” said Steve Macias, president and CEO, Optum Arizona and Optum New Mexico. “Almost 30% of the population is low income. They have transportation needs so they really need to depend on the system and that’s where we come in.”
When Dr. Trost initially started these home visits, he found the needs were plenty.
“When you’re choosing whether to keep the lights on or to eat vegetables, that’s a tough decision,” he said. “Sometimes they have to choose a medication over eating. Those are the things we deal with day to day in this population. Working for Optum or in a big company like UnitedHealth, the resources are there. Sometimes it just takes knocking on the door to get those resources unlocked.”
Shifting away from a fee-for-service model, Dr. Trost believes coordinated, value-based care can help produce better health outcomes by focusing on whole-person health and ensuring quality care is accessible whenever and wherever patients need it. And so far, the results have been highly rewarding and meaningful.
“Taking care of a patient like the one I was talking about, and going to visit him, it’s emotional because when he gives me that hug, that’s what it means. That’s value-based care,” he said. “He sat in his room and he would’ve sat there forever. For me to give him a chance at a healthier life, it means more to me than anything.”
Advancing value-based care
Dr. Trost has dropped off meals for patients, taken them to appointments, even helped avoid disruption with utility bills. For him, it’s not just about providing a health care service and moving on to the next patient. It’s about changing a community’s health, one person at a time.
“When you can use your power as a physician to make another person’s life better, that’s addicting,” he said. “When I’m in an exam room or when I’m at that patient’s home, it’s hard for me not to do everything I can and to keep following up because I know that’s my chance.”
“To take care of people the way that I have in the last year and a half, it’s special.”
Two years and 110,000 miles on the Honda Civic later, Dr. Trost and his team in New Mexico have expanded this value-based care model with the help of other clinicians, including nurse practitioners like Bryan Sanchez. Since September, Bryan and team have completed more than 300 home visits throughout the state. Optum New Mexico also has two mobile clinics that can help bring care to rural areas and complete routine screenings.
“Being able to meet people in their homes and addressing them where they feel comfortable has made a huge difference in how I understand patients, but also in meeting their needs,” Bryan said. “Dr. Trost is like a proof of concept for us. He started it and he saw there’s a big need here.”
For Teresa, the home visits mean more than a check on her health. It’s a pathway to hope.
“I got tears in my eyes, but they're happy tears, not painful tears,” Teresa said. “For somebody to be here for me, is a wonderful feeling.”
