The Race to Value Podcast: Recent Episodes
Accountable Care Learning Collaborative
We are in a race to make health value work. Join Dr. Eric Weaver and Daniel Chipping of the Accountable Care Learning Collaborative as they interview top executives, physicians, and entrepreneurs leading the transformation to health value.
Jody Long, a proud double alumna of Western Governor’s University, has dedicated her career to advancing the nursing profession since 1997. With more than 18 years of specialized experience in Emergency Care and nursing leadership, Jody has recently shifted her focus to Clinical Innovation and Technology—championing tools and solutions that elevate bedside care and empower nursing teams.
She holds both a Master of Science in Nursing Informatics and a Master of Business Administration in Healthcare Management and is a Certified Emergency Nurse. Jody is a passionate advocate for professional development and nursing excellence through her active involvement in the Emergency Nurses Association (ENA), the American Nurses Association (ANA), and the Healthcare Information and Management Systems Society (HIMSS).
Her leadership extends beyond clinical settings—Jody was appointed by the Governor to serve on the Florida Board of Nursing and contributes nationally through the National Council of State Boards of Nursing and the Commission for Nurse Reimbursement.
Committed to driving high-quality, patient-centered care, Jody is known for her energy, integrity, and people-first approach. She continues to inspire colleagues through mentorship, collaboration, and a relentless pursuit of innovation and improvement in healthcare delivery.
Today, Ashley welcomes Trista Sebastian, an expert in Early Childhood Education and a self-proclaimed nutrition guru, for an in-depth conversation about the critical role childhood nutrition plays in shaping the health and development of young minds and bodies. Together, they explore how proper nutrition during these formative years influences not only immediate behavioral patterns and academic performance but also long-term health outcomes and social equity. Trista sheds light on the profound connection between what children eat and their physical, emotional, and cognitive well-being, emphasizing the lasting effects that early dietary habits can have on adulthood. This thought-provoking discussion also examines how nutrition intersects with health equity, addressing systemic barriers and disparities that impact children’s access to healthy food. Don’t miss this enlightening episode that underscores why what we feed our children today determines the adults they become tomorrow.
Trista Sebastian is an Early Childhood Education teacher from Cincinnati, Ohio. . Currently serving as the lead teacher at a preschool, Trista not only nurtures young minds in the classroom but also oversees the school’s nutrition program, ensuring that her students have access to healthy, balanced meals. Her passion for childhood nutrition began during a deeply personal journey—her pregnancy with her daughter—which inspired her to dive deeper into the connection between nutrition and early development. Since then, Trista has dedicated herself to advocating for the importance of proper nutrition in shaping children’s health, behavior, and future outcomes. Her unique blend of classroom expertise and hands-on experience with childhood nutrition makes her an invaluable voice in this vital conversation.
In today’s Episode, Ashley sits down with Dr. Kim Kelly-Cortez to explore challenges nursing schools face, such as faculty shortages, limited clinical training slots, high burnout rates among current educators, and the financial barriers students encounter. We also delve into the ripple effects of these issues on healthcare, such as staffing shortages, overworked nurses, and potential impacts on patient care quality.
Dr. Kimberly Kelly Cortez is the Senior Associate Dean and Director for the Prelicensure BSN program at Western Governors University. She continues to support the growth of the Prelicensure program by expanding into additional states, opening simulation centers/labs, expanding access to communities and populations in need of pathways to nursing education. Her research continues to focus on student success, programmatic excellence, Competency Based Education (CBE), and simulation. She has presented research related to NCLEX, CBE, and Diversity in BSN prelicensure programs at the NLN Education Summit, AACN Transform, and the National Nursing Workforce Conference respectively in recent years.
On today’s episode, Ashley sits down with with Keith Somers. CRO at HealthCorum. Keith is an entrepreneur with a finance background who co-founded HealthCorum after a series of frustrating experiences navigating the healthcare system as a patient and caregiver. As CRO at HealthCorum, he leads the sales/marketing team on all market interactions while maintaining responsibility for company operations.
HealthCorum is a company that provides data analytics and insights focused on the healthcare industry. They specialize in analyzing data on healthcare providers, such as hospitals and physicians, to assess their quality, efficiency, and overall value in comparison to other similar providers. HealthCorum’s platform and underlying data helps healthcare organizations, insurers, and employers identify high-performing providers, reduce costs, and improve the quality of care.
Today Ashley sat down and talked with Dr. Edwin Estavez. Edwin is the founder of the Altacair Foundation. He Previously, served as Market President of Value Based Care at Prominence Health, a leading health care company that provides high quality, cost-effective care to diverse populations. Edwin, has over 30 years of experience in health care and higher education administration, risk management, and business development, with a PhD in Administration and an MSW. He is passionate about organizational transformation. From health care delivery and outcomes through value-based care tactics, to patient engagement programs, and care coordination models. Join as we chat about the mission of Altacair, how he ensures the foundation stays true to its mission and vision, and the collaboration between Altacair and The Leavitt School of Health on the Accelerator Conference.
Altacair Foundation: About Us – Altacair Foundation
Accelerator 2024: https://www.eventbrite.com/e/accelerator2024-advancing-value-for-health-equity-tickets-951490021267?aff=oddtdtcreator
On today’s episode of The Race to Value, Ashley sits down with her colleague and friend, Dr. Melissa McLaren to discuss the importance of DEI in Healthcare and Education, and why building inclusivity is not just a buzzword, but something that is vital for the future.
Dr. McLaren is an Associate Dean and Academic Program Director at the Leavitt School of Health at Western Governors University. She graduated with her BSN from The Ohio State University and her Doctor of Nursing Practice from the University of Minnesota. She received her master’s in management and leadership and an MBA from Western Governors University. Melissa and her family have engaged with lawmakers at the local and state level, as well as the Congressional LGBTQ Equality Caucus and the US Department of Health and Human Services in support of gender-affirming care and other LGBTQIA+ rights. They have spoken at state and national conferences to educate on the importance of family support when raising a transgender child. Dr. McLaren has partnered with organizations such as the Human Rights Campaign, Welcoming Schools, PFLAG, the ACLU, TransOhio, Equality Ohio, and many others to advocate for transgender youth. Dr. McLaren currently serves on the Human Rights Campaign Parents for Transgender Equality National Council. She is a board officer for Equality Ohio and was an inaugural board member of her local LGBTQ+ organization. She is a member of the AACN DEI Leadership Network Communications Committee. She lives in Ohio with her husband of 20 years, 19-year old twins, 2 dogs, and several entitled cats.
Previous Episode: Ep 137 – Authentic Truth, Love, and Compassion: A Family’s Journey in Gender-Affirming Care, with Melissa and Conner McLaren – The Race to Value Podcast™
0:50: Defining Diversity and Inclusion
4:52 Why is diversity and inclusion so important in today’s society?
9:34: How the impacts of disparities and health inequities affects absolutely everyone
13:30: How treatment of patients differs based on insurance status
21:00: Education related healthcare burdens, and how education has an impact.
24:00: How diversity enriches the learning experiences in educations settings
33:24 Stories about successful inclusive educational initiatives
38:00 Shifting policies and practices
39:30: Dr. McLaren’s personal story
On today’s episode of Race to Value, Ashley sits down with Mark Young, CEO of MyCHN to discuss how MyCHN launched a partnership with Wysa, an AI-driven mental health platform. We discuss how this collaboration aims to bolster the well-being and mental health of MyCHN’s Crisis and Behavioral Health patients by providing them access to Wysa’s innovative AI personal mental health companion at no cost.
Mark Young has worked in health services since 1989 and in community health since 1998. He has a Master’s in Business Administration from Trident University and a Master’s in Organization Management from the University of Phoenix. Over his career of 30-plus years, Mr. Young has worked with initiatives in the Rio Grande Valley, northeast Texas, and south Texas. Projects he has developed include outreach and engagement with colonia residents, residential treatment services for pregnant women and children, a tuberculosis intervention program, multiple chemical and alcohol dependency programs, behavioral health programs, and many outreach, education, and intervention projects.
Timestamps:
3:00: Discussion on how MyCHN created this partnership with WYSA and the benefits it has brought to their patients.
6:00: How this tool is used to help patients
7:30: Tools and Resources that WYSA offers
11:30: Breaking the Stigma around using AI in Healthcare
16:00: Discussion on the current state of Behavioral Health
19:00: Discussion on younger populations and if they are more likely to opt into utilizing AI for healthcare
In today’s episode we chat with Geoffrey Roche, MPA. Geoffrey is the son of a nurse, future of work and education expert, diversity, equity, inclusion, and belonging advocate, champion for transforming health equity, and the host of the Ed Up Health Up podcast. His professional career includes over nine years in hospital administration as a strategic advisor to the President and CEO and department director of various departments, including Business Development and Planning, Government Affairs, Community Health, and Public Relations, for Lehigh Valley Hospital-Pocono. At Lebanon Valley College and Harrisburg University of Science and Technology he held senior leadership roles focused on strategic partnerships, organizational strategy, and business development. As Senior Vice President, Business & Workforce Development at Dignity Health Global Education, he led a diverse team focused on developing institutional relationships with leading health systems while simultaneously championing national conversations and initiatives to develop innovative diversity, equity, and inclusion solutions for the healthcare workforce.
“We expected to see a drop in enrollment before the pandemic for all healthcare programs. Why did Healthcare and Education not come together to combat this?” – Geoffrey Roche
“We have made bad decisions as a society when taking care of our healthcare workforce.” – Geoffrey Roche“We have five generations of people in the workforce, and this is the first time we have had this.” – Geoffrey Roche“As Leaders we need to harness the creativity and passion for all generations in the workforce.” – Geoffrey Roche
2:25: What is happening in the nursing workforce?
4:30: The Supply and Demand Gap Challenge and addressing culture in healthcare organizations.
5:30: The Gig Economy is now in healthcare, and we have to get used to this model.
8:00: Millennials in the workforce and creating a culture that allows people to be the best they can be by creating a community and culture that allows them to thrive. This means they must be valued and heard.
14:00: What do we need to do as healthcare leaders to invest in our people?
17:30: Why you need to listen to your workforce, instead of just hiring consultants.
20:30: If we do not have a healthcare workforce, it will impact education, clinical placements and preceptorships.
22:50: Apprenticeships, why they are important and why healthcare has been slow to implement them
29:27: We need to do more work in the K-12 Landscape to promote and encourage people to go into healthcare careers. It is important to learn that there are jobs in healthcare that aren’t being a doctor or a nurse.
Welcome back to Race to Value! In this episode we introduce our new host, Ashley Schwartz and discuss the rebranding of the Institute for Advancing Health Value and how we are expanding our work.
Today’s guest is Dr. Keith Smith (M.A., Ed.D., MBA, L.M., RMHC (ret.)) serves as the Executive Dean and Senior Vice President for Michael O. Leavitt School of Health at Western Governors University. He has strategic leadership experience in the business, nonprofit, and higher education sectors. His 26-year career in higher education comprises holding faculty, dean, vice-provost, vice-president, and now senior vice-president positions, at five universities prior to coming to WGU, inclusive of leading schools of health, business and IT, and arts and sciences. He has taught courses and given presentations domestically and internationally on leadership and organizational change, higher education innovation, and personal growth and development. Smith has supervised educational programs in Europe, the Middle East, and Asia. He has played a lead role in both regional and programmatic accreditations. His teams have developed a wide spread of programs from the microcredential through doctoral levels, as well as partnerships with business, government, military, and community colleges across the nation.
0:19: Introduction to Keith Smith, SVP of WGU’s Leavitt School of Health.
1:42: Upcoming changes you can expect to see with the Institute for Advancing Health Value and it’s rebrand.
2:52: Expansion in content- we will be continuing our work in Value Based Care, but are expanding into workforce, health equity, diversity and inclusion and workforce development.
4:50: Health Equity Convening in the Rio Grande Valley of Texas. This is a new area of work that we are continuing to expand and explore in different areas of the United States
8:00: Discussion of the Programs that the Leavitt School of Health currently offers.
11:40: Discussion of WGU’s strategic pillars and how they will benefit the general public and the current workforce.
“We want to set a greater tone out in the Healthcare Industry, in terms of thought leaderships and opportunities to partner with those in different systems, and opportunities to be a resource center for them.” – Dr. Keith Smith
“Educational Equity feeds into Health Equity. By providing education to everyone, it opens the door for health equity and having trained, qualified and a culturally competent workforce that mirrors the diverse population that they are caring for.” – Ashley Schwartz
In this episode of the Race to Value podcast, we are sharing inspiration for a more optimistic future in the value transformation of our country. This week’s interview brings a message of hope, compassion, and human connection balanced with the business success of value-based care within a national leading health system.
Albert Einstein once said that “Only a life lived for others is a life worthwhile” and no one better captures that spirit of servant leadership than our guest this week. Philip Eaves is the President and CEO of Ascension Seton ACO | Ascension Seton Health Alliance and the Vice President of Population Health at Ascension Texas, and he is a leader in the value movement that you should know about. In this interview we focus on change management, leadership, and the human side of healthcare economics. Overseeing the value-based care strategy and operations for one of the largest clinically integrated networks in Texas, Philip is leading the ACO to outstanding success…and transforming the lives of people along the way.
Bookmarks:
01:30 The human side of healthcare economics – compassion is the currency; empathy is the language.
02:00 Introduction to Philip Eaves, President and CEO, Ascension Seton ACO and VP of Population Health, Ascension Texas
02:30 Ascension Seton ACO is the largest clinically integrated network in Texas with 3,600 providers with 300K value-based lives.
04:45 “Only a life lived for others is a life worthwhile” — Albert Einstein
05:30 Philip shares how a humble, faith-based upbringing fueled his ambition, work ethic, and compassion as a healthcare leader.
07:30 “Healthcare is about serving others.”
08:30 Occupational medicine as a stepping stone to value-based care.
09:45 Team-based care that enables providers so they can build meaningful patient relationships.
11:00 $24M in MSSP Shared Savings for 23,000 Medicare beneficiaries to achieve a top 7% performance ranking of all ACOs in the country (#32 out of #482).
12:45 Valuable partnerships with independent practices (e.g. Austin Regional Clinic, Capital Medical Clinic).
13:00 “Physician engagement is the overall key to ACO success.”
14:00 The impact of Annual Wellness Visits (AWVs) in practice transformation.
15:00 HCC recapture for documentation accuracy as an area of educational focus.
15:45 Centralized versus Embedded Care Management.
16:30 Analytical insights to drive high risk CM interventions.
17:15 Quality campaigns to close care gaps and improve population health outcomes.
18:00 Refining a Post-Acute Care network for optimal transitional care.
18:30 An after hours program as an effective ED diversion strategy.
20:00 Change management to improve team culture and reinvent the business model for VBC.
22:00 Phillip shares his experience leading an inflection point for the ACO business.
23:30 Applying the principles of the Kübler Ross Change Curve in organizational change.
24:30 Inspiration from John Kotter (“Leading Change”) – Leadership versus Management.
25:00 Recognizing the need for change in shifting a new strategic direction.
26:00 Communicating the vision and creating short-term wins.
26:45 New initiatives: a new ACO for early adopters, Medicare Advantage risk, and Direct-to-Employer partnerships.
28:00 Financial toxicity as a driver of Direct Contracting between employers and providers in value-based care.
30:00 Employer frustration with rising medical spend and the lack of solutions from their brokers.
30:45 Designing an ACO value proposition based on employer pain points.
31:00 Leveraging network adequacy and CIN care infrastructure for commercially insured populations.
32:45 PBM transparency to reduce extreme spending on pharmacy drugs.
34:00 Forging a new partnership with Signify/CVS to support practice transformation.
37:00 Accessing capital within a landscape where there is mass provider consolidation.
39:00 Financial distress in both the hospital and independent PCP sectors.
40:30 Determining cultural fit with potential partners to support capital needs.
43:00 Understanding the business model and risk track record of potential partners.
44:00 More information on the Signify/CVS partnership with Ascension Seton.
45:45 “Change is the law of life and those who look only to the past or present are certain to miss the future.” – John F. Kennedy
46:45 Parting thoughts on effective change management strategy and why we need to prioritize people in VBC business decisions.
48:45 Hope for the future. 😊
49:00 “The patient-provider-care team relationship is where the life change really occurs.”
The transformation of healthcare is a seemingly insurmountable challenge, yet overcoming any obstacle in the journey begins with the belief that it is possible to win! It’s not about the magnitude of the task; it is about the collective will to prioritize the wellbeing of every person we serve in our population. Perhaps when approached with the audacity to imagine a healthier and more equitable future for all, we’ll actually get there. And that is just what the Physicians of Southwest Washington (PSW) is realizing as they navigate a successful transition from volume to value.Our guest on the Race to Value this week is Melanie Matthews, the dynamic, creative, and innovative CEO of PSW. She leads a population health company that has been around for three decades. Melanie is not only leading their ACO and managing their progression in the adoption of full-risk Medicare Advantage delegation; she has become a nationally recognized voice for value-based health policy. In listening to this interview, you will hear from a leader that has a real personal capacity for leadership and a clear focus on excellence. If you want to hear from someone that is at the absolute forefront of risk-based contracting and innovation, who understands the issues at a granular level, this episode with Melanie is a must-listen!Episode Bookmarks:01:30 Introduction to Melanie Matthews and the Physicians of Southwest Washington (PSW)04:30 PSW has evolved over the last three decades from an IPA to a diverse business that includes a national leading ACO and risk-bearing entity for MA.06:00 “PSW is a story of independent physicians who, in a time of market consolidation, want to remain independent and focus on the patient relationship.”06:45 Achieving success in delegated risk and taking accountability for both quality and total cost of care.07:00 The impact of MACRA on the long-term value-based care strategy of PSW.08:30 Building an infrastructure and developing capabilities to move a value-based agenda.09:00 Developing a business model for agility in responding to new rules (“a kayak in a sea of cruise ships”) and engaging all types of physicians in the landscape.09:30 “The value-based movement is important as the fee-for-service chassis is not realistic, has poor quality and outcomes, and rising costs.”10:00 Taking risk with physician partners and providing them with MSO services, leveraging a technical infrastructure and population health platform.10:45 The glacial pace of scaling payment model transformation at CMS and CMMI’s bold goal for 2030.12:00 The increasing shift to home-based care delivery and the use of generative AI in reshaping care delivery.13:00 How the flawed economic design of the fee-for-service system creates industry inertia.14:00 Diverting to the known (i.e. fee-for-service care delivery) in times of stress is an unsustainable path forward.15:00 Convincing the Board room on the tenets of VBC when it hasn’t historically delivered on its promises.16:00 Trends in consumer cost-shifting and the challenges of private insurers cross-subsidizing provider losses from public payers.16:30 Unsustainable economics in employer-based healthcare and the looming insolvency of Medicare.17:00 What does the CMMI 2030 Goal mean for future of the value movement?18:30 An overview of the extensive services offered by PSW that empowers success in VBC.19:30 The explosive growth of strategic transactions of physician groups and how mass consolidation is impacting the landscape.21:00 Aligned incentives and access to a population health platform as keys to VBC success.22:00 PE investment impacts on competition in an independent physician ecosystem.23:00 Generational differences in the approach to the business of practicing medicine.23:30 “Organizations that are convened with independent physicians are able to show better costs of care.” (vs. employed or vertically integrated systems)24:45 Capital investment and consolidation as a forcing function for physicians to embrace total cost of care models.26:00 The explosive growth trajectory of Medicare Advantage and how PSW is capitalizing on innovation in full-risk MA delegation.28:30 Keys to Success in Full-Risk MA: 1) Incentive Alignment, 2) Empowering Data and Actionable Insights, 3) Standardized Workflows29:00 Developing a common set of quality and utilization goals across all payer contracts.30:00 Clinical connectivity, workflow optimization, and a data infrastructure for high- and rising-risk patient segmentation.30:30 Working with the array of incentive options in MA – from P4P, hybrid capitation, to full capitation options.31:00 How full capitation allows for an immediate recognition of the high utilizers in need of intervention.31:30 Prospective payment as a revenue stabilizer for independent practices.33:00 Using outcomes, quality, and clinical coordination data to align incentives in a physician network.33:45 PSW has a risk portfolio that covers 350,000 lives, of which 80,000 are Medicare beneficiaries in MSSP and ACO REACH programs.35:00 MSSP is vehicle for building risk maturity, while CMMI programs (e.g. ACO REACH) present the best opportunity for care delivery innovation.37:00 Consumer-centric innovation and benefit design flexibility in MA as a source of influencing CMMI payment model design.38:30 “ACO REACH is the first model that really contemplates the economic considerations of managing populations in underserved areas.”40:00 Strengths of ACO REACH (e.g. health equity benchmarking, care delivery innovation, incentives for SDOH interventions).40:30 What can CMMI do to improve the benchmarking methodology used in ACO REACH?42:00 Testing capitation and assessing health equity opportunities in ACO REACH.43:30 Executing on a playbook for Population Health improvement.45:00 Building a culture of team-based care in value transformation.47:00 Engaging patients through motivational interviewing.47:45 Ensuring access, capturing quality, and providing preventative screenings as the ABCs of comprehensive primary care.48:15 Developing shadow bundles within a total cost of care arrangement to align incentives with specialists.50:30 Melanie’s describes her experience as a leading advocate and health policy expert.51:30 The need for a unified voice to define what value-based care really is.52:00 A patient example of how social isolation caused extreme overutilization of the ED.53:45 “I feel like it’s important to shout from the rooftops on the importance of value-based care…”55:00 The Value in Healthcare Act as a policy striving to preserve Advanced APMs in the value movement.57:45 Parting thoughts from Melanie on the future of accountable care.
We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing. Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs.Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health. She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models.Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value. And make sure to tune in to Mara’s special announcement about Health Care Value Week at the end of the interview so you don’t miss out on important educational events occurring January 29th thru February 2nd.Episode Bookmarks:01:30 The need for accountable care policies that create better health outcomes and patient experiences.02:00 Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH03:00 Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event).06:00 How A4H is translating thought leadership to action in the advocacy arena.06:30 Accountable care as the solution to fragmented, uncoordinated care.07:00 Political turnover in D.C. has made VBC a “new” health policy solution.07:30 Educating the Hill comes down to conveying enthusiasm for health care transformation.08:00 Accountable for Health Members are shaping the national conversation for payment and delivery system reform.09:00 The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH).11:30 If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism?12:00 The need to overcome misunderstandings about what ACOs are trying to achieve.13:00 Providing education to dispel the myth that ACOs can actually limit services.14:00 How uninformed policy decisions could potentially create a catastrophic blow to the value movement.14:45 “Accountable care is integral to care delivery system reform.”15:45 Confusion with the term “value-based care” and why it will fail unless people understand the truest aims of the movement.17:00 The need for effective storytelling to advance care delivery transformation.18:00 Prioritizing care experience over cost reforms (delivery innovation will address costs!)20:00 The topline takeaways from CMS model evaluations and whether or not programs should be expanded.21:00 What do most people think when they hear the word “value”? (the need to reframe the conversation with more precise language)22:00 The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement.24:00 Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking).25:30 How strong relationships between MA plans and provider networks (underpinned by capitation) drive value.26:30 Understanding provider compensation in MA value-based payment and the synergies between managing MSSP and MA populations.27:00 Rethinking supplemental benefits in Traditional Medicare.28:00 An overview of the Medicare Access and CHIP Reauthorization Act (MACRA).30:30 The “cliff effect” of the Advanced APM Bonus reductions (and why that threatens the value movement).31:30 “We need strong incentives to continue this work in accountable care transformation. The Advanced APM Bonus has built important momentum.”32:30 The MIPS program maximum bonus is at 9% — in what world would the Advance APM incentive make sense at only 0.5%?33:00 Why are providers in the last year earning full bonuses in MIPS when 2-3% has been the historical average?33:30 An overview of The Value in Health Care Act of 2023 and consideration of a full-risk ACO option in the MSSP.35:45 The need for a long-term vision for MACRA (i.e. MACRA 2.0).38:45 The integration of specialists in accountable care models.39:30 Leveraging the physician fee schedule as a glide path for specialist adoption. Providing data to ACOs to better engage specialists.41:00 The responsibility of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to advance specialty-specific APMs.41:45 The move to mandatory payment models to catalyze healthcare cost savings goals for CMMI.45:00 How are Medicare-value based efforts aligning with Medicaid transformation?47:00 Health Care Value Week is a week of action from January 29th to February 2nd, providing broad-based education on VBC.48:30 The Virtual Value-Based Payment Summit is open to everyone (free registration) and the speaker lineup is incredible!49:30 A4H’s Health Care Value Week Conference in D.C.on Feb. 1st to celebrate the progress of VBC in improving people’s lives!51:00 Learn more about A4H and sign up for their newsletter at accountableforhealth.org.
The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.” As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It’s essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities.
In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet.
This week we are interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health. Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare’s Most Influential Clinical Executives as well as Modern Healthcare’s Most Influential People in Healthcare.
Episode Bookmarks:
01:30 The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.”
02:00 Climate change burden falls disproportionately on historically marginalized populations.
02:30 The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector.
03:00 Introduction to Vivian Lee, M.D.
04:30 One in four deaths can be attributed to preventable environmental causes…and climate change is exacerbating these risks.
06:00 Climate change resilience as a lens for value-based transformation.
06:45 The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere.
07:00 What are health care leaders going to do about this? (The need to manage the crisis through an empowered workforce.)
08:30 Exposed vulnerabilities in our supply chain as a complication to address climate-related crises.
09:00 The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!)
10:00 How do we decarbonize healthcare in order to “do no harm”?
11:45 Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors).
12:30 The strong business case for health care organizations to reduce their carbon footprint.
13:00 Tax credits offered by the Inflation Reduction Act to decarbonize hospitals.
14:30 “Renewable energy actually costs less than fossil fuel energy.”
14:45 The Inflation Reduction Act will cover about 30% of the capital needed to invest in a renewable energy system. (Add another 10% each for serving underserved regions and buying American made!)
15:00 ROI in the tens of millions for health systems going green! (“doing good and doing well”)
16:00 Non-productive energy use (e.g. ~60% of energy consumed by MRI and CTs occur when offices are closed on evenings and weekends!)
17:00 Putting high intensity imaging machines in idle mode would reduce the carbon footprint at a level equivalent to the NHS!
18:45 Kaiser Permanente became carbon neutral. (Referencing Kathy Gerwig article co-written with Dr. Lee – “Decarbonizing Healthcare“)
19:30 Boston Medical Center reduced carbon emissions by more than 90%.
20:00 Resources: Kathy Gerwig’s book, “Greening Health Care: How Hospitals Can Heal the Planet”, the AHRQ Climate Change Primer, and Health Care Without Harm, Medical Society Consortium on Climate & Health
22:00 “There are so many opportunities for aligning with the decarbonization effort that are completely synergistic with value-based care.”
22:45 “Primary care has a much lower carbon footprint than high intensity tertiary or quaternary care.”
23:20 How can we utilize telehealth and telenursing to reduce patient and clinician transportation needs?
24:30 Referencing the influence of Don Berwick in medical waste elimination. (see article “Eliminating Waste in U.S. Health Care“)
25:30 “Eliminating health care waste will do good for the planet, do good for the communities, and actually make ourselves financially healthier as well…all in the spirit of bringing more value to our health care system.“
26:45 The AMA is encouraging physicians to assist in educating patients and the public on sustainable practices and to serve as role models in providing environmental sustainability (see AMA Code of Medical Ethics Opinion on Climate Change)
28:00 Dr. Lee discusses the role of clinicians to advocate for eco-friendly practices in patient communities.
30:00 An example of how a pediatrician conducts climate change counseling (see Dr. Andrew Lewandowski’s study)
34:00 The tech-based application of AI, data, and analytics to combat climate change through value-based care delivery.
35:45 Using a health meter to advise patients on how best to deal with extreme heat and bad air advisories.
37:00 Lowering the health care carbon footprint through supply chain optimization.
39:00 The need for more engineering and technical innovation to support innovation in climate resilience.
39:30 The White House and HHS launched the Health Sector Climate Pledge to cut greenhouse gas emissions by 50% by 2030 and net zero by 2050.
40:00 “Solving the climate crisis is the greatest and most complex challenge that Homo sapiens have ever faced. The main solution, however, is so simple even a child can understand it. We have to stop our emissions of greenhouse gases. And we either do that or we don’t.” — Greta Thunberg
41:00 Parting thoughts from Dr. Lee on value-based care and climate change resilience. (“It doesn’t matter what political party or what socioeconomic class you are. We can’t escape this issue of climate change. We are all on this planet together.”)
A new era in value-based care is emerging where employers are no longer sleeping giants willing to tolerate a broken fee-for-service healthcare system. ‘Poor health’ costs employers $575B in lost productivity on top of the $880B they already spend in premium dollars annually. Employers (and their employees) continued to get fleeced by unsustainable double-digit premium increases every year, with hospitals using that excess spend in commercial insurance to their subsidize losses on the public pay side. The paradigm shift to value-based purchasing is underway in employer-based health insurance; however, it will not achieve the aims of population health unless a similar transformation occurs in workforce wellbeing. Joining us this week in the Race to Value is Dr. Richard Safeer, the Chief Medical Director of Employee Health and Well-being at Johns Hopkins Medicine, where he leads the Healthy at Hopkins employee health and well-being strategy. Dr. Safeer is a highly influential thought leader on building a culture of health and is the author of the groundbreaking new book, “A Cure for the Common Company: A Well-Being Prescription for a Hopper, Healthier, and More Resilient Workforce.” In this interview you will hear from one of the leading experts on employee health in our country about what it takes to cultivate a healthy workforce.Episode Bookmarks:01:30 Introduction to Richard Safeer, M.D. and “A Cure for the Common Company”04:45 Developing a holistic view where we look at individuals as both patients and employees.05:15 “Until we integrate a strategy that includes the workplace, we are not likely to optimize population health.”06:00 The economic and cultural imperatives for workforce well-being.06:30 A key factor in achieving health goals is the support of people you are closest to at home and at work.07:45 Connecting the spectrum of employee health from well-being to chronic disease.08:30 Why have attempts at corporate wellness failed so often in the past?09:30 “Our health and well-being are greatly influenced by the relationships we have in the workplace.”10:00 Most employers do not fully leverage the social sciences to optimize the support of their workforce.10:45 Innovative self-funded health insurance as a requisite component of a corporate wellness strategy.12:30 How a company benefits from a healthy workforce.13:45 Innovations to create access to high quality primary care and lifestyle medicine (e.g. Direct Primary Care and onsite clinics).17:00 Employers must fully leverage all resources (e.g. data from health insurers, EAPs, collaboration with local health systems).18:30 The 6 Building Blocks of a Wellbeing Culture.20:45 Making it easier for employees to make healthy choices.21:30 The influence of social climate in the workplace.22:30 The plight of healthcare workforce burnout and moral injury.23:45 We need supportive work environments to produce good health (not paternalism).25:00 “Employers who demonstrate genuine care and back it up with genuine resources to support health and well-being will be the ones to attract and retain talent.”25:30 Resiliency does not rest solely on the individual!26:00 Employees cannot maintain mental health if their work doesn’t align with education and skill set.27:00 Social connections to team and trust in management improves resiliency.29:00 70-80% of employees are willing to take a pay cut to get a job that better supports their mental health (see UKG study)30:00 Balancing the need for social connection with remote work.31:30 Referencing the new book, “Culture Shock: An Unstoppable Force is Changing How We Work and Live.”32:00 One-size fits all decisions about onsite work doesn’t make sense for all employees.33:30 Cisco Systems as an exemplar of a workplace culture for health and well-being.36:00 The role of technology in health is superseded in importance by the workplace, home, and community settings.37:00 How technology can be leveraged to foster community, communication, tracking, and data collection.38:00 The over-reliance of biometrics.39:00 Lifestyle Medicine as a foundation to a culture of wellness.40:00 How LM at Johns Hopkins has been successful in improving employee health.43:00 New Year’s Resolutions – advice from Dr. Safeer how to achieve success by using the workplace.45:30 Connect with Dr. Safeer and learn more about his thought leadership.
The future of health will be shaped by consumer expectations for a mobile-centric experience with personalized insights and care services. Information is determinant of health, where people already search for health information on Google hundreds of millions of times a day. Additionally people view YouTube videos about health conditions 100 billion times globally in a year. As consumers seek information ubiquity in their online experience, health information will also become more personalized through wearables and other mobile devices.
Our future in health will also be enabled by AI. Artificial Intelligence has the potential to transform the health of people on a planetary scale akin to the discovery of penicillin. If developed boldly and responsibly, AI will be a powerful for health equity on a global scale. It will also bring the joy back to practicing medicine by reducing cognitive burden and giving providers more time to spend with patient.
In this week’s episode, we explore health tech consumerism and AI enablement with Dr. Karen DeSalvo, Chief Health Officer at Google. Dr. DeSalvo is an internist and health leader working at the intersection of medicine, public health, and information technology. She has dedicated her career to improving health outcomes for all with a focus on solutions that address all the determinants of health. Dr. DeSalvo continues to be a powerful voice and advocate for eliminating inequities and improving the public’s health. Under her watch, Google has optimized search and YouTube to better answer common health questions, updated its consumer health wearables to function more like medical devices and built artificial intelligence products to meet industry demands.
This episode covers various topics in the realm of healthcare technology innovation from consumerism, Generative AI and LLMs, health equity by design, and various initiatives underway at Google to connect and bring meaning to health information. In the interview, we also discuss the role of technology in mitigating the health impacts of climate change and addressing the epidemic of loneliness and isolation at a global level.
Episode Bookmarks:
01:30 Introduction to Karen DeSalvo, Chief Health Officer at Google.
03:30 How Google understands “information as a determinant of health.”
05:00 “We see heavy consumer orientation to the way we see our opportunity to improve the health of everyone everywhere.”
05:30 The evolution of healthcare businesses to meet people in an increasingly virtual world with ever-changing consumer expectations.
06:00 Informing health empowerment through high quality information and personalized insights.
06:30 Personal reflections from clinical practice when the flow of information was not enabled by technology automation.
07:30 Modern-day tools for patient education and personal health tracking and measurement.
08:00 The optimization of Google search results to convey trust in the provision of health information.
08:30 “The conveyance of information through trusted messengers is an important way we address information as a determinant of health.”
09:00 Patients showing up with more knowledge and power – a priority goal for Google Health.
09:30 How AI can improve health for everyone everywhere. (Karen’s recent blog on the future of AI as a transformational path forward in population health.)
10:00 Leveraging AI at Google Health to advance medical research, improve accuracy and efficiency of diagnostic processes, and improve health information quality.
11:00 A future world were everyone has access to the best quality care on their phone (e.g. AI-enabled health agents combined with the human care team).
12:00 Developing health technology for the entire world. (“A billion people on the planet don’t have access to primary care.”)
12:15 AI can address workforce challenges by reducing cognitive load to address burnout and filling capability and capacity gaps.
12:45 Using large language models in high risk health scenarios (e.g. suicide-related searches, AFib detection on watch products).
13:45 How ChatGPT elevated the interest in front-facing, consumer-focused large language models.
14:15 Search generative experience and the development of Bard (a conversational AI tool by Google).
14:45 Enhancing the Fitbit experience with generative AI and large language models (seearticle)
15:00 Med-PaLM harnesses the power of Google’s LLMs in the medical domain to accelerate scientific advancement.
16:00 “Do no harm” as the ultimate guiding philosophy in AI innovation.
16:30 Human oversight needed to mitigate the risk of AI hallucinations.
18:30 Google use cases for generative AI in clinical care — from helping radiologists to detect breast cancer, to supporting diabetic retinopathy screening.
19:00 Using AI to enhance radiology clinician workflows in mammogram screening.
20:00 Using AI to identify multi-drug resistant tuberculosis in Sub-Saharan Africa.
21:00 Developing an AI model that can perform many tasks at once (e.g. medical record summary, presenting research evidence and recommended clinical pathways)
22:30 Reduction of algorithmic bias to improve health equity and quality of care.
22:30 “The next generation of AI models are going to bring joy back to medicine. They will reduce cognitive burden and give providers more time to spend with patients.”
26:45 Reduction of implicit bias and the “health equity by design” approach at Google.
28:00 Solving for global health inequities observed with the 4M’s (i.e. metabolic disease, malignancy, maternal health, and mental health).
29:00 Developing cloud partnerships and research collaborations for population health in action.
30:00 Ensuring effective deployment of tools and technology for everyone everywhere.
30:45 Diversity, equity, and inclusion of Google Health’s teams.
31:45 Challenges and risk in the early stages of AI foundation models.
33:00 Additional background on Med-PaLM as a medically-tuned, domain specific large language model.
35:00 Use cases for Med-PaLM in care delivery, payer, and life sciences environments.
36:00 Multimodal application of Med-PaLM with wide-ranging capabilities to enhance clinician workflows.
36:45 “Large language models have many capabilities. Constraining them to do the appropriate thing is such an important priority.”
38:30 There is no one-size-fits-all approach to LLMs – it depends on the preferred use case (e.g. writing contracts, customer chatbots, distilling research insights, pop health enablement).
40:00 Climate change is the biggest threat to global public health.
41:00 “Health is more than health care.” (The impact of social determinants and the physical environment on health and wellbeing).
42:00 Applying data and analytics during the pandemic to improve health equity.
43:00 Novel signals from Google searches on symptoms — identifying trends to inform public health priorities.
44:00 The need for timely, granular, and actionable data in the public health setting.
44:30 AI predictions for future climate risks associated with health, fire, and floods.
45:00 Notifying patients with pulmonary disease of air quality risks in real-time.
46:00 The impact of social isolation on public health due to its association with a range of negative physical, mental, and emotional outcomes.
46:45 The health impact of loneliness is so far-reaching that one study compares it to smoking up to 15 cigarettes a day!
47:45 Dr. DeSalvo’s important work on the WHO Commission on Social Connection to better address the global loneliness challenge.
49:00 Using technology to address loneliness and isolation (e.g. AI and robotics to augment human support for seniors).
50:00 The detrimental impact of social media on the youth – striking a balance between screen time and human interaction.
51:30 Parting thoughts from Dr. DeSalvo pm the importance of health for all and value for all.
In caring for our communities, a carefully designed Care Continuum Blueprint becomes the roadmap to enhanced population health outcomes—a testament to the profound impact of integrated care and strategic coordination. There has never been a more compelling time to adopt a system of care based on population health management. The COVID-19 pandemic revealed substantial health disparities and compels us to take action. The population is aging, and the Medicare insolvency crisis is looming. Now is the time to move away from fee-for-service care and toward an approach that prioritizes quality, outcomes, and affordability for all populations.
In this week’s episode, we interview Dr. Mark Angelo, a senior administrator of a large accountable care organization and a leader in population health and palliative medicine. He is the author of the new book Caring for Our Communities: A Blueprint for Better Outcomes in Population Health, that provides tactical guidance for developing effective population health programs and explores value-based care models. Dr. Angelo is an inspirational leader to the health value movement, providing a road map for creating an equitable, outcomes-focused system, using the right resources to nurture the health of our communities.
Dr. Mark Angelo currently serves as CEO and President for the Delaware Valley ACO (DVACO). In this role, he oversees clinical strategy and operations, including quality, population health pharmacy, clinical integration, care coordination, post-acute networks and practice transformation. In addition to serving patient communities as an executive with the ACO, he is a practicing palliative care doctor who continues to see patients. DVACO has participated in the MSSP since 2014 and also works with commercial and Medicare Advantage payers in an effort to grow and expand the mission of value-based care in the Greater Philadelphia area.
Episode Bookmarks:
01:30 Introduction to Delaware Valley ACO and Mark Angelo, MD, MHA, FACP.
04:30 Referencing Dr. Angelo’s new book Caring for Our Communities: A Blueprint for Better Outcomes in Population Health.
05:00 “Never doubt that a small group of thoughtful committed citizens can change the world; indeed, it is the only thing that ever has.” — Margaret Mead
06:00 Dr. Angelo provides his perspective on population health underpinned by his clinical practice of palliative care.
07:30 A care continuum strategy that ensures care continuity, collaborative planning, and case management for complex patients.
09:30 The post-acute care journey at DVACO that began in 2014.
10:30 The Skilled Nursing component of DVACO’s post-acute care strategy.
11:30 Using claims data and real-time readmission tracing to monitor performance of SNF partners.
12:30 Graduating from a post-acute care focus to an overall care continuum strategy.
13:45 Optimizing home health to prevent avoidable hospitalizations.
14:30 How to identify suboptimal hospice care (e.g. length of stay greater than 180 days).
16:30 Home-based therapy as part of the care continuum to reduce TCOC in a frail elderly population.
18:00 An optimal zone of therapy between 12 and 32 therapy units over the course of a year.
19:00 Medicare reimbursement differentials across the different settings in a post-acute care continuum.
20:30 Building a population health playbook in post-acute care begins with SNFs.
22:00 Assessing performance data in developing a small SNF network to guide steerage decisions.
23:30 Applying the SNF assessment strategy in the vetting of preferred providers in home health and hospice.
26:00 Are partnering PAC facilities communicating with you in a meaningful way?
26:45 “Discharge planning shouldn’t happen in the last 24 hours of discharge. It should be happening all along. This is an important factor when it comes to creating partnerships across the care continuum.”
28:00 DVACO (in partnership with Main Line Health) developed a palliative care program that reduced hospitalizations by 50%!
28:45 “If you are an ACO and you are not focusing on your seriously illness population, you are missing a big opportunity.”
29:30 Developing an analytics methodology to identify patients with serious illness.
31:00 Guidance from Dr. Diane Meier, a nationally-recognized geriatrician and palliative care expert.
31:30 Improving lives of patients while decreasing costs at end-of-life through a home-based palliative care program.
34:00 Population health data that confirms the superiority of home-based palliative care (e.g. decreased hospitalizations and ED visits, increased hospice utilization).
37:30 Dr. Angelo provides leadership insights on how best to engage providers in population health approaches to care.
38:45 An example of supporting providers in VBC (a dedicated call center that connects resources to patients most in need).
41:00 SDOH and behavioral health resources for patients (e.g. addressing food insecurity to improve population health).
42:00 Another example in supporting providers in VBC (a successful aging program).
43:00 In-home wellness assessments for patient (e.g. medication reconciliation, dietician and care coordinator consults).
44:45 “We help our providers to better care for patients at the point of care. That is a great way to get providers to want to be part of your ACO.”
46:00 Health equity as a societal flashpoint and the challenges of inequality in the Greater Philadelphia area.
47:30 How DVACO provides a health equity lens in the design and implementation of all population health programs.
48:45 The need to compare QM results between population segments (e.g. an overall mammogram completion rate of 88%).
49:30 How the pandemic highlighted health inequities and reframed opportunities for improving population health.
50:00 “In an Accountable Care Organization, you’re responsible for managing the care of your community, not the care of a fraction of your community.”
52:00 The impact of social isolation on frail and elderly populations.
52:45 People experiencing social isolation have a higher risk of heart disease, stroke, depression, and anxiety.
53:45 Surgeon General Dr. Vivek Murthy’s call to action to address “the epidemic of loneliness” as a public health crisis.
54:00 The correlation between excess utilization of healthcare services and social isolation.
55:00 Building bridges with Community Benefit Organizations to address social isolation.
57:00 The emerging “payvider” trend and how Humana became a valued partner in Delaware Valley ACO.
58:45 The benefits of a strong payer relationship within an ACO.
60:00 “Payvider relationships say to the market that we are laser-focused on the success in value-based programs.”
61:00 The Infinite Game: “Infinite-minded leaders don’t ask their people to fixate on finite goals; they ask their people to help them figure out a way to advance toward a more infinite vision of the future that benefits everyone.”
63:00 Parting thoughts on balancing fee-for-service with the “infinite game” of value-based care.
With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy. By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union. While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country!
On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington’s internal game. He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care. Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health’s first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health.
Episode Bookmarks:
01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending.
02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers.
02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies.
05:30 The glacial pace of the value-based care movement. Is there truly bipartisan consensus on the aims of health value?
07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”)
08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”)
09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.”
10:00 Explosive growth of the Medicare Advantage program.
11:00 Consumer-centric innovation and higher quality of care in MA plans.
11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”)
13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service” to those leery of privatization.
13:30 The incredible popularity of MA and the research showing it has superior outcomes.
14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years.
15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions).
16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell).
17:00 The importance of Patient-Reported Outcome Measures since process measures alone don’t achieve patient-centeredness.
19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.”
20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.”
21:00 If we are incentivized to keep patients healthy and out of the hospital, we will naturally do screenings. (Measuring number of screenings not as important as the outcome itself!)
21:30 NQF guidance on Risk Adjusting Social Risk Factors in quality measurement in order to pay for outcomes.
22:30 “Infusing SDOH, risk adjustment, and quality metrics into everything we do will shift the system to move towards outcomes.”
23:30 The role of CMMI in payment model innovation and the need for the continuation of the advanced APM bonus.
24:30 “True transformation cannot happen unless you have providers willing to take on full risk. Right now, there is not a full-risk track inside MSSP.”
25:00 The “courage of conviction” in knowing you can make people healthy.
25:30 The lack of value-based care training in medical schools and GME.
26:00 Capital requirements for full-risk.
27:00 Lack of clarity in VBC policy will perpetuate a multi-tiered system (e.g. specialists paid on FFS, primary care pushed more to capitation).
27:30 Full-risk is the only way forward to incentivize the entire system! (Everything else is just half measures.)
28:00 How the medical establishment and generational divides in medicine are holding back the value movement.
30:00 Internal, professional government affairs expertise as an essential corporate positioning and sales function.
31:00 Positioning your views front and center to a government audience through internal advocacy.
32:00 Creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation.
33:30 Speaking to policymakers and elected officials is different than speaking to investors.
35:00 Figuring out the right model for advocacy (a hired gun lobbyist vs. an embedded government affairs function).
36:30 Leveraging the lobbying power of unified voice in a trade association (versus in-house government affairs that emphasizes the uniqueness of a company’s individualized and specific interests.)
38:00 Trade associations as the place where policy gets settled before it is advocated to elected officials.
39:00 Strategies for effective in-house government affairs collaboration with professional associations.
41:30 The need to teach incoming doctors about the benefits of value-based care to prepare them for success.
42:30 It is also important to teach medical students about the importance of advocacy and the effect of health policy on their career.
44:30 Medical school funding should be tied to solving a specific problem (e.g. integrating behavioral health into primary care).
45:00 “If we want to get to VBC and outcomes delivery, we have to start teaching advocacy and policy in medical schools to effectuate the future.”
47:00 Examples of effective advocacy (e.g. addressing the pediatric uninsured, the Chronic Care Act, direct billing of LSWs within Medicare, expansion of mental health workforce)
49:30 Private sector innovation in addressing health disparities in underserved communities (e.g. Oak Street Health).
50:30 “Forming a more perfect union” – always working towards perfection while knowing it will never be perfect.
51:30 How to follow and connect with Andrew!
The future of care is not confined by walls; it thrives in the heart of homes, where compassion meets innovation, and healing becomes a daily experience. Home-based primary care with full-risk Medicare Advantage is a transformative model that not only brings health care to the doorstep of our seniors but also places the responsibility for their well-being squarely in the hands of dedicated providers, creating a proactive and patient-centered approach to aging with dignity and comprehensive care. By making primary care easier to access for our nation’s seniors, we can deliver personalized care that meets their needs; help them stay healthy and feel better; and live well with existing conditions so they can prepare for what’s ahead.
This week we are joined by two executive leaders from WellBe Senior Medical — the largest and fastest growing independent home-based medical group in the country. WellBe is a global risk medical group that provides longitudinal geriatric care to underserved, frail, complex, and homebound Medicare Advantage beneficiaries. In this episode, we feature Dr. Jeffrey Kang, Chief Executive Officer and Mike Stuart, Chief Growth Officer from WellBe Senior Medical.
Dr. Kang is a geriatrician with extensive experience in global risk and primary care for frail, elderly, and disabled populations. Mike Stuart has extensive experience in fostering partnerships with health plans, health systems, and provider groups and leads commercial strategy and partnership development for WellBe Senior Medical. In this interview you will learn about the home-based care continuum, primary care innovation, mission-driven leadership, Medicare Advantage risk, and the future of value-based primary care.
Episode Bookmarks:
01:30 An overview of WellBe Senior Medical – a global risk primary care group providing longitudinal geriatric care in the home.
02:30 Introduction to Dr. Jeffrey Kang, WellBe CEO (formerly served as ChenMed President, Walgreens SVP, Cigna CMO, and CMS CMO).
03:00 Introduction to Mike Stuart, WellBe Chief Growth Officer (formerly served in executive leadership roles at Somatus and Evolent).
05:00 An overview of the home care continuum (e.g. acute, post-acute, custodial, longitudinal primary care, DME, home infusion).
08:00 How WellBe is helping patients navigate and coordinate the fragmentation of home care point solutions.
10:30 A mission to help senior patients “lead healthier meaningful lives by delivering the most complete care”.
11:30 Opportunities to make care in the home more multidisciplinary, personalized, and SDOH-responsive.
12:00 Proactive vs. Reactive Care (leveraging analytics and unique provider skillsets for population health).
13:30 The clinical persona of the “frail elderly” and why WellBe focuses on this target population.
14:30 “Everything done in a primary care office can actually be done at home.”
15:30 “Home-based primary care is the best thing to do. You get better outcomes and better patient satisfaction.”
15:45 Is it possible to deliver high quality primary care (like ChenMed or Oak Street) in the home setting?
16:30 Referencing Marcus Welby, M.D. as an example of an empathetic approach to delivering care in the home (see Season 1 Trailer)
17:00 Care Fragmentation Challenges – NEJM found that the average Medicare patient sees a median of two PCPs and five specialist physicians per year.
18:00 “Quality of Life” is more important than “Quantity of Life” (why empathy and compassion matter most in caring for frail seniors).
19:30 Patients define a good doctor by bedside manner and respect given.
20:30 How the economics of full global risk enable complete care models for seniors.
20:30 Scalable home-based primary care is a new approach in value-based care.
23:00 WellBe’s results (e.g. >50% neighborhood engagement, patient satisfaction is at 95%, and MLR improvement >40% in 3yrs).
23:30 The importance of reaching a 4 Star Rating in a Medicare Advantage plan.
24:45 Key Measures of success: Patient Engagement, HEDIS, Medical Costs and MLR
25:45 Bringing health plan leaders on a ride-along to see high quality care in action.
26:00 Negotiating global risk deals with MA plans that offer favorable economics for both parties.
27:00 The starting HEDIS Stars score of a typical WellBe patient is 2.3-2.5 (polychronic, frail, high-risk).
27:45 “When you are at full global risk, it is in your interest to do care innovation.”
28:00 Innovation #1 = Access (“Primary care in the home needs to be both convenient and responsive.”)
29:00 How WellBe developed a mobile paramedic program to enhance responsiveness to emergent acute care needs.
30:00 Mobile paramedic program reduced emergency room visits by 33%!
31:00 Dr. Kang’s recent article in Health Affairs responding to concerns from Berwick and Gilfillan about Risk Adjustment in MA.
31:30 The CMS-HCC V28 changes to the Risk Adjustment model that begin the phasing in next year.
33:00 The evidence for Medicare Advantage being overpaid relative to FFS?
33:45 Eliminating disease-based risk adjustment is the wrong policy (e.g. need for fair payment for complex populations, avoidance of cherry picking healthy populations).
35:30 The case for HCC under-coding in Traditional Medicare (due to lack of incentives in FFS).
36:45 “The bulk of the problem with HCC coding is under-diagnosis in fee-for-service Medicare – not over-coding in MA.”
38:00 Modern Healthcare Best Places to Work 2023 – WellBe Senior Medical
38:30 WellBe Senior Medical providers see 4-5 patients per day allowing them to build trusting relationships.
39:30 A recent study from Elation Health and the AAFP confirms that VBC can ameliorate the suffering of the physician workforce!
40:30 The culture of WellBe that empowers workforce collaboration with a “patients first” mentality.
42:00 Examples of how risk-based economics improve patient care.
43:00 Creating a foundation of values to underpin a culture of collaboration is crucial before accepting risk!
43:30 A clinically-led culture vs. a financially-led culture (“If you take good care of the patients, the financials will follow in a value-based model.”)
45:00 A financially-led organization will focus almost exclusively on risk adjustment (as opposed to delivering patient-centered care).
45:30 “Most of our MLR improvement is from medical cost reduction, not HCC coding.”
46:45 Wellbe Senior Medical is now in 7 states caring for 107,000 MA patients (20% of them which are dual eligibles).
48:00 Proving the scalability of a home-based primary care model.
48:45 Expansion into rural areas.
49:45 Future growth plans.
50:00 Advantage in Scalability: (“When launching new markets, we could actually be up and running in 90-days – we don’t have the problem of bricks and mortar.”)
51:00 Disadvantage in Productivity: (ChenMed and Oak Street providers can see 20 patients a day in the office, while we are only seeing 4-5.”)
52:30 The ethno-geriatric imperative (one-third of older Americans are projected to be from one of the minority populations by mid-century).
54:00 Dr. Kang discusses how the Chinese cultural significance of taking care of elders informs his leadership at WellBe.
54:45 Healthcare disparities are driven by inadequate access to care.
56:00 An example of how WellBe provides linguistically appropriate and culturally competent care in Chicago.
57:00 The number of Americans aged 65 and older will more than doubling over the next 40 years — reaching 80 million in 2040.
58:00 Optimism for the value-based future of caring for seniors – does hope mostly reside only with Medicare Advantage and ACO REACH?
61:00 Multi-payer alignment in value-based care as an imperative to a hopeful future.
Many factors impact our health beyond genetics and aging. Collectively, these are called social determinants of health and include factors such as education, housing, income, occupation, hunger, language, literacy, where we live, and access to affordable healthcare services. However, there is a gap in the current list of social determinants of health, and that is the influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes. It is critical to consider “information” as another social determinant of health since it can be used to drive positive patient health outcomes. How we deliver it, where we deliver it, and who delivers it is crucial to value-based health care transformation and patient-centeredness.
So, how do we harness this idea that information can change health outcomes? To answer this question, we have invited Debbie Welle-Powell back to the Race to Value! As a 30-year healthcare executive veteran, value-based care thought leader, and educator, she is committed to the empowerment of change management principles to drive population health at the intersection of patient engagement and information sharing. In this episode, we discuss what is needed to empower the patient and clinician, technology-enablement and value-based payment to fine tune the delivery system, and the information ecosystem needed to drive healthy outcomes.
As a companion to this podcast, make sure to read Debbie’s new article on this topic. It is available for download on the Race to Value webpage for this episode!
Information as a Social Determinant of HealthEpisode Bookmarks:
01:30 Introduction to Debbie Welle-Powell, a healthcare executive veteran whose work focuses on delivering affordable and accessible high quality care.
02:45 Reference previous R2V episode – “Climbing the Mountain: Reaching New Heights for a Transformative Future”)
03:00 Read the companion article to this interview on the Race to Value episode website!
03:45 Debbie provides a brief update on her professional work in value-based care (and her mountain climbing adventures!)
05:30 The influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes.
06:30 Should we consider information as another Social Determinant of Health (like transportation, education, housing, and food security)?
07:30 “Information only really matters if it helps patients change behaviors. The delivery of information is crucial to empowering health outcomes.”
08:30 “The American healthcare system is not as patient-centric as it claims to be because of a failure to provide empowering information.”
09:00 The roles of clinicians and patients to improve health literacy.
10:00 Patient noncompliance – Ex: 20-30% do not pick up prescriptions, 30-40% do not follow-through on referrals.
10:45 The challenges of interpreting and addressing SDOH challenges to avoid unnecessary utilization.
12:00 The importance of the patient-provider relationship. (Eric shares insights from his healthcare trip to Cuba.)
14:30 Technology enablement and health system evolution to better address patient information needs.
15:00 Improving patient engagement through the online user journey (i.e. the digital front door).
15:45 Debbie shares a personal example from her cancer journey where the care team failed to provide adequate information.
17:00 Half of patients seeking receive misleading information when independently searching online sources.
17:30 The opportunity for clinicians to provide trusted and reliable online educational resources.
18:00 The hyper-saturation of online content (e.g. 500 hours of content uploaded to YouTube per minute!)
18:30 How the value-based care movement provides incentives for improving patient engagement.
19:30 The use of Generative AI in the clinical setting to help patients better navigate their care journey.
20:45 Merging the science of medicine with the art of information – how to best engage patients during a formidable time of distress.
22:30 Realigning healthcare investments into patient engagement information systems, AI-based tools, and team-based care delivery.
23:30 The need for change management tools at the system-level to improve patient engagement.
24:00 Transforming clinical practice using the Prosci ADKAR change management model.
25:45 Creating a patient advisory council to guide health systems in the optimal curation of patient information.
26:30 Addressing chronic disease through online resources, team-based care delivery innovation, and value-based payment.
27:00 The importance of neuroplasticity (rewiring of the brain’s neural pathways) to reinforce new habit formation.
28:00 Mountain climbing as a metaphor for behavior change in chronically ill populations (i.e. dealing with pain, incremental progress).
28:45 The overwhelming challenges of addressing SDOH in underserved communities.
30:00 Differing perspectives on the role of the individual in health accountability.
31:00 Merging system-level patient-centered engagement with individual-level accountability.
32:00 Deploying information tools to empower health and improve SDOH screenings.
32:45 Rethinking medicine to live better longer (referencing new book, “Outlive: The Science and Art of Longevity” by Dr. Peter Attia).
34:00 “Poor health literacy is a public health problem.” (9 in 10 adults exhibit poor health literacy when under extreme stress.)
34:30 Population health resources should be written at a 5th grade level to ensure they are readable, actionable, and trustworthy.
35:00 Improving Health Literacy Could Prevent Nearly 1 Million Hospital Visits and Save Over $25 Billion Per Year. (see UnitedHealth study)
35:30 The importance of primary care in empowering patient education.
36:30 A recent court ruling threatens access to critical preventative care for more than 150 million people! (see USofCare Preventive Services Resource Hub)
38:00 The importance of Patient Advisory Councils in care delivery design (e.g. telehealth, AWV campaigns, patient portal design, refill strategies)
38:45 CBO Partnerships as an opportunity to “learn, course correct, and transform.”
39:00 The flawed structure and lack of funding for a Public Health system that improves health equity and fosters patient trust.
41:00 The intergenerational impact of health information in improving health, supporting families, building social cohesion, and ensuring economic competitiveness.
42:00 What is the role of government in creating a healthy, well-educated population? How can CMS improve beneficiary engagement?
42:30 Prioritizing multipayer alignment, administrative simplification, and health equity accountability to promote value-based care.
43:30 The 21st Century Cures Act is a health policy focused on information sharing and care coordination.
44:00 Creating accountability in underserved communities through workforce competency and alignment of payments.
45:00 “You can’t talk about quality unless you talk about equity.”
46:45 ADKAR is an acronym for the five outcomes of successful change management: “Awareness, Desire, Knowledge, Ability, and Reinforcement”.
47:00 Debbie discusses the systemwide application of ADKAR as a powerful tool for change management at an individual level.
48:00 How did the ADKAR change management model improve care delivery at Essentia Health?
49:45 Applying change management principles to achieve patient-centricity.
50:45 The promise of precision medicine (at the individual level) as a compliment to community health (at the group level).
52:30 Developing a roadmap to make wellness and prevention a priority (versus sick care and chronic disease management).
53:30 Parting thoughts from Debbie on actions that can be taken today to improve patient communications.
A revolution is imminent in American healthcare, and “the revolution will not be televised” for passive observation. Value-based care transformation, like any other important movement, requires the active participation of all leaders on the frontlines. However, for these leaders to make the right decisions, they need to embrace innovation in order to realize the fullest potential of generative AI and predictive analytics. Through the reengineering of care delivery, we can achieve a more personalized, proactive, and efficient outcomes-based model that can ultimately transform population health.
As we navigate this transformative journey, data will play a pivotal role in reshaping the landscape of care delivery. And no one knows this better than Nassib Chamoun, Founder President & CEO of Health Data Analytics Institute (HDAI), our guest this week on Race to Value. In this episode, you will hear from a leader and primary inventor of a broad-based population health data analytics platform, enabling healthcare providers to make informed decisions based on real-time information. Tune in to an informative conversation covering such topics as data aggregation, predictive analytics, digital twinning, network management, generative AI in clinical care, and future advancements in technology-enabled value-based care.
Episode Bookmarks:
01:30 The Imminent “Big Data” Revolution in Value-Based Care
02:00 Introduction to Nassib Chamoun of Health Data Analytics Institute
03:00 As a teenager living in Beirut, Nassib experienced the horror of a civil war.
04:00 The inventor of Bispectral Index monitoring – a technology standard in operating rooms around the world.
05:00 Nassib discusses the pivotal moments in his life that shaped a passion for data analytics in healthcare.
07:00 80% of health information in EHRs is unstructured and entirely unusable unless converted to discrete data.
07:45 CMS provided HDAI a highly coveted Innovator’s License that allows the company access to data on 100 million Medicare beneficiaries.
09:00 How Big Data drives powerful AI algorithms and predictive models in healthcare.
10:00 “If you can’t measure something, you can’t improve it.”
11:00 Understanding the intersection between cost, outcomes, and utilization.
11:30 Making data actionable in order to effectuate change in care delivery.
11:45 Data overload can actually lead to clinical inefficiencies if it isn’t curated appropriately.
12:30 The artful curation of data to drive operational improvements at point-of-care.
14:00 The limitations of claims data in making timely clinical decisions and treatment interventions.
15:00 Interpretation of unstructured EHR data to extract potential new conditions and HCC coding opportunities.
16:00 The importance of clinical judgement in augmenting AI-based recommendations in value-based care.
17:00 Combining behavioral, psychosocial, and biometric data with the existing sciences of epidemiology and clinical medicine.
18:00 Generalized clinical use cases of AI at the point-of-care to improve costs, outcomes, and utilization.
19:00 “To be successful in value-based care, you must operationalize two separate goals: Prevention and Avoidance of Complications.”
20:30 “The goal of AI is to very simply do what a clinician does, but do it repeatedly and do it continuously for every patient in their cohort.”
21:00 How staffing limitations and an aging populations necessitates a more optimal use of technology in VBC.
22:00 In 2032, U.S. healthcare spending will reach $8 trillion (ahead of the economy of Japan) making it the third largest economy in the world!
22:45 Leveraging predictive models to drive more effective care coordination and interdisciplinary team-based care.
24:30 Patient engagement as one of the more challenging aspects of value-based care.
26:30 The integration of predictive analytics and digital twinning for individualized patient care.
28:45 Using multiple predictors to serve every component of the care team.
29:30 How the use of RAF scores to normalize utilization creates noise within a dataset.
30:30 Using digital twin matching for improved predictive modeling of patient outcomes.
32:30 Aggregation from the patient level as an opportunity to reduce predictive variance.
34:00 Benchmarking against clinical exemplars in population health management.
35:00 Empowering the care team through AI and predictive analytics to drive clinical interventions.
36:30 How Houston Methodist Coordinated Care leveraged the HDAI analytics platform to enable care teams.
38:30 Using AI as a core capability in a health system (for both FFS and value-based care).
40:00 Leveraging AI to make appropriate care management resource allocation decisions at the network level.
41:00 Using analytics to better understand post-discharge outcomes and mortality.
42:30 Early interventions driven by predictive analytics have reduced both hospital mortalities and readmissions.
44:00 AI insights to drive network management decisions in building a clinically integrated network.
45:00 With the explosion of ChatGPT, we are seeing Generative AI emerge as a technology offering transformative opportunities across society.
47:00 “A lot of the big tech companies have jumped into healthcare without the appreciation of what’s involved here.”
48:00 “There are three components of trustworthy AI in healthcare: Transparency, Explainability, and Reduction of Bias.”
49:00 Transparency
50:00 Explainability
51:30 Bias
52:30 Overcoming implicit bias in algorithms to reduce disparities in care.
53:30 The complexity of Generative AI algorithms.
54:00 HDAI’s approach to generative AI in the creation of transparent, explainable, and bias-free models.
56:30 Connecting the source code in generative AI to the recommendations made to clinicians.
58:30 Will we eventually see AI models enriched with crime data, geospatial analytics, food availability data, climate change impacts, consumer purchasing data, and biometrics?
60:00 The potential harm of applying negative use cases of AI to restrict care.
61:30 Arthur C. Clarke: “Any sufficiently advanced technology is indistinguishable from magic.”
61:45 The 4th Industrial Revolution of technology in healthcare.
63:00 EHR data has been largely underutilized until the recent tidal wave of AI.
64:00 Creating synergies within care teams on the basis of synthesized information and AI recommendations.
64:45 The application of AI in the future of health genomics.
65:30 Parting thoughts of optimism for the future of AI-enabled value-based care transformation.
Everyone needs access to quality, affordable health careregardless of health status, social need or income. To reach this paradigm shift, healthcare leaders must evangelize within industry and communities they serve. There is a better path forward for American health care – one that is people-centered and transformational; however, to get there we must unite the power of one at the intersection of people, policy, and politics. By listening to people’s needs, jointly developing policy solutions, and partnering with others, we can ensure our health care system works for everyone.
This week on the Race to Value, we bring to you Natalie Davis and Dr. Venice Haynes at the United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. It brings together stakeholders from various backgrounds, including healthcare experts, patients, policymakers, and advocates, to develop and implement practical, bipartisan solutions to improve the healthcare system in the United States. By fostering dialogue and collaboration, conducting research, and advocating for policies that enhance access, lower costs, and improve healthcare outcomes, the organization finds common ground and works across party lines and ideological divides to address the healthcare challenges facing the nation.
As CEO and Co-Founder of the United States of Care, Natalie Davis is on a mission to reshape and implement American health care policies that improves the lives of all people. Dr. Venice Haynes, the Director of Research & Community Engagement for United States of Care, is a social and behavioral scientist focused on an overarching research agenda to address social determinants of health and health disparities in underserved populations using qualitative and community-based participatory approaches. In this episode we talk about the tenets of patient-first care (a.k.a. value-based care) including affordability, dependability, personalization, and understandability. We also have an in-depth conversation on the power of storytelling in health care transformation and the imperative to overcome structural barriers in the creation of health equity.
Episode Bookmarks:
01:30 United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans.
02:00 Introduction to Natalie Davis, Chief Executive Officer and Co-Founder.
02:45 Introduction to Venice Haynes, PhD, Director of Research & Community Engagement.
05:00 Natalie shares her personal story that led her towards an entrepreneurial career path in health care policy transformation.
07:30 Mentorship from Andy Slavitt and his advice to get out of Washington, D.C. to make an impact on health policy.
08:30 Venice discusses how her science and public health background inspired her to lead people-centered health care change.
11:45 Inspiration from Camara Phyllis Jones, a physician, epidemiologist, and anti-racism activist who specializes in the effects of racism and social inequalities on health.
14:30 When offered an alternative, by a 4:1 margin, people favor a model that compensates providers for improving overall health, delivering superior care, and coordinating patient care.
15:30 What it means for United States of Care to be at the intersection of people, policy, and politics in health care transformation.
16:00 Research and listening to people as a way to overcome tribalism and build an agenda of reform for the whole country!
16:45 The 4 goals and 12 solutions of United States of Care to meet the needs of people across demographics and can drive collection action to build a better health care system.
18:30 “The 4 goals of United States of Care – Affordability, Dependability, Personalization, and Understandability – comprehensively cannot be done in a fee-for-service model.”
19:00 The need to bring new health policy leaders into the value-based care movement (at the risk of the movement stalling out altogether for lack of emerging leadership).
20:00 Reframing the value-based care movement to the specific vocalized needs of constituents in the general public (instead of just payment models, quality measures, etc.)
21:00 “There is a resounding drumbeat in our community-focused value-based research — people want more whole-person care.”
22:30 Selectively using the right language when engaging communities (“using a new approach” instead of “reforming the system”).
23:00 Communities are overwhelmingly expressing their anger about the greed of the American healthcare system.
24:00 “When engaging our communities, language matters so very much. We must find the commonality in language to resonate with people.”
25:30 The storytelling project, “Voices of Real Life”, as a vehicle to galvanize healthcare experts, patients, policymakers, and advocates around a human-centered focus.
26:00 Movements are led by effective storytelling and these stories can revitalize communities of people. (Is a social movement like civil rights or gay marriage any different than the movement for value-based care?)
27:30 The fear that people have in making large scale changes to American healthcare.
30:00 The importance of everyone feeling like they are a part of the change that is needed. (Reframing health care failures from “individual” to “systemic.”)
31:00 Venice shares personal stories from her work with community focus groups and how people often feel alone when it comes to navigating health care challenges.
32:45 An example of poor maternal health care – a patient driving an hour for a prenatal checkup only to find that her doctor was not at that clinic on that day.
33:00 People often make life altering decisions over health care (e.g. marrying someone they don’t love, taking a second mortgage on their own).
34:00 People that are “satisfied” with their health care do not really exist! (They are just “satisfied” because they are one of the lucky ones with health insurance and access to care.)
37:00 Health Care Affordability and USofCare Poll showing 42% of voters have foregone health insurance in the past, and 41% of those under 30 have opted not to seek medical treatment in the last year.
38:00 Driving a multi-state approach to expanding coverage through public option.
39:00 “Affordability is always the #1 issue that comes up in our community conversations, regardless of the entry point where people enter the health care system.”
39:45 The breaking point of health care costs (e.g. federal deficits, employer cost shifting) and the levers that can be utilized to reign in costs through a public option.
40:30 The “hidden fees” passed on to patients by hospitals.
41:00 The different levers of change at the state level, and how they can impact change at the federal level.
41:30 The equity component to reforming health care costs at both an individual and societal level. (Check out the USofCare Health Equity Report)
42:00 Enhancing primary care access will lower overall health care costs in our country in the long-term.
43:00 Dependable healthcare coverage is an anchor in the storms of life, providing individuals and families the peace of mind that their health and well-being will be safeguarded in times of need.
43:45 More than 9 million people have been disenrolled by Medicaid redeterminationsresumed several months ago.
44:45 Common stories of people fearing lack of health care dependability (e.g. contractors, employees in the gig economy, pregnant women worried about repercussions from employers).
47:45 The challenge of health policies being written by people without the lived experiences of those directly impacted.
48:00 “Policy is nothing if not implemented well.”
49:00 The Texas Court Case (Braidwood v. Becerra) — may cause nearly half of Americans (more than 151 million people ) the loss of access to free preventive services!
49:45 How the United States of Care is fighting to preserve the rights of Americans to retain their access to free preventive primary care. (See USofCare Preventive Services Resource Hub)
52:00 Personalized care to support to caregivers, improve mental health coverage, enhance maternal and newborn care, make care more convenient, and ensure that people can equitably access care virtually.
53:30 “We cannot reimagine health care with a one-size-fits-all approach.”
54:00 The work in Colorado to build a public option and culturally responsive networks.
55:30 How do we ensure that access to virtual care doesn’t exacerbate health inequities?
58:30 For people to get behind value-based care, we must relate to them at a personal level.
59:45 Speaking in terms of “quality over quantity” when personalizing the message of value-based care to patients.
60:00 Why “Value-Based Care” is such a poor choice of wording and causes confusion with patients.
62:00 A much-needed wave of patient consumerism is needed; however, the complexity of the system stifles innovation and creates a lack of understanding.
64:00 Natalie provides perspective on the need for community feedback on people-centered change in health care.
65:00 “We need to change the way we do change in health care. This is not working!”
65:30 Can health care be as consumer-friendly as Uber or Chick-fil-A?
67:00 The importance of asking the right questions and engaging stakeholders before implementing a new technology innovation.
68:00 Creating trust in the system through co-creation and rightsizing of change management.
70:00 The amazing opportunity in engaging patient communities!
73:00 Support the work of United States of Care and follow Natalie on LinkedIn– “Be a part of the narrative change to follow the more systemic change that is necessary.”
In the Race to Value, we must recognize that quality of life is the ultimate currency of healthcare, and this aim is all the more important in senior living facilities. Transforming health outcomes for skilled nursing and senior living populations is not just a goal; it’s a commitment to providing the care and dignity our elders deserve. This week, we profile a leader in the value movement who leads a company on a mission “to improve the health, happiness, and dignity of senior living residents”. We are joined by Mark Price, CEO of Curana Health – a leader who lives by the mantra that “extreme passion” is the single most important ingredient to reform the American healthcare system.
Curana Health is a provider of value-based primary care services exclusively for the senior living industry, including in nursing homes, assisted/independent living facilities, CCRC/life plan communities and affordable senior housing communities. Curana Health serves more than 1,100 senior living community partners across 30 states and participates in the MSSP ACO, ACO Reach and Medicare Advantage programs with CMS. Backed by more than $300M in venture capital funding, the organization is poised to disrupt care delivery in senior living on a meaningful scale through innovative care models and applied analytics.
In this episode, you will learn about how to transform health outcomes for skilled nursing and senior living populations through extreme passion. We cover such topics as how to leverage APMs such as MSSP and ACO REACH in the senior living setting, the performance results of Curana Health across their value-based portfolio, technology innovation, palliative care, the state of the nursing home industry, and future trends in the shift to home-based care delivery.
Episode Bookmarks:
01:30 Introduction to Mark Price, CEO of Curana Health.
03:45 An estimated 27M more people are aging into the 75+ cohort through 2050, resulting in rising age and higher health acuity levels of residents moving into senior living.
05:00 Curana Health has achieved a 39% reduction in 30-day hospital readmissions and a 37% reduction in total hospital admissions among Medicare Advantage I-SNP members.
06:00 “There are many subsectors in the industry where value-based care can succeed. The important thing is ensuring that your people have an extreme amount of passion for making it work.”
07:00 Founding story of Curana Health based on how we would want our loved ones to be cared for at the end of life.
08:45 The majority of Americans will spend some time in senior living or skilled nursing in the final years of their life.
10:00 Elite Patient Care ACO performed in the top 1% of ACOs in its first year of operation, achieving PBPY savings amount of $2,235—the highest PBPY for any first-year MSSP ACO since 2012.
11:30 Curana Health also has one of the top performing ACO REACH and risk-based MA I-SNP programs in the country.
11:45 “Our core business is not a payment model. It is a clinical model that produces health outcomes which, in turn, enables affordability as well.”
13:00 Developing a population health playbook for the senior living space.
14:00 Success in developing a level of clinical integration within a senior living facility that is now owned by the company.
15:00 MA Institutional Special Needs Plans (I-SNPs) are designed to meet the needs of people living in long-term care settings such as long-term care nursing, skilled nursing facilities, and inpatient psychiatric facilities.
16:45 Facilities are taking an ownership position of MA plans for senior living and skilled nursing residents.
17:00 Mark provides perspective on I-SNPs and how the Curana Health clinical model is achieving results to improve clinical outcomes.
18:30 Performing well by recognizing the commonality between MSSP, ACO REACH, and Medicare Advantage.
20:00 How CMS and CMMI is incorporating innovation to value-based payment models (e.g.SNF 3-Day Rule Waiver).
22:00 Building a technology enablement ecosystem within a high-touch, integrated care model for senior living communities.
23:00 Value-based care technology adoption starts with the input from the clinical care teams.
24:00 Seeking technology enablement for both common and specialized challenges.
26:00 Developing technology partnerships with intentionality. Augmenting those partnerships with internally-developed customized analytical and educational solutions.
28:45 A survey by Leavitt Partners and NAACOs shows that only a 10% of ACOs selected palliative care as a top priority for improving efficiency and lowering costs.
30:00 Mark provides perspective on the importance of palliative care and advanced care planning in their senior-focused care model.
33:00 Many nursing home providers operate on thin margins and have been squeezed tighter as they’ve struggled with occupancy.
34:00 Chapter 11 bankruptcies among nursing homes and senior living operators continue to increase and show no signs of abating going into next year.
35:30 The impact of the pandemic on the senior living industry.
36:30 The workforce challenges faced by nursing homes.
37:00 Financial impact of rising variable interest rates on nursing homes attempting to service their facility debt.
38:00 CMS-imposed staffing mandates on Skilled Nursing Facilities.
38:45 The impact of aging baby boomers on distressed SNFs and senior living facilities.
40:45 Collegiality and information sharing is important to advance value-based care transformation across the country.
41:30 Skilled Nursing and Senior Living communities traditionally ignored value-based care (and how they are now waking up!)
43:30 Success in the future requires us to think differently than we did in the past.
44:30 Up to $265 billion worth of care currently delivered in traditional facilities for Medicare FFS and MA beneficiaries could shift to the home by 2025.
46:45 Post-acute skilled care will increasingly move to the home in the future.
48:00 The significant demand for senior resident models in the future.
49:30 Mark discusses why technology won’t disrupt the senior living space like it will other sectors in care delivery.
52:00 CMS’s goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030.
53:00 Americans aged 65 and older will more than double over the next 40 years — reaching 80 million in 2040.
53:45 Parting thoughts of optimism on the imperative for value-based care transformation in the country.
Connecting the health and wellbeing of patients of patients directly to the bottom line isn’t just good business; it is a visionary approach that shows how healthier outcomes can actually drive healthier profitability. Continued success in demonstrating the correlation between clinical and financial outcomes will be a catalyst for generating societal wellbeing that paves the way for others to adopt value-based care. And in doing so, we create a more sustainable and effective healthcare ecosystem. In this Race to Value, the true race isn’t about speed; it is about the journey to improved outcomes. Strategic and transformational partnerships guided by an enabling vision to improve population health will ultimately create a healthcare system that we can be proud of.
In this episode, you will hear from Kyle Wailes, the Chief Executive Officer and Board Member of value-based care company, Wellvana. Kyle Wailes is someone on a mission to demonstrate how fully-capitated models in primary care, empowered by the right partnerships to create enablement, will ultimately drive patient behavior change. Under his leadership, Wellvana is an industry-leading example of a company that is connecting the healthy outcomes of patients directly to healthier profitability. With the tools, technologies, analytics, and resources for healthcare providers to successfully and seamlessly transition to value-based care, Wellvana is getting outstanding results and growing at an exponential rate for such a young company. This is highlighted by the recent announcement of their partnership with AdventHealth to revolutionize primary care in the state of Florida. Don’t miss this important interview to learn more about VBC enablement, high-touch primary care and clinical integration, the power of storytelling, patient behavior change, lifestyle medicine, and the current state of private equity investment in healthcare!
Episode Bookmarks:
01:30 Connecting healthy outcomes of patients to healthier profitability. (A High-Touch Approach for High Performers)
02:00 Introduction to Kyle Wailes, Chief Executive Officer and Board Member at Wellvana.
04:00 Big Announcement — AdventHealth partners with Wellvana to transition its Florida primary care network to VBC
05:00 Wellvana is the first value-based care enablement organization in the country to partner with a multi-state/national health system.
06:00 Kyle provides more details on how Wellvana’s recently announced partnership will impact the delivery of healthcare in Florida.
06:30 “Building clinically integrated primary care networks across the country requires flexibility.”
07:00 Expanding primary care impact through interdisciplinary roles (e.g. case management, care coordination, pharmacy integration, social work, coding)
07:45 Health systems across the country are extremely distressed with expenses growing 2X as fast as Medicare payments.
09:30 “The pandemic has been an accelerant overall to drive the adoption of value-based care.”
09:45 The opportunity to reposition primary care in the health system setting, taking it from loss leader to profit center, as a strategic cornerstone for transformation.
10:00 A health system focused only on fee-for-service can lose up to $200-300K per employed PCP.
10:30 “Clinically integrated primary care networks can drive better clinical outcomes, but they can also drive profit and growth as well.”
11:00 Flexibility in growing a PCP network through either an employed or affiliated model.
11:30 Kyle’s personal journey as a professional athlete, student of neuroscience, and value-based healthcare executive.
12:30 “The Story of the Chinese Farmer” – a parable that illustrates the idea that events that initially seem bad or good can lead to unexpected outcomes.
14:00 Kyle provides perspective on the highs and lows of life and how that translates to theculture at Wellvana.
15:00 Lessons learned from playing competitive sports (discipline, hard work, and preparation in winning…while also overcoming losses).
16:00 Wellvana has raised $140 million in capital since 2021 and is now in 22 states, reaching more than 100K lives through multiple payers, Medicare Advantage and ACO REACH.
17:30 Building large high-touch primary care networks at scale requires behavior change.
18:15 Aligning a high-quality specialty network with tech-enabled primary care to achieve appropriate procedural utilization and lower costs.
19:00 Merging High-Touch with High-Tech (“Technology as a standalone solution doesn’t work well in healthcare today. You have to wrap services around it to drive behavior change.”)
19:45 Building Capabilities to Improve Care for High-Risk Patients (“The ability to transition into fully-capitated risk is impossible for a doctor to do on their own.”)
20:30 The connection between improved patient outcomes and higher profitability — a patient success story showing how high-touch care management reduced avoidable ED utilization.
22:00 The power of effective storytelling in value-based care transformation.
24:00 Kyle discusses how Wellvana utilizes storytelling to revitalize care teams and provider partners in creating positive change.
26:00 The Challenging Politics of Value-Based Care (differing ideologies, debates about government involvement, conflicting interests and lobbyists, uncertainty about implementation, economic concerns, partisan politics).
27:30 Kyle shares insights from his involvement in advocating for value-based care on Capitol Hill.
28:30 The evidence that fully-capitated models work despite low market penetration in Medicare (e.g. MA <10% full-risk, ACO REACH).
29:00 How Wellvana educates legislators on the importance of frontloading savings payouts and provider aggregation in networks to drive success in fully-capitated risk.
30:00 Advocacy in patient communities is just as important as political advocacy.
31:00 How Wellvana engages and educates patients on the purpose of value-based care and care planning.
32:00 “To win long-term in this industry, you’re going to have manage medical spend more effectively. We do this by engaging patients in way that can drive behavior change.”
33:30 Wellvana co-founder, Charlie Martin: “Building a Sustainable Economic Model for Lifestyle Medicine”
34:45 Kyle discusses the importance of Lifestyle Medicine in creating a holistic, patient-centered wellness model.
35:45 Wellvana is conducting a clinical trial study on LM with the goal of applying broader findings that drive behavior change at scale.
37:30 Are investors placing more bets on value-based care enablement?
38:30 The runway for value-based care companies in the current investment landscape and why PCPs relationships are so critical to success.
39:30 Digital health and AI solutions will support primary care value transformation.
40:00 Nashville as the epicenter of healthcare investment.
41:00 ACO REACH as an inflection point for adoption of fully-capitated risk in the primary care setting?
42:00 How fully-capitated models will strengthen the connection between improved SDOH interventions and Health Equity outcomes.
43:45 Kyle discusses the future of Wellvana in terms of continued growth and sustained high performance.
46:00 “Success in value-based care is not about the speed; it is about overall outcomes and finding the right partners to take risk.”
Unlocking wellness and reshaping healthcare involves the profound bridge between Lifestyle Medicine and the Social Determinants of Health, a blueprint found in the wisdom of the Blue Zones. Blue Zones are regions of the world where people are known to live longer, healthier lives compared to the global average, often to 100 years of age. These areas have gained attention from researchers and health enthusiasts because they provide valuable insights into the factors that contribute to longevity and well-being. Researchers have reverse-engineered longevity to find the common denominators and found that these Blue Zones are all places where people enjoy a diet rich in plant-based foods, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life. Given these lifestyle factors that contribute to the remarkable longevity and well-being of the people in these Blue Zones, we need to find a way to replicate them in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize these essential elements of health and well-being. If population health success is at the intersection of Blue Zones and Lifestyle Medicine, how can drive the necessary realignment of financial incentives for value-based care?
In this enlightening episode of Race to Value, we dive deep into the world of healthcare transformation with Dr. Dexter Shurney, President of the Blue Zones Well-being Institute. He is responsible for creating innovative health and well-being solutions that have broad impact. The Blue Zones Institute is a “Living Lab” to create, study, and codify best practice, including a whole-person approach to care, that can be replicated across regions and communities, including those of greatest need. In this episode, we explore the potential for wellness through the lens of Blue Zones research, discuss the impact that chronic disease has on declining U.S. life expectancy, uncover the profound connection between stress-induced inflammation and chronic disease, and address the impact of both racism and SDOH variables on health equity. Additionally, we go deep into the tenets of lifestyle medicine and how it aligns with the broader movement value-based care. Tune in for a thought-provoking conversation that unveils the pathway to healthier lives, stronger communities, and a brighter future in healthcare!
Episode Bookmarks:
01:30 Introduction to Dr. Dexter Shurney and the wellness potential of applying Blue Zones research.
03:30 After peaking in 2014, US life expectancy has declined each subsequent year, trending far worse than peer countries.
04:00 Chronic diseases remain our nation’s greatest killer, erasing more than double the years of life as all overdoses, homicides, suicides, and car accidents combined.
04:30 The death rate gap between the rich and poor has grown almost 15x faster than the income gap since 1980.
05:30 We have the answers to address declining life expectancy…but haven’t put in place the right policies to solve the problem.
06:00 Referencing the new Netflix docuseries, “Live to 100: Secrets of the Blue Zones”
06:30 People living in Blue Zones often live to be 100 and do not suffer from high rates of chronic disease.
07:00 “Blue Zones countries spend far less than the U.S. on healthcare, and their good health is driven by things others than genetics.”
07:45 “Drug overdoses, homicides, and suicides with our youth are all deaths of despair. It touches back to people being lonely and not connected to friends, family, and society.”
09:00 The common denominators of long life expectancy (plant-based diet, regular physical activity, strong social connections and community support, and a sense of purpose or meaning in life).
09:30 Finding ways to replicate Blue Zones in our uniquely American society, which is often limited by modern fast-paced living, processed foods, and social structures that de-prioritize health and well-being.
10:00 There are 75+ Blue Zones projects in the U.S. showing transformation by reverse engineering research from the original Blue Zones.
10:30 Singapore is an example of an emerging Blue Zone that has put in place the right policies to ensure continued health improvement.
11:00 Applying Blue Zones principles in underserved and marginalized communities has proven successful.
11:30 Healthcare systems are not the only player in a Blue Zone transformation. You must form community-based partnerships!
12:00 Making the connection between stress-induced inflammation and chronic disease.
12:30 The release of stress hormones and inflammatory agents that affect the immune system (e.g. cortisone, norepinephrine, cytokines).
13:00 A chronic burden of stress leads to allostatic load, which refers to the cumulative physiological wear and tear on the body that occurs in response to chronic stressors.
15:00 “The common path to disease is inflammation, and stress is the common denominator.” (stress can come from lack of sleep, poor diet, or even stress itself)
16:00 Referencing the work of Arlene Geronimus: “Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society”
16:30 The acute and chronic stressors of living in an underserved community.
17:00 Lifestyle medicine reduces stress levels in patients to improve overall health and wellbeing.
17:30 Addressing “Weathering” and “Allostatic Load” at a community-level. Delivering Lifestyle Medicine at an individual level.
18:30 Over half of all Medicare beneficiaries are treated for five or more chronic conditions which account for over 75% of Medicare spending.
19:00 The alarming statistics of health disparities in racial and ethnic minority communities.
20:30 Eliminating the root cause of inflammation through Lifestyle Medicine will reduce the prevalence of chronic disease.
22:30 Genetics are not the prime determinant of chronic disease (e.g. identical twins growing up in separate environments)
23:30 Black women with a college degree have higher rates of maternal mortality than white women without a high school education.
24:00 Addressing socioeconomic status doesn’t always solve the problem of health disparities due to institutional racism.
25:30 Don’t be too quick to blame the patient for poor compliance; lack of trust and poor living environments determine behavioral choices.
27:00 The example of how lack of good employment options (due to discrimination) leads to chronic stress and poor health.
31:00 In talking about value-based care, we must ask ourselves “value for whom”?
32:00 Why many employers may not see “value” in VBC.
32:30 Not a single HEDIS measure exists for the reversal (elimination) of chronic disease!
33:30 Changing quality metrics to realign incentives for lifestyle medicine.
35:00 Referencing prior Race to Value episode (Ep 87 – The Future of Value: Lifestyle Medicine and the Reversal of Chronic Disease, with Dr. Dean Ornish)
35:30 The concept of Food as Medicine (“When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.”)
37:00 Referencing Geisinger Fresh Food Farmacy and prior Race to Value episode (Ep 70 – The Geisinger Value Journey, with Dr. Jaewon Ryu)
38:00 The success of a Food as Medicine strategy is ensuring that the food tastes good!
39:30 Finding ways to pay for Food as Medicine initiatives (think of it just like you would a prescription for a drug on a formulary).
41:30 The cost vs. benefit investment decision in food prescriptions for chronically ill patients.
42:30 Unlike drug prescriptions, food prescriptions will not have an adverse reaction.
42:45 50% of patients will no longer need their food prescriptions after 12 months.
44:00 Large employers will spend over $10 million a year on wellness programs that are largely ineffective.
45:45 “Half of Americans receive their healthcare through an employer. It is a great place to start with wellness, and the incentives there are more pure.”
46:30 Employers that focus on workforce wellness perform better overall at a financial level.
47:30 EAP employee participation is in the single digits, despite employees dealing with overwhelming amounts of stress. We must remove the stigma!
51:00 Transformation at the Venn Diagram intersection of Blue Zones and Lifestyle Medicine.
Data interchange and interoperability are the keystones of a united ecosystem for value-based care, where information flows seamlessly, connecting patients, providers, and payers to drive better outcomes, lower costs, and improved patient experience. Overcoming siloed information is the key to breaking down the barriers that fragment care delivery, and in doing so, we unlock the potential for a healthier future for all. While health data interoperability has arguably become an industry buzzword over the past decade, the concept’s importance for digital health transformation cannot be understated. The benefits of optimal interoperability in healthcare includes improved care coordination for patients and reduced administrative burden for healthcare payers and providers. Interoperability also supports public health surveillance and population health initiatives that are so critical to value-based care transformation.
In this podcast episode, you will hear from two executives on a mission to unlock greater value in American healthcare by aggregating, normalizing, and unifying data. Venkat Kavarthapu and Dr. Summerpal Kahlon are the Chief Executive Officer and Chief Medical Officer for Edifecs, a Best in KLAS interoperability platform that serves as the foundation for the solutions that eliminate stakeholder friction to overcome healthcare’s biggest challenges. We discuss how interoperability will accelerate value-based payment adoption and help providers obtain more complete and accurate care funding for alternative payment models. We cover such topics as the future of AI, the potential for automated prior authorization, how ACO REACH will drive population health management, and the collaboration that is enabled by technology.
Episode Bookmarks:
01:30 Introduction to Venkat Kavarthapu and Dr. Summerpal Kahlon and their company Edifecs that provides a leading interoperability platform.
04:00 Industry struggles to implement interoperability requirements of the CMS Interoperability and Patient Access Final Rule.
04:30 The benefits of interoperability and how it serves as a foundation for value-based care.
05:30 Venkat discusses how value-based care is the only path forward in creating a sustainable healthcare system.
06:30 The need for data to improve patient experience and quality of care.
07:00 “True value-based care can only be accelerated if information is available to all entities in all three dimensions – clinical, administrative, and financial.”
08:00 Exchanging information across organizations and between systems without friction, while ensuring privacy and security.
09:00 How data siloes create healthcare dysfunction.
10:00 Extreme data siloing increases data management costs (25-30% of total cost spent to ensure data accuracy).
10:30 Payer-provider collaboration supports value-based care but is still limited by interoperability adoption.
12:00 “Driving interoperability is not a burden on the industry, but a true competitive advantage for the industry.”
12:30 How interoperability reduces administrative burden and the cost of human capital.
13:45 “An interoperability framework can drive a meaningful dialogue, and communication is key to driving good patient outcomes.”
14:30 Summer describes how an overly-fragmented healthcare system that still relies on fax machines contributes to data inaccuracy.
16:00 Emphasizing data accuracy within an interoperability framework ensures patient safety.
16:30 How Natural Language Processing and AI can provide context and improve communication at the point-of-care.
19:00 CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule
20:00 The need for fully automated Prior Authorization (PA) enabled by EDI processing, FHIR-based APIs, AI/ML, and NLP.
21:45 Electronic PA will foster payer-provider collaboration and drive clinical decision support.
23:30 PA transactions are only automated 30% of the time at present (compared to 90% or more for claims eligibility, enrollment payment, etc.)
24:30 The value of PA automation in alleviating physician workflow burden.
26:00 Implementing an electronic Prior Authorization system will enhance clinical decision support (without adversely impacting UM metrics).
27:45 Correcting physician perspectives on value-based technology adoption following bad prior experiences in EHR adoption.
29:00 Venkat discusses the challenges facing providers as they look to adopt technology to drive value-based care performance.
31:00 Physicians can only succeed in value-based care when empowered by information at the point-of-care.
33:00 “Providers need systems and technology to participate in the value-based care revolution.”
34:45 Summer provides a physician perspective about the friction posed by documentation in EHRs.
36:00 Structured data vs. Unstructured data
36:45 The potential for Natural Language Processing in extracting information from EHR notes to tell a story.
37:30 “As we transition to value and look to enhance communication through technology, NLP is going to be front and center.”
38:00 ACO REACH as inflection point for the value movement.
40:00 The transfer of financial risk to ACOs and Risk-Bearing Entities.
42:00 The need for real-time data exchange from payers to providers.
43:00 Making it easier for technology to integrate into the value-based care ecosystem.
45:00 Applying lessons learned in the development of new alternative payment models.
46:00 The evolution towards full risk prospective payment/capitation and disease-specific models.
47:30 Developing a Population Health Management platform that accommodates both existing and new payment models.
49:30 The explosion of ChatGPT and the potential for Generative AI to drive healthcare transformation.
51:00 Venkat shares his optimistic perspective on the future of AI in transforming care delivery.
53:00 “By leveraging interoperability, AI and workflow optimization, the industry has a potential to lower costs and save Medicare from insolvency.”
54:45 AI works best when it runs behind the scenes and is invisible to the end user.
56:00 AI has a role to play in eliminating the noise from extremely large, disparate datasets.
58:00 Summer discusses a successful use case for effective AI and NLP in the risk adjustment environment.
60:30 Leveraging AI to mitigate inconsistencies with human-based coding (upwards of 15% observed variance between two coders).
65:00 4 characteristics of Industry transformation: 1) Existential Threat to current model, 2) Regulatory Environment favorable to transformation, 3) Technology advancement, 4) Consumerism
66:00 Why you should be optimistic about the future of value-based care!
Innovation and partnership are the twin engines that propel us into a new era of healthcare. The fusion of cutting-edge technology and clinical innovation, empowered by collaborative relationships, can revolutionize primary care. This cohesion of innovation and partnership makes primary care more accessible, effective, and patient-centered than ever before. There is no better example of primary care modernization than Central Ohio Primary Care (COPC), the largest physician-owned primary care group in the United States with over 480 physicians and 83 locations in central Ohio. Rooted in a long history of clinical excellence and a commitment to the highest ethical standards, COPC is building a new holistic model for primary care that gives physicians time to build relationships with their patients and one another. Through ACO REACH, full-risk delegated capitated Medicare Advantage Plans, and direct-to-employer value-based arrangements, they are able to engage their entire team in the innovation of their primary care model. Furthermore, through partnerships they are able to share risk and build a pathway to sustainability in the provision of value-based care for decades to come.
Joining us on the Race to Value this week is Donald Deep, M.D., the CEO of Central Ohio Primary Care. In this episode, we discuss the modernization of primary care that is underway at COPC – including technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up. We explore the successes of their Extensive Care Center and Comprehensive Home and Palliative Care programs. There is also in-depth discussion on low value care, the importance of payer partnerships, direct-to-employer strategies for commercial populations, accessing capital partnerships in full-risk MA, and collaborative leadership for success in VBC.
This episode is sponsored by Agilon Health, a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program.
https://vimeo.com/870324462?share=copyEpisode bookmarks:
01:30 Introduction to Donald Deep, M.D., the CEO of Central Ohio Primary Care (the largest physician-owned primary care group in the U.S.)
02:45 Referencing prior episode featuring Dr. Bill Wulf (“The Value Game”: Achieving Success with Capitated Risk and Patient-Centered Primary Care)
03:00 This week’s episode is brought to you by Agilon Health
04:30 COPC has directing 2,200 employees across 90 locations covering six counties and has been on a value journey since 2010.
05:30 The modernization of primary care at COPC.
06:30 Patient care coordination that includes technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up.
07:30 “We are responsible for the care of our patient population, even outside of the exam room.”
07:45 Empowering PCPs to spend more time with patients and engage patients and families in the care process.
08:00 Addressing prevention and SDOH requires a modernized primary care model.
08:45 Extensive Care Center (ECC): A Novel Approach to Reducing Emergency Department Visits and Observation Unit Utilization
10:00 The Extensive Care Center at COPC returns 95% of patients to the home (ER Avoidance) and prevents 2-3 hospital admissions each week.
11:00 Scaling the ECC model in co-location with Same Day Centers at COPC to provide immediate access for emergent primary care needs.
12:00 Addressing chronic disease in the extensive care center avoids unnecessary ER visits and hospitalizations.
13:30 Payer recognition of the ECC model, with high levels of patient satisfaction.
14:45 The Comprehensive Home and Palliative Care (CHPC) program at COPC provides primary and palliative care in the home setting.
15:30 Palliative care in ACOs have demonstrated reductions in 30-day readmissions, avoidable hospital admissions, and ED visits.
15:45 Advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.
16:30 The difference between palliative care and hospice.
17:30 Dr. Deep reflects on his experience as a hospitalist that repeatedly saw patients readmitted to the hospital due to poor symptom management.
18:00 “Palliative care is invaluable in primary care, and we must take it into the patient’s home. Poor symptom management leads to unnecessary ER visits and inpatient stays.”
20:00 The composition of the interdisciplinary team that provides comprehensive home and palliative care services.
21:30 Spending on low-value care range from $100 billion to $700 billion each year.
23:30 Identifying waste in the provision of primary care and defining clinical pathways that define value.
24:30 Patient advocacy for services provided outside of the practice in the promotion of high value care.
25:00 Demanding risk-adjusted outcomes for specialists seeing COPC patients. Providing RFPs to specialists to ensure accountability to expectations for high value care.
25:30 How PCP-led global capitation and compensation redesign incentivizes high value care.
27:00 Referencing a recent Morgan Health study that shows extreme variations in clinical quality for employer-sponsored health plans (e.g. statin medication adherence for CAD).
27:45 COPC’s partnership with JP Morgan Chase to provide onsite health clinics, health coaching, behavioral health services, and after-hours access to care.
28:30 Dr. Deep explains COPC’s advanced primary care model that is provided on a direct-to-employer basis.
29:30 Direct-to-employer care that is convenient, longitudinal, preventative, and consistent.
30:00 How partnering with Vera Whole Health expanded behavioral health services at COPC.
30:30 Providing an advanced primary care access point to large employers as a critical success strategy for VBC.
33:00 Dr. Deep discusses how the ECC model has allowed them to forge more collaborative partnerships with payers.
34:00 “Shifting of financial risk to prepayment (instead of Shared Savings) allows us to engage our entire team in the innovation of our care model.”
35:00 Assessing data to identify high-risk patients. Developing win-win payer-provider partnerships.
36:30 The history of COPC’s partnership with Agilon Health.
37:30 The COPC-Agilon partnership with COPE Health Solutions that led to the development of a primary care Advanced Practice Provider (APP) Fellowship Program.
39:00 The exciting potential of a new value-based care fellowship for APPs.
40:00 “The old way of delivering care where a physician does everything is not sustainable. Team-based care will ensure that we are sustainable decades into the future.”
41:30 How the partnership with Agilon Health enabled value-based care transformation at COPC.
42:30 Finding a VBC enablement partner that truly believes in partnership (beyond just the provision of capital).
43:30 Parting thoughts from Dr. Deep on the importance of collaboration in value transformation.
45:00 “Leaders in healthcare must ensure that both their organization and the community they serve is strong. Doing that through trusted partnerships will make a lasting impact.”
Fourteen years ago, surgeon, writer, and public health researcher, Atul Gawande wrote his landmark article, The Cost Conundrum, about the healthcare challenges of the Rio Grande Valley (RGV) of South Texas. Gawande showcased the challenges that health systems confront when dealing with public and private insurers and the paradox between high-cost treatment options and low-quality outcomes. His careful assessment of McAllen, Texas, a small city on the border, found that it had the most expensive healthcare system in the nation. This “cost conundrum” in the Rio Grande Valley inspired President Obama to pass the Affordable Care Act and begin a national movement to value-based care. Now that ACOs have reached a critical mass in the Rio Grande Valley we must now ask ourselves “to what degree can value-based care accelerate health equity?”
Value-based care is the seed from which health equity transformation can bloom, nurturing a system that values every life, cultivates well-being, and harvests a future where health disparities are but a distant memory. Health equity transformation in underserved regions (like the RGV) is not just a matter of providing medical care; it’s a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity. Equity transformation is currently underway in the Rio Grande Valley, one of the most underserved regions in the entire United States. The RGV – a 50-mile stretch of towns that span the border of Texas and Mexico – is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country. Issues like poverty and lack of access to healthcare burden the Valley. These factors are the leading cause of health problems like diabetes, obesity, and cervical cancer.
Our guest this week is Dr. Edwin Estevez, a nationally-recognized value-based care leader and champion for health equity in the RGV. His vision is to activate the local health ecosystem to expand access and promote inclusivity through the power of co-opetition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem.
If you want to be a part of the health equity transformation in the Rio Grande Valley, register today for Accelerator2023 on October 17th! (Attendees can attend in-person in Mission, Texas or virtually). More information at www.equity-accelerator.org
https://vimeo.com/decibelrocks/accel?share=copyAdditional Resources:
WGU Aims to Transform Rio Grande Valley’s Healthcare
A Vision of Pioneering Co-opetition for Health Equity
Episode Bookmarks:
01:20 The landmark article, “The Cost Conundrum” about the healthcare cost crisis and how it inspired a national movement to value-based care.
01:45 Obama’s Favorite New Yorker Article led to the passage of the Affordable Care Act and the development of ACOs.
02:00 Edwin Estevez returns to the Race to Value! (Episode #1 with Edwin)
02:30 The underserved region of the Rio Grande Valley (RGV) as a focal point to create a replicable convening model of equity-based co-opetition.
04:30 Advancing health equity through a community-based ecosystem – Eric and Edwin discuss their upcoming collaboration in the RGV.
05:45 “Value-based care is a platform to shape policy, redirect programs, and understand services better through the lens of health equity.”
06:00 Edwin’s prior VBC success with RGV ACO, one of the earliest (and most successful) physician-led MSSP ACOs in the country.
06:30 Edwin discusses AltaCair, a new population health enablement company borne out of the desire to optimize efficiencies and maximize care management.
08:45 The RGV is a bilingual, border region is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country.
09:00 According to the RGV Health Connect Organization, the region’s median household income is $46,016, compared to $71,347 median household income state-wide in Texas.
09:30 The RGV has 24.7% of families living below poverty level, nearly triple the percentage for the nation. The Rio Grande Regional Hospital states that an estimated 76,000 people in the region have diabetes.
10:00 Edwin provides his perspective on the economic development and demographic growth in the RGV (and how it has not contributed to a rising tide for underserved communities).
11:00 The opportunity for whole-person care and community collaboration to address social determinants of health.
11:45 Despite value-based interventions to reduce avoidable ED visits in the RGV, SDOH challenges still contribute to overutilization of healthcare services.
12:00 The opportunity for Community Benefit Organizations (CBOs) to create a “collective impact model.”
13:30 Dr. Gawande’s careful assessment of McAllen, Texas, a small city on the border, that found that it had the most expensive healthcare system in the nation.
14:00 According to the U.S. Census Bureau, 9.8% of people under the age of 65 do not have health insurance nationwide, but the percentages in the RGV are much higher at around 30%!
15:30 How a broken system of big business fee-for-service healthcare emphasizes profiteering at the expense of community health outcomes.
16:30 “The economics of value-based care galvanized our healthcare community in the RGV following the wake of Gawande’s The Cost Conundrum.”
17:00 The continued challenges of accessing primary care in the RGV (wait times may be up to 2 hours).
17:30 Various community ACOs (e.g. RGV ACO, RGV Health Alliance, South Texas Clinical Partners ACO) have triggered an elevation of consciousness to drive accountability.
18:30 “A mindfulness of engagement to see the whole-person” (focusing on prevention and AWVs)
18:45 RGV-based hospital systems are now focusing on value-based care (e.g. direct admissions)
19:30 Finding opportunities to disrupt the local ecosystem to improve equity (whole-person care responsiveness and focus on social influencers that drive health).
20:00 The critical shortage of PCPs, nurses, and other healthcare professionals and the opportunity to create equity in the access and attainment of education for underserved learners.
21:00 A recent survey of healthcare CEOs by ACHE shows the #1 challenge is workforce — eclipsing even financial challenges which held the top spot for 16 years in a row up until last year!
22:00 Edwin discusses the Higher Education landscape of the RGV (WGU Texas, UT RGV, STC) that are actively engaged to address staffing shortages and workforce development needs.
23:00 How the pandemic created a perfect storm to transform the educational landscape in the RGV for health professions.
23:30 The presence of educational institutions change the relationship of labor to community-based health challenges in a given region.
24:00 “Access to care is at the pinnacle of problems related to equity and opportunity for people of the Rio Grande Valley.”
24:30 “It is astronomically crazy that folks in our market can find it easier to access basis care in the ER than see a primary care physician!”
25:00 A renewed focus on the development of additional primary care access points in the RGV.
25:30 “We must think of access to primary care and labor shortages as a matter of equity. Collaboration can better coalesce around the opportunities to better meet these needs.”
26:30 A Vision of Pioneering Co-opetition for Health Equity — a partnership between theInstitute for Advancing Health Value at the Leavitt School of Health and AltaCair.
26:45 “Co-opetition is a transformation strategy that combines elements of both cooperation and competition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem.”
27:30 Accelerator2023, will be held in Mission, Texas on October 17th, bringing together competing health system and ACO leaders, CBOs, Higher Education, entrepreneurs, civic and other community leaders.
28:00 Collaboration with Aneesh Chopra and Sister Norma Pimentel to advance value for health equity in the Rio Grande Valley.
29:30 “We want to advance equity through community-based focused conversations. Transformation in health equity in the RGV will result from co-opetition.”
31:00 Edwin discusses how a researched-backed convening event can foster impactful strategies that drive high-level tactical execution in the advancement of equity.
32:00 To what degree has health value accelerated health equity?
33:00 The activation of an ecosystem for better health.
34:00 Creating replicable models for health equity co-opetition across the country.
34:30 “Health equity transformation in underserved regions is not just a matter of providing medical care; it’s a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity.”
35:00 “It is impossible to continue on a trendline where your zip code is a better determinant of health than your genetic code.”
36:00 Activating entrepreneurship for social justice and health equity through community collaboration.
37:00 Parting thoughts from Edwin on our upcoming event to transform health equity in the Rio Grande Valley.
38:30 Register for in-person or virtual attendance to Accelerator2023!
The plasticity of primary care, in the new value-based era, embodies remarkable adaptability, innovation, and responsiveness to evolving community health needs. As our understanding of health and well-being expands, primary care stands as the first line of defense, ready to transform and customize its services to address the unique challenges faced by diverse populations. This flexibility allows primary care providers to pivot swiftly, whether it’s in responding to public health crises, addressing disparities in healthcare access, or integrating innovative technologies into daily practice. In embracing this plasticity, primary care not only becomes a cornerstone of community health but also a powerful catalyst for positive change, driving us closer to the goal of a healthier, more equitable society.
In this week’s episode of the Race to Value, we are joined by R. Shawn Martin, Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. The AAFP is the medical specialty organization representing 129,600 family physicians and medical students nationwide. Shawn Martin works with the AAFP Board of Directors on the mission, strategy and vision for the AAFP and provides representation to other organizations, including medical, public, and private sectors. He is nationally recognized for his thoughtful leadership on a range of healthcare and workforce issues. While his career portfolio has focused on numerous health care and public-policy issues, he is best known for his extensive work on the development and implementation of primary care delivery and payment models.
In this episode, we discuss such things as payment reforms in primary care, the industry impact of primary care consolidation, physician-led ACOs, the new Making Care Primary (MCP) payment model and the need for multipayer collaboration, health equity, rural healthcare transformation, physician workforce challenges, and the future implications of AI on the medical profession. With leadership from Shawn and his constituents throughout the primary care ecosystem, we are well-positioned for transformation in the race to value!
Episode bookmarks:
01:30 The plasticity of primary care and how it can evolve to meet community health needs in the new value era.
02:30 Introduction to R. Shawn Martin, the Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians.
04:45 People who have access to advanced primary care tend to have better health, receive timelier diagnoses, and get more prompt treatment when it is needed.
05:30 The U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries.
06:00 AAFP Advocacy Priorities: Fighting for Family Medicine!
07:00 Shawn discusses the need for additional investment in primary care at a national level.
08:30 The misalignment of fee-for-service in the primary care setting.
09:00 “Appropriate investment in primary care, coupled with a prospective payment model, will transform both patient experience and care team performance.”
09:45 PCP Infrastructure Investments + Rapid Transition to Value-Based Care = Primary Care Transformation
10:45 Vertical integration of primary care can lead to higher prices and costs, including insurance premiums, without improving care quality or patient outcomes.
11:30 Site-of-service payment differentials create uneven playing field between independent practices and hospital-owned primary care.
12:00 Shawn’s congressional testimony to the Senate Finance Committee on the “Consolidation and Corporate Ownership in Health Care”
13:00 The Medicare program created siloed benefits between hospitals and physicians, and these design flaws created incongruencies in system economics and patient health outcomes.
14:30 The inability of independent physician practices to survive on the regulatory framework of the modern healthcare system.
15:30 Community-based primary care innovation empowered by partnerships.
16:30 The explosion of IPAs and clinically integrated networks and how these models are applied to population health management.
17:00 Data sharing and interoperability empowering chronic care management and transitional care pathways.
17:30 The trend of provider consolidation within “payvider” platforms offered by major payers (e.g. Optum, Centerwell).
17:45 Wall Street interest in primary care that led to additional capital infusion in the absence of public payer support.
18:30 “Private equity investment has created a necessary lifeline of capital for primary care to survive the onramp of value-based care.”
19:00 “It is difficult to focus on primary care transformation when you are seeing 30-35 patients a day, 6 days a week, for 48-49 weeks out of the year.”
19:30 How investments in primary care created the physician mindshare needed to transform their practices.
20:45 On average, physician-led ACOs produce almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACOs.
22:45 Shawn discusses how the autonomy of physician-led ACOs leads to them having better Shared Savings results than their hospital counterparts.
23:00 “The empowerment of PCPs with the autonomy to be patient-centered at the point-of-care has shown what is possible with value-based care.”
24:00 “The challenging occupancy-dependent model of hospitals is not insurmountable if you create collaborative, community-based physician networks.”
24:45 Overcoming the toxicity of fee-for-service in primary care.
25:00 “Primary care is built upon the foundation of a trusting, longitudinal relationship between a patient, their caregivers, and the primary care team.”
25:45 Leveraging virtual care and telemedicine to enhance relationships in the primary care setting.
26:00 “The combination of primary care autonomy with risk-based payment models will help us overcome the toxicity of fee-for-service.”
26:30 The new state-based multi-payer model from CMMI, “Making Care Primary” (MCP), supporting primary care practices in the transition to prospective value-based payment.
27:00 Recent AAFP Press Release: “Primary Care-focused APM Checks AAFP Advocacy Boxes”
27:30 Shawn discusses how the multipayer MCP model construct (Medicare/Medicaid) will serve to eventually bring value to primary care at scale.
29:30 The rationale behind making MCP a 10-year transformation project (instead of a 3-4 year evaluation cycle).
30:00 The imperative for CMMI to transition providers to more sophisticated payment models with downside risk over time.
31:00 Referencing Shawn’s recent article: “How Moneyball can teach us to invest in primary care”
32:00 A recent AAFP member survey that indicated while 85% of surveyed physicians believe social needs are directly related to poor health, 80% are not confident in their ability to address their patients’ social needs.
33:00 Inspiration from Michael Lewis regarding the applicability of Moneyball in healthcare transformation.
34:00 “The single best investment to improve health equity in our system is primary care. It is a main street discipline of care in our communities that is not confined to a building.”
34:30 The plasticity of primary care to meet community health needs and why equity must start with empowered, community-based PCPs.
35:00 The AAFP formed the Center for Diversity and Health Equity to address social determinants of health with The EveryONE Project.
35:30 “You cannot even begin to change the trajectory of health inequities in our health system without primary care.”
36:00 Meeting the workforce goals having access to primary care in every community.
37:00 Mortality rates are 23% higher for people living in rural communities than those who live in urban communities.
38:00 “The movement to prospective, capitated payment models is nowhere more important than in rural communities.”
38:45 How trusting relationships and localized interventions drive patient engagement in rural communities.
39:00 Shawn shares the lessons learned from his father who was a primary care physician in a rural area.
40:00 The relationship between the physician workforce and critical access hospitals and the opportunity to reinvent the rural healthcare ecosystem.
41:30 Physicians have higher levels of satisfaction when practicing in a value-based environment.
42:30 U.S. health is threatened by a primary care workforce shortage, and the country will need up to 48,000 more primary care physicians by 2034.
43:00 Shawn shares his perspective on the physician workforce and the how the AAFP is working to ensure that we have an adequate physician workforce in the decades to come.
45:00 The “infatuation of specialization” that favors procedural intensity.
46:30 The multi-faceted roles of primary care are not fully understood in medical schools.
47:30 How specialty economics contribute to the shortage of primary care.
49:00 The transformative potential of AI in family medicine.
49:45 AAFP recently adopted a policy on the “Ethical Application of Artificial Intelligence in Family Medicine.”
50:30 The need for transparency in the development and implementation of AI in healthcare.
51:30 How AI can be used to reduce administrative burden in primary care practices (e.g. documentation, prior authorizations, utilization management, chart reviews)
52:00 Using AI to decompress the knowledge management of specialization in medicine in order to support more comprehensive primary care.
53:00 The future of AI-enabled, comprehensive primary care.
53:00 Empowering patients with AI through lifestyle-based knowledge transfer and improvement of health literacy.
55:45 Parting thoughts of optimism on the future of primary care and how the value movement will drive us to improved population health.
58:00 The presence of primary care increases life expectancy.
59:00 Stay connected with Shawn on social media and find out more about the work of the AAFP.
Democratizing access to value in healthcare through primary care enablement is the compass guiding us toward a future where health is a universal right, not a privilege, and where the promise of value-based care is accessible to all. It represents a fundamental shift in our approach to healthcare delivery. By prioritizing primary care and leveraging technology, we can extend the reach of healthcare services, making them more affordable and accessible to diverse populations. This approach emphasizes preventive care, early intervention, and patient education, reducing the burden on emergency rooms and hospital admissions. Ultimately, primary care enablement has the potential to transform the healthcare landscape, promoting healthier communities and improving the overall well-being of individuals while also making healthcare a more equitable and sustainable system for everyone.
Joining us this week on the Race to Value is Michael Kopko, the CEO of Pearl Health – a company that is on a mission to democratize access to value in healthcare. More than 800 primary care providers across the country partnered with Pearl to align payments with patient health and leverage emerging data and technology to achieve better outcomes more efficiently. And earlier this year, they closed on a $75M Series B funding round to bring even more capability to the health value economy, by empowering providers to transition to a more proactive care model, enabling them with a technology solution that surfaces urgent cases before they become emergent, and rewarding them for outcomes aligned with value. This is a company that you need to know about, and it is my pleasure to have Mike on the podcast this week to discuss the challenges facing our industry and how Pearl Health is accelerating the development of innovative solutions that place providers at the center of healthcare delivery and cost management.
Episode Bookmarks:
01:30 Introduction to Michael Kopko and Pearl Health — a company that is on a mission to democratize access to value in healthcare.
03:30 After more than a decade of value-based care efforts, the U.S. still pays about twice as much for healthcare than any other country, despite underperforming in quality and outcomes.
04:00 How do we reach a critical mass with ACOs and other APMs to save the Medicare Trust Fund from insolvency by catalyzing care delivery transformation?
05:45 There is reason for optimism for healthcare in the long-term, e.g. R&D in the health sector, the steady march to value since Michael Porter coined the term in 2006.
07:00 The increasing adoption of Medicare APMs and value-based Medicare Advantage (see HCP-LAN APM Measurement Effort).
07:30 “The underlying infrastructure and operating system for healthcare is positioned well for value.”
07:45 More work needs to be done, e.g. Medicare negotiations with pharma companies to lower drug costs, further realignment of incentives.
08:00 Medicare cost growth has abated. (See recent NYT article: “A Huge Threat to the U.S. Budget Has Receded. And No One is Sure Why.”)
08:30 The need to balance ACO Shared Savings performance over time with the democratization of data to improve population health outcomes.
09:00 “We are starting to get the highways and freeways established for data interoperability to be very proactive in creating health value.”
09:30 “Our healthcare system has so much money that with the right capability sets and incentives, we will solve any problem as long as we have the will to do so.”
10:00 Pearl has seen 10X year-over-year growth, expanding from 10 to 29 states, since its founding in November 2020.
11:00 Technology enablement requires the harmonization of the platform with the wisdom of experienced healthcare professionals.
12:30 Michael shares key learnings in his healthcare leadership journey and how that led to the founding of Pearl Health.
14:45 The realization that the missing piece of value transformation was the enablement of PCPs to visualize and understand how to better care for patients.
15:00 “VBC is no longer a gamble when the right physicians are plugged into the right enablement partners.”
15:45 The renaissance of primary care due to value-based care and business intelligence (and how that is addressing historically high levels of PCP burnout).
16:30 Predictive analytics in primary care (e.g. future diagnosis codes, ER admissions, missed medication moments).
17:30 Aggregation of data to power an Urgency Score, which prioritizes patients in need of outreach and creates holistic, longitudinal visibility.
18:30 The overburden of primary care (e.g. it would take 21.7 hours/day for a PCP to accomplish everything that he or she is expected to do to for patient care and maintaining a business.)
20:00 The assembly line of FFS compared to the “New World of Value” and how innovation can reduce administrivia and create cost effectiveness.
22:00 Using automation to streamline patient outreach efforts.
22:30 The delayed absorption of technology into healthcare as compared to other business sectors.
23:00 “The future of automation and AI in healthcare is just beginning, and that is a reason for optimism.”
23:30 Does the MIPS program really add to population health? (JAMA article: Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System)
23:45 How ACO REACH reduces the administrative burden of MIPS. (Reach for Simplicity: How ACO REACH Makes Quality Measurement Easy)
24:30 Since FFS favors procedural intensity over cognitive care, population health suffers. And the mental health of primary care physicians suffers too.
27:00 The crucible moment for PCPs to become elite practitioners in our healthcare system!
27:30 Getting “above the visit” by combining tools and technology to succeed in VBC.
28:00 A renewal of entrepreneurship and a willingness to change your business model.
28:30 An elite segment of the PCP landscape (5-10%) with business performance that surpasses FFS, along with impacts made in community health.
29:00 Solow Growth Model – the application of technology, labor, and capital to support long-run economic growth.
29:30 The enablement sector in value-based care is not feeling the pain of capital constraints.
30:00 “People are adopting and considering value-based models more rapidly than I’ve ever seen in a decade of working with and building networks in healthcare.”
31:00 The average PCP generally earns relatively little but influences ~$10M in downstream healthcare costs.
31:30 PCPs taking fully capitated risk must get specialists contracted into VBC arrangements and that requires overcoming friction due to oligopolistic market dynamics.
33:00 Recent Atul Gawande article in The New Yorker about the Costa Rica healthcare system (improved population health and longer life expectancy through primary care enablement).
33:30 The regression equation for healthcare – advanced primary care with optimal specialty management would address 60-80% of medical costs!
34:00 The changing business model for specialists due to advancements in VBC.
35:00 The tipping of the fulcrum – alignment of primary and specialty care is progressing due to data interoperability.
36:00 Democratization of access to value due to changes in enablement and economics.
37:00 Will advanced hospital systems have a role to play in the future of value?
38:00 Innovators and disrupters will be at the leading edge in VBC because they will be more nimble, agile, and unconflicted.
39:30 15% of the insurance premium dollar goes to administration and profit. (The shift of risk to providers will lower that admin cost to 4-5% or less!)
40:00 Upstarts can create real economic value. (Just look at how AWS disrupted intensive server requirements for businesses.)
40:30 VBC enablement can be as revolutionary as cloud-based computing!
41:00 Michael’s advice to entrepreneurs: “Focus on creating value in a thesis of change.”
41:30 Other opportunities for disruption, e.g. Drug delivery and development, AI and automation, data interoperability.
42:00 Creating an escape velocity through TAM (Total Addressable Market) and Team.
43:00 ACO REACH is a gamechanger for value because it presents an opportunity for PCPs to increase and stabilize revenue with prospective payment.
44:30 Keys to success in models like ACO REACH: reducing the cost of access and improving intelligence capabilities.
45:30 “ACO REACH is a cheaper, faster path to an alignment shift.”
46:30 “Healthcare doesn’t have a data problem. The real test now is what data matters and when does it matter. How do you synthesize and distill information at the POC in a salient way that is actionable.”
47:00 Developing an urgency score, promoting the patients that are most at-risk, and surfacing interventions through a suggestion engine.
48:45 The trend towards PCPs selling their practices to larger enterprises like hospitals and PE-backed physician aggregators.
49:30 The benefit of working within a larger primary care practice (more capabilities, risk protection, negotiation leverage).
50:00 Autonomy and independence of PCPs and how that can happen in a corporatized model.
51:00 Clinical integration – “Hospitals are a key ingredient in VBC when properly applied.”
52:00 Finding a business model that is aligned morally and ethically to what one wants to contribute to the world.
53:00 “The new practice of the future will be less capital intensive with these new value-based models becoming more proliferated.”
53:30 “Culture is what everyone says it is at that moment in time. It’s an evolving organism.” (A Values-Based Culture: Principles at Pearl)
54:00 Creating a company with a strong value compass.
55:00 Transparency and Interoperability.
56:00 Recognition that you get what you pay for. (FFS rewards chronic disease. We need to realign incentives to reward health.)
57:00 Technology, Automation, and Artificial Intelligence.
58:30 The value of health equity in value-based care transformation.
59:00 How ACO REACH finally put an emphasis on the importance of equity in the value movement.
59:30 “Start where the patient is, not where the business model begins.”
60:30 Multidisciplinary care to enhance the health of communities and how capital markets are the great unlock.
61:30 “The model of providing agency to the stakeholders generating high costs is a backwards model. We need a more proactive, sentient system.”
63:00 Parting thoughts on transforming a complex system.
In the ever-evolving landscape of healthcare technology, humility is the compass that guides successful change management. It reminds us that the journey towards seamless adoption of health information technology is a collaborative one, where the wisdom of many outweighs the knowledge of one. The humility to acknowledge one’s limitations fosters an environment where collaboration and learning thrive. In the context of clinical informatics, allyship and teamwork are indispensable. Effective clinical informatics demands a diverse skill set, often spanning healthcare providers, IT specialists, and administrative personnel. Allyship within this multidisciplinary team is essential, and applied clinical informatics can be the linchpin in the transition to value-based care. Through successful HIT implementation, leaders can illuminate the path to better outcomes, reduced costs, and patient-centered excellence. A new era for Clinical Informatics is upon us and will empower healthcare with data-driven insights, AI capabilities, virtual care at scale, and precision medicine to ensure that quality triumphs over quantity in our pursuit of healthier communities.
On the Race to Value this week, we are joined by Brittany Partridge, a national thought leader on health data management and informatics. Brittany is passionate about implementing technology that impacts clinical workflow in a positive way and increases patients’ access to care. Join us for an informative discussion on Clinical Informatics, the importance of allyship to mitigate medical technology risk, the impact of Generative AI and virtual care on health system transformation, and change management best practices to lead your organization to successful healthcare innovation.
Episode Bookmarks:
01:30 Introduction to Brittany Partridge, an industry leader in Virtual Care Technical Architecture and Informatics Implementations.
03:00 Recent book collaboration with Ed Marx – “Voices of Innovation: Fulfilling the Promise of Information Technology in Healthcare”
04:30 The sub-disciplines of Health Informatics (e.g. Nursing, Pharmacy, Public Health, Biomedical, Medical, and Clinical Informatics).
06:00 AMIA: Why Informatics? – “Informatics is the overarching field of study that pulls all these subdomains into one discipline focused on improving health and healthcare.”
06:30 Applied Clinical Informatics – the frontline of healthcare innovation with direct clinician interaction.
07:00 Early experiences in e-prescribing implementations that led to other care delivery innovations such as virtual care and remote patient monitoring.
08:00 The intersection of Clinical Informatics and VBC (ensuring tech usability to optimize care workflows for clinical quality improvement).
09:00 Best Practice Advisories (BPAs) – pop-up alerts to empower clinicians to make the best informed decisions at the point-of-care.
09:45 Leveraging technology innovations to improve patient access and affordability.
11:30 The importance of shadowing and workflow analysis as a catalyst for innovation.
13:00 How shadowing is incorporated into user validation, user design, and Lean (“Go to the Gemba”)
14:00 Simply asking clinicians to describe a workflow is insufficient in understanding the entire process.
15:00 “Get a robust current state workflow before you implement any innovation project because you need to know what you’re going to be replacing.”
15:45 How virtual interactions with providers can complement provider shadowing in an embedded CI model.
16:30 Non-judgement in applied clinical informatics is required to build trust.
17:30 “The most important part of rolling out any technology project is clinician trust. They need to know that you have their best interests at heart.”
19:45 Allyship is key to reducing medical technology risk because the inclusion of diverse perspectives yields the greatest rewards.
21:30 “Fail fast and iterate” and “Perfect being the enemy of good” philosophies don’t work in healthcare technology adoption because human lives are impacted.
22:30 Leaders should not surround themselves with “Yes People” – you need allies with a different focus or strength to help you fully understand the risks.
23:30 Finding allies with certain traits and behaviors such as listening, empathy, communication and transparency.
24:30 Medical technology risk increases when trust is lacking and people try to hide things.
25:30 The future impact of Generative AI in the field of clinical informatics. (With the explosion of ChatGPT, how can Generative AI provide transformative opportunities in healthcare?)
27:45 The difference between Generative and Predictive AI.
28:30 The need for clinician trust with Generative AI models in healthcare.
29:00 How Clinical Informaticists can create transparency with Generative AI models to support adoption at the point-of-care.
30:00 “The biggest opportunity for Generative AI in medicine is the reduction of physician administrative burden so they have more time to meaningfully interact with their patients.”
31:00 How UC San Diego Health is piloting Generative AI to support more efficient Provider Inbox messaging to patients.
32:00 The application of Generative AI in ambient listening during the provider-patient encounter and how that will improve information capture and care experience.
33:00 Additional uses of AI in the clinical setting (e.g. medical imaging analysis, diagnostic decision support, diagnostic accuracy).
34:00 The development of a framework and standards to enable trust with AI models.
35:00 The success story of how UC San Diego Health rapidly scaled their telehealth program during the height of the pandemic (i.e. 1,200 visits a day — a 1000% increase).
37:00 Teamwork during a time of crisis.
39:00 Agile governance to ensure rapid decision-making.
40:00 Training and tip sheets to enhance communication during technology adoption.
41:30 Current telehealth utilization at UC San Diego Health post-pandemic.
44:00 Humility as a foundation for communication and collaboration in medicine.
45:00 Why the foundational premise of humility is antithetical to how medicine has been structured in our country (e.g. Flexner Report).
47:30 The challenges of ego in attaching self-worth to what you produce, what you know, and how you earn.
48:45 “Humility and vulnerability in health tech requires you to look at what you’re creating to see if it this making a positive impact in the lives of an end user.”
49:30 “Radical curiosity” as a key to humility in healthcare innovation.
51:00 Knowing what you don’t know. Seeking first to understand prior to being understood. (how this drive success health tech adoption)
52:45 “Having an open mind and getting radically curious will make health technology have a better impact.”
53:30 Lessons learned from the “Meaningful Use” adoption of Electronic Health Records.
55:30 Using The Kotter 8-Step Process for Leading Change to guide effective Change Management.
57:45 Generating short-term wins with the use of AI.
60:00 Follow Brittany on Twitter and LinkedIn for more thought leadership on clinical informatics, AI, and virtual care!
Crossing the Value-Based Healthcare Rubicon isn't just a journey, it's a revolution in care, where the currency is quality, and the compass is compassion. This transformation is both an economic and moral imperative, and in the alchemy of healthcare, transforming economics isn't just about numbers; it's the catalyst for transmuting care outcomes into golden results that enrich both lives and ledgers. This week you have access to two of the leading minds in value transformation. We are joined by Dr. Edward McEachern (Executive Vice President and Chief Medical Officer for PacificSource) and Jenni Gudapati (Value-Based Healthcare Program Director and Clinical Associate Professor at Boise State University). In this illuminating episode, we delve into the transformative realm of value-based healthcare with a diverse range of topics. Our insightful interview explores the value movement and its profound impact on economics and care outcomes. We unravel the intricate dynamics of care management, particularly in the context of chronic diseases, while shedding light on the crucial aspects of risk adjustment, Annual Wellness Visits, and Quality Improvement. We also investigate the concept of "Gold Carding" and the role it plays in healthcare transformation. Furthermore, we delve into higher education's pivotal role in shaping the future of healthcare value, emphasizing the essential skills that healthcare leaders of tomorrow must possess. Tune in for an enlightening discussion that navigates the evolving landscape of healthcare, economics, and leadership! Episode Bookmarks: 01:30 Introduction Edward McEachern, M.D. and Jenni Gudapati, MBA, RN 06:00 The slow uptake of accountable care (HCP-LAN: only 20% of healthcare payments flow through Categories 3B and 4 APMs). 06:30 Provider challenges: supply chain disruptions, labor shortages, high inflation, and the end of COVID-19 relief payments. 07:30 Congressional Budget Office projects insolvency of the Medicare Trust Fund by 2026. 08:00 The economic necessity of value-based health care to reduce unnecessary spending. 08:45 “In the shadow of COVID we have crossed this Rubicon where there is a push on the current paradigms of care delivery and payment.” 09:15 Stressor #1: The retirement of the Boomer workforce will create a 14% structural deficit in accessible labor. 09:45 Stressor #2: FFS infrastructure collides with APM adoption strategies and cannot support value transformation. 10:30 Stressor #3: Shift of hospital care delivery to the outpatient and home setting. (“It is never coming back.”) 11:00 “This chronic complex system of care that takes care of people in the post-acute setting is not adequately available in most communities.” 11:30 “LAN 3B and 4 payments will only help in the context of the operational reshaping of the health delivery system.” 12:00 Value-based consumer perspective needed: 46% cannot afford out-of-pocket healthcare expenses! 12:30 Low value services that do not track to best patient outcomes. 13:00 Revenue dependency on a sick-care model of fee-for-service medicine. 13:45 “Too many health inequities exist. We need to financially incentivize providers to take care of underserved populations.” 14:30 “Healthcare is the only industry that is Yelp proof.” (the dislocation between costs and consumerism) 15:30 What if we created a well-financed and integrated SDOH health system to work alongside the sick care health system? 17:00 The power of the Annual Wellness Visit (AWV) in patient-centered care. 18:30 Clinical intuition in assessing patient risk during the AWV (going beyond the diagnosis code). 20:45 Mapping the system of care to improve patient navigation. 21:30 Healthcare costs for chronic conditions totals $1.65 trillion—equivalent to nearly eight percent of the nation’s GDP. (Projected to be $6 trillion by 2050!) 24:00 PacificSource’s collaboration with Summit Health (ex: managing burden of illness through care management and gold cardi...
Now is the time to embark on a journey towards a brighter and more resilient future. As the U.S. healthcare system grapples with the aftermath of a global pandemic, we find ourselves at a pivotal crossroads. This episode delves deep into the profound changes brought about by the pandemic, examining how it has exposed vulnerabilities in our existing systems and ignited conversations about the need for transformative change. Join us as we navigate this critical juncture, exploring the shifts in healthcare, economy, and societal values that could ultimately lead us to a high-value system that prioritizes well-being and sustainability for all. Get ready to be inspired and informed as we embark on this enlightening exploration of the post-pandemic world. Joining us in the Race to Value this week is David B. Nash -- an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. His accolades and achievements in healthcare transformation are innumerable. (The week before this interview was recorded he had received the Lifetime Achievement Award from the American Association for Physician Leadership.) Dr. Nash is also a bestselling author with his new book, “How COVID Crashed This System: A Guide to Fixing American Health Care.” In this episode, we discuss insights from Dr. Nash’s research on COVID-19’s impact on the healthcare system and how this post-pandemic era can help us transition to a high value health care system. Episode Bookmarks: 01:30 Introduction to Dr. David Nash, an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. 03:30 Have we learned our lessons from the COVID disaster? 05:00 Dr. Nash reflects on his recent experience with Dr. Ashish Jha on the last day of service to our country as the White House COVID-19 Response Coordinator. 05:30 “The office of the presidential response to COVID is now a janitorial closet somewhere in the West Wing of the White House…it is sad.” 06:00 “1.2 million dead from COVID-19 is more than the total of all combat casualties of every war since the Revolutionary War of the United States!” 06:30 “Sadly in the history of our country, when the dying stops, the forgetting begins.” 07:00 PTSD from the pandemic with physicians and healthcare professionals, coupled with societal apathy towards COVID-19 and surging cases in China. 08:00 Medicaid Redetermination as the consequence of the end of the Public Health Emergency and how lost coverage will impact marginalized populations. 09:00 3,000+ people died from 9/11, and we are still taking our shoes off at the airport. 1.2M died from COVID-19, and it is back to business as usual. 09:30 Societal issues (e.g. structural racism, inequality) persist in our country. 10:00 What is the True North for American Healthcare really? ($4 Trillion in spend with significant amount of low value care, declining life expectancy, low ranking in world health rankings) 10:30 Additional societal measures of a poor performing health system (alcoholism, depression, suicide, opioid abuse). 11:30 How Philadelphia is suffering an exacerbation of pre-pandemic problems (lack of access, redlining, crime, homelessness, educational disparities). 11:45 There is a 20-year disparity in life expectancy between rich and poor communities in Philadelphia. 13:00 The persistence of health inequities and social injustice since the transatlantic slave trade. 13:30 COVID-19 blasted a searing light on social determinants of health! 14:30 “You can’t have value-based care without equity.” – the costs of health inequities are in the hundreds of billions (see recent JAMA article). 15:00 Employer engagement in health equity transformation. 15:30 “The emergence of the payvider model has given value-based care additional energy.” 17:00 The evolution of medical and nursing education to improve heal...
In value-based care, true leadership emerges from the depths of the heart, where empathy, compassion, and authenticity converge to illuminate the path of positive change. Purpose-driven leadership can not only revolutionize community health but also create a ripple effect that reaches every corner of society. At the intersection of purpose, compassion, and community lies a transformation of our healthcare system with a tangible impact on the well-being of individuals, families, and neighborhoods. Now is the time for healthcare leaders to harness the power of the heart to shape a healthier and more harmonious world for all. The heart’s power of purpose knows no boundaries, for it holds the strength to heal, inspire, and connect the threads of humanity. Joining us this week on the Race to Value is Mikelle Moore, a nationally recognized health executive with more than 25 years of experience impacting communities through forward-thinking, collaboration, and leadership. Mikelle has payer, provider, business and start-up experience in healthcare having served in executive leadership at Intermountain Health, an integrated system serving an 8-state region. During her tenure at Intermountain, she served as Chief Community Health Officer and as the first female CEO of the system’s flagship hospital. In addition, Mikelle has worked in contracting for a provider-owned health plan and in strategy for Mayo Clinic Arizona. As a thought leader in the space, Mikelle knows the value in moving from healthcare to health. In this week’s episode, prepare to be inspired and enlightened by Mikelle’s heartfelt exploration of “The Power of Purpose: Transforming Community Health Through Leadership of the Heart.” Episode Bookmarks: 01:30 Introduction to Mikelle Moore, a nationally-recognized VBC executive leading system change to improve population health outcomes. 03:15 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Broadening the scope of care delivery in health systems to address the determinants of health through equity, impact investments, and ESG factors. 06:00 Mikelle discusses her leadership journey as an expression of authenticity and purpose to right the wrongs of a broken system. 08:00 Intermountain Health as a leading health system that is designed for a consumer-provider approach to improving health care. 09:00 Advocating for improvements in the variability of care and the reduction of wasteful healthcare utilization. 09:30 Listening to the community in the strategic planning of a hospital. 10:00 Pivoting from “sick care” to “health care.” 10:45 The realization that health disparities were far reaching beyond just the care delivered, e.g. poverty, homelessness. 11:00 “If we want to be health leaders that are making healthcare better, we have to be champions for addressing disparities in underserved and marginalized communities.” 13:00 Finding common ground with Community Benefit Organizations (CBOs). 14:00 Mikelle shares his insights on the importance of relationship-building in community partnerships. 16:00 How the principles of collective impact forged new community partnerships to address behavior health and SDOH. 17:00 Defining success by really understanding the problem and what issues get in the way (e.g. how nonmedical issues such as homeless and social isolation impact health outcomes) 19:00 Developing a system of communication and data sharing between the CBO and health system that is centered on patient needs. 20:00 The Alliance for the Determinants of Health as a vehicle to address social needs to improve health. 21:00 The impact of institutional racism on health equity. 24:00 Viewing social factors in society as a lens to view and understand racism. 25:00 “Inequities are often delivered at a subconscious level. It is our accountability to identify those disparities and build systems of care to prevent them from occurring.”
Peering into the horizon of healthcare, we unveil the vanguard of value-based care research and innovation, where data-driven insights and daring ideas converge to shape a healthier tomorrow. In the ever-evolving landscape of healthcare, trailblazing research serves as the guiding light that illuminates the path toward a value-based care revolution. By delving into the intricate dynamics of accountable care, dissecting payment models, and exploring innovative strategies, research on healthcare transformation provides the foundation upon which healthcare stakeholders can build a more equitable, efficient, and patient-centered future. This work not only dismantles traditional barriers but also empowers policymakers, providers, and patients to collectively navigate the complex journey toward a value-driven healthcare paradigm. Our guest this week on the Race to Value is none other than the esteemed David Muhlestein, PhD, JD a true trailblazer in the field of value-based care research and innovation! With a passion for accelerating the adoption of accountable care and driving meaningful change, David has dedicated his career to unraveling the complexities of the value movement by telling a story with data. As the chief research and innovation officer at Health Management Associates (HMA), David Muhlestein’s research and expertise centers on health care payment and delivery transformation, understanding health care markets, and evaluating how the broader health care system is changing. In this interview, we cover topics such as the value-based care movement and the goal of speeding the uptake of accountable care; the current growth trajectory of ACOs; payment model reforms that are taking place to advance health equity; the positioning of Medicare Advantage in the accountable care landscape; the inclusion of specialists in value-based care; multi-payer alignment to reduce administrative burdens and increase the impact of accountable care reforms; hospital and health insurer price transparency; and the new Primary Care Alternative Payment Model ("Making Care Primary"). Episode Bookmarks: 01:30 Introduction to David Muhlestein, PhD, JD – one of the nation's leading value-based care research executives. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 The glacial pace of scaling payment model transformation and CMS’ goal of speeding the uptake of accountable care. 05:30 Industry challenges (e.g. supply chain disruptions, labor shortages, inflation, financial distress) that complicate value-focused investments. 07:30 The plateau of accountable care growth over the last three years in terms of total number of participating ACOs and lives covered. 08:30 The business model for value is supported by payment mechanisms, unique population health capabilities, and playbook approaches. 09:30 Who is really the customer of a health system? (Is it the patient, the health plan, or physician practices that drive referrals?) 10:30 The capacity-focused world view of a FFS model – creating capacity for well-reimbursed services and then driving transactional patient volume. 11:00 The population health focus of VBC and how that creates conflicts within health systems optimized for fee-for-service capacity. 14:00 Changing the reality of an organizational culture dominated by FFS is increasingly more difficult in a post-pandemic economy. 15:30 Has anyone else noticed that the VBC solutions vendors at healthcare conferences are less predominant in recent years? 16:00 “When times are tough, organizations revert to the lowest common denominator that is their underlying business model. That is the current challenge for value transformation.” 17:00 Recent stats on the growth trajectory and overall savings of Medicare ACOs over the last few years. 19:00 Average savings in the MSSP (after bonus payments) is about 1% relative to the projected benchmark.
In this thought-provoking episode, we delve into the transformative world of value-based care, exploring the multifaceted facets that are reshaping the future of healthcare. Join us as we dissect the vital components of this paradigm shift, from tackling social determinants of health and championing health equity, to seamlessly integrating behavioral health into patient care. Discover how population health enablement is empowering communities, while bundled payments revolutionize the healthcare landscape. We'll also uncover the incredible role of technology and patient outreach, enabling unprecedented levels of personalized care and accessibility. And lastly, we navigate the critical importance of physician engagement, a driving force behind the success of value-based care. As we peer into the crystal ball, we envision the future role of hospitals, embracing change and embracing innovation. Joining us in the discussion this week are three important thought leaders in value-based care transformation:
Dr. Caroline Goldzweig, Chief Medical Officer – Cedars-Sinai Medical Care Foundation Cynthia Deculus, Vice President and Chief Population Health Officer, Cedars-Sinai Dr. Michael Conseulos, Vice President Strategy, Growth, and Innovation Consulting at OptumInsight
Get ready to be inspired as we illuminate the path toward a healthier, fairer, and more compassionate healthcare system. The journey starts now!
This week’s episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes. To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today.
There is a dynamic interplay between health economics, patient-centricity, and value assessment—an intersection that holds the key to unlocking better health outcomes, improved access to care, and sustainable healthcare systems. With the principles of health economics guiding our decision-making processes in healthcare, we can allocate resources effectively and maximize the value delivered to patients. Patient-centricity lies at the heart of this convergence, emphasizing the importance of putting patients and their unique needs at the forefront of healthcare delivery. Despite decades of investment in patient-centered health care, decisions about access and value are typically made in the context of financial risk management, and often without the input of those who should benefit from care. In addition to a myriad of payment reform strategies, rising interest in cost-effectiveness evaluation commands a central place in the debate about how to measure and pay for high-quality, efficient, and equitable health care. This week on the Race to Value we are joined by Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI). The IVI is a collaboration of scientists, patient organizations, payers, life sciences companies, providers and delivery systems dedicated to finding scientifically credible approaches to measuring value in healthcare. The IVI provides the technical knowledge, resources, and collaborative learning platform that facilitate exploration and application of value-based care. In this podcast episode, you learn how partnership with patients, researchers, and industry and purchaser stakeholders can build consensus on the scope and inputs needed for value assessment models. Only by assessing true value in health care will we win the Race to Value! Episode Bookmarks: 01:30 Podcast Introduction with background on Dr. Jason Spangler, the Chief Executive Officer for The Innovation and Value Initiative (IVI). 03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 Creating open-source models that allow researchers and decision-makers to explore, apply, and test scientifically credible approaches to measuring value in health care. 05:30 “The IVI is a nonprofit research organization that focuses on the science and the methodology for determining value, new medical technologies, and innovations.” 06:00 Health technology assessments (HTA) typically have only included payer perspectives (not the patient perspective!) 07:30 Going beyond the academic research understanding of value assessment to reflect real world patient experience. 08:00 How is patient-informed value assessment and comparative effectiveness research used to impact health policy at a national level? 11:00 Defining “value” from a health economist perspective provides the standard equation. 11:45 What is important to patients beyond the clinical outcomes – these must be measured too! 12:30 The costs of healthcare beyond the financial domain (e.g. time, future prospects, family) forces us to deviate from the simple value equation. 12:45 The “Value Flower” – the elements of value that are important to all stakeholders (e.g. QALYs Gained, Net Cost, Productivity, Equity, Hope, Knowing, etc.) 14:00 Asking patients what is important to them in the formation of specific patient-reported outcome measures. 15:00 “We typically look at cost effectiveness in terms of patient populations and averages. This must be balanced with individual patients or smaller patient communities.” 15:45 How good are we…really…in actually listening to patients? Fee-for-service care complexity gets in the way of meaningful connection. 17:00 Using both qualitative and quantitative data to advance patient-centered innovation. 17:30 The IVI is driving innovation in value assessment through the Open-Source Value Projectwhich is a laboratory for advancing the science and improvi...
In this week’s episode, we embark on a journey into the realm of transforming rheumatology care with tech-driven value-based care. Autoimmune conditions affect millions of people worldwide, causing chronic inflammation, pain, and a host of complex challenges. These patients often receive substandard care, as it takes almost 2.5 years to receive a diagnosis and patients often wait six months to receive an appointment with a rheumatologist! This is often a neglected patient population in the movement to value-based care, but what if there was a new frontier of care that leveraged technology and a value-based approach to transform the lives of those living with autoimmune conditions? This podcast explores how a virtual specialty practice, centered on improving patient outcomes and reducing healthcare costs, is driving the transformation of rheumatology care. We are joined today by Anuj Patel (Founder) and Dr. Elizabeth Ortiz, the CEO (Chief Medical Officer) from a new startup company called Motto Health. Anuj is a seasoned digital health innovator and operator with over 15 years of experience in the healthcare industry. And Dr. Elizabeth Ortiz is a board-certified rheumatologist with patient care experience ranging from large public medical centers to concierge practices. Episode Bookmarks: 01:30 Where does rheumatology care intersect with the world of value transformation? 02:45 Introduction to Anuj Patel and Dr. Elizabeth Ortiz, the Founder and Chief Medical Officer respectively for Motto Health. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:00 The rheumatology workforce faces a deficit of physicians trained to provide high-quality care to patients with rheumatic diseases (only 0.5 rheumatologists per 100,000 people). 06:00 Chronic inflammatory conditions are very expensive to treat (e.g. the average healthcare cost for a patient with Rheumatoid Arthritis is $32k per year). 06:30 Why aren’t ACOs and other Risk Bearing Entities actively addressing this patient segment like they do patients with diabetes, CHF, COPD, or even kidney disease? 06:45 The epidemiological fragmentation of chronic diseases across the care delivery landscape. 07:30 Lack of overall marketplace adaptation in rheumatology care and treatment (e.g. specialty pharmacy injectables) to the shift in value-based care. 09:00 The wide breadth of conditions in the specialty of rheumatology and how that creates a “black box” for other physicians to understand. 10:15 Patients waiting so long to see a rheumatologist that it takes, on average, 2.5 years for a patient to receive a confirmatory diagnosis! 10:30 Rheumatology provider shortage worsening (50% of adult and 32% of pediatric rheumatologists projected to retire over the next 10 years). 11:30 The window of opportunity for clinical outcomes improvement if chronic autoimmune and inflammatory diseases are diagnosed early. 12:30 Limited capacity for rheumatologists to see new patients due to long persistence of disease and the shortage of providers. 13:00 How virtual care can increase access by offloading the maintenance burden of managing a large patient panel. 13:30 Enablement of expanded geographic access through a virtual care model. 13:45 “Virtual care delivery can democratize access for patients in need of rheumatological care.” 14:00 In Texas, 213 of 254 counties in the state do not have a practicing rheumatologist leading to 5M people without access to care. 14:45 A huge opportunity in value-based rheumatological care is to tackle the exorbitant specialty drug costs for drugs like Remicaid or Humira that have an annual cost of $70k. 15:00 Mark Cuban’s online pharmacy announced that it will be selling a biosimiliar of Humira for a steep discount. 15:30 Since 2016, AbbVie has raised the price of Humira 30X from $522 per syringe to $2,984 per syringe. 17:30 Biosimiliar adoption should not be over-indexed in valu...
We need to change the calculus of self-interest in health care. If the trend of unfettered greed in fee-for-service medicine continues, we will have a bleak future ahead of us. Our industry is on a ventilator, demanding another cigarette. Yet despite its moribund appearance, a few critical vital signs do offer hope. There is an opportunity to find optimism with unifying language and shared virtues to guide health care transformation. By developing a shared vernacular for value-based care, we will be able to have the meaningful conversations to reimagine care delivery. And this new language will be shaped by the evidence from leading exemplars in the value movement. Amidst the vast wilderness of the healthcare landscape, we can find hope in these green shoots, sprouting with resilience and the promise of a brighter future. This post-pandemic era is a tremendous opportunity for value creation. Now is the time to have the conversation and be the change we want to be. The elevation of social consciousness related to health equity, transparency, and financial accountability—coupled with industry challenges related to escalating inflationary pressures, workforce shortages, lack of patient access, supply chain disruption, and weaknesses in our public health infrastructure—will provide the catalyst for a new modus operandi in American healthcare. Joining Eric Weaver on the Race to Value this week are Craig Solid and Andrew Kopolow. Together they recently co-wrote an article published by the American Journal of Medical Quality entitled, “Changing the Calculus of Self-Interest in Health Care.” In this podcast discussion, they discuss their views about greed in healthcare and what it will take to transform our industry to a more sustainable, value-based model.
“Greed has poisoned men’s souls, has barricaded the world with hate, has goose-stepped us into misery and bloodshed. We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical. Our cleverness, hard and unkind. We think too much and feel too little. More than machinery we need humanity. More than cleverness we need kindness and gentleness. Without these qualities, life will be violent and all will be lost…” -- The Final Speech from “The Great Dictator” (Charlie Chaplin) Bookmarks: 01:30 Referencing the recently published article, “Changing the Calculus of Self-Interest in Health Care” written by Eric, Craig, and Andrew. 01:45 Eric reads an excerpt from The Final Speech from “The Great Dictator” by Charlie Chaplin. 02:45 How is the greed of fee-for-service healthcare holding us back from our human potential? 03:00 Introduction to Craig Solid, PhD and Andrew Kopolow, MPA MSW CPHQ PMP CLSSMBB FNAHQ. 05:30 Don Berwick’s JAMA article entitled, “Salve Lucrum: The Existential Threat of Greed in US Health Care” which called out our industry for the glorification of profit (Salve Lucrum) 07:30 The difficulty in addressing profit motive through value transformation when “none of us speak the same language” through a shared vernacular in healthcare. 08:30 The emotionality of Dr. Berwick’s article as a recognition of the existential threat of greed in healthcare. 09:15 Hospital closures across the healthcare landscape are seen as just the normal course of business. 09:45 How can we even talk about the quality of care when people can’t even access the care they need? 10:00 The oversimplification of “quality” and “value” is holding us back. 10:45 What is the solution to price gouging of prescription drugs, exploitive market consolidation, upcoding, overpaid executives, lack of transparency, and patient medical bankruptcies? 11:30 The need to align incentives in healthcare so that it does not personify greed as a primary virtue. 12:00 Optimism for socially-conscious healthcare based on Bright Spots and Green Shoots! 12:45 The exemplars of value-based health care (i.e.
Since diabetes is one of the few chronic conditions that can be very effectively managed by an individual, why are there so many people with poorly managed diabetes? Despite conventional logic, it’s not that most people aren’t willfully noncompliant with their diabetes care. Instead, many have extenuating socioeconomic or other circumstances that can lead to drifting away from their care plans. There is an opportunity in value-based care to engage diabetic patients more effectively through data-driven personalized care interventions. By merging rich, non-traditional data sources such as purchase trends with foundational elements like claims and clinical services, trusted care team members can develop one-of-a-kind insights into individuals’ risks and behaviors. Translating broad, extensive multiple data sets into actionable information specific to an individual holds the potential to better manage populations while simultaneously changing the trajectory for each patient living with a chronic disease. On this week’s episode, we have: Richard Mackey, Chief Technology Officer at CCS, a company that transforms chronic care management by combining equipment and products with comprehensive education, monitoring, and coaching…serving more than 400 employers and more than 1,800 managed care plans nationally to support patients with diabetes. Joining Richard on the podcast is Jean-Claude Saghbini, Chief Technology Officer at Lumeris who also serves on the advisory board for CCS. Richard and Jean-Claude address how technology-assisted disease management makes the patient experience less arduous. They also discuss how devices and digital tools such as continuous glucose monitors, insulin pumps, chatbots and smartphones can generate an enormous amount of new and unique data. The information from these additional data feeds can be used to derive valuable insights into both the individual and population levels to drive the future of personalized care. Episode Bookmarks: 01:30 Data-driven, personalized care interventions are key to effective chronic disease management. 02:00 Introduction to Richard Mackey and Jean-Claude Saghbini. 02:45 An overview of technology-assisted disease management. 04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:00 Diabetes is such a significant problem in the United States, affecting over 37 million people, and it leads to numerous health complications. 07:00 Richard provides his perspective on the potential for aggregating disparate data sources and applying advanced analytics to transform diabetes outcomes. 08:30 How technology solutions can enhance the relationship between the care provider and the patient. 09:00 An overarching data interoperability framework is not necessarily required to leverage the power of data and technical solutions. 09:30 Jean-Claude on balancing the aims of interoperability, data normalization, and predictability in data flows with current day realities. 12:00 The importance of partnerships in driving scale in population health management through combined data feeds and biometric capabilities. 13:00 Richard expounds on the importance of partnerships in data-driven solutioning and medical device optimization for effective delivery of VBC. 14:30 Jean-Claude on how healthcare organizations can extract insights from technology to change the trajectory of disease in their patient population. 16:00 Predictive analytics can accelerate progress in understanding relationships between external factors and human biology. 17:30 Richard discusses the impact of predictive analytics to enhance the reengineering of clinical pathways to deliver personalized care to patients. 18:15 The unique opportunity to customize patient segmentation at the individual-level (versus relying just on profiling patients at the population-level). 19:45 Jean-Claude on how SDOH predictive models focused on housing instability or...
We are on an enlightening journey to transform American healthcare in the race to value. Medicare Advantage increasingly stands out as a superior vehicle for value transformation due to its ability to catalyze care delivery innovation through full-risk capitation. By promoting coordinated care and integration among healthcare providers, MA plans foster a patient-centric approach that improves overall care quality and health equity. Additionally, these plans prioritize preventive care and wellness initiatives and enable early identification and management of chronic disease, ultimately reducing healthcare costs. By incentivizing providers to prioritize outcomes over volume, Medicare Advantage is our path forward to a uniquely American healthcare system that we can be proud of. Joining us this week on the podcast is Don Crane, former CEO of America's Physicians Groups. In this episode, he shares his valuable insights and expertise on Medicare Advantage and how it will shape our future in healthcare transformation. Join us as we explore the challenges and opportunities that lie ahead for Medicare Advantage and discuss the potential impact on the healthcare landscape! Episode Bookmarks: 01:30 Introduction to Don Crane (Former President and CEO of APG) and the potential for Medicare Advantage to transform American healthcare. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Don Crane joins the Race to Value again as returning guest. (Check out his prior episode on Primary Care Transformation!) 05:00 The explosive growth of MA and the evidence showing that MA plans deliver better economic and clinical outcomes. 06:30 How a capitation in Medicare Advantage enables population health outcomes through effective SDOH interventions. 08:00 The criticisms of Medicare Advantage from notable thought leaders Richard Gilfillan and Don Berwick. 09:30 Protection of the Medicare Trust Fund is the common point of agreement between MA proponents and opponents. 10:00 Don addresses the criticisms of risk adjustment gaming and the program’s overall spend. 10:45 Is it necessarily a bad thing if MA costs more than Traditional Medicare if it provides better care outcomes and supplemental benefits? 11:30 “Spending more on Medicare Advantage makes all the sense in the world to me if it provides better outcomes and value for seniors.” 12:00 The perspective from seniors enrolled in Medicare Advantage on the appropriateness of spending for supplemental benefits. 12:30 “The astronomical growth of Medicare Advantage should be celebrated.” 13:00 The V28 HCC changes to the Risk Adjustment model for payment year 2024 will decrease the number of codes by more than 2,000 from the HCC model. 14:00 The adverse impacts of risk adjustment coding changes will increase administrative complexity and hurt seniors by reducing MA funding to the tune of $10B. 15:45 The need to evaluate both Traditional Medicare and MA to determine the best path forward. 16:30 Risk adjustment is grounded on the premise of fairness to both the payer and provider and should prevent both over- and under-payment. 17:30 “Risk adjustment is such an important ingredient in capitated payment models and provides a business case for addressing inequities in underserved communities.” 18:30 Concerns about the elimination of risk adjustment and how that will adversely affect sicker patent populations through “cherry picking” during MA enrollment. 19:30 Don compares the bad actors in MA who perform upcoding to the overpayments and overutilization that occurs in Traditional Medicare. 20:00 Is the potential for upcoding exaggerated by detractors of Medicare Advantage? 20:30 Eliminated risk adjustment in Medicare Advantage is an example of throwing out the baby with the bathwater. 21:00 How Star Ratings work in Medicare Advantage to unlock bonuses and rebates when improving care quality.
We have Dr. Omolara Thomas Uwemedimo as a guest on this week’s Race to Value! She is a healthcare social entrepreneur, board-certified pediatrician, community health equity consultant, career transition and business coach, public health researcher, and health justice advocate. She is currently the CEO and Co-Founder of Strong Children Wellness, a multi-award winning healthcare practice in New York City, providing integrated, physical, mental, and social health services for low-income communities of color. Back in 2019, Omolara lost her ability to walk. She was diagnosed with Multiple Sclerosis, a chronic autoimmune condition. During her recovery, she became a staunch wellness advocate for women of color who in healthcare often experience disproportionally higher rates of chronic disease due to weathering – the deterioration of one’s health due to medical racism and toxic environmental stress in the workplace and in society. In response, she founded “Melanin and Medicine”, a community health equity consulting and social entrepreneurship company that helps women of color thrive by building purposeful careers within healthcare enterprises. She also has a weekly podcast called “Funding Your Healthcare Vision” that helps visionary leaders of health centers & practices to secure grants, contracts and other funding to strengthen, scale & sustain their vision, mission & impact to support under-resourced communities of color. With her leadership insights, you too can break the barriers to health justice by building a healthcare social enterprise built on CBO partnerships and social impact innovation! Episode Bookmarks: 01:30 Introduction to Dr. Omolara Thomas Uwemedimo (CEO and Co-Founder of Strong Children Wellness, founder of Melanin and Medicine, and host of Funding Your Healthcare Vision). 04:00 The intersection of Social Entrepreneurialism and Value-Based Care, where private profit creates public good. 06:30 The difference between “health equity” and “health justice”. 07:00 Creating health justice for a psychosocially complex Medicaid patient population dealing with social and mental health challenges. 07:30 Working with grant partners and Community Benefit Organizations (CBOs). 08:30 Closing the loop between physical health and social determinants of health (SDOH). 09:00 Overcoming a flawed business model by moving physical health care delivery into the CBO setting. 09:30 Aligning the public health interest in patient outcomes with economic incentives. 09:45 How healthcare capitation (PMPM reimbursement) merges with philanthropy dollars to drive holistic care delivery. 10:00 “The collective impact of capitation and philanthropy is the precipice of an integration model that makes an impact with payers and patients.” 11:00 The majority of healthcare organizations are not conducting place-based interventions to improve health equity and create health justice. 12:30 The fatigue of healthcare providers dealing with under-resourced communities. 13:30 Starting with the patient first by addressing the referral process in addressing social health needs. 14:00 Developing a social navigation workforce as a baseline to deliver primary care to Medicaid populations. 15:00 Funding a healthcare social enterprise through embedded CBO partnerships (“reverse integration”). 16:00 “We thought we were dealing with psychosocially complex patients until we integrated our care model with CBOs. This in where the impact can be made in VBC.” 16:30 Identifying the right community organizations (e.g. homeless shelters) in creating a holistic care model. 17:30 Securing over $2 million in grant funding within a community health network and working with other BIPOC, women-led healthcare practices to create sustainable health justice. 19:45 “Human social organizations are an essential leader in health. We must think beyond the delivery of care when building a mission-driven healthcare social enterprise.”
The only way for the health care sector to sustainably contain costs and fulfill its mission is by putting the patient -- and the delivery of outcomes that matter to patients -- at the center of the industry’s efforts. We must align incentives around the continuous improvement of health outcomes in a cost-effective matter. This is what value-based health care is all about – better health outcomes to patients for the money spent. Contrary to traditional approaches to health system reform that emphasize cost containment, value-based health care shifts the focus to continuous improvement in the outcomes delivered to patients. On the Race to Value this week, we are joined by two of the four authors from the new healthcare book, “The Patient Priority”. With this book, they wrote a practical step-by-step guide for clinicians, payers, policymakers, and other industry stakeholders to lead patient-centered, value-based health care innovation. It presents case studies from leading innovators and provides a roadmap for the comprehensive value-based transformation of national health systems. On the show this week is Stefan Larsson, MD, PhD -- an independent advisor in health care and life sciences, and a senior advisor to Boston Consulting Group (BCG). Joining him is Robert Howard, a former senior editor at Harvard Business Review and MIT Technology Review who collaborates with BCG on the topics of value-based care and health system transformation. Episode Bookmarks: 01:30 Putting patients first is the only way for the health care sector to sustainably contain costs and fulfill its mission. 02:00 Introduction to Stefan Larsson, MD, PhD and Robert Howard and their new book, “The Patient Priority.” 03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 The Triple Crisis: There is a Crisis of Value, a Crisis of Evidence, and a Crisis of Purpose in American Healthcare! 05:30 How the vicious cycle of how a continued explosion of medical research knowledge drives higher costs due to anxiety and lack of guidance. 07:00 The crisis of outcomes (e.g. obesity, declining life expectancy) have persisted over a long period of time. 07:30 “The health care crisis will only get worse unless there is a fundamental shift in how we lead, define success, and agree on what good looks like.” 08:00 The criticality of shifting to an outcomes measurement model that values what matters to patients. 08:30 “Outcomes that matter to patients is the essence of the future of health care.” 09:00 Why the value-based care movement should focus more on the system than the individual provider organizations. 09:30 “The only way individual organizations can sustain value-based change is if we transform health systems as a whole – on a regional, national, and even international level.” 10:00 Health care is a complex adaptive system, and you don’t change it through rules-based policy. 11:00 “Measuring outcomes in accordance to what matters to patients should be the key metric to drive change in health care.” 12:30 This importance of clinical registries that collect comprehensive data on health outcomes in a population of patients with the same condition. 13:00 How a fragmented specialty-dominated healthcare system limits our ability to develop consensus standards for measuring outcomes that matter to patients. 15:00 “By measuring the outcomes that matter to patients, we take a holistic view of health care. We can then integrate all the different professional capabilities in the most ultimate way.” 15:45 The important work of the International Consortium for Health Outcomes Measurement (ICHOM). 16:00 How Sweden is a driving force for the international adoption of patient-centered outcomes measures and clinical registries. 17:30 Why a health care comparison of Sweden to the United States is relevant. (Patient needs are the same!) 18:00 Stefan discusses how his partnership with Michael P...
In the universe of value-based care transformation, there has been one disease that represents a metaphorical black hole, where the gravitational pull of fee-for-service is so strong that nothing can escape. These patients experience the fullest depths of pain and despair, and this chasm is so deep and wide that there is only darkness. You may have guessed it, but we are talking about chronic kidney disease, a condition that impacts 37 million people in the U.S. The suffering of those inflicted with CKD is so immense, yet the Medicare reimbursement system is designed to fail this patient population. In fee-for-service medicine, we wait until patients succumb to end-stage kidney disease, where they crash and burn and need costly dialysis to stay alive for a little while longer. Because of this flawed reimbursement model, Medicare pays over $125 billion for people with all stages of renal disease, which is around 20% of all Medicare spending! Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited. We must “give life” to this patient population in the Race to Value! The giving of life and that is what DaVita Kidney Care is doing. In fact, the name DaVita is an adaptation of the Italian phrase for giving life. In value-based care, DaVita works with healthcare payers and providers to develop and implement care delivery models that focus on improving outcomes and reducing costs for CKD patients. And I am excited to share with our listeners, that our guest this week is Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita. Dr. Weinstein works across numerous lanes helping bridge the intersection of IT, clinical nephrology, and healthcare policy. He is focused on delivering IT tools that take advantage of DaVita’s clinical data and help nephrologist and DaVita teammates deliver the best care possible. A kidney doctor from Maryland, Dr. Weinstein is passionate about slowing the progression of chronic kidney disease in patients. This was such an outstanding conversation with one of the true innovators in technology and clinical care! Episode Bookmarks: 01:30 The importance of crossing the chasm of chronic kidney disease, a condition that impacts 37 million people in the U.S. 02:30 Introduction to Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita Kidney Care. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:30 Dr. Weinstein shares how his lived experiences and positive mindset have shaped his work as a nephrologist, healthcare executive, and technology innovator. 06:45 Treating kidney disease costs Medicare $130B – although CKD patients are 1% of the population, they account for over 7% of all Medicare spending! 08:30 An overview of the DaVita Integrated Kidney Care (IKC) program and how it produces solid results through data enablement and relationship building. 10:30 Integrated Kidney Care accomplished through people working in collaboration, predictive modeling, and population health management. 11:30 Facility versus At-Home Dialysis and the empowerment of patients through education and health literacy. 12:30 An overview of DaVita’s participation in value-based care payment models focused on CKD and ESKD. 14:30 Dr. Weinstein on how to bring scale to value-based payment innovation in kidney care. 16:00 The need for specialist and care team coordination that goes well beyond the office visit. 17:00 Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models and how they provide financial and philosophical alignment for integrated care. 18:00 The challenges of including broader specialties and building an advanced data infrastructure in value-based kidney care. 19:00 The “clinical nebulous” that requires a longer runway for value-based payment model innovation to deliver improved patient outcomes.
Data enablement has the power to transform American Healthcare. It can foster trust between patients and clinicians and make healthcare more accessible, affordable and equitable. This future of an open and connected health ecosystem may seem elusive, but it’s not out of reach. Technology will not hold us back — instead our biggest challenge will be creating a value-based model of care where new innovations can thrive. This week we our joined by Dr. David Feinberg, the Chairman of Oracle Health. Dr. Feinberg is committed to advancing thought leadership and strategy related to unleashing the healing power of data through an open and connected healthcare ecosystem. Previously Dr. Feinberg served as president and CEO of Cerner, now Oracle Health, where he led teams delivering tools and technology to improve the patient and caregiver experience. He has also served as the VP of Google Health, and he served as the President and CEO of Geisinger where he led a complex turnaround and guided Geisinger’s transition to value-based care. Episode Bookmarks:01:30 Introduction to Dr. David Feinberg, Chairman of Oracle Health.02:45 The massive generation of data by humankind in the modern day (projected to be 175 Zettabytes by 2025).03:45 Approximately 80% of healthcare data today is unstructured.04:30 People are dying unnecessarily and suffering poor outcomes despite the amount of data generated by the healthcare system.05:30 “Healthcare fundamentally is people caring for people. Data is secondary; the primary aspect of healthcare is trust.”06:30 Making Electronic Health Records usable is of paramount importance (PCPs Need 27 Hours a Day to Do Their Best Work!)07:00 Digitizing the medical record has made clinical workflows humanly impossible and compromises trust.07:30 The vision for an open and connected health data ecosystem.08:45 The Meaningful Use program did nothing for EHR usability (an example of the Gartner Hype Cycle).10:00 Dr. Feinberg’s clinical and executive leadership background provided a great lesson in technology adoption.11:00 Can there be a high level of technology adoption in healthcare like Google dominates the non-healthcare marketplace?12:30 We have solved for interoperability, but healthcare lacks a level of usability to allow a true longitudinal health record.14:00 Motivating doctors for high performance ultimately comes down to the data scorecard.15:00 Knowing the game (volume vs. value) and the promise of data enablement in value-based care.16:00 The 21st Century Cures Act and the path forward in interoperability.17:00 Can scalable FHIR-based interoperability and Open APIs eventually reach critical mass in the U.S. to improve population health?19:45 Dr. Feinberg describes the two points of failure by technology companies trying to disrupt the healthcare ecosystem.20:30 How Oracle Cerner is designing an intelligent, cloud-enabled platform to change healthcare for the better.22:00 An example of disruption with Internet Banking and how application of those principles could change the healthcare system.23:45 Digitization of medical records was a requisite first step.24:00 Integration and normalization of disparate data sets provides an opportunity to create data intelligence.25:00 How Larry Ellison’s impatience for healthcare disruption clashes with the realities of the industry.26:30 Recognizing the “life and death” aspects of healthcare transformation.27:00 Making incremental progress with a digitized medical record…and then COVID happens to accelerate value-based care!29:00 Workforce burnout and EHR usability – “Simplicity is the ultimate art of sophistication.”30:00 “Value-based care is ultimately the best way to address the root cause of burnout in the workforce.”30:45 The need for UX in the design of EHR applications to optimize physician workflow.31:30 Results in usability redesign — ex: 19% reduction in nursing time at the terminal, 8M less clicks at one health system.31:45 “The future of EHRs has to be where everything is voice-enabled. Physicians and nurses should be freed from the terminal.”32:30 An example of how sophisticated AI can be used to generate EHR documentation in a regular primary care visit.33:30 Nurses spend half their time at the terminal. (Voice-enabled EHR documentation could double the nursing workforce!)34:30 The game changing nature of voice-enablement. This innovation is in our lifetime!36:00 The historical opportunity to address health inequities.37:00 The Oracle Cerner Learning Health Network — unlocking the power of data to improve health equity.38:00 Using clinical trials to build a foundational infrastructure for equity.39:00 The use of advanced AI and clinical trials to improve diagnostic capabilities and clinical outcomes.41:00 The movement to precision-based care to personalize treatment (ex: genomics, wearables)42:00 Geisinger’s population-based precision health model and how it drives patient-specific care pathways.43:00 Making data understandable and culturally sensitive for patients in order to improve adherence.44:00 Parting thoughts — the importance of making healthcare understandable, accessible, and affordable.46:00 Why sharing of best practices is so important for the future of our industry. The time is now!
Dr. Stephen Klasko is a transformative leader and advocate for a revolution in our systems of health care and higher education. He has been a university president, a dean, a CEO, and an obstetrician, and now pursues his vision for the creative reconstruction of American healthcare by bridging traditional academic centers with entrepreneurs and innovators. His passion is using technology to eliminate health disparities and offers everyone the promise of health assurance. Dr. Klasko is also a lifelong DJ who believes that the message in the music can give us the courage to tackle a broken, fragmented, unfriendly, expensive, and inequitable healthcare system.
In this episode, Dr. Klasko merges with his alter ego “Stevie K the DJ” to discuss his new book, “Feeling Alright: How the Message in the Music can Save Healthcare” published by ACHE. Feelin’ Alright leverages the emotional power of song lyrics to inspire healthcare executives to envision and build a more accessible, high-quality, and equitable healthcare system. Using music as a metaphor, Dr. Klasko encourages us to examine what is problematic in the existing healthcare model and to take tangible steps toward a more consumer-centered healthcare experience.
Infused with the passion inherent in music, this interview motivate healthcare leaders to take the lead in building a better healthcare system!
Episode Bookmarks:
01:20 DJ Eric “The Dream” Weaver introduces Dr. Stephen Klasko (aka Stevie K the DJ)!
03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:30 Using the power of music to inspire a more optimistic world.
05:30 Dr. Klasko discusses his prior career as a DJ and how getting fired started him on the path to medicine.
06:30 Using music at Jefferson to inspire his others to find hope in overcoming the pandemic, financial tsunami, and systemic racism.
07:00 “Choice of Colors” by Curtis Mayfield and the Impressions (healing during the George Floyd protests)
https://www.youtube.com/watch?v=Zr0SLv9WFr407:45 “Courage to Change” by Sia become a theme song for frontline workers and their heroic response to the COVID-19 pandemic.
https://www.youtube.com/watch?v=mWQACEqf4QY10:00 Health care delivery during the pandemic was a war and how music helped to see a brighter day.
10:45 “We have to stop saying we are the best healthcare system in the world.”
11:00 “Medicine’s Dilemmas: Infinite Needs Versus Finite Resources” and the “Iron Triangle” of Healthcare
11:30 The performance of stocks as evidence for flawed thinking around healthcare disruption.
12:30 Kaiser Permanente and Geisinger come together to launch Risant Health and expand access to value-based care.
13:00 Payer-Provider Alignment in Medicare Advantage
13:45 Cityblock Health leveraging capital investment to build a Community Health Worker model for population health.
14:30 Taking population health, social determinants, predictive analytics, and health equity to the mainstream of healthcare.
14:45 “Keep the Customer Satisfied” by Simon & Garfunkel as inspiration for health assurance to rebuild trust and equity in a broken system.
https://www.youtube.com/watch?v=qx6_0Do0qGQ17:00 In healthcare, do we really view the people as the customer?
18:00 The healthcare system is setup to enrich the people in control.
18:30 “The concept behind health assurance is that costly sick care will give away to affordable, personalized, and preemptive care, partly through genomic sensors and AI-based digital therapies.”
19:00 The future of Jefferson as a health system without a location.
20:00 Livongo and Jefferson Health — a strong, sustainable partnership between technology and providers to remake medicine.
21:00 Poor consumer segmentation in American healthcare (viewing patients monolithically).
22:45 Radical change needed! (collaboration, concentration on health disparities, creativity, and portfolio diversification)
24:00 Dr. Klasko’s prediction for the future market landscape of health systems and hospitals.
25:00 “Mr. Roboto” by Styx bemoans the plight of ‘modern man’ oppressed by technology and is a cautionary tale for the use of tech-enabled healthcare.
https://www.youtube.com/watch?v=uc6f_2nPSX827:30 The interface between technology and humans (“When offline meets online, what happens to the human in the middle?”)
27:45 Elon Musk and Generative AI
28:00 The importance of recognizing change in society when selecting and training medical students.
29:00 How do we create humans that are more human than robots, instead of more robotic than robots?
29:45 Retraining doctors and faculty who “joined a cult” when entering medicine.
30:00 The lies to providers that technology would make their life easier.
31:30 Building a relational bridge between healthcare leaders and generative AI.
32:00 Failure of IBM Watson vs. Success of Aidoc (why it is important to augment – not replace human intelligence).
33:00 “I am Changing” by Jennifer Hudson from the movie Dreamgirls – a theme song for American healthcare delivery in the 2020s.
https://www.youtube.com/watch?v=4UfyVZNejSE35:30 “Hospital CEOs need to think like Target and Walmart trying to compete with Amazon.”
37:45 Why hospital billboard ads and commercials make no sense!
38:30 The new marketing in healthcare is all about consumerism (helping patient navigate, offering convenience, inspiring loyalty).
39:45 “We need to demonstrate value by giving consumers a single point of contact to create a seamless experience across the continuum.”
40:00 The Amazon acquisition of OneMedical is emblematic of a failed primary care model that lacks consumerism.
41:00 The inevitable failure of Chief Marketing and Growth Officers that are aging white men.
41:45 Examples of innovation: Strongline (staff safety) and Guild (upskilling the workforce)
43:00 Dr. Austin Chang and his incredible work as a Chief Medical Social Media Officer at Jefferson.
44:00 Overcoming the “poor me” mentality (embracing payer-provider alignment, lower costs, consumerism,Jand portfolio diversification).
44:30 “For the Love of Money” by The O’Jays speaks to the destructive impact that a singular focus on money and profit can have on individuals and society at large.
https://www.youtube.com/watch?v=GXE_n2q08Yw44:30 The Maryland All-Payer Model – mandated global budgets for hospitals achieved great success.
46:30 Dr. Klasko discusses the concept of a single payer by state model.
47:45 Fear and greed caused by the flow of money into politics.
48:30 Direct patient marketing of expensive, specialty drugs.
49:00 Spending 4X more for obstetrical care than other countries (with far worse outcomes).
50:00 The dilemma of expecting a system to change when salaries depend on it not changing.
51:00 Our healthcare system does absolutely great! (for plaintiff’s lawyers, specialists, pharma and insurance industries, EMR companies, PBMs, and patients with unlimited resources who have the best insurance)
52:00 The unconscionable deaths of people during the pandemic who died at home when telehealth companies made record profits.
53:00 The need for companies to fail.
54:00 “Born This Way” by Lady Gaga as an anthem for self-acceptance and celebrating diversity.
https://www.youtube.com/watch?v=wV1FrqwZyKw55:30 Dr. Klasko on how zip code and living conditions mean more to life expectancy than one’s genetic code.
56:30 Dr. David Nash and his landmark population health research on Social Determinants of Health.
57:00 “In a practical world, a health system CEO is incentivized to keep their population as healthy as possible.”
57:30 The radical shifts that took place at Jefferson Health to improve health equity.
60:00 Solving for food deserts through bar coding and drone delivery.
61:00 The challenge of focusing on SDOH interventions when fee-for-service revenue declines.
62:00 “The Myth of Trust” by Billy Bragg as a somber reminder that people have lost trust in institutions.
https://www.youtube.com/watch?v=evAJlMotrFM63:00 Lack of trust in the healthcare system (citing the failure of GPS technology to improve health)
64:30 Distrust with genomics testing and the privacy of data.
65:30 Patients being able to monetize their own data when participating in clinical studies.
66:30 Nurses who feel that CEOs do not care about them.
67:00 Reinstating healthcare as a public good with servant leadership at the helm.
68:00 “Don’t Stop Believin’” by Journey
https://www.youtube.com/watch?v=1k8craCGpgs69:00 The future of 3D printing, RPM, and digital medicine in serving humankind alongside compassionate providers
70:00 Dr. Klasko describes a future scenario in 2033 where technology could prevent a global pandemic.
73:00 Optimism for the future of health assurance with currently available technologies.
74:00 “Will it Go Round in Circles” by Billy Preston as reminder that we do not want to reform healthcare 360 degrees!
https://www.youtube.com/watch?v=W1TmIhddn0c
In rural communities, the transformation towards value-based care is an ongoing journey rather than a fixed destination. Rural healthcare faces unique challenges such as geographic barriers, limited resources, and reduced access to specialized care. The value journey in these communities involves adapting care models to meet the specific needs of rural populations. It requires innovative solutions to overcome barriers which can bridge the distance between patients and healthcare providers. It represents a fundamental shift in healthcare delivery, focusing on improving patient outcomes, enhancing the patient experience, and controlling costs. Ultimately, this journey involves continuous adaptation, collaboration, and innovation that is fostered by a mission-driven culture to improve community health and wellbeing.
One of this nation’s leading examples of value-based rural health transformation is the Bassett Healthcare Network, and we are joined this week Leonard Lindenmuth, their Vice President of Strategy and Population Health. Since 2014, he has been leading value-based care transformation throughout Central New York. In this episode you will learn about what it takes to lead a successful value journey through a cultural evolution that increasingly seeks innovation to improve rural health outcomes. We discuss such topics as risk progression, the use of commercial ACOs as a learning laboratory in value-based care, population health playbook success that focuses on pharmacy optimization and interdisciplinary team-based care, deploying remote patient monitoring to rural populations, how workforce burnout is related to fee-for-service payment, and the importance of SDOH innovation to better serve vulnerable patients in underserved communities.
Episode Bookmarks
01:30 Introduction to Leonard Lindenmuth, DHA – Vice President, Strategy & Population Health, Bassett Healthcare Network
02:00 Bassett Accountable Care Partners, LLC – BHN’s Accountable Care Organization founded in 2014
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
05:30 How a data-enabled value-based care journey changed the culture of the health system.
05:45 “The value journey helped us understand much more about ourselves so we can better care for our rural communities. It has evolved our culture.”
06:00 A calculated progression to downside risk as a rural healthcare provider.
09:00 An increase in Medicare Advantage penetration in the marketplace and how that is impacting value-based care strategy.
10:00 Developing a co-branded regional MA product and the intention to take aggregated risk with a national MA plan.
12:00 Leveraging brand equity of the health system to develop a MA plan in the future.
12:30 Approaching MA risk-readiness of providers through coding education.
13:00 “MA Risk is clearly on the horizon.”
14:45 Leonard describes BHN’s commercial value-based playbook strategy that includes focus on pharmacy spend.
15:30 The Ambulatory Intensive Pharmacotherapeutics (AIP) program to reduce pharmacy costs through lower medication-related adverse events, avoidable hospital admissions and ED visits.
16:00 How the AIP program reduced BHN’s commercial spend on pharmacy through comprehensive medication management.
16:30 1% of the population drives 55% of specialty drug costs.
17:00 Risk progression in a two-sided risk arrangement with Excellus Health Plan (a local Blue Cross affiliate).
18:00 What being in a Commercial ACO has taught BHN about value-based care transformation.
18:30 How a rural health system balances the “two canoes” – volume vs. value.
19:00 “We have to get to a point where value drives the equation, but it is not an overnight transformation.”
19:30 How a healthcare organization performs better – both financially and clinically – under a fully-capitated environment.
21:30 An alarming divergence of health outcomes and life expectancy between urban and rural populations.
22:00 The challenges of improving population health in rural communities that are highly agricultural and farm-based.
23:00 Leveraging remote patient monitoring and other digital devices to better serve rural populations in upstate New York.
24:00 Bridging the digital divide in rural communities where access to broadband access is limited.
24:45 The Bassett Research Institute conducts research to understand and improve the health and well-being of rural populations.
25:00 Leonard describes the rural community of Cooperstown, New York and how their patient population is challenged by SDOH (lack of transportation, housing instability, food insecurity).
26:00 Medicaid expansion in New York fostered partnership and innovation with Community Benefit Organizations (ex: partnership with a local food bank).
28:00 Creating an anchor institution in a community where the health system is an enabler of improvement in social determinants of health.
29:00 Moving the needle on value by moving closer to the premium dollar and building infrastructural capability to manage delegated premiums from payers.
30:00 The maldistribution of premium dollars that disproportionately benefits insurers through excess profits (at the expense of health system investment to improve patient outcomes).
31:30 The imperative to adopt a payment system that supports lower costs and improved population health outcomes.
32:00 The importance of knowing trends in medical claims costs and utilization.
33:00 Being conscious of what you are getting into when it comes to assumption of risk-based payment.
33:45 Lessons learned from building a vertically integrated system and how that informed perspective on opportunities in a risk-based world.
34:45 Referencing prior podcast — Ep 141 – Cultivation of Physician Wellbeing in the Value Journey, with Dr. Dike Drummond, Dr. Moshe Cohn, Dr. Amadeo Cabral
35:00 How capitation can alleviate workforce burnout and moral injury.
36:00 The unsustainable pharmaceutical cost trajectory, with Americans spending an average of over $1,500 per person on prescription drugs, paying much more than comparable nations.
37:00 Leonard discusses the challenges of pharmacy spend and how Comprehensive Medication Management (CMM) has become an important area of focus in their population health playbook.
39:30 Understanding disease-specific use cases for pharmacy optimization and the340B Drug Pricing Program.
40:30 “Increased pharmacy spend is only acceptable if it crowds out medical spending on the inpatient side.”
41:30 The role of pharmacists in interdisciplinary team-based care and how they can meaningfully collaborate with physicians.
43:30 Value-added pharmacy programs that create a win-win-win for patients, providers, and payers.
45:00 The ticking timebomb of the healthcare workforce!
46:30 Alarming rates of nursing turnover resulting in higher costs due to increased reliance on agency nursing.
48:00 “At any given shift, we are down anywhere from 6-16 nurses. We have the demand to fill our beds, but we can’t get them in because of the nursing shortage.”
49:00 How nursing burnout is ultimately related to the dependence on a fee-for-service payment model.
50:45 New York is one of a number of states that is attempting to address the social needs of Medicaid enrollees through Section 1115 waivers with SDOH-related provisions.
53:00 Economic development zones and SDOH networks in New York supported by Section 1115 demonstration projects.
55:00 Examples of innovative SDOH programs (ex: giving patients free air conditioners to prevent acute exacerbations of chronic asthma).
56:30 Tackling disparities in care through VBC will drive community health outcomes (more so than philanthropic support of CBOs).
58:00 Parting comments on the challenges of health equity transformation.
This week is National Nurses Week, and it is a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world. As workers who perform the most essential healthcare tasks, nurses serve as the first point of contact for most patients…and they save lives and restore health in the process. Yet, nursing is often a thankless profession that is underappreciated and experiences high levels of burnout and moral injury. There are a multitude of factors related to societal attitudes towards the nursing profession, and many of them result in a lack of recognition and support, inadequate compensation, limited opportunities for career advancement, and ultimately a lack of respect and appreciation for the work they do. We must begin to think about how to better position the profession to take a leading role in healthcare innovation. Nurses must become more empowered as we transition to a future of value-based care.
This week on the podcast, we are honored to be interviewing Rebecca Love. She is an experienced nurse executive, the first nurse featured on Ted.com, and part of the first nurse panel at South by Southwest. Rebecca is a regular contributor on the Forbes Business Council, and has been featured in BBC, Fortune, Becker’s, Forbes, Chief Healthcare Executive Magazine and ABC news. Rebecca, was the first Director of Nurse Innovation & Entrepreneurship in the United States at Northeastern School of Nursing – the founding initiative in the Country designed to empower nurses as innovators and entrepreneurs, where she founded the Nurse Hackathon, the movement has led to transformational change in the Nursing Profession. In early 2019, Rebecca, along with a group of leading nurses in the world, founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders, a non-profit that quickly attained recognition by the United Nations as an Affiliate Member to the UN. Rebecca is a world renowned Nurse Entrepreneur and currently serves as the Chief Clinical Officer of IntelyCare.
Click here to learn moreEpisode Bookmarks:
01:30 National Nurses Week – a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world.
02:00 We must better position the nursing profession to take a leading role in healthcare innovation. Nurses must become more empowered as we transition to a future of value-based care.
02:30 Introduction to Rebecca Love – a nationally-recognized nurse executive and entrepreneur, the first nurse featured on TED.com, and part of the first nurse panel at SXSW.
03:00 Rebecca founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders and currently serves as the Chief Clinical Officer of IntelyCare.
04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:30 How do we better position the nursing profession in the value-based care movement?
06:30 “There is going to be no healthcare in the future without nurses leading value-based care.”
07:00 How tracking VBC outcomes by Provider NPI # is a challenge since nurses do not have assigned NPI #’s.
07:45 Nursing costs were rolled into room rates in the 1930’s with the establishment of modern-day insurance models. This occurred due to a male physician-dominated environment.
08:30 Nurses are the only clinical professional in the healthcare environment without a NPI for billing or tracking outcomes!
08:45 “Value-based care cannot fully be amplified or adopted until we address the lack of a NPI number with nurses.”
09:30 The infuriating pay inequity between executives and nurses. (Nonprofit hospital CEOs make on average 10X the rate of nurses!)
10:00 Should we align compensation to both executives and clinicians tied to patient outcomes?
10:45 North Carolina’s seven largest hospital systems reaped billions of dollars in profit from COVID Relief Funding but couldn’t afford to pay nurses! (Read more hereand here)
12:00 CEO pay doubled over five years in North Carolina, but nursing pay there only increased 12-14% over the last decade!
13:00 The national increase in nurses pay over the last decade was 1.6% per year(less than the increase in cost of living).
13:45 The UK Nurses Strike – the largest labor protest in the history of the nursing profession.
14:00 How the cost allocation methodology for nursing will cause continued exacerbation of the nursing working shortage in the U.S.
14:45 “We have to find a way to unpack nursing overhead from the room rate to make sure our healthcare system stays operational and can support our communities.”
15:30 Inspiration from President John F. Kennedy about recognizing the opportunity in a crisis.
16:00 There is a shortage of 450,000 nurses in the US today, and it is projected that over 1 million registered nurses in the U.S. will leave the workforce by 2030.
16:45 70% of new nursing graduates have left the bedside since last year!
18:00 Rebecca speaks about the compassion and empathy of nurses and how they are suffering due to burnout and moral injury.
19:30 How the healthcare industry treats nurses like an “endless commodity” and does little to address their burnout.
20:00 What if we invested only a quarter of what we spend in healthcare technology on nurses?
20:30 “Nurses have been degraded and relegated to the lowest rung of healthcare delivery today. If we want VBC to be successful, we must stabilize the nursing workforce.”
21:00 “Value-based care will certainly not survive without the nursing workforce at the heart and the center.”
22:00 93% of nurses are experiencing staffing shortages in their hospitals, which is a significant increase from 59% in a 2020 survey.
23:00 Last year over 90,000 qualified nursing applicants to nursing school were turned away due to lack of space!
24:00 We have more nurses today than any other time in American history, but we have a critical shortage because they are unwilling to work in the current healthcare environment.
24:30 The highly controversial RaDonda Vaught Homicide Case where a nurse was found criminally negligent for a self-reported medical error.
26:00 1 in 3 bedside nurses have left the profession since the RaDonda Vaught case!
26:30 Nurses and CNAs being criminally prosecuted for errors in long-term care delivery when not a single owner is held responsible for the unsafe care environment!
27:00 Rebecca speaks about the role of Higher Education in building bridge pathways and ensuring diversity to support the nursing workforce shortage.
30:30 Workforce challenges are now the #1 issue on the mind of hospital CEOs (ACHE Survey)
31:00 Hospitals have turned to travel nurses to ease staffing shortages during the pandemic, contract labor expenses have risen more than 250% over the past three years!
31:30 Annual burnout-related turnover costs are $9 billion for nurses!
32:30 Rebecca speaks about the need to enable more nurses to serve in senior leadership roles and as governing fiduciaries on hospitals boards to redesign care delivery.
33:30 “Innovation is opposite of the definition of insanity.”
34:00 How hackathons can be utilized in the empowerment of a nurse-led innovation movement.
35:30 Investing in technology to improve nurse staffing (e.g. improving float pool and per diem services).
35:45 80% of women nurses do not return full-time after they have a baby! (Could tech solutions provide staffing flexibility to empower nurses to continue working?)
37:00 “Reverse pitch events” – honing frontline innovation to address adverse events in the healthcare setting.
37:45 Applying the UI/UX methodology to the healthcare end user in order to improve care delivery at scale.
40:30 The lack of nursing input when health systems role out new technologies (and how these tech decisions often end up creating more work and administrative complexity).
42:30 The importance of the Chief Nurse Health Informatics Officer.
43:45 The role technology can play in Patient Safety.
46:00 The work of Healing Politics in getting nurses more involved in the political arena to reshape healthcare.
47:00 The lack of business education in nursing programs.
48:00 The need for more nurses holding political positions and why more nursing input is needed in health policy. (Betty Rambur is currently the only nurse on MedPAC.)
49:00 Nurse-led innovation happens when nurses are trying to save lives!
50:00 How the COVID-19 pandemic depended on nurse-led innovation.
51:30 “Why are we not trusting in nurses now – to hear them and trust them – so we can build the system needed to sustain workforce, sustain healthcare, and sustain our communities?”
52:00 How Florence Nightingale forever fundamentally changed the future of science, history, and medicine with the establishment of the nursing profession.
54:30 Rebecca discusses how attending a healthcare hackathon changed her life and led to a career path in nursing innovation!
60:00 What the hackathon taught Rebecca about the importance of the nurses voice and how they can save healthcare.
62:30 Parting thoughts from Rebecca and the life lesson learned from surviving a shipwreck at sea. (Bet on yourself and believe you can overcome adversity!)
64:00 “Were there none who were discontented with what they have, the world would never reach anything better.” – Florence Nightingale
65:00 2030: Florence Nightingale’s prediction of a future nursing renaissance.
Medication adherence remains an important yet vexing issue in American health care. According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than a specific treatment itself. Still, it is estimated that a staggering 50% of Americans don’t take their chronic long-term therapy medications as prescribed. Statistics show that each year, poor adherence contributes to more than $500 billion in avoidable health care costs, around 125,000 potentially preventable deaths, and up to 25% of hospitalizations in the United States. This issue of medication adherence is so important, yet so vexing to solve for because it is so multi-faceted and entrenched into the business economics of healthcare. In this Race to Value, we must find a better way to ensure affordability and promote adherence to medication therapies. This is a life or death situation – both from an economic and a clinical perspective. If we don’t find solutions to improve medication adherence as part of value-based care, patients will die. And eventually, the weight of the entire healthcare system will collapse upon itself due to the unsustainable costs that are incurred due to avoidable healthcare utilization that medication adherence would have prevented!
Our guest this week is Jason Rose, a leading expert on the trillion dollar impact of the medication adherence issues in our country and what can be done to address them. Since 2018, Jason Rose has been spearheading value-based care as CEO of AdhereHealth. The innovative technology company is focused on transforming healthcare by leveraging intelligent data analytics, promoting medication adherence and working with patients to resolve social determinants of health. Customers are managed care companies and employers looking to improve quality of care and reduce costs for their patients and employees, respectively. After one year in his role, AdhereHealth experienced its fastest-ever year of growth and has grown from about 100 employees to nearly 1,000 employees over the past three years. This is a leader in the value-based care movement that you should be listening to, as medication adherence is one of the most critical challenges to overcome in the transformation of our industry.
Episode Bookmarks:
01:30 According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than a specific treatment itself.
01:45 50% of Americans don’t take their chronic long-term therapy medications as prescribed.
02:00 Poor adherence contributes to more than $500 billion in avoidable health care costs, causes 125,000 potentially preventable deaths, and up to 25% of hospitalizations.
03:00 Introduction to Jason Rose, a leading expert on medication adherence and CEO ofAdhereHealth.
04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
06:30 If unabated, medication non-adherence will soon be a trillion-dollar problem with no end in sight.
07:00 Jason discusses the financial impact of non-adherence and the criticality of addressing this issue in healthcare.
08:00 “Medication non-adherence should be one of the top issues in all of healthcare, given the size of the actual problem.”
08:30 How value-based care programs can improve adherence outcomes in both senior and commercial populations.
10:00 A series of factors, rather than a single one, determine patients’ ability to follow treatment recommendations correctly.
11:00 Jason discusses the impact of social determinants of health (SDOH) on medication adherence.
12:00 How SDOH symbolize the “Maslow Hierarchy of Needs for Health Care” (e.g. safe drinking water, transportation, health literacy).
13:00 A critical decision point – paying for the food of a beloved pet instead of purchasing lifesaving medication!
14:00 Referencing Jason’s recent AJMC article: “Medication Adherence is a Force Multiplier for Medicare Advantage Profitability, Enrollment, and Star Ratings”
15:00 70% of MA prescription drug plans earned a rating of 4.0 Stars or higher in the 2022 Star Ratings compared with 49% for 2023.
16:00 Medication-related measures make up 52 percent of the overall Stars Ratings weighting, and adherence measures for cardiovascular, hypertension, and diabetes are all triple-weighted.
16:30 The exacerbation of chronic diseases during the COVID-19 pandemic and implications on value-based adherence programs.
18:30 Jason explains the reason for the year-over-year MA Star Ratings adjustment due to lower health plan investment and more competitive ratings.
19:30 How Hemoglobin A1c quality measures for diabetics relates to medication adherence.
20:30 33% of Star Ratings relate to patient experience, and these CAHPS measures will suffer if plans to perform well in medication adherence measures.
21:00 “It is quite obvious and logical that medication adherence outcomes is exactly what CMS is focusing on with quality measurement.”
21:45 How CMS will be “tripling down” on medication adherence outcomes related to MA Star Ratings.
22:30 The importance of achieving the 4 Stars (or above) to unlock needed health plan profit margin to compete in the open MA marketplace. (“Darwinism in Healthcare”)
24:30 More than a quarter of 30-day hospital readmissions are directly tied to medication adherence reconciliation issues.
25:00 AdhereHealth Survey: 62% of discharged patients would have had at least one drug therapy problem that would have gone unaddressed without telepharmacy outreach.
26:00 Jason discusses why CMS will soon be retiring Medication Reconciliation Post Discharge (MRP) measures for higher-weighted Transitions of Care (TRC) measures.
26:30 How TRC measures will emphasize PCP admissions and post-discharge notifications along with increased emphasis on medication reconciliation.
28:00 25-40% of medication issues related to lack of reconciliation (referencing a personal story of a patient that almost died because of taking two different statins).
29:00 The need for automated clinical workflows to drive provider notifications and data-analytics to identify drug therapy problems.
30:30 For every 100 prescriptions written, just 50 to 70 are ever picked up at the pharmacy. Once a patient leaves the pharmacy, a mere 25% of the medications are taken as directed at home. And then just a fraction—15% to 20%—are refilled.
31:00 A typical Medicare beneficiary saw a median of 7 physicians per year, highlighting the need for more coordinated, multifaceted strategies in medication management.
32:00 Home care is expected to increase nearly 4-fold by 2025, comprising up to $265 billion in care services (a quarter of the total cost of care for Medicare fee-for-service and MA members).
33:00 Lack of clinical integration and interoperability contributes to poor medication reconciliation in the healthcare industry.
34:00 Fee-for-service incentives do not align with improving medication adherence outcomes.
35:00 The need for health plans to reconcile drug utilization data with a targeted list of patients for which medication adherence outcomes could improve.
36:00 “Seventy-percent of medication adherence problems are related to patients not taking the drug they were prescribed. It’s not even low adherence; it is no adherence.”
36:30 How a value-based care environment provides an incentives platform for collaboration and co-development of tools to address non-adherence.
38:00 Public-private partnerships (like Medicare Advantage) as the best opportunity to drive value-based care.
38:30 The lack of chronic care management and focus on medication adherence in the home health environment.
40:00 How the lack of care management analytics for home health providers causes them to “fly blind” in their clinical workflows for medication-related issues.
41:00 The opportunity for medication adherence analytics and real-time data to improve clinical outcomes for home-based patients!
42:30 Collaborative care models that include a clinical pharmacist have been shown to alleviate some of the demand for physician-provided care and facilitate access to primary care services.
44:00 Jason discusses the need for more integrative models of care that utilize a team-based, multidisciplinary approach.
44:30 How Walgreens and CVS are freeing up the dispensing time of pharmacists so they can spend more time counseling patients.
45:30 The opportunity for ACOs to enable pharmacy-led interventions with targeted high risk patients.
46:30 Polypharmacy (the use of 5 or more prescription medications) is present in nearly 20% of the U.S. population and 40% of the population over 65 years or age.
47:00 Nearly 20% of seniors take 10 drugs or more, which can lead to a higher risk for adverse reactions and drug interactions!
48:30 How AdhereHealth is accessing reference databases to drive real-time analytics that identify potential over-prescribing of drugs.
51:00 The importance of capturing patient-reported data in a medication management program.
52:00 Over 75% of all ambulatory communications are over facsimile (fax machines) – not EHRs!
54:00 The moral imperative of ensuring that diabetics can afford life-saving insulin.
54:45 Price gouging by the pharmaceutical industry – a vial of insulin now costs about $300 — roughly 30,000% more than the original cost of the patent!
55:00 Eli Lilly’s recent announcement that it will slash its high list prices for some of its insulins and will immediately offer programs to limit out-of-pocket costs to $35 per month.
56:00 Jason explains why the Eli Lilly change was not voluntary and is more related to regulation by the Inflation Reduction Act.
57:00 According to IQVIA Institute for Human Data Science’s 2020 report, prescription abandonment rates are less than 5% when the prescription carries no out-of-pocket cost; it rises to 45% when the cost is over $125 and to 60% when the cost is more than $500.
58:00 Optimism for the future in the lowering of prescription drug prices.
59:00 Real-time benefit checking of formularies at the point-of-care.
60:00 The future of medication adherence to be addressed in value-based care through partnerships and collaboration.
61:00 Medical cost inflation as a continued challenge for those taking risk.
62:00 How AdhereHealth is bringing patient-centered solutions to the marketplace to guide clinical outcomes and improve patient relationship management.
In value-based care, we have both an economic and a moral imperative. What’s at stake is so much more than saving our healthcare system. It is about ensuring the continued prosperity of our nation to ensure that we leave it better for future generations. The best indicator of whether our country is on the right path is the assurance that healthy mothers can give birth to healthy children. And those children, in turn, must be assured of good care and a sound education that will enable them to face the challenges of a changing world. If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.
This week on the Race to Value, you are going to hear from a value-based care leader who is boldly moving beyond with a call to action to serve our nation’s youth. Karen Wilding, the Chief Value Officer at Nemours, is on a passionate pursuit of the Quadruple Aim, and her health system is redefining children’s health in our country. Nemours Children’s Health is truly “leaning in” to the promise of population health by transforming the very definition of what it means for children to be healthy. And their value journey reflects a bold vision to create the healthiest generations of children that will take us beyond medicine by ultimately impacting the world. If you are looking for an example of inspirational leadership in value-based care, look no further than Karen Wilding and the Nemours Children’s Health System!
Episode Bookmarks:
01:30 “If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.”
02:30 Introduction to Karen Wilding, the Chief Value Officer at Nemours Children’s Health
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
05:45 Karen describes the whole-person care orientation at Nemours and how the mission of “Well Beyond Medicine” guides their value-based care journey.
06:45 Social Determinants of Health (SDOH) screening in underserved populations to expand care network and create community partnerships.
07:45 Driving “macro-system impact” as an anchor institution (e.g. best practice clinical research, cross-sector partnerships, health equity investments)
08:30 Health Equity opportunities in pediatric whole-person care (e.g. teen birth rates, preventative care access, infant mortality rates…and even household income).
09:00 “Well Beyond Medicine is a commitment to not just care for the medical aspects of children – we also care for the larger health ecosystem to create whole-child health and healthier generations.”
11:45 “Payment transformation is foundational to being able to create sustainability in value-based care.”
12:30 Karen explains how the fee-for-service infrastructure does not align incentives for healthy outcomes (e.g. asthma exacerbations with children in Delaware).
13:30 “Investing in children’s health is the single most important thing we can do as a society.” (balancing present-day economics vs. future economics).
14:45 Partnering with payers to pursue health equity transformation and the importance of community-based investments.
16:45 Nemours has been utilizing Community Health Workers to conduct SDOH screenings and individualized interventions through a culturally competent care model.
17:45 Karen explains how the interdisciplinary care team at Nemours works together to capture, assess, and address SDOH barriers.
18:45 The importance of enterprise-level buy-in when launching a SDOH population health strategy.
20:30 Overcoming fears and concerns of families in sharing personal information about their social barriers.
21:00 The creation of a national toolkit on whole-child population health and how Nemours is collaborating with policy stakeholders at the federal level.
23:30 “We want to be where children live, learn, play, and grow. In order to address health in communities, you need partnerships.”
24:00 The role of virtual care and home health in a community-based ecosystem.
25:00 Karen describes how Nemours provides physical and behavioral health services in partnership with elementary schools.
26:00 Working with CBOs and faith-based organizations to address SDOH barriers in communities.
27:00 Partnering with government agencies (e.g. juvenile justice, CPS) to elevate the health of vulnerable children.
28:30 The focus of Nemours leadership in technology innovation to develop the system’s EHR infrastructure and digital, consumer-centric strategy.
30:45 Karen discusses the importance of technology enablement to drive population health through an omni-channel patient experience.
32:00 EHR optimization to drive clinical decision support at the point-of-care.
32:30 Leveraging analytics to bridge the clinical and claims data experience.
33:00 How the MSSP empowered healthcare organizations through the provision of claims data. (Medicaid data in children’s health is not the same.)
34:00 The need for national data standards to have consistency with all payers in the country.
35:45 1 of 6 children between the ages of 6 and 17 has a treatable mental health disorder, yet only around half ever receive treatment.
36:45 The pandemic created an increase in childhood Emergency Department utilization (25% increase in children 5-11, 30% increase in adolescents 12-17).
37:00 40% of children are living with anxiety and 45% are living with behavioral health disorders.
37:45 How Nemours is handling the pediatric behavioral health crisis through clinical integration, telepsychiatry, and digital mental health tools.
38:45 Behavioral health diagnoses is 17% more prevalent in a Medicaid population.
40:00 Referencing Daniel Dawes (“The Political Determinants of Health”): We would save over $300 billion per year if we were to eliminate American racial health disparities in our healthcare system.
40:30 Black children are 3X more likely to die in infancy than white children, 7X more likely to die from asthma attacks, and more than 3X more likely to die after elective outpatient surgery than white children.
41:00 Disparities in household income based on race and how that contributes to teen birth rates and health inequities.
42:00 Nemours commitment to equity through program development to ensure education and access.
43:00 The Chief Health Equity Officer role supports health equity transformation, community partnerships, and workflow process changes.
45:00 How payment disparities and demographical attributes between Medicaid and commercially-insured pediatric populations may contribute to health disparities (ex: asthma).
45:45 Designing a whole-person care model to ensure every child is given optimal treatment regardless of their health insurance status.
47:00 Integrated behavioral health in the primary care setting needed to make timely interventions.
49:30 Parting thoughts on the meaningful and impactful work of value-based care transformation and how that provides the passion for service-oriented leadership.
Patients who are high utilizers, also known as multi-visit patients (MVPs) or frequent flyers, whether found in the ED, inpatient units or other departments, drive up readmission rates and tie up resources. Often, clinicians and administrators hold out little hope that they can end the multi-visit cycles of these patients. Yet, by looking at a patient’s multiple visits as a symptom of a deeper problem, and then identifying and rectifying that underlying problem, clinicians can end a patient’s cycle of care utilization.
On this podcast, a leading expert in high-utilizer care discusses her MVP Method which has been used by rural hospitals, community hospitals, safety net hospitals, and academic medical centers across the country. Dr. Amy Boutwell, President of Collaborative Healthcare Strategies, is a nationally recognized thought leader in the field of reducing readmissions and improving care for highest risk and multi-visit patients. She is the developer of the STAAR, ASPIRE, ASPIRE+ and MVP methods to reduce avoidable acute-care utilization and deliver whole-person care across settings and over time.
The general principles and actions of the MVP Method can revolutionize care, break the cycle of utilization and change the life of your patients. The Institute for Advancing Health Value has released an Intelligence Brief and Case Study to accompany this special podcast episode.
- Download the Open Access Intelligence Brief: “Building An Effective Care Pathway for Multi-Visit Patients: The MVP Method” (Available to Everyone!)
https://www.advancinghealthvalue.org/building-an-effective-care-pathway-for-multi-visit-patients-the-mvp-method/
- Download the Members-Only Case Study Brief: “Transforming Care MVPs at a Safety-Net Health System” (Available to Institute Members – Join the Institute for free if you work for a Provider Organization!)
Episode Bookmarks:
01:30 High utilizers, also known as multi-visit patients (MVPs) or frequent flyers, whether found in the ED, inpatient units or other departments, drive up readmission rates and tie up resources.
02:00 Can high utilization by MVPs be impacted by addressing symptoms of a deeper problem?
02:30 Introduction to Dr. Amy Boutwell and the MVP Method to improve care for High Utilizers.
03:15 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:45 Referencing the Dr. Atul Gawande article called “The Hot Spotters” which showed how a health system experienced a 40% reduction in super-utilizer reduction.
07:00 The risk of conflating the terms of “high risk,” “high utilizer,” “high cost,” and “complex”.
07:45 Busting the myth that multi-visit patients are un-impactable.
08:30 “We must walk away from the dogma that it is not worth serving high utilizers. The industry must reengineer its thinking around that to advance health equity.”
09:00 Dr. Boutwell references the work of the Camden Coalition and how “Hot Spotters” did not confirm the myth of un-impactability.
10:30 The Hospital Readmissions Reduction Program (HRRP) aims to minimize the number of avoidable hospital readmissions by incentivizing hospitals to improve post-discharge planning.
11:30 Dr. Boutwell discusses the challenges of HRPP as a health policy and why hospitals have still yet to evolve in care delivery transformation.
12:30 Readmissions programs often are treated as a pilot instead of as a strategy for transformation.
13:30 Dr. Boutwell’s work in partnering with health systems to develop a population health playbook to lower hospital readmissions.
14:30 The challenge of focusing on just one chronic condition in a readmission reduction strategy (e.g. heart failure).
15:45 “Multi-visit patients account for over half of all readmissions at every single hospital in the United States.”
16:45 “We have to go beyond payer-specific or disease-specific paradigms to find higher leverage population segments to impact.”
18:00 The MVP Method was designed for scale and is used by rural hospitals, community hospitals, safety net hospitals, and academic medical centers across the country.
19:00 Dr. Boutwell provides a thorough explanation of the MVP Method and how it supports hospitals in achieving delivery system redesign.
22:30 Multi-visit patients are typically determined to be ~7% of all patients, yet account for 20% of hospital admissions, 50% of readmissions, and 10% of ED visits.
24:30 Physicians identify the cause of a symptom to accurately diagnose a patient. (This is the same paradigm one should apply to a MVP with a symptom of recurrent overutilization!)
26:00 The root cause approach is at the core of the MVP Method.
26:45 Harris Health article (“A New Way to Support Frequent Emergency Department Visitors”) about how they achieved a 15% reduction in ED visits across all MVPs (with Ben Taub reducing theirs by 77%!).
28:00 The success that Harris Health has had in implementing your MVP Method for addressing frequent ED utilizers. (Join the Institute and download the members-only Harris Health Case Study!)
35:00 New York State Medicaid is the largest sponsor of the MVP program so far and is focusing on hospital and community partnerships in care delivery redesign as part of its DSRIP strategy.
37:00 A personal story about a multi-visit patient dealing with housing instability.
38:45 Human-centered pathways and systems are a crucial determinant of success with the MVP Method.
39:00 How the New York State Medicaid system built equity value-based population health through cross-continuum team-based care on the frontlines.
42:00 The need for accountable teams to ensure definitive and timely linkages to MVP root cause solutions.
43:00 A personal story about successful care team engagement with a complex multi-visit patient.
48:00 ASPIRE Framework to Reduce Hospital Readmissions
50:00 The importance of understanding patient data before implementing a readmissions reduction strategy.
51:00 How analyzing data led to health systems learning for the first time that alcohol abuse was the main cause of hospital readmissions.
53:00 A great example of how a hospital developed a collaborative team-based interdisciplinary approach to readmissions reduction.
55:00 Nationally, 56% (or roughly 67 million ED visits) are potentially avoidable. The average cost of an ED visit is $580 more than the cost of a comparable office visit.
57:00 The importance of advanced primary care access and the need to address the fear and uncertainty that patients experience regarding their condition.
60:00 Emergency rooms do not adequately address fear and uncertainty (an opportunity for person-centeredness).
62:00 How the state of Maryland dramatically decreased overutilization once financial incentives were realigned (from worst place to above the national average!)
65:00 “Value-based is the way we must practice medicine with regard to whole-person care.”
65:30 Parting thoughts from Dr. Boutwell on the importance of value-based care in the practice of medicine.
Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward.
This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare’s Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence.
In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey. He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He’s responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care.
Episode Bookmarks:
01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare’s Path Forward”
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability
05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory
06:00 Optimism for healthcare because how bad things really are!
07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change.
08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.”
09:00 “Healthcare is not working for anyone. That is where real change can happen and what makes me optimistic.”
09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters.
11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once?
12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient. There are many other things that have to happen.”
12:30 Michael Porter’s Value Chain and the importance of clarity and differentiation in the creation of value.
13:30 “Payment reform is just one activity of healthcare reform. We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.”
15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture.
16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change.
17:30 No one can do everything! If leaders focus on only three things, they will be successful in strategy execution.
18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain
18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson
20:30 3 Functions of Managers: Create Social Capital, Bring High Reliability Principles to Life, Eliminate Waste of all Types
21:30 “Social capital is more important than financial capital in the times in which we live.”
22:00 Applying High Reliability to all the dimensions (including patient experience) and refusing to tolerate failure in matters of trust.
23:45 “Culture of No Waste” – includes both time and resources
24:30 3 Functions of Frontline Caregivers: Create a Culture of Respect, Be Full Participants on Great Teams, View Job as Shaping the Memories of Patients and Families
25:30 The healthcare workforce often feels that they are part of a organization that does not respect them.
26:30 “Treating people with respect should be treated in the same way that the industry tackled hand hygiene to improve patient safety.”
27:45 Referencing the TED Talk from Daniel Kahneman: “The Riddle of Experience vs. Memory”
29:00 Frontline caregivers are like Steven Spielberg, i.e. they are the producers and directors of the patient memories.
32:00 “We live in a time where trust is under attack in society. You can’t take trust for granted in healthcare.”
33:00 Trust goes beyond the clinician encounter – it encompasses the whole episode of care, including the web presence of the provider before the visit.
35:30 The importance of 5-Star Ratings online in building trust.
36:30 “Patients are unnerved from friction, chaos, and any indication that they may not be safe. The pandemic has really heightened their fears.”
38:00 Dr. Lee discusses how Press Ganey has begun surveying patients on their perceptions of patient safety.
39:45 High-reliability and the Anna Karenina Principle (“Happy families are all alike; every unhappy family is unhappy in their own way.”)
41:45 In 2021, the Press Ganey Employee Engagement Indicator declined in every single job category!
43:00 Dr. Lee discusses how building trust with workers coincides with the actions taken to build trust with patients.
44:30 Personal Pride: Pride in the organization, Pride in what you do for the organization, Pride in what your team does.
45:30 Personal Alignment: Aligning with the cultural beliefs of employees and the need for inclusion. (Lack of DEI creates a 4X greater risk of employee turnover.)
46:00 Personal Resilience: Activation (employee motivation) and Decompression (ability of employees to forget about work when at home).
47:30 Activation is increasing in healthcare, but decompression continues to go down!
50:00 Dr. Lee explains how the pandemic and social unrest has created a deeper understanding of human suffering and how systems create harm.
50:30 Understanding Patient Safety beyond Physical Harm by also considering Emotional Harm (e.g. not feeling safe or financial distress due to healthcare)
51:30 The nuance of perception in Patient Safety (an example of how patients didn’t feel safe when a change when a hospital starting using odorless disinfectant).
53:00 Lack of respect as a safety issue.
53:00 The murder of George Floyd prompting an examination of the impact of inequality throughout society.
54:00 Diversity, Equity, and Inclusion in healthcare as a form of social capital and the pursuit of zero inequity.
55:00 The importance of DEI in health equity is now understood at a deeper level by healthcare leaders following the murder of George Floyd.
56:00 “Zero Inequity should be our goal just like Zero Harm is our patient safety goal.”
56:45 The data from safety net hospitals showing continued challenges in assessing pain with African American patients.
58:00 How organizational mistreatment of patients creates mistreatment of workers (and why lack of patient-centeredness is main reason for employee turnover).
61:00 Dr. Lee touts the virtues of healthcare and why it is such a great industry to work in.
62:00 New Skills for the Era Ahead: Strategy (Porter’s Value Chain), Social Capital (Teamwork, Leadership), Growth Mindset (read Grit: The Power of Passion and Perseverance!)
64:00 The potential to do great work in medicine and making a difference in the lives of others.
64:30 “This is the best time to be going into healthcare. You can really make a difference in a noble field.”
65:00 How to reach out to Dr. Lee and learn more about his work in healthcare transformation.
It is Black Maternal Health Week, and this week’s episode provides context and value-based solutioning on how to address the alarming rise of maternal mortality in the U.S. We have horrifically poor maternal health outcomes in the African American population of our country, and it is directly attributable to a flawed design of our healthcare system juxtaposed with the presence of longstanding and systemic institutional racism. If there ever was an opportunity for improving health equity through value-based care, it is with this moral imperative to ensure the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival. On this week’s podcast, you are going to hear from one of the leading voices in health equity, reproductive justice, and value-based maternal health.
Our guest is Dr. Neel Shah, the Chief Medical Officer of Maven Clinic, the world’s largest virtual clinic for family health care. He is also a visiting scientist at Harvard Medical School where he previously served as a professor of obstetrics, gynecology and reproductive biology. Dr. Shah has been recognized with the Franklin Delano Roosevelt Humanitarian of the Year Award from the March of Dimes for his impact on maternal health in the United States. He is featured in the films Aftershock, which won the Special Jury Prize for Impact at the 2022 Sundance Film Festival, and The Color of Care from the Smithsonian Channel and Executive Producer Oprah Winfrey. As a physician-scientist, Dr. Shah has written landmark academic papers on maternal health and health care policy, and contributed to four books, including as senior author of Understanding Value-Based Healthcare. He is listed among the “40 smartest people in health care” by the Becker’s Hospital Review, and he currently serves on the advisory board of the National Institutes of Health, Office of Women’s Health Research.
In this podcast, we discuss a special documentary that Dr. Shah contributed to called “Aftershock”. This inspiring film on black maternal health equity turns pain into power and should be watched by all who strive to make a positive change in American healthcare. Join us on April 12th, for a screening of the Aftershock documentary and a discussion with other attendees.
This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system.
Bookmarks:
01:30 Black Maternal Health Week and the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival.
02:15 Introduction to Dr. Neel Shah, one of the leading voices in health equity, reproductive justice, and value-based maternal health.
03:30 AFTERSHOCK, is an original documentary on black maternal health equity. (Watch Trailer and attend special free virtual screening on April 12th).
04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:15 This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system.
05:30 Since 1970, we have seen a 500% increase in C-Section procedures over vaginal deliveries, with the rate of C-sections among black birthing persons being much higher than the general population.
06:00 C-sections bring in an average of $10k per procedure, compared to an average reimbursement of $4,500 for a vaginal delivery.
07:30 “Childbirth is the most utilized healthcare service in the United States of America and accounts for 25% of all hospitalizations.”
08:30 The opportunity to extract more “value” in the maternal health system.
08:45 “In childbirth, we predominantly have a “too much too soon” problem. One in three receive a major surgery to give birth, and one in ten babies go to ICU.”
09:00 Profit margin of 50% per case has normalized C-sections, despite the overwhelming adverse outcomes and contra-indications for most C-sections performed.
09:30 How the surgical apparatus for childbirth creates flawed financial incentives.
09:45 The institutionalization of both birth and death in the American healthcare system.
10:30 Pregnancies are the easiest episodes of care to define and that lends itself readily to bundled payments.
11:00 The need to pay less for C-sections and the need to pay more for vaginal deliveries.
11:30 The maternal mortality rate for black women is 43 per 100,000 which shows that they have a pregnancy-related death risk that is 3-4X greater than that of white women.
12:45 “The wellbeing of Moms is a bellwether for society in general. Every injustice in society shows up in maternal health and maternal health outcomes.”
13:30 The high degree of racial inequity across outcomes, which include death, morbidity, undertreated illness, economic disempowerment, and social isolation.
14:00 The data shows that anti-black racism contributes to the most severe forms of health inequities.
14:30 How public health data has conflated race and racism in interpreting evidence-based practices in medicine.
15:30 The flawed maternal health outcomes calculator that erroneously downgrades patients for being black as a physiologic indicator.
16:15 “Redlining in healthcare” – how historical racism in urban planning decisions creates social barriers and leads to systemic health inequities.
16:45 The 1921 Tulsa Race Massacre as an example of how the legacy of racism contributed to the worst maternal health outcomes in the country (still persisting to this day).
17:45 Black moms often aren’t dying of the medical condition like what is stated on their death certificate…what they are really dying of is failure of communication.
18:30 Disparities in health literacy can have serious consequences for the health outcomes of Black individuals.
19:45 Joint Commission: 80-90% of sentinel events (near misses, deaths) are due to failures of communication and teamwork.
20:00 Communication and teamwork are the ultimate artisanal crafts in medicine, but medical schools traditionally do not teach this.
21:00 Childbirth is the ultimate team sport, but “the team” only forms for the first time upon the onset of delivery.
22:00 Dr. Shah discusses how a communication whiteboard in the maternal health setting can improve both teamwork and patient outcomes.
23:30 The importance of collaboration in an interdisciplinary care team.
24:00 The longstanding racism in the medical establishment that leads to multigenerational distrust of the health system.
25:00 “The existential challenge for the healthcare system in 2023 is trustworthiness. The job is not for patients to be more trusting of us; we need to be more trustworthy.”
26:00 How the legacy of the institution of slavery commoditized the reproductive potential of people and contributed to anti-black racism.
26:45 The insidious nature of adequately responding to pain reported by African American patients in the healthcare setting.
27:00 Racism in healthcare is systemically embedded and irrespective of status or income. (Examples include Serena Williams, Beyonce, Meghan Markle.)
27:15 How racism is embedded in medical textbooks.
27:45 Horrendous racist medical experiments (e.g. Tuskegee Experiment, Henrietta Lacks, “welfare queens”)
28:00 The three criteria of trustworthiness: Competence, Affirm Dignity for People’s Lived Experience, Reliability.
28:30 The competency of reliability is what we furthest from in the healthcare system.
30:00 J. Marian Sims, the father of gynecology, developed the C-section procedure so slaves could avoid fistulas from vaginal births to produce more slave labor.
31:00 Despite the longstanding track record of racism in maternal health, journalists didn’t really start telling the telling the story of back women dying in childbirth until 2018.
32:30 Injustices in society comprise gender inequity, racial inequity, geographic inequity, and generational inequity.
32:45 The pervasiveness of generational inequity in our politics, e.g. MAGA, Build Back Better.
33:00 “Hope, opportunity, and progress in our country are eroding in our country. There is empirical evidence that this is true. We see it in policing, educational attainment, and maternal health.”
33:30 The danger of leaving African Americans behind in the pursuit of generational equity.
33:45 The most convincing evidence that racism still exists in America in 2023 (comparing risk of wealthiest black woman to poorest white woman).
34:00 Dr. Shah speaks about his personal experiences traveling across the country to better understand maternal health inequities.
35:00 How George Floyd and BLM movement changed awareness for the presence of racism in healthcare.
35:30 Maternal mortality is the lagging indicator and recent increases are discouraging (despite that leading indicators are strong).
36:00 Avoidance of preventable deaths are an improving leading indicator.
36:30 Maven Clinic is the world’s largest virtual clinic for family health care that offers continuous holistic care for fertility and family building.
39:00 Loretta Ross as an inspiration for optimism in reproductive justice (“making sure the chain doesn’t break at your link”)
40:00 Dr. Shah provides an overview of the Maven Clinic and how it “thinks differently” in providing a model for health.
41:00 Providing a model for care, support, and access by meeting people where they are.
42:30 Earning trust through the provision of virtual, cultural-affirming care.
43:45 Developing economies of scale through technology.
44:00 “Social determinants of health need a hyper-local response, especially when it comes to material needs like food and housing.”
44:30 How Maven Clinic employs a short-form digital SDOH screening tool that reduces barriers to identifying addressing social needs.
45:00 Defining loneliness and why community partnerships are so important in the birthing process.
45:45 “The birth equity movement is in a similar place that the HIV/AIDS movement was in the late 1980’s. There are a proliferations of CBOs galvanizing on behalf of their community.”
47:30 Identity shift from academic physician to technology executive and CMO (WSJ: “Obstetrician Neel Shah Joined the Telehealth Revolution”)
49:30 How COVID-19 caused an awakening within Dr. Shah to make a more outsized impact on maternal health equity at a national level.
50:45 Building a Car Instead of a “Faster Horse” – seizing the disruptive opportunity for innovation in maternal health.
51:30 “Correctly deployed science gives you confidence in what you think you are observing is true. It then allows you to create products that can fit into markets and drive scale.”
54:30 Parting thoughts of inspiration from Dr. Shah’s experience as a contributor to the Aftershock documentary.
56:00 “Historically, the healthcare system has treated people’s experience as a secondary luxury after you made them safe. We got it backwards – the way you make people safe is by attending to their lived experience.”
A large wooden ship encased in glass sits prominently in the lobby of Humana’s Louisville headquarters. Its placement seems out of the ordinary, until you understand its symbolic purpose. The ship symbolizes the collaboration necessary from all of those focused on member/patient well-being. We must all row together to make progress and help those we serve live their healthiest lives. Physicians. Nurses. Health coaches. Pharmacists. Health plans. And many others. Collaboration and teamwork are critical to now and in the future of value-based care.
The annual Humana Value-based Care Report spotlights the progress value-based care physicians make in achieving better outcomes for their patients with Humana individual Medicare Advantage. It details four key areas—prevention, outcomes and utilization, patient-physician experience and costs and payments.
Humana shares these results annually to highlight how the company supports physicians in helping their patients achieve their best health. In this special episode, we are joined by Kate Goodrich, MD, MHS, the Chief Medical Officer for Humana. Dr. Goodrich discusses the annual Humana VBC report and strengthens the care for value-based care as the future of healthcare!
Episode Bookmarks:
01:30 Download the ninth annual Humana Value-Based Care Report
02:15 Introduction to Kate Goodrich, MD, MHS, is Chief Medical Officer for Humana
04:00 How a large wooden ship in the lobby of Humana’s Louisville headquarters symbolizes collaboration in Value-Based Care.
04:45 Collaboration within the care team. (“Financial incentives matter in optimizing the care of patients.”)
07:00 Collaboration within communities. (“It takes a village to take care of patients and their social determinants of health.”)
09:00 Collaboration at the national level across entities and within the federal government.
11:00 The Institute for Advancing Health Value as a leading example of national collaboration in VBC transformation.
13:30 Humana has over 74,000 primary care physicians in value-based relationships, caring for over 3 million Humana MA members.
14:30 How value-based Humana Medicare Advantage achieved better outcomes than FFS (e.g. hospitalizations, ED utilization, diabetic control).
16:15 “Control of blood sugar is a critical leading indicator of value-based care success.”
17:00 Avoiding low value care services that provide little or no clinical benefit (e.g. MRIs and CTs for routine low back pain).
18:00 Humana MA members receive 9.2% fewer low value services than those that are enrolled in fee-for-service.
19:00 Dr. Goodrich on the importance of VBC in addressing the healthcare cost problem in our country.
19:45 50% of Humana value-based programs earned shared savings (compared to original Medicare at 20.1%).
20:00 Humana value-based care physicians earn almost three times as much of Medicare’s fee schedule.
21:00 “If you’re a primary care physician, frankly, you will make more money in value-based care arrangements.”
22:30 Humana MA members average $500 in annual additional health plan benefits (e.g. home care, prescription delivery, healthy food cards) when associated with a value-based physician.
23:30 How screening for social barriers aligns with the provision of additional health plan benefits that improve care outcomes.
25:00 Examples of preventive care and CCM programs that close care gaps and increase Stars Ratings.
26:00 “Our outreach campaigns have closed more than 350,000 gaps in care per year. That’s paved the way for 10% of members who were previously non-compliant with the screening to identify a particular condition and then have the opportunity to seek more focused care.”
27:00 The success Humana is having in improving medication adherence in value-based arrangements.
28:00 “Non-adherence to medications is traditionally seen as a patient non-compliance issue. And I would argue that that it is rarely true that patients “don’t want to take their medications.”
31:00 Humana’s senior-focused primary care model as a holistic approach to healthcare that empowers patients.
33:00 Examples of Humana’s primary care model include CenterWell, Conviva, and alliance partnerships with Cano Health, Oak Street Health, and ChenMed.
35:00 Clinical Integration within senior-focused primary care teams (e.g. behavioral therapy, social work, pharmacy, nutritional counseling)
37:00 The positive correlation between value-based financial incentives and improved utilization outcomes.
37:30 Ambulatory-sensitive chronic conditions (e.g. CHF, COPD, asthma) that can be better managed in primary care setting.
39:00 Compared to traditional Medicare beneficiaries, Humana MA members had lower rates of hospital stays, emergency department visits, and 30 day readmissions (Referencing research article: “Comparison of Health Care Utilization by Medicare Advantage and Traditional Medicare Beneficiaries with Complex Care Needs”)
41:00 Dr. Goodrich discusses how Star Ratings are reflective of member experience (90.6% of Humana members are in contracts rated four star or above, and 66% are in contracts rated 4.5 stars or higher.)
43:00 How value-based care arrangements can address the plight of physician and nurse burnout.
45:00 Dr. Goodrich discusses Humana’s strategy to reinvest value-based savings in future innovation.
49:30 The future growth of Humana’s portfolio.
50:30 Continued investment in closing health equity gaps.
51:00 The importance of the annual Humana Value-Based Care Report – showing progress and sharing data of value-based success!
This week we have the honor of being joined by a world-renowned family physician and health equity expert, with deep experience in value-based care transformation, technology and innovation, and health disparities improvement. You are going to hear from the one and only Dr. Nwando Olayiwola, a leader in this Race to Value who is committed to ensuring that everyone has access to fair, high quality and equitable health and health care, no matter their background. To achieve this, she has committed her career to health system reform, practice transformation, primary care redesign and leveraging technology and other innovations to mitigate health disparities.
Dr. Olayiwola is Nigerian American physician, professor, author, speaker, consultant, and health equity leader. She was named the American Telemedicine Associate’s Woman of the Year in 2019, she was named one of the most influential minority executives in healthcare by Fierce Healthcare in 2021. Dr. O is a tireless advocate for healthcare of underserved populations, women and girls, and community and social determinants of health and innovations in technology, and the intersection of social justice and healthcare. As the inaugural Chief Health Equity Officer and senior VP of Humana, a role that she started in 2021, and she’s responsible for setting equity agenda and strategy for Humana.
In this episode, you will learn about the enablement of an equitable healthcare ecosystem through actionable data, performance measurement and quality improvement, health equity innovation, and relationship-based care.
Episode Bookmarks:
01:30 Introduction to Dr. J. Nwando Olayiwola, a Nigerian American physician, professor, author, speaker, consultant, and health equity leader.
02:30 Dr. O is the inaugural Chief Health Equity Officer and senior VP of Humana.
04:00 Personal background and formative experiences that has led Dr. O towards a career path in healthcare equity transformation.
05:30 The Health Equity Journey at Humana. (“Making Health Equity Part of the Value of Value-Based Care”)
06:45 Humana became a pioneer of health justice and health equity in rebuilding and uniting Louisville after the murder of Breonna Taylor.
07:00 Humana’s Bold Goal Population Health Initiative to enable an equitable healthcare ecosystem.
07:45 “We need to innovate constantly in the way that we deliver and finance healthcare. It must fit within the lives of people’s own lived experience.”
08:00 Optimism for the evolution of our healthcare ecosystem to better prioritize health equity.
09:00 “We must do everything we can to eliminate barriers to healthcare that are unnecessary, that are avoidable, and that are unjust.”
09:45 Imagining a world where healthcare is more than just having an insurance card – it actually becomes an equitable ecosystem of liberation and authenticity.
10:30 Dr. O provides specifics on the various types of health disparities that we encounter in our country and how those impact minoritized and marginalized populations.
12:00 Dr. O’s TED Talk: “Combating Racism and Place-ism in Medicine”
13:00 How is Humana positioning itself as a catalyst for equity innovation by leveraging it health plan and provider assets collectively?
15:00 How the Health Equity movement mirrors the path of the Health Quality movement following the “To Err is Human” report.
16:30 Referencing landmark National Academy of Medicine paper: “An Equity Agenda for the Field of Health Care Quality Improvement”
17:00 Measuring health equity on dashboards measuring organizational performance.
18:00 “We must get the right data to validate we are providing culturally affirming, culturally sensitive, and culturally humble care to people we’re caring for.”
18:00 Referencing NEJM Catalyst article on how Humana developed a health disparities impact measure: “Building the Foundation for Reducing Disparities in Medicare Advantage”
19:30 The need for committed leadership to support health equity work.
20:45 The importance of equity-focused executive hiring practices and actionable SDOH data capture.
22:00 Preventive care measures as a component of a health equity action plan.
22:45 Social Barriers preventing Equitable Care: Financial Strain, Food Insecurity, Housing Instability, Loneliness, Lack of Transportation.
23:00 Positive correlation between social risk and high medical loss ratio.
24:00 Building a more relationship-based delivery model of care that engenders trust between patients and providers.
25:30 The importance of continuous learning in health equity through performance measurement, testing, and validation.
26:30 Building partnerships with Community Benefit Organizations (CBOs) across the country.
27:00 Leveraging insights from acquired data intelligence on underserved communities to improve patient health literacy and economic empowerment.
29:00 “Our vision is that every person will have a fair, just, and dignified opportunity to reach their full health potential.”
30:45 Inspiration from Oprah Winfrey: “I firmly believe that none of us in this world have made it until the least among us have made it.”
31:45 How structural racism limits the positive impact of education as an ultimate opportunity equalizer.
32:30 Learning from Serena Williams’ challenge in accessing equitable health care.
34:00 Working at the “speed of trust” to overcome generational traumas from racism and inequities in healthcare.
35:30 “Trust is earned – it is not given.”
As the healthcare industry moves towards achieving CMS’s goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030, we must focus on patients in institutional settings. For long-term care patients, better care and better health means ensuring patients receive advanced care planning and regular wellness visits. And it also requires providers and facilities to work together in preventing avoidable hospitalizations and unnecessary SNF and hospice utilization. Unfortunately, the needs of geriatric patients in an institutional setting are often overlooked as compared to other populations in the vast environment that falls within the influence of value-based care. LTC ACO — the first ACO in the country focused specifically on the special needs of Medicare beneficiaries residing in long-term care facilities — is changing that narrative. The mission of LTC ACO is to dramatically improve the quality and cost of healthcare delivered to these Medicare beneficiaries, rewarding participating providers for achieving these outcomes. Using this approach, it is their vision to revolutionize the way healthcare is provided to Medicare beneficiaries residing in long-term care facilities.
Joining us this week in the Race to Value is Jason Feuerman, the President and Chief Executive Officer of LTC ACO. In addition to leading one of the only ACOs that is dedicated exclusively to management of long-term care facility residents, Jason supports managed care and strategic value-based initiatives for Genesis HealthCare, the biggest post-acute care operator in the country. In this episode, you will learn about LTC ACO implemented a program in the traditional Medicare population that mirrors Institutional Special Needs Plans (I-SNPs). He discusses how the ACO engages and incentivizes providers and facilities and has operationalized a data infrastructure to drive care interventions. They have woken up an entire ecosystem with their approach to value-based care and have generated well over $40M in Shared Savings throughout their lifespan. By focusing on improving care outcomes and engaging providers, they have become the industry-leading exemplar for improving patient outcomes in long-term care!
Episode Bookmarks:
01:30 Introduction to Jason Feuerman and LTC ACO, the first ACO focused specifically on the special needs of Medicare Beneficiaries residing in long-term care facilities.
03:00 LTC ACO was launched by Genesis Healthcare, the biggest post-acute care operator in the country, with significant experience in MA risk and bundled payment models.
06:00 Lessons Learned from MA: How Institutional Special Needs Plans (I-SNPs)provided an operational thesis for LTC ACO in the Medicare Shared Savings Program.
07:00 By improving quality and driving down unnecessary costs, LTC ACO returns the Shared Savings earned to LTC facilities and the physicians who support them.
08:00 “Waking up the ecosystem” by providing outcomes data to long-term care providers.
10:00 Achieving capital efficiency in a model where there is no downside risk.
12:00 How capital requirements for delegated Medicare Advantage differ from the MSSP model.
13:00 Less than 15% of residents in long-term care facilities are in a MA plan. (Limited business opportunities in Medicare Advantage)
15:30 Applying the same tenets of I-SNPs to a Medicare ACO (e.g. aligning providers and providing rewards with surpluses)
16:00 “Waking up an Ecosystem”: Most LTC providers do not know what happens to their patients once they leave the long-term care institutional setting.
17:00 How data can be used to inform long-term care providers how their patients are doing across the continuum.
18:30 The use of AI for population-based predictive analytics to identify potential health risk (see recent Press Release regarding ClosedLoop AI partnership)
19:00 “Long-term care providers gravitate towards population health data and how they can contribute to bending the cost curve.”
21:00 Alzheimer’s dementia is the only top-10 cause of death that cannot be prevented, cured or slowed. We spend $200B on Alzheimer’s and Dementia care (more than Cardiology and cancer care combined!)
22:00 Jason discusses the potential implications of Alzheimer’s/Dementia in value-based care.
25:30 The impact of hospitalization on a LTC patient can include more time in bed, which can result in increased blood clots, pressure ulcers, muscle atrophy and loss of function.
26:30 Using data from EHRs and pharmacy utilization (Medicare Part D) to predict the risk of hospitalization.
28:00 “Our goal is to reduce hospitalizations and the need for skilled care using predictive analytics.”
29:00 How primary care physicians can become the “true quarterbacks of care” by empowering them with data.
29:30 How LTC ACO is approaching pharmacy utilization to better care for their patients.
32:00 LTC ACO has achieved well over $40M in Shared Savings during its lifespan.
34:00 Jason provides an industry-leading example of how to align providers and facilities in the ACO’s value-based care strategy.
35:30 Most ACOs incentivize SNFs by just providing them with them the promise of referrals.
36:30 LTC ACO recently distributed $1.5M to providers and facilities from its most recent Shared Savings event.
37:00 Balancing both cost and quality initiatives of the CMS program to achieve Shared Savings.
37:30 The “feel good” aspect of independent providers working with the ACO beyond bonuses earned (e.g. lowering unnecessary SNF and hospice utilization to improve care).
38:30 “Our goal is to get as much money into the hands of providers as possible. This is not about holding back dollars so the ACO can make money.”
41:30 Jason describes the impact of COVID-19 on LTC ACO and the overall long-term care segment of the industry.
43:00 How social isolation with the pandemic created a high increase for inpatient rehabilitation needs.
44:00 The trauma of the pandemic on the healthcare workforce that comprises the LTC ACO network.
44:45 How hospitals learned a lesson to “care in place” during the pandemic (instead of referring patients to a long-term care facility).
47:00 The number of Americans aged 65 and older will more than double over the next 40 years — reaching 80 million in 2040.
47:30 Did CMS contemplate the institutional population when developing its goal to have all patients in an accountable care relationship by 2030?
49:00 Jason describes the importance of the value-based movement in improving care for the geriatric population.
50:00 ACO REACH focuses on communities (not institutions!)
51:00 “Most people not being addressed in value-based care are in institutional settings.”
52:00 How CMS will continue to move the needle on VBC, in partnership with private industry innovation, will benefit the entire geriatric population.
53:00 LTC ACO, with six years of experience as an ACO, is driving industry-leading results in improving care outcomes!
The healthcare system in the United States is ailing and in need of a massive value-based transformation. While we are increasingly polarized in our politics, there is one issue on which most Americans agree: our health care system is broken. Despite spending more per capita on health care than any other country, Americans are in worse health, with lower life expectancies, higher hospital admissions, and at greater risk of suicide and maternal mortality compared to peer nations. This is largely because our health care model has been focused on “sick care” aimed at addressing acute or chronic conditions rather than preventive health maintenance. We have increasingly placed greater value on specialty care over primary care. If we are to right the course and seize this historic opportunity to deliver care that is patient-centered and financially accountable for outcomes, we must unleash the potential of massively powerful primary care!
This week on the Race to Value, you are going to learn about Southeast Primary Care Partners (SPCP) – an independent primary care MSO committed to upholding the independence, innovation and collaboration of Primary Care Physicians, with the ultimate goal of transforming healthcare and achieving true value-based care everywhere. Eric Lisle is the CEO, President and Co-Founder of Southeast Primary Care Partners. And joining him is Craig Worland, the Chief Development Officer for SPCP. These two industry leaders paving the way for a revitalization of primary care in the Southeast and are leading a value journey that we are excited to share with you on the podcast this week!
Episode Bookmarks:
01:30 Our ailing healthcare system and the need to unleash the potential of massively powerful primary care.
02:30 Introduction to Southeast Primary Care Partners (SPCP) and our guests Eric Lisleand Craig Worland.
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
05:30 Eric Lisle shares his “Personal Why” and how that informs his leadership in value transformation at SPCP.
06:30 “Our passion is bringing the love of medicine back to primary care physicians.”
07:30 Craig Worland describes personal challenges navigating the healthcare system and how that inspired him to create meaningful change.
08:45 “The fee-for-service economic system is not designed to streamline care delivery in a way that keeps the patient well.”
09:30 How pivoting to a new economic model creates enablement for primary care transformation.
12:00 Value transformation in primary care is often limited by regional dynamics in the payment landscape.
13:30 How primary care enablement improves patient care outcomes.
14:30 Primary care is the only specialty in medicine that increases life expectancy when community access is enhanced.
16:00 Only 32% of primary care physicians work in a private practice outside of corporatized care delivery business model.
17:00 How independent physician-enablement strategy at SPCP creates whole-person care and improves health equity in underserved communities.
19:30 “The culture, leadership, and long-term strategy of a primary care practice must be oriented towards robust Total Cost of Care revenue models.”
20:00 Can hospital-owned and PE-backed primary care groups effectively pursue a value transformation agenda?
23:00 Investing in FTEs to enhance the population health capabilities of a primary care MSO.
24:45 Creating EHR interoperability and data aggregation to empower population health insights.
25:30 How the SPCP MSO leverages capital to invest in a PCP-led, patient-centered care environment.
26:30 Forming effective payer-provider partnerships through spirited collaboration and demonstration of risk capability.
28:00 The SPCP MSO is differentiated through provider empowerment, payer agnosticism, and commitment to both rural and urban communities.
31:45 Creating a holistic patient view by combining data analytics from aggregated claims with an integrated electronic health records system.
33:30 Displaying actionable insights at the point-of-care to close care gaps.
36:00 Prospective payment models in primary care are a “gamechanger” because they allow for investment in critical infrastructure to drive value.
37:30 Is the CMS goal to move all Medicare patients in accountable care relationships by 2030 realistic?
38:00 ACO REACH is an encouraging sign of risk progression and prospective payment.
40:00 Health inequities in Georgia and Alabama (e.g. cardiovascular disease, diabetes, CKD, cancer, strokes, HIV/AIDS, maternal deaths).
41:00 “The beauty of prospective payment is that it allows providers to do what makes the most sense to improve the health of patients.”
42:30 Getting the economic right – how the dollars provided through prospective payment are agnostic to minority and underprivileged populations.
44:00 The true path to health equity is driven by economic incentives just as much as moral imperatives.
44:45 Hospital closures in rural areas are compounding health inequities. (How can VBC transform care outcomes in these areas?)
47:00 Eric Lisle discusses how SPCP will be able to replicate their MSO model at scale to succeed in new markets in the southeast.
49:30 Craig Worland on the importance of “leadership with empathy” in a successful primary care model.
51:30 The importance of the Institute for Advancing Health Value in supporting organizations like SPCP.
Are you ready to climb the mountain and reach new heights for a transformative future?
In the “race to value”, the mountain climber must not be intimidated by the steep terrain of a broken healthcare system. Instead we must look within ourselves, while also finding inspiration from others, to keep climbing! The ultimate summit of value transformation is what drives us, but the climb itself is what matters. If you are looking for inspiration in your value journey, look no further than our guest this week, Debbie Welle-Powell. Debbie is a healthcare thought leader, educator, national speaker, and content expert in delivery systems, clinical models of care, population health, and digital care. She is also an avid mountain climber, having attempted three of the Seven Summits while also reaching the summit of all 58 of Colorado’s 14,000 peaks. She has also climbed Mt. Rainer in in Washington and Grand Teton in Wyoming and, she has climbed peaks in Bolivia, Mexico, France, Argentina, and Mt. McKinley in Alaska. In this podcast, you will learn how taking the path least travelled is when you learn the most about yourself and why value transformation is a most noble journey to undertake in healthcare.
As the former Chief Population Health Officer at Essentia Health – an integrated delivery system with 14 hospitals, and 1,500 provider health system spanning the states of Minnesota, North Dakota, and Wisconsin – Debbie Welle-Powell designed, built, and operationalized Essentia’s $2.5 billion dollar transition from a primarily fee-for-service model of care to one that focused on value. She oversaw risk-based contracting with payers and care delivery transformation, resulting in forty-five percent of the system’s fee-for-service revenue tied to financial and clinical performance which produced record earnings on shared savings. Debbie’s exceptional experience and background in multi-state, large integrated delivery systems, coupled with industry involvement and insights into emerging opportunities, trends, and challenges, have been valuable to health systems and purchasers seeking to grow, diversity, and promote expertise in the development and implementation of data-driven strategies and solutions in population health and value-based care.
Episode Bookmarks:
01:30 Introduction to Debbie Welle-Powell, a nationally-recognized leader in value-based care transformation.
03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:00 The grim statistics of American healthcare and the moral and economic imperative to reform it!
05:00 Recent article from Don Berwick about the excess profiteering and greed in healthcare: “Salve Lucrum: The Existential Threat of Greed in US Health Care”
06:30 Debbie discusses the current state of the healthcare industry and how she spent her career moving healthcare delivery to full-risk and globally capitated payments.
07:30 A leadership commitment to test models of care that address the moral imperative for improved outcomes.
08:30 Reflections on Dr. Berwick’s article and the need to expand the conversation by focusing on solutions.
11:00 The Innovation Center Strategy Refresh is a stake in the ground for 100% of Medicare beneficiaries to be in an accountable care relationship.
12:00 The need for innovation in specialty care and new risk models that improve health equity.
13:00 “Medicare is a laboratory for change.” (e.g. alignment of quality measures, multi-payer approaches to improvement, expansion of access in rural areas)
13:45 Two-thirds of those in Medicare Shared Savings contracts are now taking risk.
14:00 Balancing the need to move fast while not being too aggressive (“people are exhausted!”)
15:00 In the last year, hospitals have seen their operating costs increase upwards of 10%, and their bottom lines are now hemorrhaging to the tune of billions of dollars.
16:00 Pay inequity with nonprofit hospital CEOs making on average 8X the rate of hospital workers without advanced degrees (while the highest paid receiving 60X the hourly pay of general workers).
17:30 How do we better align hospitals and health systems with VBC? How should they be rethinking their approach to investment in delivery assets and organizational culture?
18:00 “Value-based care and the ACO movement has significant opportunities to create more affordability and better outcomes for our patients.”
18:15 The need for a federal framework that provides a groundswell of support to move in the direction of value.
18:30 Leveraging the CMMI Strategic Framework to move 150 million Americans into value-based payment models.
19:30 Debbie describes how she led her health system towards the acceptance of downside risk in 2015. (Learn more about Essentia’s Population Health Strategy)
20:30 When Debbie left Essentia Health, 42% of health system revenue was flowing through value-based contracts (upside and downside).
21:30 The importance of leadership, organizational culture, and data in a health system’s value journey.
22:30 Referencing Debbie’s recent article on “The Future of Integrated Virtual Care.”
23:30 Essentia Health’s integrated virtual care generated higher patient satisfaction scores, eliminated many SDOH barriers, prevented ED visits, and saved approximately $2.5M in healthcare costs.
24:00 Debbie discusses the Essentia Health integrated virtual care journey and how they navigated the challenges of COVID-19.
26:00 How remote patient monitoring and a Personal Health Record (Epic MyChart) lowered healthcare costs and utilization for specific chronic conditions.
27:00 Implementing a Hospital-at-Home program – lessons learned in testing a different model of care.
28:00 What is the permanent nature of virtual care in the post-pandemic era?
29:00 The need for Telehealth ROI and the demands of younger patients for virtual care.
31:00 Unlike in a fee-for-service model, payer contract negotiations in value do not always have to be a zero-sum game.
32:30 Debbie explains how to cultivate meaningful payer-provider partnerships to improve population health outcomes and reduce health disparities.
34:00 Strategies for engaging payers to get “must have” value-based contract terms and meaningful data to deliver on care model transformation.
37:00 “The willingness to solve problems in partnership with payers is the true test of the commitment to deliver better care for communities.”
38:45 The importance of data, governance, and strategy to guide the fluidity of ever-evolving payer-provider relationships.
41:00 Debbie elaborates on her success in planning targeted SDOH interventions to eliminate health disparities using the ADKAR® Model for change.
42:00 Recognizing the health divide between North and South Minnesota and how Essentia Health addressed gaps in care and health inequities.
43:30 Conducting health risk assessment screenings on all patients and how that data drove community-based interventions.
44:30 Using community benefit funding within the health system to support CBOs taking care of patients’ social needs (e.g. food, transportation, housing).
47:00 In 2023, 10.9 million beneficiaries are being cared for in MSSP ACOs, while 2.1 million are being cared for by REACH ACOs.
48:30 Debbie provides her leadership perspective on CMS payment model innovation.
49:30 Improving alignment and consistency between MSSP, REACH, MA, and Medicaid payment models.
50:30 “If you are not in risk, take the first step in an upside-only value-based arrangement. The benefit is knowing your performance against your peer groups.”
51:00 The inevitability of mandated bundled payments.
52:00 The lack of payer alignment in the commercial market creates a challenge for them to lead in value transformation.
52:45 Expect to see significant growth in the value movement by 2025.
54:00 How important is it that we teach emerging healthcare leaders about value-based care? Do we need a new kind of leader to disrupt legacy thinking in healthcare?
56:00 “Be involved and willing to take risks. That is what it is going to take to challenge the status quo and push our stakeholders to be better.”
57:30 As an avid mountain climber, Debbie has attempted three of the Seven Summits and climbed all 58 of Colorado’s 14,000 peaks, as well as Mt. Rainer in in Washington and Grand Teton in Wyoming. Additionally, she has climbed peaks in Bolivia, Mexico, France, Argentina, and Mt. McKinley in Alaska.
58:00 Parting thoughts of inspiration on what it means to reach the summit and how mountain climbing relates to the value journey.
58:45 “When you take the path least travelled, that is when you learn the most about yourself. People deserve this race to value.”
One of the most widely known and influential thinkers on management, Peter Drucker, once said, “The entrepreneur always searches for change, responds to it, and exploits it as an opportunity.” In this movement to value, it’s seems that the new players – innovators and disrupters with unbridled passion for entrepreneurialism – are going to be in the best position to be at the headwaters of a transformation in American healthcare. The financial incentives in the current model of healthcare are simply too entrenched to be overcome by most legacy incumbents worried about how value transformation will create demand destruction in their fee-for-service lines of business. We need a better way forward. Now is the time to throw away traditional economic principles to reshape healthcare in our country!
Our promise to build a uniquely new American healthcare system that is patient-centered and economically viable will be realized by innovators like the one you will hear on this week’s episode. We are joined this week by Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare. Thompson has the mindset that if it’s broken, you fix it…we as industry leaders shouldn’t wait for someone else to figure out how we are going to win in this Race to Value! Thompson is a health economist and entrepreneur that you should be listening to. As the co-founder and CEO of Nice Healthcare, he has created a technology-enabled primary care clinic that delivers all care in the comfort of the patient’s home and contracts directly with small employers. Thompson built this company in response to the economic dysfunction and lack of cost accountability that he observed in our broken healthcare system. According to Thompson, it will be necessary for innovators to lead the way since the legacy model is too entrenched to reform itself. Listen to this incredible interview to find out why Thompson believes that value-based care (if done right) will ultimately lead to the bankruptcy of legacy companies!
Episode Bookmarks:
01:30 Introduction to Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare.
02:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!
03:30 In 2017, Thompson co-founded Nice Healthcare – an on-demand, in-home technology-enabled clinic that delivers comprehensive healthcare to employees of small and medium-sized businesses.
04:30 Thompson shares the horrific story of the poor healthcare his one-year old son received and how that shaped his entrepreneurial vision to start his company!
06:45 How the lack of consumer-centric innovation in healthcare harms the spirit and hurts patients financially.
08:00 Thompson’s privilege allowed him and his family to overcome their poor healthcare experience unscathed…how many people do not have that fortune? (The inspiration for Nice Healthcare)
09:00 Referencing the famous article, “It’s the Prices, Stupid,” by the late health economist Uwe Reinhardt where he argued that high prices explain most of why U.S. healthcare costs are so much higher than those in other advanced countries.
09:45 The problem with supplier-induced demand, where a physician (i.e. the “supplier”) also serves the economic role as a consumer by generating their own demand.
10:15 Nice Healthcare is fully capitated (no fee-for-serve whatsoever) which allows it to offer unlimited virtual care and home visits, along with lab tests, drugs, xrays, and EKGs conducted in the home.
10:45 “The problem with healthcare is the unit price.”
12:00 Thompson explains the pricing inelasticity demand in healthcare and why that creates flawed incentives for consumer price gouging.
13:00 Profit maximization by increasing market share is not necessarily the modus operandi in healthcare when you can get away by charging whatever you want.
14:45 “Unless you create a completely new business model in healthcare, you are not going to change the price.”
15:00 How Nice Healthcare has changed the pricing model through a disruptive business model.
17:00 Receiving delegated risk from payers in the form of capitation.
18:30 “Our technology and processes allows us to operate at a lower unit price point that we, in turn, pass on to the consumers of care.”
19:00 Referencing prior Race to Value episode with Dr. Farzad Mostashari
21:30 “The very notion that a legacy model for-profit entity would deliberately engage in activities (like value-based care) that lower their revenues or profit is ludicrous. Innovators and upstart companies must solve this problem.”
23:00 “If none of the incumbent healthcare players are going out of business, you don’t have value-based care. The ultimate result of true value-based care should be bankruptcy of legacy companies.”
24:30 A new innovator can be profitable and create value for shareholders and communities with much lower revenues than incumbents.
26:00 True innovators in healthcare do not grow fast because they are creating value.
26:45 Referencing “The Innovator’s Prescription’ by Clayton Christensen (the wasteful spending in healthcare that can be addressed by innovators)
28:30 “Simplicity doesn’t start with Technology. Technology only makes simplicity elegant.”
29:00 The simplicity of the Nice Healthcare care delivery model.
31:00 The surge of venture capital and private equity investment going into virtual care and high-touch primary care models and the move to asset-light hospitals.”
32:45 “Hospitals should not be for-profit and should not even be private organizations. They should serve as a utility offering a public good.”
34:30 Removing the profit motives from hospitals will make them a public utility (just like police and fire departments).
35:30 “Everyday primary care should be as easy to access as air. That is where free market principles, competition, and true innovation come into play.”
38:00 Employer-sponsored health plans have gone up 54% in the last decade. Are employers the “sleeping giants” that will awaken to force the change needed in our healthcare system?
39:30 Thompson explains how Medicare and commercial insurance plans are inextricably linked together. (Lower wages because increased healthcare costs creates less tax revenue to fund Medicare program.)
42:00 “Any solution we want for Medicare has to involve the commercial population.”
42:30 “The federal government needs to wake up to the fact that the healthcare industry is making it impossible to fund Medicare.”
43:30 “The most expensive and complex care should be provided by the government. The lowest risk pool has everyone in it.”
44:00 “Funding Medicare through income taxes harms employees. We have to be free from that paradigm so employers can affect change in healthcare with true innovation.”
45:30 How the high barriers to entry in the healthcare marketplace prevent new entrants from coming in to impact real change.
45:45 The need to create national provider licensure, loosen telehealth regulations, and lower the debt burden for students in medical schools.
47:45 The healthcare economic model must change to better serve society – healthcare should be a “right” instead of a privilege.
49:00 Will increased patient expectations become a formidable agent of change to hold the healthcare industry accountable for consumer-centric innovation?
50:00 Consumer demands will not lead change in healthcare because they lack agency and ultimately succumb to pricing inelasticity.
51:30 Thompson explains how Nice Healthcare provides patient-centered care by pulling up a random patient review on Google (and compares it to a random competitor clinic in Minnesota).
55:30 Nice Healthcare Results: 98% of patients rate care as better than their previous clinic, $453 net yearly savings per employee, and the company has a 93.2 Net Promoter Score.
56:30 Saying “no” to insurance and partnering with innovative, forward-thinking brokers led to product distribution at a low price point with minimal friction.
58:00 Combining virtual care with in-home visits to replicate the clinic experience.
62:00 Thompson provides a contrarian view of Population Health by stating that it has nothing to do with predictive modeling and algorithms (we should instead focus on changing our food industry, educational system, and policing to improve health.)
63:00 “The sole purpose of population health management is to improve patient experience and lower the cost of care to improve quality and outcomes. You don’t need data to do that. All you need is to provide access to primary care at a lower unit price.”
66:00 Thompson provides parting thoughts about what it takes to be a healthcare innovator (and provides criticism for those incumbents who are lying about the value they are creating.)
Disclaimer: The information provided in this podcast is purely for educational purposes and should not be interpreted as a recommendation for a specific treatment plan, medicinal plant, or course of action for medical treatment. None of the statements or ethnobotanical information in this episode have been evaluated by the Food and Drug Administration (FDA). The purpose of the information conveyed in this podcast is simply to explore the ancient healing practices of indigenous cultures. Please consult a professional if you are considering the use of plant-based medicines.
In many ways people have become disconnected, dislocated, and dislodged from their place in the world as a result of trauma. Trauma due to physical, emotional, and sexual abuse, neglect, household dysfunction, or just everyday unmanaged stress as an important social determinant of health. These traumas can actually change the chemical makeup of the brain and increase the risk for developing certain physical ailments, including digestive problems, diabetes, chronic pain, and heart disease. Unfortunately, the American healthcare system is not effective in addressing the root causes of the chronic issues we face at a psycho-emotional level. Western culture is now looking for alternative ways to stem the epidemic of anxiety, depression, and stress we see in the modern world. Is there an opportunity in health transformation to seek alternative and ancient sources of healing medicine that finds coherence between the mind and heart and the body and the spirit?
This week we are offering our listeners with a Bonus episode to discuss the healing potential of ayahuasca. Our guest is Kevin Johnson (also known by the Q’ero people of Peru as Puma Blanco). He is a shamanic healer who has become a popular public speaker, giving presentations on consciousness, shamanism, plant medicines and psychedelics. He’s been featured in several magazines and periodicals, and has appeared on many popular podcasts including; “Tangentially Speaking” with Christopher Ryan, “The Duncan Trussell Family Hour”, “The Warrior Poet” with Aubrey Marcus, “Not Just Paleo” with Evan Brand, “Fat Burning Man” with Abel James, and “The Truth Junkie Podcast” with Kevin Bates…just to name a few. This won’t be your typical Race to Value episode. Not only are we exploring the congruency between ayahuasca and healing and the parallels between shamanism and Western medicine, but we will also be learning about the Q’ero people of Peru who have a special relationship with the planet and an approach to energy balancing that maybe we could all learn from.
If you have an open mind and an open heart, you will find this conversation to be quite enlightening and informative as people around the world are retracing the ancient pathways of shamanism, the oldest spiritual practice of healing on the planet. So let’s now hear from Kevin Johnson, who is joining us for this special bonus episode of the Race to Value!
Episode Bookmarks:
01:30 Trauma as an overlooked social determinant of health that leads to chronic disease.
02:30 Introduction to Kevin (Puma Blanco) Johnson – a shamanic healer and popular public speaker on the topics of consciousness, shamanism, plant medicines, and psychedelics.
03:00 The healing potential of ayahuasca, parallels between shamanism and Western medicine, and the Q’ero people of Peru.
05:45 Referencing prior episode with Dr. Charles Nemeroff, the Co-Director for the Center for Psychedelic Research & Therapy.
06:00 Inspiration from Hippocrates: “The greatest medicine of all is teaching people how not to need it.” “Foolish the doctor who despises the knowledge acquired by the ancients.”
06:30 Ayahuasca is a very ancient medicine, with archaeological evidence for the consumption of ayahuasca going back at least a thousand years.
07:30 An overview of ayahuasca as a plant medicine and how it can provide healing, alleviate suffering, and enhance spirituality.
09:45 Is cultural appropriation of ayahuasca in the West necessarily a bad thing according to indigenous healers?
11:00 Celebrities like Prince Harry and Aaron Rodgers are touting the benefits of ayahuasca.
11:45 Dr. Rick Strassman was the first person in the U.S. to undertake human research with DMT (the psychoactive component of ayahuasca) and called it “The Spirit Molecule.”
12:45 Research shows that most ritualistic ayahuasca users have a shared experience with something that is deeply spiritual and mystical in nature.
13:30 “There is an intelligence behind the medicine that is directing the experience.”
14:00 “A hygienic process for psychology” — the universe has an energetic impact on human beings (positive and negative), and ayahuasca can help people purge negative energies.
15:30 Is there a potential physical healing component to ayahuasca?
16:45 The psychological healing of a ceremonial ayahuasca experience.
17:45 The “mother” can provide clarity, insight, discernment, and wisdom.
18:30 The ancient culture of the Q’ero – a Quechua-speaking community that live in one of the most remote places in the Peruvian Andes.
19:30 The Q’ero have kept their ancient teachings, secret codes and Andean cosmovision intact and alive for centuries.
20:00 The destructive nature of Western Culture that leads to domestication and conditioning that is incongruent with living as a spiritual being in Nature.
21:00 A pilgrimage to the Q’ero Nation in the Peruvian Andes and the ancient wisdom ofDon Gino Chaka-Runa.
22:00 How the Q’ero people experience happiness by living in close connection with the earth and their community.
22:45 The Mystical World of the Q’ero as “Masters of the Living Energy”
23:00 “The game is energy, and you play it through acquisition, maintenance, and investment.”
23:45 Living in reverence and harmony to the spirit of nature (Pachamama) and managing a system of living energy.
24:45 How Western culture creates physical, psychological, emotional, and spiritual sickness due to living incongruently with the natural world.
27:30 The ancient Q’ero healing principles and approach to energetics (the balance of “Sami and Hucha” – light refined energy vs. heavy dense energy).
30:00 The domestication of Western culture that leads to an atrophy of the energy system (“Poq’po”), resulting in trauma and sickness.
32:00 “We must always be in Ayni – living in sacred reciprocity.”
33:00 The Q’ero as “wisdom keepers” and their prophecy to restore ancient wisdom for the healing of the world.
33:45 The Ancient Prophecy of the Eagle and Condor and why the Q’ero moved to South America to preserve their wisdom.
36:30 A planetary realignment that shifted Earth into a new epoch and signaled the restoration of wisdom to people in the West (the people of the Eagle).
37:30 How the release of condors in California is emblematic of the fulfillment of a prophecy!
38:30 “Thoughts, words, and actions are energy. We need to control of the ways we are using our energy so that it benefits us, the people around us, and the world as a whole.”
39:45 The energetic concept of sympathetic resonance (like energy attracts like energy).
41:00 Changing the energy we address the world with to determine the outcomes of the situations in our lives.
42:00 How shamans engage with plant medicines on an energetic level to curate vibrational energies in ceremony that facilitate healing.
45:00 Are their similarities between Q’ero energy practices and other cultural practices of shamanism, mindfulness, yoga, meditation, etc.?
47:00 The optimism of ancient wisdom spreading in the West to provide more holistic healing.
48:30 Plant medicines are not a panacea. Ayahuasca is for everyone, but not everyone should drink ayahuasca or take other psychedelics.
49:30 Other ways to alter consciousness for profound transformation (e.g. floatation therapy, yoga, meditation)
50:30 A warning about bad acting shamans that can weaponize ayahuasca.
51:30 How ayahuasca tourism in South America has created a dangerous environment for healing with plant medicine.
52:30 The importance of music in ayahuasca ceremonies. Medicine songs known as Icaros can create waves of frequency to move blocked energies and repel negative energies.
53:30 “There is a lot of potential with plant medicines and psychedelics, but we must approach with wisdom and discernment. We must always keep safety in mind.”
54:00 Find out more about Kevin (Puma Blanco) and his work in the ancient practices of shamanism through Vida Brilliante.
55:00 Kevin (Puma Blanco) closes the podcast by singing an Ayahuasca Icarosthat calls the spirit of a tree.
Implementing value-based care can help providers improve patient health and reduce care costs, but it also presents the opportunity to explore new and emerging areas of research in breakthrough treatments that can revolutionize healthcare as we know it today. Embracing such a paradigm shift is for the mindful, who acknowledge that certain aspects of medicine are not working as intended. If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine. On this week’s podcast, you will learn about some of the research being done to further scientific rigor and expertise in the study of psychedelic therapy. In clinical research settings around the world, renewed investigations are taking place on the use of psychedelic substances for treating illnesses such as addiction, depression, anxiety and posttraumatic stress disorder. Psychedelics fell from medical grace nearly half a century ago, their reputation mired by associations with counterculture drug excesses and Cold War era enhanced interrogation, but now a new wave of research has returned to psychedelics as potential candidates to treat mental health disorders.
We are joined this week by Charles B. Nemeroff, M.D., Ph.D the Co-Director of The Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin. Dr. Nemeroff is one of the nation’s most influential psychiatrists and has published more than 1100 research studies, and his research is currently supported by grants by groups such as the Multidisciplinary Association of Psychedelic Studies (MAPS). His research is focused on the pathophysiology of mood and anxiety disorders with a focus on the role of child abuse and neglect as a major risk factor. He has also conducted research on the role of mood disorders as a risk factor for major medical disorders including heart disease, diabetes and cancer. At the Center for Psychedelic Research and Therapy, he aims to advance the application of psychedelics for the treatment of mental health disorders through impactful clinical research. Additionally, the center looks to improve the health of those suffering from severe depression, anxiety and PTSD through psychedelic-assisted psychotherapy and research focused heavily on military veterans and adults affected by early childhood trauma.
Episode Bookmarks:
01:30 “If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine.”
02:45 Introduction to Charles B. Nemeroff, M.D., Ph.D the Co-Director of the Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin.
04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!
05:00 The field of human-based research into psychedelic drugs has in the last ten years become a legitimate field of study, after decades of repression by governments around the world.
05:30 The renaissance of psychedelic research with renewed media and medical interest in LSD, psilocybin, MDMA, ayahuasca, DMT, and ketamine.
05:45 From the Woodstock generation to present day – Dr. Nemeroff provides an overview on this history of psychedelic research.
06:30 Early psychedelic research conducted by Timothy Leary and Ram Dass (formerly Richard Alpert) that created a spiritual awakening and captured a generation.
07:30 A research moratorium that persisted for decades until the Dr. Rick Strassmanundertook human research on N,N-dimethyltryptamine, also known as DMT.
08:00 Distinguishing recreational use for spiritual awakening vs. psychedelic-assisted treatment for serious psychiatric disorders.
08:30 How psychedelics can rip away defense mechanisms in the mind that prevent people from facing the certainty of death and other unpleasant realities.
09:30 Dr. Nemeroff discusses his medical practice specialty in the psychiatric treatment of severe PTSD and treatment-resistant depression.
10:00 Military veterans, victims of sexual trauma, victims of childhood abuse, and others with severe depression often do not respond to conventional FDA-approved treatments.
11:30 The Public Health Problem of Suicide: There are approximately 50,000 suicides each year in the United States (the only leading cause of death that is increasing in number!)
12:00 The Next Big Addiction Treatment: Substance Use Disorder (SUD) can also be effectively treated with psychedelic-assisted therapy.
13:30 The economic burden of major depressive disorder among U.S. adults is an estimated $236 billion, an increase of more than 35% since 2010!
15:00 Lack of access to care for patients with depression leads to under-treatment, whereby increasing ED utilization and driving up overall healthcare costs.
15:30 Depression is a risk factor for the development of heart disease and stroke (and is a major risk factor for poor treatment outcomes).
16:00 Carving out psychiatric treatment from most commercial health plans exacerbates access challenges.
16:30 Further access challenges posed by cash-only mental health practitioners (i.e. psychologists, psychiatrists).
18:00 Most mental health practitioners do not offer Cognitive Behavioral Therapy (CBT)(“rent a friend” mental health support is not evidence-based treatment!)
18:30 Two-thirds of patients with depression are treated in the primary care setting – lack of specialization in treatment leads to over-reliance of pharmacological interventions.
19:30 The lack of medical concordance in behavioral health therapy due to lack of familiarity with the current evidence base.
21:30 Dr. Nemeroff discusses his research in psychedelic-assisted therapy for treating military veterans and their families dealing with PTSD (see Heroic Hearts Project and The Mission Within).
23:30 How psychedelics have fundamentally changed the lives of military veterans.
24:45 The promising research from Multidisciplinary Association of Psychedelic Studies (MAPS) on MDMA treatment of PTSD.
25:00 Recent study on MDMA-assisted therapy for severe PTSD (“the largest magnitude effect benefit of the psychedelic in any psychiatric condition studied so far”).
27:00 The National Institutes of Health recently awarded a grant to scientists at Johns Hopkins University to study whether psilocybin can help people quit smoking tobacco.
27:15 Dr. Nemeroff discusses his interest in studying the use of psilocybin to treat alcohol use disorder.
28:30 Private foundation funding of study to evaluate treatment of severe depression using both psilocybin and transcranial magnetic stimulation (TMS).
30:00 The vast majority of those receiving moderate high doses of psilocybin have mystical experiences that are forever life-altering. 80-90% of people often report their psychedelic journey as one of the top 5 most meaningful and spiritual experiences in their entire life, comparing it to the birth of their first child or the death of a parent!
30:30 The classic psychedelics like mescaline, LSD, psilocybin, and DMT have effects that emerge from a particular type of serotonin receptor in the brain.
31:00 “Although psychedelics share a common pharmacological property, it is still unclear what the real mechanism of action of psychedelics actually are. We need to better understand this through research.”
31:45 “The psychedelic experience is not for the faint-hearted. It is pretty intense.”
32:30 Can non-hallucinogenic psychedelic analogs be created that block the psychedelic experience but still provide the same therapeutic benefits?
33:00 Dr. Nemeroff discusses the effects of psychedelic neuroplasticity where the brain can actually become rewired to overcome incessant fear-based thinking associated with mental health conditions.
35:30 “Psychedelics can help those suffering from PTSD and depression overcome the ‘circle of hell’ associated obsessive thought storms and irrational fear generalization.”
37:00 Given the overlapping experiences of ego dissolution and expanded consciousness between meditation and psychedelics, should we consider meditation as a core component of psychedelic therapy?
39:00 The need for medical supervision in the administration of psychedelic medicines and the importance of identifying ideal candidates for treatment.
40:00 The adverse consequences of allowing the widespread use of psychedelics to proliferate without regulation.
40:30 The US psychedelic drugs market is projected to grow from $2 billion in 2020 to $10.75 billion due to research innovation and the increasing prevalence of treatment-resistant depression and mental health disorders.
41:30 Dr. Nemeroff discusses recent psychedelic company IPO activity and the drive to commercialization.
43:00 Most promising research that will lead to immediate commercialization opportunities are MAPS (MDMA for PTSD) and Compass Pathways (psilocybin for TRD).
44:00 How much will companies charge for these new psychedelic therapies once they are approved to make them commercially viable?
45:45 How will the FDA handle the approval of psychedelic therapy in conjunction with psychotherapy?
47:15 How will Psilocybin or LSD microdosing be treated in the context of approved therapies?
48:30 Mescaline, psilocybin, and ayahuasca have be used for thousands of years, administered in cultural contexts that are ritualized with use limited to religious or healing purposes.
50:00 The ethical concern for quality assurance to provide dosing consistency of psychedelic medicines.
51:30 Personality contraindications to taking psychedelics.
52:00 Psychedelics are not drugs of abuse – no one takes them every day.
52:30 Tragic outcomes will quickly change the dialogue on the treatment potential of psychedelics. We must be careful!
53:45 The potential to provide psychedelic medicines in a controlled palliative care setting to help cancer patients deal with end of life.
The healthcare industry is facing immense financial pressure. Staffing shortages, skyrocketing labor costs, continuing supply chain disruptions, inflation, rising interest rates, and volatile markets are pressuring both revenue and expenses for provider organizations. These economic challenges, however, are an opportunity to catalyze value-based care. The promise of value in health can lift up communities through improved clinical outcomes, reduced disparities, financial rewards associated with population health, and emerging opportunities for upskilling the workforce. Now is the time to prioritize value-based care as a key strategic priority for long-term success and sustainability. There are few other health systems in the country that have demonstrated more of a longstanding commitment to transformation than Ochsner Health through its population health enterprise.
A leader in innovative healthcare delivery, Ochsner Health Network (OHN) is the accountable care network of the massive Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana (and one of the largest health systems in the Southeastern region of the US). Ochsner has 47 hospitals and more than 370 health and urgent care centers across Louisiana, Mississippi, Alabama, and the Gulf South. Ochsner Health Network – the value-based care arm of the health system –has 277 affiliated physician practices with nearly 3,500+ physicians spanning 625 locations. They are responsible for managing 406,000 lives across six risk-based, accountable care contracts in their value-based care portfolio. Through its collaborative efforts, OHN is making a difference for the nearly 1 million patients throughout Gulf South communities each year.
In this week’s episode of the Race to Value, we are engaging two incredible leaders from Ochsner Health Network (OHN). As Chief Executive Officer for OHN, Eric Gallagher is responsible for directing network and population health strategy and operations, including oversight of value-based performance management operations, population health services and care management programs, post-acute and home care strategies, value-based analytics, and OHN network development and administration. Joining him is Dr. Sidney “Beau” Raymond, the Chief Medical Officer for OHN who is board-certified by the American Board of Internal Medicine and has been on staff at Ochsner since 2016 and practicing medicine since 2000. These two leaders discuss what it takes to transform a health system in the “race to value” and how to ultimately improve the health for an entire state in the process!
Episode Bookmarks:
01:30 Ochsner Health Network (OHN) is the value-based care arm of the Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana.
02:30 Through its collaborative efforts with patients, communities and employers, OHN is caring for nearly 1 million patients in Gulf South communities.
04:00 Introduction to Eric Gallagher (CEO, OHN) and Dr. Sidney “Beau”Raymond (Chief Medical Officer, OHN)
05:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!
06:00 A recent Kaufman Hall report on the mounting pressures facing providers (e.g. staffing shortages, labor costs, supply chain disruptions, inflation, rising interest rates, volatile markets).
07:30 Eric Gallagher discusses the critical challenges of staffing shortages and the skyrocketing cost of labor.
08:30 “Staffing shortages and rising costs of labor is a critical challenge. It serves as a catalyzing environment for value-based care.”
09:30 Investments in value-based infrastructure has forged collaborative relationships within the entire system.
11:00 Dr. Raymond on how post-pandemic workforce pressures have impacted primary care access and care delivery innovation.
13:00 The number of Americans ages 65 and older is expected to more than double over the next 40 years.
14:00 Approximately 10,000 Americans are aging into Medicare each day.
15:00 The Ochsner value journey in caring for seniors — from global capitation risk in Medicare Advantage to the Ochsner Accountable Care Network (OACN) ACO.
15:30 OCN/OACN have saved CMS over $100 million in the last 5 years! (recent press release on OACN Shared Savings Results)
16:30 Ochsner Health Plan – the only Medicare Advantage plan sponsored by and fully integrated with Ochsner Health.
17:30 Oschsner 65 Plus – a new initiative consisting of freestanding, PCP value-focused clinics delivering high touch, team-based primary care for seniors.
20:00 In the last three years, OACN MSSP ACO has doubled in size to 63,000 attributed beneficiaries.
21:30 How Ochsner has improved quality results performance in the ACO and is scaling it through continued growth.
23:00 The importance of value-focused leadership in building infrastructure and culture to drive performance outcomes.
23:45 “You can’t undervalue the importance of having the talent, leadership-buy-in, and investment to drive value-based outcomes.”
26:00 How senior-level engagement and alignment creates an environment for care delivery innovation.
27:45 The elevation of value-based care to one of four pillars of success for Ochsner Health.
28:00 Hardwiring VBC success into the compensation model for both system executives and physicians in the Ochsner Health enterprise.
28:30 How primary care engagement has led to next-level partnerships with specialists in the network.
30:00 How compensation plans and bonus incentives have driven provider engagement in value-based performance.
33:00 Ochsner’s partnership with Walmart to provide integrated, coordinated, high value care for employees across Louisiana.
34:30 The importance of employer-provider partnerships in improving the health and wellness of a workforce.
35:30 Sharing of financial-risk with self-funded employer-sponsored health plans.
37:00 Negotiating PMPM prospective payment with employers for a care management team model that improves clinical outcomes.
40:00 How Ochsner has been very intentional in building a population health data infrastructure to support its partner physicians.
41:00 Using claims groupers and population-based analytics to evaluate the totality of care spend for specific patient populations.
41:45 Collaborating with partner hospitals and community physicians to democratize population health data analytics at the point-of-care.
43:00 “HIT infrastructure capability and democratization of data at the point-of-care are the dual challenges in reaching greater depths of analytical precision.”
43:45 Ochsner’s patient population: 14-percent have diabetes and 40-percent have hypertension.
44:00 Improving outcomes for patients through enrollment in the Ochsner Digital Medicine program.
46:30 The use of algorithms for personalized care interventions to better engage chronically ill patients.
47:00 Overcoming physician concerns that the use of digital medicine is competitive to in-person E&M encounters.
47:30 The digital medicine program has improved outcomes (e.g. screenings, care gap closures, patient engagement) without diminishing office-based RVUs.
48:30 Piloting digital medicine for Medicaid populations and how that has increased care access and engagement.
50:00 Digital Health as a core component of Ochsner Health’s strategy (along with value-based payment).
51:00 The role of innovationOchsner (iO) as an important think tank and lab for digital health innovation.
52:00 Piloting the Ochsner Connected Stability Fall Prevention digital health program for MA members who are the highest risk of falls.
56:30 How the Ochsner population health enterprise delivers integrated behavioral health in the primary care setting.
58:00 Virtual behavioral health integration as the next big opportunity for care delivery innovation.
59:00 The Office of Professional Well-Being at Ochsner that has been established to improve the well-being of the workforce.
60:00 The growing concern of burnout and moral injury with physicians, APPs, and other clinicians.
61:30 A conscious effort to minimize inbox messaging for providers as a way to eliminate administrative burdens that contribute to provider burnout.
62:30 Integration of pharmacists in primary care setting to help manage prescription refills.
63:30 Team-based care (e.g. social workers, nurses, care coordinators, dieticians, patient engagement specialists) as an opportunity to improve overall workforce outcomes.
66:30 Partnering with Higher Education for interprofessional upskilling opportunities (e.g. Delgado Community College partnership in training nurses and CHWs).
69:00 The Healthy State by 2030 initiative as a catalyst to improve health equity in marginalized and underserved communities in Louisiana.
71:00 Community partnerships that recognize the impact of education as an opportunity equalizer.
74:00 Parting comments on the importance of health equity as a societal priority that is a shared responsibility in communities.
The message from state and federal regulators, healthcare leaders, and our society-at-large is being heard loud and clear: Health equity is a moral imperative.
A cultural zeitgeist for health equity has been awakened in the collective consciousness of all ethnicities in the context of COVID-19 health disparities and the ongoing fight for civil rights and social justice. The economic imperative for equity is also too big to ignore, given that inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed. The future of equitable health is important to the future of our country, and we must address this moral imperative with business solutions.
Joining us this week in the Race to Value is Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator. Dr. Bhatt is the Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), Dr. Bhatt directs the research, insights, and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. He is a prominent thought leader around the issues of health equity, health care transformation, public health, and innovation.
Do you want to learn more about how we can create a catalytic engine for equitable health? Tune in to this podcast to learn from one of the nation’s leading minds on how to advance health equity through business solutions. In this episode, we discuss collaboration with life sciences and health care industry to advance health equity, digital transformation, ACO REACH, and climate-related strategies.
Episode Bookmarks:
01:30 Introduction to Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator.
03:00 Subscribe to the Race to Value weekly newsletter and leave us a review and rating on Apple podcasts!
04:30 The three root causes of health equity: 1) socioeconomic, gender, racism and other biases, 2) disparate circumstances in the drivers of health, and 3) inadequately designed healthcare systems.
06:15 Creating a catalytic engine for the future of equitable health and why the Deloitte Center for Health Solutions and The Deloitte Health Equity Institute (DHEI) are so critical to the health of this country.
06:30 “There is a workforce imperative, a market imperative, and a moral imperative for health equity. We must address the moral imperative through business solutions.”
07:00 Deloitte Report: “Inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed.”
07:30 Collaboration with life sciences and health care industry to advance health equity, digital transformation, and climate-related strategies.
08:30 Engaging key decision makers and global leaders in health equity through Deloitte’s involvement in the World Economic Forum.
09:00 Activating Boards and C-Suite leaders in health equity and implementing place-based change through community outreach and population health interventions.
09:40 Health equity innovation through an accelerator that supports minority-led non-profit organizations and social entrepreneurs.
10:00 Addressing access to maternity care deserts that contribute to inequities throughcollaboration with the March of Dimes.
10:45 A recent research report conducted by the Deloitte’s Health Equity Institute and other partners entitled, “Collection of Race and Ethnicity Data for Use by Health Plans to Advance Health Equity.”
11:45 “Continuing to analyze the delivery of care and examine patient outcomes across demographics, including race and ethnicity but also sexual orientation, gender identities, and language is critical to administering more equitable and inclusive care, and building trust with communities across America.”
12:45 “Building and sustaining trust is critical to improve the availability of high quality race and ethnicity data to advance the journey of health equity.”
13:30 The importance of proximity and lived experience, community partnerships, transparency, and assurance of patient privacy in the collection of race and ethnicity data.
14:30 Federal agencies are advancing more inclusive standards for self-reported, voluntary identification of race and ethnicity data.
14:45 “Health Equity by Design” through interoperability standards developed by the Office of the National Coordinator (ONC).
15:30 “Transparency, trust, and partnership can improve the collection and use of race and ethnicity data. If we want better results, we have to create better systems.”
16:30 Medical Home Network (MHN) – a FQHC that is one of the nation’s foremost clinically integrated and digitally connected delivery networks to improve the health of Medicaid beneficiaries in safety net communities in the Greater Chicago area.
17:45 Chicago is a city facing immense challenge in health equity. In the last decade, life expectancy has fallen for everyone except for non-Hispanic white Chicagoans.
18:30 ACO REACH explicitly identifies Equity – not just Value – as a central goal. Have other payment models perpetuated racism and structural inequities?
19:30 REACH ACOs now being required to develop a Health Equity Plan.
20:00 Dr. Bhatt speaks to the MHN FQHC model and how it contributes to improved community health outcomes.
21:00 Health Risk Assessments (HRAs) that drive the advanced application of AI and predictive analytics for targeting population health interventions in underserved communities.
21:45 Individuals with unstable housing have a life expectancy that is 27-years less than others with a stable housing situation.
22:30 “Industry collaboration is an ecosystem. The alliances we make support trust, collaboration in alternative care sites, and reduce friction to care access.”
23:00 The importance of the “Digital Front Door” and Virtual Care Delivery Transformation in value-based care.
24:00 How SCAN Health Plan educed disparities in medication adherence for cholesterol medications by 35%.
26:30 The ACO REACH payment model and a data-driven strategy will be key to designing a more equitable model for care delivery.
27:30 Translating key learnings in equity improvement through rapid cycle evaluation and improvement in action.
28:00 An example of a SDOH intervention to find improved housing for someone dealing with allergen exposure.
29:00 Seizing the moment for industry to galvanize around the advancement of health equity.
30:00 The seminal IOM Report, Unequal Treatment, that determined Black and Hispanic Americans typically receive lower quality of care—across a range of diseases—when compared to white Americans.
31:00 Referencing the recent actuarial analysis from Deloitte entitled, “Breaking the Cost Curve”
32:00 Dr. Bhatt explains why our country can no longer afford to endure systemic health inequities.
32:30 COVID-19 awakened a national consciousness for health equity.
33:00 How nonprofits, CBOs, governments, and the private sector can collaborate to overcome the challenges of the past, heal the present, and build a more resilient healthcare system for the future.
33:30 Gender equity and how placed-based change can help to identify, understand, and address social issues.
34:00 Diversity, Equity, and Inclusion (DEI) in the workforce as a key lens and driver of health equity.
34:45 Creating an ecosystem for equity through community partnerships and collaboration.
37:30 How digital tools (e.g. SMS texting, virtual care, remote patient monitoring, VR) can empower healthcare consumerism.
38:45 Creating digital literacy and improved access to broadband connectivity in underserved communities.
40:30 Designing clinical workflows and implementing training programs to avoid provider burden.
41:00 The impact of life sciences and research & development to improve diversity in clinical trials and address issues with pricing and affordability.
41:30 Referencing the 2022 Deloitte Global Life Sciences Outlook focused on health equity innovation in the life sciences sector.
42:00 Dr. Bhatt speaks about the need to improve diversity in clinical trials.
43:30 Establishing relationships with community leaders in black colleges and minority-serving institutions.
45:00 Dr. Bhatt discusses the future of Public Health and how it will overcome extreme challenges such as a decades-long backlog of funding needs and a global pandemic.
48:00 The complex relationship between climate change and health equity (climate change is now the “greatest threat” to global public health)
49:30 Dr. Bhatt on how climate change exacerbates health inequities and increases the total cost of care.
51:00 “Climate change stands out as a key force multiplier that amplifies the effects of health inequities in an exponential, non-linear way.”
53:00 Parting thoughts from Dr. Bhatt on rebuilding trust between minoritized communities and the health care sector.
Physicians are looking for novel solutions to streamline and improve care delivery in our ever-changing industry. They already don’t have enough time to do all that they want, and they are always being asked to do more! They want more time with patients, but the fee-for-service machine demands they see more patients more quickly. It’s a system that demands more and more and offers less to accomplish it.
But there is potential for more success via risk-based reimbursement in value-based programs is on the horizon. Doctors in private practice or employed by systems are excited to know that there is a way they can provide the care they’ve always envisioned, to be that caring individual who spends time getting to know and serve the patient. When they discover the possibilities in VBC they oftentimes turn to seek a partner that can help them adapt, so that they can take advantage of the opportunity to really care for patients.
This week on the Race to Value we are interviewing Dr. Keith Fernandez to discuss physician enablement and how helping doctors helps patients. Dr. Keith Fernandez is the Chief Clinical Officer of Privia Health, and CEO at Privia Quality Network South Texas, located in Arlington, Virginia and Houston, Texas, respectively. Privia Health is a national physician practice management and population health technology company that partners with leading doctors to keep people healthy, better manage disease, and to reward providers for delivering high value care. Privia is dedicated to providing value based care to its patients, and an improved lifestyle to its physicians.
Episode Bookmarks:
01:30 Creating physician enablement is key to population health success.
03:30 Introduction to Dr. Keith Fernandez, Chief Clinical Officer at Privia Health
04:45 Subscribe to the Race to Value newsletter for weekly updates on new episodes!
06:30 Establishing governance to ensure a high degree of physician engagement.
07:45 Creating a National Clinical IT Advisory Council to provide feedback on Clinical Decision Support and AI.
08:30 The impact of clinical-decision support and data at the point-of-care.
09:30 Using data to understand specific populations covered under value-based arrangements.
11:00 Surfacing data in a team-based care environment drives quality patient care.
12:00 Using technology and remote scribing to ameliorate physician burnout.
13:45 Technology tools for billing and coding to alleviate provider documentation requirements.
14:30 Providing an “unencumbered interaction between the physician and a patient” brings joy to medicine.
15:30 Supporting competency in revenue cycle management to optimize fee-for-service.
16:30 Workflow optimization in an interdisciplinary care team to support higher efficiency and improved patient outcomes.
17:45 The pandemic left independent primary care practices operating on razor thin margins.
19:00 How does stabilizing PCP finances help care teams devote more time and energy and resources to patients?
20:00 Automated technology is helping practices in fee-for-service claims appeals to improve revenue capture.
21:30 Dr. Fernandez discusses how a natural disaster during his career provided key learnings in RCM optimization.
23:45 The importance of ancillary revenue streams to support value-based contracting success.
25:00 Using a clinical research program focused on population health.
27:00 Rebuilding practices for the future through the National Physician Advisory Council at Privia Health.
28:00 Effective use of Nurse Practitioners and Physician Assistants to reach full clinical effectiveness.
30:00 Conducting a complete analysis of each practice joining a value-based network.
32:00 Onboarding contracted doctors into the population health platform.
35:00 Engaging all doctors – both PCPs and specialists – as a key to physician enablement success in VBC.
36:00 “We’re trying to empower doctors, improve their life, and help drive great care for their patients.”
36:30 Developing a Physician Leadership Program and how that leads to physician-led ACO success.
38:00 The challenges of improving Social Determinants of Health in managed patient populations.
39:30 Aligning physician compensation to value-based care performance, especially with populations that are SDOH-challenged.
41:00 Home care and remote patient monitoring to improve outcomes in underserved populations.
42:30 The role of consumerism in value-based care and how care teams should prioritize patient preferences and values.
45:00 The benefits of practicing medicine in a group and how peer learning dynamics drive VBC performance outcomes.
48:00 Convening physicians and attentively listening to their concerns will ultimately lead to operational efficiency.
50:30 “If you improve patient outcomes and satisfaction, you reduce the cost. It is a matter of fact that better care reduces the cost of care.”
52:00 “If we want to transform healthcare, we need to save money. That means we need to win on these contracts.”
52:45 Behavioral Health integration, referral management, CDS, and clinical research partnerships are future strategies for Privia Health.
54:30 Finding local partnerships in communities to address SDOH.
57:00 Evolving physician leadership in healthcare transformation as the ultimate inspiration.
Nearly 75% of Americans are overweight, including 42% who have obesity. The pandemic has heightened the problem, since many of us find comfort in food, and delivery services like Door Dash and Uber Eats make it easier than ever to consume calories while barely getting off the couch to answer the door. This obesity epidemic has huge implications on value-based care due to the impact it has on chronic morbidity, increased mortality, and unrelenting demands on the utilization of limited healthcare resources. Chronic conditions associated with obesity include, but are not limited to, type-2 diabetes, hypertension, hypercholesterolemia, and heart disease. These diseases have a destructive effect on the US healthcare system, and leaders in value-based care must start thinking about lifestyle medicine and evidence-based nutrition interventions. While there are many apps and tools for consumers or patients to use to lose weight on their own, programs that incorporate medically-assisted weight management and obesity care yield the best outcomes.
Rather than weight loss as a sidebar suggestion once a disease state is diagnosed, weight loss can be a potent catalyst for disease prevention within value-based care. Dr. Jamy Ard is the Co-Director of the Weight Management Center at Atrium Health Wake Forest Baptist. Joining him this week in the Race to Value is Rich Steinle, CEO of Carium – a technology company that partners with clinicians to offer a complete, virtual care platform ensuring every person – regardless of location, demographic or disease state – has access to quality, personalized care, education, and tools to support health and wellness goals. In this episode, we discuss the importance of partnerships between healthcare providers and technology companies to empower clinicians, patients, and their caregivers. Do you want to learn more about how real-time, aggregated health data and analytics can guide clinical decision-making in obesity? Well, this is an interview that you will not want to miss. Within a platform-enabled, virtual care ecosystem, weight management care teams can achieve positive outcomes that deliver on the promise of value-based care!
Episode Bookmarks:
01:30 An introduction to the concept of Virtual Weight Loss Management in Value-Based Care
02:00 Background on Dr. Jamy Ard (Atrium Health Wake Forest Baptist) and Rich Steinle(Carium)
03:30 Subscribe to our newsletter and leave us a Review and Rating on Apple Podcasts!
04:00 Chronic conditions associated with obesity include type-2 diabetes, hypertension, hypercholesterolemia, and heart disease.
04:45 Direct medical costs attributed to obesity account for $147 billion. Lost productivity due to obesity cost $303 billion. Adding chronic diseases make obesity a $1 Trillion problem!
06:00 Dr. Ard speaks to the economic challenges of obesity – “Obesity is a multifocal chronic relapsing disorder. It is a disease epidemic that can be addressed through patient engagement.”
07:00 The limitations of medical education in training doctors on nutrition and how to effectively treat and manage patient obesity.
08:30 Dr. Ard discusses the Weight Management Center at Atrium Health Wake Forest Baptist and the challenges with patient engagement in an obesogenic environment.
09:00 The impact of the COVID-19 pandemic on societal obesity and how technology empowers an effective patient engagement strategy.
10:00 Rich discusses the diametrically opposed reality that treating obesity is typically conducted as a prescription upon the onset of chronic disease (instead of as a prevention).
11:30 How technology can extend team-based care to provide a conduit for meaning patient engagement and treatment interventions.
12:00 Technology can be leveraged to address community health and equity, especially for patients living in food deserts.
13:00 How can a trusting business partnership between a care delivery organization and a technology company embolden relationship-based care for value transformation?
14:30 Dr. Ard on how technology can identify care gaps and then inform the agile development of intervention solutions.
15:00 “Technology doesn’t replace providers. It instead enables the provider to do more than what they can do alone.”
15:30 “A data-assisted approach to obesity care (e.g. patient-reported outcomes, physiologic monitoring) can enable personalized medicine.”
17:00 Rich outlines the tenets of relationship-based care – a common vision, trust, and innovation.
19:45 Demonstrating results with innovation can create expanded scale and reach in clinical efficacy.
21:00 How can research into the science of behavior change improve our understanding of how to influence health-related behaviors, such as diet, exercise, and medication adherence.
22:30 Lifestyle medicine as the starting point for any treatment strategy.
23:30 Uncontrollable variables in an obesogenic environment (i.e. Social Determinants of Health) determine the development of a personalized treatment strategy.
25:00 Having a trusted resource provided real-time feedback and guidance can guide better lifestyle choices.
26:30 Tailored feedback provides the opportunity for more sustainable changes (versus self-monitoring)
26:45 How automation of a “one-to-many” engagement strategy can be reinforced with individualized feedback.
27:30 The saturation of DIY health applications and how it differences from a patient-centered care model that emphasizes trusting relationships.
28:30 The real-time continuous learning of engagement algorithms used in weight management programs.
29:30 Incorporating biometric data from wearables to care management programs capturing self-reported data.
31:30 Rich on how the founders of Carium had a vision for data-enabled predictive analytics in healthcare (based on prior experience with telecommunications industry).
33:00 Creating data visualizations and actionable insights to drive value-based care outcomes.
35:00 In the conventional treatment of obesity, we often rely on a “one-size-fits-all” approach despite significant pathophysiological heterogeneity among people with obesity.
36:45 Dr. Ard provides perspective on the opportunity for precision medicine and individualized care planning in the personalized treatment of obesity.
38:00 The heterogeneity of treatment response for obesity allows for much faster realization of patient outcomes (i.e. a short-term ROI opportunity for medical cost savings)
39:30 Precision medicine and individualized care planning allows for a more effective utilization of healthcare workforce.
40:30 Rich discusses how virtual care delivery and remote patient monitoring can provide the enablement to help clinicians “deliver care at the point of life.”
41:30 White labeling or co-branding of technology supports the curation of a trusted engagement platform.
42:30 An example of how the technology relationship between Carium and Dr. Ard helped improve data capture and integrity.
43:30 The importance of shared goals between providers and technology companies.
45:00 Healthcare needs a renaissance of human experience design in technology solutions.
46:30 Moving medicine from an episodic, fee-for-service paradigm will require patient-centered technology design.
50:00 Approximately 13-percent of US households report food insecurity, meaning that they lack consistent, dependable access to enough food for active, healthy living.
51:45 Dr. Ard on how tech-enabled VBC can support the elimination of health disparities related to obesity with low-income and minoritized populations.
56:00 Rich describes how the proliferation of obesity-specific patient engagement can extend to other areas of medicine (e.g. fetal maternal health, oncology).
56:45 Technological scarcity is a social determinant of health and we must “bridge the digital divide” if it exists.
57:30 Does income fragility mean that people do not have access to smart phones and broadband access?
60:00 Are we in the beginning of a 4th Industrial Revolution where scalable disruption of our current care delivery model will occur through digital transformation?
60:45 Why hasn’t the Internet transformed healthcare like it has all other industries?
62:00 Rich discusses what the future look like in the next few years with emerging advancements in AI, internet of things, 5G, wearables, and gamification of consumer health apps.
63:00 Dr. Ard on how providers will eventually prescribe technology applications to their patients and provide automated meal planning based on context and geolocation.
This week on the Race to Value you will hear from Dr. Neil Wagle, the Chief Medical Officer at Devoted Health. This is a company we have been wanting to profile on the podcast for quite some time! Devoted Health is a healthcare company that designs Medicare Advantage plans for seniors; however, they are so much more than just a MA plan. Devoted Health has built a different model of care that starts with knowing their members on a personal level and earning their trust. By focusing on each member as a person and not as a chart, they are able to provide the best quality care for older Americans through an all-in-one healthcare solution combining the MA plan, access to high quality local providers alongside virtual and in-home care, and full-service guides—with world-class proprietary technology powering it all. This company is a leading innovator in value-based care.
Dr. Neil Wagle knows a thing or two about transforming healthcare. He is an internal-medicine physician by training, spent six years at Partners Healthcare (now Mass General Brigham) leading the health system’s efforts to improve the quality of care for patients. In 2017, he joined Devoted Health, a $12.7 billion health-insurance startup. As its chief medical officer, he’s spearheading the development of a model of care aimed at improving the health of older Americans by getting them the right care at the right time while saving costs for the US healthcare system.
In this episode, we discuss clinician burnout and moral injury, post-pandemic recalibration of the healthcare system, virtual care delivery, the benefits of a fully-integrated technology platform, health equity transformation, creating a virtual “Blue Zone”, patient-reported outcome measures, activation of chronically ill patients, and the importance of company culture in delivering relationship-based care.
Episode Bookmarks:
01:30 Introduction to Dr. Neil Wagle, the Chief Medical Officer at Devoted Health.
03:45 Dr. Wagle provides his background as a “synthesizer between medical-scientific world and the business world.”
04:15 Inspiration and mentorship from Dr. Tom Lee and being a part of Mass General Brigham’s first value-based contract.
04:45 “We’ll probably lose $70m in the first year, but we’re moving to value-based care because it is the right thing for patients.”
05:45 A chance coffee meeting with Ed Park led to the “ridiculously challenging” quest to build a system that could radically transform healthcare!
07:00 Provider burnout and moral injury is one of the major crises in healthcare (along with rising costs and inadequate care for aging Americans).
08:45 Dr. Wagle on how the pandemic has exacerbated moral injury and why we need to return to the altruistic underpinnings of medicine.
09:30 “The ability for physicians to connect with others has been decimated by overbooked 15-minute visits.”
09:45 How documentation requirements in fee-for-service medicine robs providers of “pajama time” with their families.
10:00 The Great Resignation in healthcare is being driven by the perpetuation of the fee-for-service business model.
10:30 Resolving the three crises of healthcare (i.e. Provider burnout, aging population, and rising healthcare costs) through care delivery transformation.
11:00 The good news in VBC: providers want to practice medicine in this way and patients actually have better outcomes with lower costs!
11:45 “You have to be able to monetize fewer hospitalizations. If you can’t, the value-based model of care won’t work financially.”
12:30 The emotional fuel of seeing better patient outcomes in VBC drives continual value-based care transformation.
13:00 The new wave of healthcare consumerism from the pandemic is causing a much-needed recalibration of care delivery.
14:00 “COVID exposed cracks in our fee-for-service model…”
15:45 “Value-based care is actually the ideal home for virtual care services because you don’t have to worry about over-utilization.”
16:00 Dr. Wagle describes how Devoted Health dramatically improves the health and wellbeing of Americans through person-centered care.
16:30 The “all-in-one healthcare” offering of Devoted Health as a virtual in-home medical group and MA plan, enabled by full-service guides and integrated technology.
17:30 Medicare Advantage patients receive this “all-in-one” care for free as part of their enrollment in the health plan.
17:45 Scaling a virtual care model further enhanced Devoted Health’s mission to treat members like family.
19:15 Overcoming the challenges of loss aversion in the perception of patients when adopting a virtual-first care delivery model.
20:00 The benefits of a virtual-first mentality when it comes to organizational scalability and culture.
21:30 Devoted Health has developed an end-to-end data and technology system that choreographs care delivery in a single, vertically integrated, tech-enabled model.
22:00 Dr. Wagle on the well-deserved skepticism of technology as a panacea…but how that is balanced with the practical vision of Ed and Todd Park.
22:45 Building a full-stack technology platform from the ground up was necessary (market-based solutions are based on FFS medicine and are incredibly fragmented).
23:00 Full-stack tech platform at Devoted does everything! (e.g. sales, enrollment, pharmacy, medical claims, prior authorizations, customer service, full EHR)
23:30 “Having a full-stack technology platform with all information in a single place allows us to deliver on the promise of complete, coordinated, and customized care.”
24:00 How human-centered technology design drives targeted population health interventions and personalized care delivery.
27:00 Human connection (relationship-based care) can be fostered with a full-stack technology platform because people don’t have to remember minute details.
28:00 Enabling tech-enabled rapid cycle innovation to deliver improved population health outcomes.
29:00 The challenges of defining “value-based care” and how health equity is changing how we understand value.
30:30 The historical debate about the adjustment of outcome measures to account for demographic factors.
31:00 “The world has moved to a different place where we have put a spotlight on health equity itself, rather than burying it in adjustment methodologies.”
31:45 How “Community Guides” at Devoted Health correlate the overcoming of SDOH with the Maslow Hierarchy of Needs to help members achieve full potential.
32:30 An example of how helping a member successfully enroll for public benefits can give them an extra $ 325/mo.
33:00 The development of a Health Equity Dashboard to measure their impact in closing equity gaps.
34:00 The product goal of Devoted Health is to be the world’s first virtual “blue zone” where people enjoy much longer, healthier lives than average.
35:00 “Longevity is not the ultimate goal. The first task of a health system is to make sure we treat people like family so they are happy and fulfilled.”
36:30 Dr. Wagle on what it really means to create a virtual Blue Zone at Devoted Health.
37:45 Creating the “Devoted Social Club” to help members overcome loneliness and social isolation through human connectedness and resilience tools.
39:30 Dr. Wagle on why the people and the culture is the foundation of Devoted Health.
41:30 “As we go out and look for new team members we look for experience, clinical acumen, and love in your heart.”
43:00 Caring for the clinician workforce so they can cultivate the love in their heart for the caring of others – it is a self-perpetuating phenomenon.
45:00 Keeping the mission as a “prime directive” by closing your eyes and imagining someone you love…than take action.
46:45 How Community Guides cultivate trusting relationships with members and help people overcome their mistrust of the healthcare system.
47:30 Spending time with members as an enabler of trust and empathy (e.g. a 90-minute phone call).
49:00 Trusting relationships are why Devoted Health has such a high net promoter score of 79 (higher than Apple, Netflix, and Amazon).
50:30 Starting with “Patient Priorities Care” in member engagement first…and then moving to data-enabled, rapid-cycle deployment of interventions.
51:30 Dr. Wagle discusses the importance of Patient-Reported Outcome Measures in value-based care.
54:00 6 in 10 adults have a chronic disease, and it is the leading driver of the nation’s $3.8T healthcare spend.
54:30 Dr. Wagle provides examples of how Devoted Health is making an impact in medication adherence and Hgb A1c reduction.
56:00 85% of diabetic members have their blood sugar under control, with an average A1c reduction of 2.3 within 100 days.
56:30 77% of hypertensive members now have their blood pressure under control, with an average reduction in systolic BP of 15.2 within 40 days.
57:00 Reduction of acute events related to Congestive Heart Failure by 50%.
57:45 Dr. Wagle shares an a research example of “learned helplessness” in dogs and how that behavioral pattern relates to most chronically ill patients managing their disease.
60:00 “We must relate clinical outcomes back to patient priorities. Those cycles are what capture momentum.”
61:30 Dr. Wagle discusses company growth and expansion and how Devoted Health is entering eight new states in 2023.
62:15 How will Devoted Health consistently replicate and scale as it enters into new markets at a national level?
64:00 Parting thoughts of appreciation from Dr. Wagle and how gratitude makes dreams come true in value-based care!
64:45 “Value-based care is more than possible…it is coming. The arc of history is bending towards progress, and I am grateful to be a part of that journey.”
Did you know that an estimated 80 million Americans currently lack access to dental care? As oral health is essential to the overall health and well-being of an individual, the high volume of those without access can have potentially devastating health consequences such as an increased risk of developing cardiovascular disease, respiratory disease, diabetes, and adverse pregnancy outcomes. Oral health can also influence eating habits and sleep patterns, which in turn can adversely impact both physical and mental health. And tragically, research shows that poor oral health is more common among individuals with lower income and educational attainment. And in value-based care, the growing number of emergency department visits for conditions related to poor oral health clearly shows the relationship between oral health and physical health. (There are approximately 1.8 million hospital ED visits annually for non-traumatic dental conditions which cost $3.4 billion to treat!)
We need to establish a more integrated, accessible, and equitable oral health landscape in our country. In this special episode, you will hear from a leader in the field of oral health who is working to reduce disparities in access to and quality of care. Kaz Rafia is the Chief Health Equity Officer for the CareQuest Institute for Oral Health — a leading national nonprofit focused on creating a more accessible, equitable, and integrated oral health system. At CareQuest, he leads strategic initiatives to advance access to integrated oral health care for ethnically and socially diverse communities. He is someone definitely leading us in this Race to Value!
If you like what you hear, you can also access a companion blog to this episode entitled, “Why Oral Health is Critical in a Value-Based System” brought to you by the Institute for Advancing Health Value and the CareQuest Institute for Oral Health!
Episode Bookmarks:
01:30 An estimated 80 million Americans currently lack access to dental care.
01:45 Lack of dental care can lead to devastating health consequences and an increased risk of developing chronic disease.
02:30 Introduction to Kaz Rafia and the CareQuest Institute for Oral Health
03:30 Companion blog to this episode: “Why Oral Health is Critical in a Value-Based System”
04:30 The link between oral health and community health.
06:30 Kaz speaks about the work that CareQuest is doing in building alliances to create a more accessible, equitable, and integrated oral health system.
07:00 “The inability of a person to receive oral health care is a clear threat to their overall health far beyond the mouth.”
07:30 Chronic periodontitis results in a higher risk of developing Alzheimer’s disease.
07:45 Oral care is a key intervention for reducing the risk of aspiration pneumonia.
08:00 The link between poor oral health and adverse birth outcomes.
08:30 CareQuest has developed MORE Care to integrate oral health capabilities into a person-centered primary care model.
09:30 Community Oral Health Transformation (COrHT) initiative and framework for safety net dental clinics to transform oral health care delivery.
11:00 Health disparities data showing that oral health varies across racial and socioeconomic lines.
12:00 Drivers for lack of access to dental care include geographic isolation, lack of transportation, and poverty.
13:00 How poor Medicaid reimbursement and “provider clustering” due to compensation economics contributes to oral health disparities.
14:00 Black adults are 68% more likely than white adults to have unmet dental care needs.
14:30 Dental coverage gaps contributing to oral health disparities in rural communities.
15:30 Alabama is now the only state currently lacking adult dental care benefits in Medicaid.
16:00 “The work done to evangelize value-based care models in dental care are reducing barriers to access nationally.”
17:30 World Health Organization recognition of dental care as a fundamental human right and their landmark global strategy on oral health.
18:30 Kaz discusses the importance of value-based care in oral health and how we define it.
19:00 Examples from Sweden and other countries on how to provide universal access to dental care.
19:45 The use of dental therapists to expand access to dental care and the recent legislative win for dental therapists to practice in Oregon.
22:00 The importance of clinical integration and how the “100 Million Mouths” campaign is integrating oral health into primary care.
23:30 Complications associated with lack of oral health, e.g. high blood pressure, diabetes, Alzheimer’s, poor pregnancy outcomes, behavioral health issues.
24:00 Research showing that medical-dental integration can enhance closure of medical care gaps.
24:30 Value-based opportunities to lower costs and improve clinical outcomes, e.g. checking Hemoglobin A1cs at dental appointments for diabetic patients.
25:30 Kaz discusses how the 100 Million Mouths campaign is integrating dental health into medical school curriculum.
26:45 There are 1.8 million hospital ED visits for non-traumatic dental conditions (NTDCs), which cost $3.4 billion to treat.
28:00 Kaz discusses the financial impact of non-traumatic dental conditions and how trends in ED utilization for NTDCs relate to social determinants of health.
29:00 Out-of-pocket expenditures are 40% of overall dental care spending and how this contributes to lack of optimal oral health outcomes.
30:30 “Accrued interest” that occurs when delays in front-end dental care treatment and prevention results in costly ED visits.
31:00 NTDC-related ED visits costs 3X what a regular dental visit would cost.
31:45 90% of NTDC-related visits are only given treatment for pain and then referred back to the dentist!
33:00 The mouth horror scene in Cast Away and how that relates to the millions of people facing access challenges to dental care!
33:30 6 million adults lost their dental insurance during the COVID-19 pandemic!
35:00 Kaz discusses the impact of the pandemic on dental care delivery and the potential for telehealth innovation in the long-term.
37:00 Teledentistry as a successful modality for triaging care needs to avoid unnecessary ED visits.
38:00 Investments to scale a value-based care infrastructure for oral health.
40:00 Kaz discusses the recent progress being made by CMS to include dental benefits coverage in the Medicare program.
42:00 “Oral health care is, in fact, health care.” – Kaz explains why preventive dental care coverage makes sense in value-based care transformation!
44:00 Anti-Racism in Dental Public Health: A Call to Action and the recent CareQuest collaboration to expand research in this area.
45:00 “Racism is a public health epidemic, and having difficult conversations is a key ingredient to change.”
46:30 “Being anti-racist is not a zero-sum game that takes away from anyone else. It is about the betterment of our society.”
49:00 Investing in Health Equity Innovation – how CareQuest Innovation Partners through a new initiative called SMILE Health will scale early-stage startups.
50:00 How do we effectively invest in health equity in a sustainable and meaningful way?
54:00 A recent CareQuest Institute survey revealed that more than half (51%) of oral health providers surveyed had never heard of APMs in dentistry.
55:30 Kaz on the importance of understanding the past to envision a more optimistic future for value-based care.
57:30 “The misnomer of dental insurance is that it seems more like a luxury than an absolute need and human right to ensure population health.”
59:00 nspiration from Michael Leavitt in the building of alliances to impact health inequities and low value care.
Paying it forward begins in the heart. Leaders who use their gifts in the service to others are those who understand that value given is value added.
By every measure of success, Dr. Shawn Griffin has become one of the most impactful physician executives in value-based care transformation. And his story is all about how he recognized his unique gifts and built amazing teams to improve population health outcomes. Additionally, his sharing of best practices and key learnings with others across the country – through peer learning and mentorship – has amplified impact in improving the lives of others. The host of this podcast, Eric Weaver, was one of the people impacted by the mentorship of Dr. Shawn Griffin. His mentorship inspired Eric to make a difference as an evangelist for a better way of delivering care in this country.
In this episode, you will gain access to an in-depth conversation with Dr. Shawn Griffin, the President and CEO of URAC. You will be inspired by his servant leadership in the pursuit of value-based medicine, and you will learn of his career path from rural physician to one of the leading physician executives in the country. We discuss the important of team-based care delivery and primary care transformation. We also cover such important topics as healthcare accreditation, quality improvement, rural health care, pharmacy integration, technology innovation, and genomics-based care.
The truest measure of a leader is whether they are generous, have a big heart, and pay it forward. Dr. Shawn Griffin is the quintessence of this type of servant leadership in the race to value!
Episode Bookmarks:
01:30 Introduction to Dr. Shawn Griffin, the President and CEO at URAC
04:00 Eric shares a personal extension of gratitude to Dr. Griffin for the mentorship he provided years ago.
06:45 Dr. Griffin describes his journey in value-based care, beginning in the early days of practicing rural family medicine.
08:00 The United States is an outlier in that Primary Care is not at the center of medical care delivery.
08:45 A decision to impact more lives by taking on leadership roles in system design and care delivery transformation.
09:30 How love for family and others manifested into a commitment to patient care quality.
10:30 Building an effective Population Health Team at Memorial Hermann ACO during his leadership tenure.
11:00 The importance of effective storytelling and celebrating wins to drive value transformation.
12:00 “One has to decide in life if they are going to use their gifts to help themselves or help others.” (how VBC leadership is Dr. Griffin’s way of paying it forward)
12:45 The impact of constantly changing health policy on ACO success (and how frustration led Dr. Griffin to make a difference at a federal level).
13:30 How mentorship and teaching in value-based medicine can transform care delivery on a national scale.
17:00 Dr. Griffin explains the importance of accreditation programs and how URAC was founded to set standards in healthcare.
19:00 Specialty Pharmacy Services Accreditation as an example of standard setting to drive quality improvement.
20:00 Telehealth Accreditation and how “Telemedicine is more than just a good camera. It is good quality medical care using technology to do it.”
21:00 “Raising the bar and advancing the quality mission as things change is what accreditation should be doing.” (Reference video on revamping telehealth accreditation)
22:00 Why an accredited program (e.g. URAC Gold Star) provides a basis for a patient to validate their trust in the care provided.
23:00 Dr. Griffin discusses how URAC accreditation is driving care delivery redesign across the world (e.g. Egypt and Saudi Arabia).
25:00 The challenges of defining health care quality.
26:30 “Measuring quality is an ongoing unsolved problem in health care.”
27:30 The power of a trusting patient-provider relationship in care quality and how patient definitions differ.
28:30 The limitations of HEDIS measures.
29:30 Quality measurement data capture at the point-of-care is a major contributor to provider burnout (“checking the boxes”)
32:00 “Most of us have better information available on picking a hotel in Paris than we do selecting a high quality primary care provider.”
34:00 Realigning incentives to get more medical students to practice family medicine in rural communities.
35:00 The role of the federal government to ensure adequate access to primary care in rural areas.
36:00 The crushing economic pressures on rural hospitals.
36:30 “We talk about food deserts in cities. We have provider deserts in the country.”
37:30 “If we are concerned about providing electric charging options for someone’s Tesla crossing the country, perhaps a bigger concern is whether you can receive healthcare in rural parts of the country.”
40:00 Dr. Griffin on opportunity for pharmacy integration and team-based care.
41:00 “One of the good things about medicine in the last 40 years is the recognition that a ‘captain of the ship’ model is not sustainable for doctors or patients. Team-based care is the way to go.”
42:30 The role that URAC is playing in Pharmacy Accreditation and Rare Disease Certification.
45:30 Dr. Griffin on the importance of data liquidity and information sharing in value transformation.
47:00 How concerns about HIPAA compliance (a “HIPAA-chondriac”) can contribute to the problem of data siloing.
47:30 “More data is not always better for physicians. Technology will not always make health care better. A relationship will do more for a person’s health.”
49:00 Balancing Population Health Management with Targeted, Individualized Interventions (examples such as Kaiser Permanente, Intermountain, UPMC).
52:30 Dr. Griffin discusses how the pandemic shifted consumer demand for telemedicine and what we should expect for telehealth delivery in the future.
54:00 Behavioral health telemedicine visits are effective. Pre-surgical screening for heart transplants does not work with telemedicine.
55:00 The “Telemedicine Tug-of-War” going on nationally and why we must always consider the most appropriate application of technology.
56:00 Convenience doesn’t trump quality.
57:00 Telemedicine, Remote Patient Monitoring, Wearables, ML/AI – these will not suddenly make healthcare the “Garden of Eden” overnight.
58:30 Parting thoughts on genomics-driven care and individualized-care planning in a population health model.
59:00 A patient’s Walmart receipts are more valuable to a physician than genomic data.
60:00 Screening genomics for hereditary diseases are scaling as costs come down, but we still cannot discount the impact of lifestyle choices on health.
63:00 How to find out more about URAC and the importance of peer learning and sharing of best practices.
Did you know that musculoskeletal care is one of the biggest challenges facing the value transformation of healthcare? Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade! Many of these procedures (such as knee replacements and spinal fusions) contribute to overspending on care that is not even needed, as it has been estimated that only 50% of MSK procedures are evidence-based. The rising costs ofmusculoskeletal care is now a top cost driver for employers and health plans. Yet despite rising costs, MSK outcomes for members haven’t gotten better over the last ten years. Studies have shown that, despite a dramatic increase in health care expenditures for patients with back and neck problems over the last decade, there has not been a corresponding improvement in patient clinical outcomes. In short, spending more money has not correlated with better outcomes. We are in dire need of a value-based revolution in the provision of musculoskeletal care. The current system is clearly broken. Studies have demonstrated that common approaches to MSK care (surgery, imaging, injections, opioids) do not effectively resolve back and joint pain. And the challenges of escalating costs associated with such low value are too big to ignore.
There is a better way, and this week on the Race to Value, we interview two of the leading innovators in orthopedic value-based care! In this special episode, we will begin with an interview with Dr. Kevin Bozic, the chair of surgery and perioperative care at the Dell Medical School at The University of Texas at Austin. He is an internationally recognized leader in orthopedic surgery and value-based health care payment and delivery models and currently serves on the Board of Directors for the American Academy of Orthopaedic Surgeons – a clear signal from the AAOS that the specialty is moving into the value-based care arena. Our second interview on the podcast is with Dr. Kian Raiszadeh, the CEO and Co-Founder of Livara and SpineZone, an orthopedic surgeon who has created an innovative orthopedic care management system for payors, providers, and health systems to unify the patient experience and transition to orthopedic value-based care.
Episode Bookmarks:
01:30 Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade!
01:45 It has been estimated that only 50% of MSK procedures are evidence-based.
02:00 Increased MSK spending in healthcare not associated with a corresponding improvement in patient clinical outcomes.
03:00 Introduction to Kevin Bozic, M.D., MBA and Kian Raiszadeh, M.D.
03:45 Upcoming conference in value-based orthopedics – OVBC on January 26th-28th
05:00 At the Musculoskeletal Institute at UT Health Austin, Dr. Bozic has created a MSK Integrated Practice Unit.
06:30 Dr. Bozic provides an overview of the Musculoskeletal Institute and how it functions as an Integrated Practice Unit.
07:30 “The vast majority of patients with musculoskeletal conditions do not require or benefit from surgery.”
08:00 The role of the primary care in treating MSK disease within a “musculoskeletal medical home”.
08:45 Comorbid conditions with chronic MSK disease (e.g. anxiety, depression, obesity) are rarely treated in a non-integrated model.
09:45 Holistic integration of primary care-based orthopedic physicians, APPs, physical therapists, dieticians, and social workers.
12:30 Dr. Bozic discusses the potential for condition-based bundled payments in the treatment of MSK disease.
13:45 The role of bundled payment care pathways in lowering overall costs with better clinical outcomes.
14:00 How reduction of inpatient post-acute care can result in lower episode spend with “no detrimental impact on patient outcomes.”
15:00 The big value opportunity — addressing the continuum of care across the spectrum of disease (not just focusing on the surgery).
16:00 Redesigning MSK delivery for optimizing outcomes associated with pain, functional status, and quality of life.
16:30 “Value is all about improving health outcomes in ways that over time reduce the cost of health care. Health is inherently less expensive than disease.”
17:00 The Value Institute for Health and Care and its work in improving health outcomes. (Reference podcast with Elizabeth Teisberg).
19:00 Dr. Bozic discusses the important of patient-reported outcomes (PROs) and how they are used in his musculoskeletal IPU.
20:45 How PROs provide an understanding of a patient’s baseline for pain, functional status, quality of life, and mental health.
23:30 Dr. Bozic provides his parting thoughts on physician leadership in the progression of VBC and the role that AAOS will play in this movement.
26:45 Dr. Raiszadeh and his founding of SpineZone and Livara to reverse the trend of overutilization in orthopedic care through integrated care delivery.
29:30 Dr. Raiszadeh provides perspective on the lack of value-based care from his years of practicing as an orthopedic surgeon.
31:00 “We can create a radically new patient experience in orthopedics allows patients to heal without surgical intervention.”
33:30 Dr. Raiszadeh describes the concept of Orthopedic Whole Health and how it evaluates patients comprehensively from the top-down.
35:30 The impact of obesity, anxiety, and depression on hormonal physiology that affects how patient sense musculoskeletal pain.
36:30 “MSK pain is like the canary in the coalmine. It is giving us an indication of something that is deeper, and that is what Orthopedic Whole Health addresses.”
37:30 The life altering perspective of orthopedic whole health and how this model can be built to scale.
38:00 Transitioning orthopedic care from a biomedical to a biopsychosocial model.
39:00 In the 1990’s, doctors began to view pain as a fifth vital sign, and they over-prescribed opioids (without focusing on safer and more holistic interventions).
40:00 Dr. Raiszadeh discusses the Bio Psychosocial Model of Pain Management in value-based care.
41:30 60-70% of orthopedic patients experience some degree of anxiety, depression, or shame and anger associated with childhood trauma.
42:30 How 1:1 and group sessions, expressive writing, and meditation can be used in MSK treatment.
43:30 Opioid dependency and risks of addiction in orthopedic care.
45:00 “How you feel is the overall foundation of health. It changes our entire chemical environment.”
46:00 The rise of consumerism in orthopedic care and how SpineZone’s consumer-centric model boasts an industry-leading net promoter score of 94.
47:30 Dr. Raiszadeh provides his insights about orthopedic consumerism and how to change a patient’s mindset for MSK treatment.
49:30 How orthopedic consumerism and bio psychosocial care aligns with employer expectations for risk-based payment.
50:30 Creating a MSK model that is non-transactional and opens one up to all aspects of life.
51:45 The launch of Livara – an orthopedic care management system to transition to value-based care at scale.
53:00 Using cost and clinical outcomes data to build a scalable platform that applies to all of orthopedics.
54:30 Leveraging data-driven algorithms to drive diagnosis and value-based care interventions.
57:00 Parting thoughts on the movement to value-based orthopedic care.
For all of you leaders out there on a value-based care journey, it is not lost on any of you that health value has become synonymous with health equity. We are at an inflection point in our society in the recognition that everyone needs a fair and just opportunity to attain their highest level of health. Achieving this will require ongoing societal efforts to address injustice, overcoming socioeconomic barriers to health, and eliminating preventable health disparities. But we cannot do that as a healthcare industry without the proliferation and scale of payment models that align incentives so we can realize true change for the better. On the Race to Value this week, you will hear from one of the foremost leaders on the national scene who is shaping the landscape for accountable care delivery that can advances health equity.
Dr. Dora Hughes is someone who has taken this charge to lead in service to the underserved so that we may realize the dream of a more equitable and healthy society. She is the chief medical officer at the CMS Innovation Center at the Centers for Medicare & Medicaid Services (otherwise known as CMMI). She leads the Center’s work on health equity, provides clinical leadership and input on models, serves as the Innovation Center’s primary liaison with medical and clinical stakeholders, and provides leadership to the Innovation Center’s clinician community. In addition, Dr. Hughes is part of the CMS Innovation Center’s Senior Leadership Team, helping to provide enterprise-level leadership and strategic direction to the Center. In this interview, we discuss the elevated national consciousness to advance health equity, how ACOs and other risk bearing entities can succeed with a health equity strategy, and the work being done by the Innovation Center to redesign alternative payment models for equity. We spend considerable time discussing ACO REACH and value-based Medicaid transformation as well. This is certainly a conversation you should listen to as you plan for success in your Race to Value!
Episode Bookmarks:
01:30 Health Value has become synonymous with Health Equity — everyone needs a fair and just opportunity to attain their highest level of health.
02:30 Introduction to Dora Hughes, M.D., M.P.H., the chief medical officer at the CMS Innovation Center (CMMI)
04:30 If you control for all variables that may contribute to health disparities, African Americans still get the worst quality of healthcare of any demographic in the country.
05:30 The first pillar of CMS’ Strategy Plan is Health Equity
06:30 Cara James, Ph.D., president and CEO of Grantmakers in Health: “I’m someone who’s working on equity before it became cool to work on equity.”
07:00 Referencing the seminal findings of the Heckler Report in the 1980s that investigated racial and ethnic disparities in the United States.
08:00 Momentum has been building towards addressing health inequities, despite the historical lack of national prioritization.
08:30 “It really took the pandemic and police brutality to blast the issues of health inequities into the national consciousness.”
09:00 Disparities go beyond COVID (e.g. black disparities in maternal health, colorectal cancer, kidney disease)
09:45 “Executive pay is now being tied to reduction in disparities. You wouldn’t have heard that 10 years ago or even perhaps five years ago.”
10:00 Referencing CCSQ Deputy Jean Moody-Williams: “For those of us engaged in health equity, this is our moment, but it is only a moment.”
10:30 Actions Needed: collecting and analyzing demographic and health data, knowing patients individually and at the population level, identifying disparities, implementing evidence-based interventions.
11:45 “It takes vibrancy, resiliency, and an indomitable spirit to tackle disparities and scale progress at a national level.”
13:00 CMMI’s work to address Social Determinants of Health (SDOH), e.g. ACOs, Accountable Health Communities (AHC) Model
14:30 80% of what contributes to health reflects non-medical or social determinants of health (e.g. healthy eating, stable housing, educational economic opportunity, jobs)
15:00 “To maximize our patients health, we as providers have to think about our role both inside and outside the health system.”
15:45 The revolutionary nature of the AHC model in fostering healthcare and community partnerships to plan SDOH interventions.
16:30 Results from the AHC Model showing a 9% reduction in emergency department use among participants.
17:00 “Our understanding of healthcare has evolved. We are not going to be able to achieve our health goals without addressing health related social needs.”
17:30 The flaw of Medicare FFS that does not allow providers to code for SDOH interventions.
18:00 The flexibility of MA benefit design and capitated payments in advanced Medicare APMs supports hiring of social workers and CHWs.
18:45 Dr. Hughes responds to criticism from providers that SDOH interventions are “out of my lane” when it comes to health care delivery.
19:30 The need for health policies to address food deserts, lack of affordable housing, weak transportation infrastructure, etc. at the community level.
20:00 Dr. Hughes describes how CMS and other agencies are working to support culturally-competent and linguistically-appropriate care.
20:45 Resources: “A Physician’s Practical Guide to Implementing Culturally Competent Care” (CMS), “Think Cultural Health” (OMH), and “Multicultural Health Care” (NCQA)
22:00 Is implicit bias within current payment models contributing to health inequities?
24:00 Referencing Dr. Hughes’ and Melissa Majerol’s recent blog in Health Affairs: “CMS Innovation Center Tackles Implicit Bias”
25:00 How the estimated glomerular filtration rate (eGFR) leads to erroneous results and findings of kidney disease in African Americans.
26:00 Another example of how a heart disease risk calculator may incorporate racial bias into diagnosis of disease.
27:30 Identifying potential sources of bias before the launch of new payment models.
29:30 The longstanding history of bipartisan support for the movement to VBC and accountable care.
30:00 The 2021 performance year marks the fifth consecutive year that the MSSP has generated net positive savings to CMS. (See recent Race to Value podcast and Institute Brief)
31:30 Dr. Hughes responds to concerns about the reduced growth and participation in the Medicare ACO program and how this challenge is addressed in the CMMI Strategy Refresh.
33:00 Addressing health equity and ACO growth through external partnerships like the Health Care Payment Learning & Action Network (LAN) and provider site visits.
35:00 Developing a CMS-wide vision for Accountable Care expansion (Referencing recent NEJM Article on “Expanding Accountable Care’s Reach among Medicare Beneficiaries”)
35:45 The ACO program is a chassis for testing innovation center models in achieving 2030 accountable care goals.
36:00 CMS has proposed scaling successful features of the ACO Investment Model (AIM)and will leverage ACO REACH more broadly in years to come.
37:30 The ACO REACH program unlike other APMs to date, has made health equity a bedrock of payment model design.
39:30 Dr. Hughes on healthcare complexity, PCP and specialist fragmentation, and the challenges of reforming the system to better care for underserved communities.
41:00 MSSP ACOs and ACO REACH models are helping providers coordinate care and improve health outcomes for Medicare beneficiaries.
42:30 How the ACO REACH model provides flexibility to healthcare providers in how they deliver and they coordinate care (e.g. telehealth, diabetes preventive care, dental care, pharmacy integration)
44:30 “ACO REACH is forging new ways to address the health inequities underserved communities experience.”
44:45 Health Equity Action Planning and Health Equity Benchmark Adjustments under ACO REACH.
46:00 Dr. Hughes addresses concerns expressed by critics of the ACO REACH model.
50:30 Dr. Hughes provides perspective on CMS’s newly refined eligibility criteria and design characteristics for ACO REACH and why it matters to advance health equity.
55:45 Dr. Hughes discusses the work that CMS is doing to advance accountable care to Medicaid beneficiaries and how they are engaging with safety-net providers.
62:00 Parting thoughts from Dr. Hughes on how CMMI is engaging beneficiaries and caregivers in conceptualizing, designing, and testing payment models.
The Quadruple Aim of physician satisfaction is such an important aspect of value-based care. In the predominant world of fee-for-service reimbursement, physicians are struggling and burned out. Consequently, over half of all doctors won’t even recommend medicine as a career. This negative shift in wellbeing is important to understand because the attitudes and feelings of doctors bear directly on the way they treat patients. A recent Harvard report calls physician burnout “a public health crisis that urgently demands action.” Some physicians are even going as far as to say the profession is dealing with moral injury because the word “burnout” is insulting and insufficient in describing the pain they feel when the fee-for-service system prevents doctors from doing what’s right, thereby forcing them to inflict harm on patients – where physicians themselves experience a form of injury.
The business of fee-for-service medicine continues to get in the way of physicians healing patients. It breaks the spirit and the heart of our physician workforce, and it is imperative that physicians become empowered to lead a system transformation. Value-based care will be a losing effort if we do now cultivate physician wellbeing in the value journey.
In this podcast, you will hear from three physician thought leaders about the plight of physician burnout and its impact in advancing the aims of the value-based care movement. Most importantly, you will learn the tools necessary to transform organizational culture to ameliorate this important workforce challenge.
Speakers:
– Dike Drummond, M.D., CEO, Physician Coach & Speaker, TheHappyMD.com
– Moshe Cohn, M.D., Associate and Advisor, Moral Injury of Healthcare
– Amadeo Cabral, M.D., President, Turning Point Healthcare Consultants
Sponsored by: VBCExhibitHall.com (VBCEH)
Episode Bookmarks:
01:30 The differentiation between physician burnout and moral injury.
02:15 “Physicians need to heal in order to provide their best care for patients.”
03:00 Moral injury is a symptom of something larger – our broken health care system.
04:00 Introduction to Drs. Drummond, Cohn, and Cabral
05:45 Physician burnout and moral injury is a leadership failure.
06:30 Dr. Drummond provides context for why the physician workforce is suffering.
07:30 “The business of fee-for-service medicine gets in the way of physicians healing patients. It breaks our spirit and breaks our heart.”
07:45 “Burnout is a symptom of overwhelm in a physician that cares about what they do, when their purest expression of healer, helper, and light worker is blocked.”
08:15 Burnout is a physician impairment when it comes to ensuring quality and patient satisfaction.
08:45 Dr. Cohn explains the concept of why “language really matters” in communicating the public health crisis of physician burnout.
10:00 How physician moral injury is related to a clinical diagnosis of PTSD.
11:00 The leadership need for healthcare executives to address the repeated moral injury of their physician workforce.
12:30 How physician burnout differs from burnout we observe in other facets of the non-healthcare workforce.
13:15 The repeated barriers imposed by a system that prevents physicians in getting patients what they need to get better.
14:00 Dr. Cabral explains how the “slow boiling” public health emergency of physician burnout differs from more explosive public health emergencies like COVID-19.
15:00 Referencing confirmatory research (e.g. New York Times, Advisory Board) on the incongruence between the business of medicine and relationship-based care.
15:30 “Healthcare is not a broken “business” model — it is a broken “health care” model. It is imperative that physicians are at the table to lead a transformation.”
16:00 How do we get the incentives of business and medicine to merge into a congruent state?
17:30 The “canary in the coalmine” – physician suicides are signaling that something is wrong with the overall healthcare system.
18:00 An interesting dialogue about how Don Berwick posed an expansion to the Quadruple Aim as an apology for the Triple Aim.
19:00 Dr. Cabral on how true Value-Based Care (a wellness model) is a solution for physician wellbeing which can sometimes differ from the business model of VBC.
20:30 Dr. Cohn discusses the need a better definition for “Value” and why the Triple Aim does a disservice to the industry when the overall cost model is broken.
22:30 “As a physician, the only thing we really care about is patient outcomes. However, our outcomes are now mostly centered on checking boxes.”
24:20 Dr. Drummond reflects on the need for physicians to carve out a more rewarding practice in the reality of their business model.
24:45 Does capitation actually produce a healthier physician workplace with better patient outcomes?
26:30 The need for non-physician administrators to respect the healing encounter. (How many leaders regularly shadow their doctors?)
28:30 Dr. Cohn reflects on how investment levels prioritize societal importance (in relation to pediatrician compensation, mental health, education)
29:30 Dr. Cabral on how other countries are able to better align the incentives of their health care systems.
30:30 The physician burden of meeting end-of-life treatment expectations with heroic interventions that are costly (profitable) and result in poor quality of life.
31:45 The “classically American” problem of patients seeking low value care at end of life. (How does this factor into value-based care?)
32:45 “Eighty-percent of the hospital beds in our country are unnecessary if we granted our society the ability to determine what is a reasonable and unreasonable investment in quality of life.”
33:00 Dr. Cohn compares the current healthcare delivery system to a “fast food” model influenced by big money and advertising.
34:00 Advancements in technology and innovation in healthcare does not mean that we can fix everything that is wrong with patients.
36:15 Dr. Cabral discusses how patient satisfaction scores are being weaponized against providers.
37:30 The need for quality measures to translate into quality outcomes. (The misalignment leads to “check the box” medicine and weaponization against physicians.)
39:30 Dr. Cohn tells the painful story of a pediatric patient with a terminal brain bleed that led him to the realization of how administrators value documentation over human emotion.
41:30 Dr. Drummond explains how patient satisfaction should never be 100% (unless you are a criminal!)
42:00 “A true value journey requires a culture of provider support and a proactive burnout prevention strategy.”
42:30 The need for a super-majority value-based revenue tipping point in a contracting portfolio to bring about true cultural change.
43:45 Dr. Cabral on how the $4T American healthcare system spends 30% on administration (compared to 9-10% in other countries).
44:15 Healthcare Job Growth since 1970’s: 200% for providers and 3500% for non-clinical providers!
46:00 Drs. Cabral and Cohn speak about the monolithic structure of medical education that is over 100 years old and why that is a barrier to team-based care.
48:30 Dr. Drummond on how there are no leadership classes in medical school or residency (leadership is instead learned once practicing in a broken industry).
50:00 Dr. Drummond references Team Care Medicine, Dr. Jim Jerzak, and Dr. Corey Lyon as leading exemplars in team-based care models.
51:00 Dr. Cabral on how physicians “crossing the schism” into leadership often imposes unrealistic meeting expectations (unless the practice of medicine is completely abandoned).
52:45 Dr. Cohn on how healthcare leaders takes physicians for granted (referencing “The Daily Exploitation of Medical Staff” by Danielle Ofri)
54:00 Dr. Drummond – Should I go the extra mile for a patient if the organization gets in my way and it is unhealthy for me and my family?
55:30 Parting thoughts from our guests on implementing strategies to cultivate physician wellness.
Are you ready for the risk-based tsunami on the horizon? If you are a frequent listener to this show, you understand just how seismic this shift to value-based care really is and why we need the right culture, people, processes — fueled by capital – to spawn care delivery innovation. It is in reimagining care delivery that we can truly deliver on the aims of improved outcomes, lower cost, better patient experience, and equity for all populations. Joining us in this Race to Value this week are two outstanding leaders in the value movement, Drs. Brian Silverstein and Yates Lennon. We discuss how organizations should be preparing for the risk-based tsunami on the horizon through care delivery innovation.
Dr. Brian Silverstein is the Chief Population Health Officer for Innovaccer, a leading healthcare technology company committed to helping healthcare care as one. He is an expert in value-based care delivery and health system transformation with vast experience in helping providers improve population health initiatives. And joining him in this interview is Dr. Yates Lennon, the President of CHESS Health Solutions – a population health MSO empowering physicians and health systems to make the transition to value-based care. Dr. Lennon has extensive experience in quality, practice transformation, and physician engagement and has been instrumental in teaching health systems and providers across the country how to transform patient care and shift to value-based payment. If you are looking to understand the state and science of value-based care, look no further than this conversation with two of the leading minds in industry transformation!
Episode Bookmarks:
01:30 The seismic shift towards value-based care and the risk-based tsunami on the horizon.
02:00 Introduction to Dr. Brian Silverstein and Dr. Yates Lennon
04:30 Progressing in the value journey by understanding the landscape
05:45 Dr. Lennon provides an overview of the value ecosystem with varying adoption of risk in provider organizations.
07:00 “The days of sitting on the sideline are running out. It is time to get started with value-based care if you haven’t already.”
08:00 The State and Science of Digital Maturity at U.S. Healthcare Providers (a recent report from Frost & Sullivan, commissioned by Innovaccer)
09:30 Dr. Silverstein on the legitimacy of the value movement with perspective on how digital infrastructure impacts the pacing of adoption.
10:45 The differentiation of the technology stack utilized by providers accepting full risk-based payment.
12:00 Traversing the value landscape with emerging changes in payment model design focused on the reduction of health disparities.
13:30 Dr. Lennon on how VBP and population health technology tools are perfectly suited to address problems in health disparities.
14:00 Codifying the health equity design of the ACO REACH payment model into operational programs.
14:30 Ensuring access to care in a medical home – an example from Atrium Health Wake Forest Baptist
15:30 “Access is important in value-based care when attempting to address health equity.”
16:00 Focusing on the quality and performance improvement measures that can improve equity.
16:30 Clinical workflow optimization and the use of Community Health Workers to conduct patient outreach.
17:00 Leveraging community resources to address Social Determinants of Health (SDOH).
17:30 findhelp (formerly Aunt Bertha) and Unite Us as examples of technology platforms that can improve SDOH interventions and community partnerships.
18:15 Lifestyle coaching to improve health outcomes with dual eligible populations.
19:00 Dr. Silverstein explains how traditional healthcare will not able to improve population health outcomes in a silo.
20:00 The correlation between a patient’s zip code and their overall health and wellbeing.
20:30 Dr. Lennon provides perspective on how the creativity of value-based care will improve models for patient engagement and care delivery.
21:30 Organizations that are in a “payment straddle” trying to figure out where the fee-for-service curve and the value curves can intersect.
22:30 Capitalizing on both FFS and VBC through Annual Wellness Visits (AWVs), Advanced Care Planning (ACP), Chronic Care Management (CCM), and Transitional Care Management (TCM).
24:45 “I can’t emphasize enough how important providing patient access is for primary care physicians in value-based care.”
25:30 The importance of coding and documentation in risk stratification and compliance.
26:00 Making quality “second nature” by leveraging teams to close care gaps.
26:45 The challenges of finding a competent workforce and retaining physician independence to ensure care delivery innovation.
28:30 The plight of primary care and the struggle to retain independence.
29:00 Referencing recent article from Dr. Mai Pham on how a hybrid payment model will be a lifeline for primary care physicians.
30:00 Dr. Silverstein discusses the inherent complexity of value transformation and the importance of local market dynamics and the art of timing.
32:00 Dr. Lennon on the climate for value-based payment in the North Carolina market and PCP considerations to reach a critical mass in value.
33:00 Should independent PCPs consideration a physician aggregation model to pool lives and access capital?
34:00 Managing contract availability with available cash flow and the timing of investment decisions.
34:45 The difficulties of ensuring holistic patient care delivery while simultaneously maximizing fee-for-service revenue.
37:00 Dr. Lennon discusses the insufficiency of Risk Adjustment in truly understanding the needs of vulnerable populations.
38:00 Educating providers on risk adjustment coding on the connection between good patient care and financial accountability.
39:30 Optimizing an EHR workflow for risk adjustment data capture and clinical data visualizations at the point-of-care.
40:45 Dr. Silverstein on the importance of accurate risk adjustment coding to appropriately plan population health interventions.
42:00 Dr. Lennon discusses the need to importance of coding accuracy to eliminate compliance scrutiny.
42:30 The shift in changing the mindset of FQHCs to focus on diagnosis code specificity.
43:00 How point-of-care tools embedded in the EHR can improve risk adjustment data capture.
43:45 “EMRs and digitization in patient care is just the beginning – not the end state.” (referencing the use of transaction engines from other industries)
44:30 Focusing more on patient care than the sophistication of tech stacks will ensure long-term success.
45:30 Are mandated risk-based payment models the right thing to do in ensuring value-based care adoption?
47:00 Dr. Silverstein on the “multi-level complex Chess” of payment model innovation and provider adoption.
48:30 Dr. Lennon speaks against the mandating of APMs in the current healthcare delivery environment.
49:00 The beauty of the natural progression of value-based care innovation at the physician-level.
50:30 Dr. Lennon reflects on the inability of fee-for-service to create sustainable population health models.
52:30 Drs. Lennon and Silverstein speak about controversies associated with Medicare Advantage upcoding and potential abuses in value-related plans.
55:30 Why don’t we shift the industry coverage of Medicare Advantage to the benefits and opportunities of the program?
57:30 The burdensome regulations that hinder those providers who are not the bad actors. (ex: the SNF 3-Day rule, home-based infusions)
60:00 Referencing recent report from Morning Consult, commissioned by Innovaccer onThe State and Science of Value-Based Care.
61:45 Parting thoughts from Drs. Lennon and Silverstein on the moral imperative of value transformation.
The Health Care Payment Learning & Action Network (HCP LAN or LAN) is an active group of public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate our care system’s adoption of alternative payment models (APMs). The LAN mobilizes payers, providers, purchasers, patients, product manufacturers, policymakers, and others in a shared mission to lower care costs, improve patient experiences and outcomes, reduce the barriers to APM participation, and promote shared accountability.
Last month the LAN held their 2022 Summit, and this year’s event featured appearances by CMS and CMS Innovation Center leadership, the release of the 2022 APM Measurement Effort results, a discussion on the HEAT’s Social Risk Adjustment Guidance for APMs, and the announcement of the LAN’s 2030 APM Adoption Goals for Medicare, Medicaid, and commercial plans. Joining us this week in the Race to Value are LAN Executive Forum Co-Chairs, Dr. Judy Zerzan-Thul and Dr. Mark McClellan. They discuss the overall goal of the LAN and the LAN Summit is to collaborate and act on strategies that will accelerate the transition to innovative, patient-centered payment models by focusing on equity, access to high-quality and affordable care, engagement of patients, and reduced provider burden.
https://www.advancinghealthvalue.org/hpclan_summit_22/
Visit the Institute for Advancing Health Value’s website.
- Download their recently released Intelligence Brief summarizing the 2022 LAN Summit.
Visit the LAN’s website:
- Learn more about 2020 & 2021 APM Measurement Efforts
- Consult the HEAT’s APM Design Guidance – Advancing Health Equity Through APMs
Episode Bookmarks:
01:30 The purpose of the Health Care Payment Learning & Action Network (HCP LAN)
03:00 Introduction to Dr. Mark McClellan and Dr. Judy Zerzan-Thul
05:45 Dr. Mark McClellan speaks to the impact of the pandemic on value-based health reforms
06:45 “Payment flexibilities are one of the unsung heroes in the pandemic when it comes to value transformation.”
07:15 How capitation enabled some to navigate the pandemic favorably, while others struggled with FFS revenue disruption, team-based care, and telehealth deployment.
08:45 CMS payment flexibilities will soon go away so prepare for continued focus on patient-longitudinal well-being and outcomes tracking.
09:45 The especially challenging times of high inflation and workforce resilience and how value transformation is a strategy for sustainability.
12:00 Dr. Zerzan-Thul speaks about the Accountable Care Commitment Curve and how that can guide organizations to advancements in Health Equity.
13:30 The LAN’s Health Equity Advisory Team (HEAT) and its recommendations for developing a Health Equity action plan.
14:30 Measuring equity outcomes through an enhanced data infrastructure and community partnerships.
15:45 Dr. McClellan speaks to how Social Risk Adjustment (SRA) can advance health equity through APMs (starting with ACO REACH)
17:30 The challenges of implicit biases in individual measures of social risk.
18:15 “Risk factors like food insecurity and transportation will eventually get more built in to our approach to health care.”
19:00 The additional considerations of community engagement, peer transformation, and other payment incentives to advance health equity.
20:30 The recent release of the APM Measurement Effort (survey data compiled the HCP LAN).
21:30 Dr. McClellan discusses the current status of 2022 APM adoption (see interactive graphic showing that nearly 20% of payments flowing through Category 3B-4 models.)
24:30 Dr. Zerzan-Thul comments on trajectory of APM adoption and current status of Medicaid transformation in population-based payment.
27:00 Dr. McClellan discusses the Accountable Care Commitment Curve more at length.
29:00 “You can’t get to a critical mass of value transformation in the U.S. healthcare system without multistakeholder alignment.”
30:00 Dr. Zerzan-Thul speaks to what state agencies like the Washington State Health Care Authority can do to move healthcare organizations along the Commitment Curve.
31:00 Examples of legislative tools in Washington State that are advancing value-based payment and collaboration.
33:00 Data and transparency – how do we measure progress in health equity and value transformation?
34:30 Dr. Zerzan-Thul speaks about the work LAN is doing with State Transformation Collaboratives (STCs) (see Summit video on State Transformation)
35:00 Primary care transformation and multi-payer alignment as the starting points to transform healthcare at the state-level.
36:00 The impact of the economic downturn and Medicaid transformation in states moving to value.
37:00 Dr. McClellan on the importance of state leaders (e.g. policymakers, employers) to reform healthcare.
38:30 The STC pilot states (Arkansas, Colorado, California, North Carolina) are working closely with CMS in reaching their value-based care goals.
39:30 Key directional alignment between CMS and states will reshape health policy at the federal level.
41:45 Dr. Zerzan-Thul discusses the importance of FQHCs as “safety net” providers and how they can transition to APMs.
42:45 Oregon, Colorado, and Washington are leading states in FQHC adoption of APMs.
43:30 Dr. McClellan on how Medicaid payment shifts in Washington State are bringing more affordable and accountable care to patients.
46:00 Dr. McClellan discusses the strategic importance of multi-payer alignment in the national movement to value-based care.
49:00 Reducing care variation and supporting more efficient processes in delivering care across disparate populations.
50:00 Dr. Zerzan-Thul on how multi-payer alignment of quality measures can lead state-level value transformation efforts.
51:00 “We are asking payers to align on paying primary care at a Level 4 level, and we have commitments from payers to do that.”
52:00 Data aggregation and exchange at the state-level.
52:30 Certifying advanced primary care at a centralized level as a means to direct payment transformation.
53:15 Engaging health plans in various states to adopt and scale APMs in the transition away from FFS.
55:00 How the LAN, in partnership with states, are engaging purchasers in the commercial market.
56:30 Dr. McClellan on how to get patients to understand “accountable care” or “value-based care” by delivering on our goals.
58:00 “Value-based care is not a privatization plot of Traditional Medicare.”
59:00 Paying for “health” can help with the reduction of chronic diseases.
59:30 The political pressures of disrupting the status quo in healthcare.
60:00 The importance of effective storytelling in value-based care success as a way to inform legislators.
61:30 Dr. Zerzan-Thul on how the U.S. is 4% of the world’s population but spends half of the $8T global spend on healthcare services.
62:30 How do we measure whether people are getting person-centered care? (We need patient-reported outcomes in addition to CAHPs.)
65:00 Dr. McClellan on the imbalances of healthcare worker supply and demand.
63:30 Capital investments in value-based care are going towards digital transformation and upskilling of the workforce.
65:30 “The biggest challenge in the movement to value-based care is the workforce.”
67:30 Dr. Zerzan-Thul speaks about the challenging demands of managing the workforce pipeline for behavioral health professionals.
68:00 The importance of team-based care (everyone) in guiding us to the health care that we want.
69:20 APMs and the work of the LAN is key to building a better workforce and improving health care!
Equitable and accessible care must ensure appropriate and optimal use of medications since nearly 70 percent of clinician visits involve drug therapies. However, each year there are an estimated 275,000 deaths and $528.4 billion wasted in the US due to suboptimal medication use through inaccurate prescribing, medication errors, adverse drug reactions, skipped doses, or treatment failures.
Given that most therapeutic options for the treatment of illness involve pharmaceutical interventions, we must find a way to maximize medication benefits and mitigate harm. That promise for a more patient-centered approach to optimize medication use can be found through Comprehensive Medication Management (CMM). The GTMRx Institute defines CMM as: “The standard of care that ensures each patient’s medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.”
Joining us this week on Race to Value are three amazing thought leaders who recently wrote a Health Affairs article on how CMM should be integrated within value-based care delivery:
- Katie Capps, is co-founder, executive director and board member of the Washington-based Get the Medications Right Institute (GTMRx) and founder and president of Health2 Resources, a national health care project management and consulting firm practicing in the Washington area for nearly 23 years. At GTMRx, Capps collaborates with fellow board members to develop and execute the Institute’s strategy, bringing together critical stakeholders to focus on appropriate use of medications and gene therapies.
- Michael Barr, MD, MBA, MACP, FRCP – Dr. Michael Barr is a mission-driven physician executive with 35+ years of clinical and leadership experience is founder and president of MEDIS, a health care consulting company which provides customized, client-driven services and support for health care organizations and the dedicated professionals who deliver care to people. In addition, he is the executive physician advisor at GTMRx.
- M. Shawn McFarland, Pharm.D., FCCP, BCACP — Dr. McFarland is the National Program Manager VA Clinical Pharmacy at Veterans Health Administration in Washington D.C. In the past, Dr. McFarland was responsible for the direction of clinical pharmacy services within the Tennessee Valley Health Care System.
In this episode, we discuss the role of CMM in value-based care, the importance of interprofessional collaboration, CMM implementation strategies, CMM use cases, HIT infrastructure requirements, pharmacoequity, and value-based payment reforms needed for CMM adoption growth and sustainability.
Episode Bookmarks:
01:30 Nearly 70 percent of clinician visits involve drug therapies; however, there are an estimated 275,000 deaths and $528.4 billion wasted due to suboptimal medication use.
04:00 Introduction to Dr. Michael Barr, M. Shawn McFarland, Pharm D., and Katie Capps (and their recent Health Article on CMM and VBC)
07:00 Katie defines Comprehensive Medication Management (CMM).
07:45 Dr. Barr further explains that CMM helps provide “better care for people” and the work GTMRx Institute is doing to bring much-needed attention to it.
09:00 Katie outlines the multitude of problems in care delivery associated with the inappropriate use of medications (e.g. polypharmacy issues, adverse events, high costs)
10:00 The important role of a clinical pharmacist working in close collaboration with physicians.
10:30 Shawn discusses the success of CMM in the Veterans Affairs system.
13:45 Shawn describes the confusion about the role of the pharmacist and how CMM can expand the profession.
15:00 The role of the pharmacist in interprofessional, team-based care and how CMM relates to winning teams in football.
16:45 “When we integrate a pharmacist on a care team to provide CMM, we provide the utmost benefit to patients and can win together by improving outcomes.”
17:30 CMM services have an estimated 12:1 return on investment when used for patients with chronic conditions. (Referencing Fairview Case Study)
18:45 Dr. Barr describes his prior experiences with team-based care with a clinical pharmacist.
20:00 Katie describes how a winning strategy for interprofessional, team-based care is to appropriately define roles.
21:45 USC School of Pharmacy study that shows 87% of patients receiving CMM reached their blood pressure targets within 45-days.
22:45 “Adding a clinical pharmacist to the interprofessional team makes sense from a clinical and economic perspective – and it is a more humane way to manage medication needs.”
25:30 Shawn outlines the three components of successful CMM implementation.
25:45 #1 Success Strategy: “Philosophy of Practice”
26:30 #2 Success Strategy: “Fidelity to the Practice Management components CMM”
28:00 CMM Practice Management Assessment Tool
28:40 #3 Success Strategy: “Well-Defined Patient Care Process”
30:30 Katie references the multitude of free CMM resources that are available through GTMRx (GTMRx Resource Page on Value-Based Care)
31:20 The confusion between CMM and MTM
32:00 Dr. Barr discusses the importance of trust in interprofessional, team-based care delivery and the need to make CMM broadly available.
33:00 Katie describes how trust brings about success in performance measurement and accountability.
35:00 Shawn provides an example of how the VA incorporates patient experience into the delivery of CMM services.
37:00 How the VA enhanced patient access – creating an additional 3 weeks of provider availability – by implementing CMM.
38:30 “CMM occurs over the journey of healthcare – not just in the 30-minute patient appointment.”
40:30 The extensive studies that show how pharmacist integration improves clinical outcomes.
41:00 How CMM decreases provider burnout and improves patient satisfaction.
42:45 Dr. Barr explains how clinical pharmacist integration can impact on CAHPs scores, HEDIS measure performance, and overall Medicare Advantage Stars Ratings.
44:15 Katie references the GTMRx Library of CMM Use Cases and further explains how Fairview Health received 12:1 ROI on CMM and lowered overall healthcare costs by 31.5%
46:00 The HealthPartners CMM Use Case showing 3.5 ROI with $1,268 PMPM healthcare cost reduction.
49:00 The Four Formative Pillars: Top Health IT Capabilities that will Improve Comprehensive Medication Management
49:30 Dr. Barr speaks to how CMM success is at the mercy of a sophisticated data infrastructure.
52:20 How important is Artificial Intelligence in CMM?
53:00 Katie on the importance of liberating actionable data at the point-of-care.
54:00 Identifying all drug therapy problems (not just those related to one medical condition).
54:45 Creating a care plan, that includes medication management, in collaboration with patients.
55:30 Shawn provides an example of how the VA creates automated dashboards for recommending patients to CMM.
58:00 Recent JACCP issue on pharmacoequity and how equitable medication use is paramount to eliminating health disparities.
59:00 Dr. Barr discusses the intersection of health equity and Comprehensive Medication Management.
60:30 The origin of the term “pharmacoequity” by Dr. Utibe Essien as a policy prescription for reducing health disparities.
61:00 Shawn discusses the integration of health equity within the VA system.
65:00 Katie on why a common definition for CMM is important for value-based payment policy reforms.
66:00 Shawn provides an in-depth explanation comparing CMM vs. MTM (Patient-focused process vs. medication-focused activity)
68:20 The Medicare Modernization Act was an early attempt to promote CMM, but it fell short.
69:00 Katie on why value-based payment needs to evolve to a point where care teams are directly reimbursed for CMM services.
70:20 “Value-based payment models are optimal for the provision and sustainability of CMM.”
72:00 Measuring the value of CMM with attributable patient outcomes measures and clinical information provided at the point-of-care.
72:30 Integrating pharmacogenomics into the CMM process to improve clinical decisionmaking.
74:00 Will the new vision for Medicare to advance accountable care and health equity by 2030 catalyze policy changes to support patient-centered CMM programs?
75:30 Focusing only on drug costs does not support access and appropriateness in medication use.
The fight over access to gender-affirming medical care for trans youths — like the fight over abortion rights and other issues at the intersection of health, politics, gender, culture and race — is impacting where Americans live, work and raise families. And it’s grown particularly acute over the past year, as conservative governors and legislators have restricted access to medical care for gender dysphoria, a condition that stems from one’s lived experience of gender being different from the sex assigned at birth. The rhetoric is leading to violence and hate, and it must be overcome through education and understanding if we are ever to regain civility in our country.
This is a special bonus episode about authentic truth, love, and compassion demonstrated with a family’s journey in gender-affirming care. Eric interviews Melissa McLaren and her transgender daughter Conner just a few days after the horrific mass shooting at a nightclub in Colorado that targeted LGBTQ individuals. Conner is a 17-year-old transgender woman, and her mother Melissa has been supportive of her gender transition since Conner expressed her preference to be a girl as a toddler. Through the support of loving parents and a health system that provided gender-affirming care, Conner was able to find her truest self and live a life of authenticity.
Episode Bookmarks: 01:30 An introduction to Melissa and Conner and their family’s journey in seeking gender-affirming care 02:30 The recent mass shooting tragedy at Club Q targeting LGBTQ individuals on the same day as Transgender Day of Remembrance (Nov. 20) 02:45 The conservative rhetoric against gender-affirming care that engenders hate and violence. 04:00 An overview of Conner’s gender transition and how Conner “would be dead today” had she not received gender-affirming care in her childhood. 05:00 Conner discusses the challenges she faced during her transition (most of it was “smooth sailing except for politicians”) 05:15 Melissa describes Conner’s gender transition since the age of 4 (she is now 17). Conner began expressing her female identity as early as 18-months old. 08:30 How a babysitter traumatized Conner as a 4-year old, stating that changing her gender was “against the Will of God” and that she would be “sent to Hell.” 09:00 Melissa begins her search for medical support to help her child overcome the emotional distress of gender dysphoria. 10:30 Gender-affirming care began with a social transition related to clothing choices. 11:30 Conner’s insistence at the age of 4 that she be identified by She/Her pronouns. 14:00 The team of medical providers that helped the McLaren family navigate the journey in age-appropriate gender-affirming care. 16:00 How mainstream media misleads the public about gender-affirming care. 16:45 The use and efficacy of puberty-blockers in pediatric gender-affirming care. 18:00 Conner describes what it was like to receive her first puberty-blocker shot (a big needle with thick serum) 19:00 The constant clinical monitoring and lab testing that coincides with puberty suppression treatment. 20:00 The patient-centeredness and family support provided in gender-affirming care. (Isn’t this what value-based care is all about?) 21:00 Patient-centered gender-affirming care is not about corralling patients into choices. It is about collaboration between the family and the medical team. 22:00 “We feel so well protected, understand the goals and how to safely get there, and what the offramps are.” 23:00 Approximately 300,000 teenagers identify as transgender, which adds up to 1-2 percent of the nation’s population within that age. 23:30 Referencing the prior Race to Value podcast, “The Truth and Beauty of Gender-Affirming Care, with Dallas Ducar” 24:00 Conservative political opposition to gender-affirming care, especially for the pediatric population, with some states saying this constitutes child abuse. 24:30 There have been hundreds of anti-trans laws res...
The need for physician leaders has never been greater. As the healthcare industry continues to undergo significant change, there is a clear opportunity for physicians with extensive administrative experience to rise up. In order to drive value-based care, physicians will need to assume leadership positions that are all too often filled by executives who do not possess medical training. In the emerging health value economy, a physician leader needs to have both medical expertise and a business acumen to succeed. However, how can physician leadership thrive when the entire profession is beleaguered, burned out, and depressed? Fee-for-service medicine is causing moral injury in the medical profession and doctors suffer immensely when the system prevents them from doing what’s best in the care of their patients. Consequently, 50% of physicians are considering a career change, and it will cost health systems upwards of $1 million to replace a physician who leaves profession. A balanced value strategy to ensure future success will ultimately require effective cultivation of both physician leadership and workforce wellness. Joining us this week on the podcast is Dr. Peter Angood, the Chief Executive Officer and President of the American Association for Physician Leadership (AAPL). AAPL focuses on maximizing the potential of physician-led, inter-professional leadership to help create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally. Since inception nearly 50 years ago, AAPL remains the only healthcare organization solely focused on providing full-service professional development offerings, an array of information resources, leadership education, and management training oriented toward the physician workforce and the organizations where physicians work or represented. AAPL CEO Dr. Peter Angood is an industry leader, a researcher that has authored over 230 publications, and he is a well-recognized international speaker on the host of issues related to physician leadership. His recent book, “All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Healthcare”, has been well received the medical profession. Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022) 03:00 Introduction to Dr. Peter Angood and the American Association for Physician Leadership (AAPL) 05:30 Defining Value-Based Care (the changing value equation and the Quintuple Aim) 07:00 Patients don’t understand the language we use to define value-based care! 08:00 Patient perspective is the most important in defining value creation in the health system. 09:00 The aspiration of person-centered care is not being realized because of system complexity. 09:30 The need for physicians to have both medical expertise and administrative experience for leadership effectiveness. 11:00 Patient-physician relationships drive the majority of care delivery. 11:30 “The medical profession does not provide physicians with adequate training or experience in leadership or management.” 12:15 Additive training beyond medical school and residency is necessary for physicians to become leaders. 13:00 Non-clinical administrators can be effective, but there is an added benefit of physician leadership. 13:45 Quality performance outcomes are 25-33% better in health systems with physician CEOs. 14:30 Health systems in the US News & World Report rankings are predominantly led by a physician CEO. 15:00 The length of the education track for physicians delays leadership impact potential. 16:15 Mutual respect between clinical and non-clinical administrators as a key to organizational success. 17:30 Value-based care experimentation (e.g. Medicare Innovation Center, employer-based risk contracts with providers) 18:00 The capitation engine is driving from groups like Oak Street Heal...
Value-Based Care is at a tipping point. But it’s not just about whether providers adopt alternative payment models (APMs) or ACOs. The real tipping point is whether traditional health systems can get on board fast enough to survive the corporate health care business that is poaching providers and patients. Corporate health care is not only unfazed by downside risk of APMs, but also have built their business models on population-based payments. The pendulum is clearly swinging away from fee-for-service and future success will be dependent on a transition strategy to APM success. Joining us this week on the Race to Value is Terry Hush, CEO and Co-Founder of Roji Health Intelligence. Terry is a health care strategist and change management expert with experience across the health care spectrum. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs. In this podcast episode, Terry discusses the impact of private equity on physician consolidation and how that landscape change will impact value-based care adoption. She also provides strategic guidance on how to build a population health infrastructure and develop a successful APM adoption strategy. Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022) 03:00 Introduction to Terry Hush (CEO and Co-Founder of Roji Health Intelligence) and Free E-Book (“Smart Guide to APM Success”) 06:00 The regulations behind value-based care – are they moving us fast enough to a tipping point? 06:30 “Private equity-backed physician medical groups, ACO enablement companies, and other corporate healthcare ventures are forcing legacy health systems to change.” 07:00 Population-based payments within APMs are predictable revenue streams for health systems. 07:30 “Going forward, the driver of VBC will be the competition between corporate interests and legacy health systems – not health policy.” 08:00 Major financial losses within national health systems are a wakeup call to reimagine care delivery as a strategy for survival. 09:00 “Health systems that do not adopt APMs will ultimately be in jeopardy and will need to start devolving unprofitable lines of services.” 10:00 The alignment of financial incentives in the overall health economy favoring value over volume are virtually non-existent. 11:30 Changing the care delivery system as a requirement for APM success with investment motivation predicated on reforming fee-for-service. 12:30 “Advanced EHR adoption is not the same as a value-based care technology adoption strategy.” 13:00 Preferred VBC technology functionalities (e.g. risk stratification, outcomes and cost driver analysis, episodes of care tracking, platform for managing patient-centric interventions) 13:30 Managing data (e.g. claims, patient-reported outcomes, biometrics, prescriptions) 14:30 Non-EHR technologies in value-based care (e.g. patient engagement, behavioral health, CRM and consumerism, virtual care and telehealth, AI, wearables) 15:30 APM adoption will often happen first before the technology infrastructure is built to adequately assess cost and risk. 16:30 Lack of connectivity between EHRs and VBC technology platforms due to data blocking and lack of advancement in FHIR interoperability. 17:00 Technology integration is the substrate of population health activities. 18:00 Unstructured EHR data that is unreportable and cannot be queried (e.g. diagnostics, cancer staging information, genomic risk data) 19:00 SDOH and health risk assessment data (how should this data be used and structured?) 19:30 Prescription drug usage and treatment plan adherence data (lack of data integration makes treatment plans ineffective) 20:45 Tracking data to determine the effects of clinical and non-clinical Interventions (e.g. community services,
How can primary care physicians retain their independence in planning for future success in value-based care? A medical practice must have access to capital to optimize physician workflow and improve patient experience; however, if it chooses the wrong partner, physicians will lose autonomy and compromise their own personal wellbeing. Privia Health is a technology-driven, national physician enablement company that is on a mission to enable doctors and their teams to focus on keeping people healthy. Their goal is to transform healthcare by enabling physicians, and they want to build the largest primary care-centric ambulatory delivery system in the country. With a healthcare provider partner base of over 3,500 providers managing 3.9 million patients across eight states and the District of Columbia, they are well on their way. And their results in value-based care are superlative, as recently demonstrated by their most recent 2021 Performance Year in the Medicare Shared Savings Program yielding $99.9 million in savings. Joining us in the Race to Value this week is Shawn Morris, the Chief Executive Officer of Privia Health. Shawn is a seasoned industry leader focused on building a platform that can transform the healthcare delivery experience for physicians and patients. He is driving initiatives to meet providers where they are on the transition to value, by building strategic partnerships with physicians, health plans, health systems, and employers to better align reimbursements to quality, affordability, patient satisfaction and provider wellbeing. In this podcast interview, you will hear from one of the leading voices in value transformation discussing such topics as risk-based contract progression, the importance of workflow optimization in supporting provider wellbeing, technology enablement based on the tenets of automation and consumer-centric innovation, effective governance and management of physician-led risk-bearing entities, bridging FFS to value through a multipayer contract portfolio, and the national movement to value-based care transformation.
Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022) 03:00 Privia Health -- a technology-driven, national physician enablement company leading in value-based care transformation. 04:00 Introduction to Shawn Morris, Chief Executive Officer – Privia Health 06:30 Privia Health has expanded its healthcare provider partner base to over 3,500 providers managing 3.9 million patients across eight states and the District of Columbia. 08:30 “Our goal is to transform healthcare by enabling physicians. We want to build the largest primary care-centric ambulatory delivery system in the country.” 09:00 Shawn describes the value-based care contract portfolio held by Privia’s physician partners. 10:00 Average practice size of a Privia Health practice is 5 clinicians. 11:00 “If you are not focused on both patient experience and provider wellbeing, you cannot achieve success in value-based care.” 11:30 The importance of understanding medical risk to run a success physician practice. 13:00 The five key elements of the Privia Platform to optimize value-based care performance. 15:00 Shawn describes the opportunity for value transformation in a physician practice landscape that is unsophisticated in managing risk. 17:00 Building hubs of transformation within states, starting with Single TIN anchor groups that are enabled by a technology and MSO wraparound capabilities. 18:00 Creating enablement for physicians by embedding insights directly into a unified EMR workflow. 19:00 The challenges of an un-optimized EMR workflow when physicians are forced to click in and out of disparate information systems. 20:00 Enabling provider access through relationship-based care and a purpose-built platform (“digital front door”) built around the tenets of consumerism.
Chronic Obstructive Pulmonary Disease (COPD) afflicts 24 million adult Americans and represents the 3rd leading cause of death. COPD is also the 5th most costly chronic disease in the US with attributable direct healthcare costs estimated at $49 billion! Given the edifice of fee-for-service payment in US healthcare, we have allowed the care of COPD patients to become fragmented and inconsistent. We continue to see care of this chronically ill population wrought with poor clinical outcomes and a high economic burden. However, we are now seeing that value-based care is beginning to catalyze COPD care delivery innovation for a more promising future!
Our guests this week our Geoff Matous and Dr. Abi Sundaramoorthy of Wellinks – a digital health company offering the first-ever integrated, virtual chronic obstructive pulmonary disease management solution. These two leaders are connecting the dots on COPD to create a constellation of care that includes pulmonary rehabilitation, personalized coaching and monitoring, and connected devices. Disruption in payment incentives have spawned care delivery innovation at Wellinks, and they are poised for further success of their platform with the promise of global capitation in ACO REACH and MA plans. Don’t miss out on the important conversation to learn how partnership and innovation can transform your healthcare organization’s COPD population health playbook strategy! Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value”(December 1, 2022) 03:00 COPD affects 24 million adults and represents the 3rd leading cause of death and the 5th most costly chronic disease in the US. 03:30 The direct healthcare costs of COPD is $49 billion (and growing!) with COPD-related hospital admissions costing upwards of $40k 04:00 Introduction to Geoff Matous and Dr. Abi Sundaramoorthy 05:00 November is National COPD Awareness Month 06:00 COPD is an Ambulatory Care Sensitive Condition (i.e. a chronic disease for which good outpatient care potentially prevent the need for hospitalization) 07:30 Balancing the population health management requirements for COPD (Coding and Documentation, Quality measures, and Cost Reduction) 08:30 Impacting patient behavioral change to impact COPD-related healthcare utilization 09:30 “COPD Total Cost of Care reduction is a significant opportunity in value-based care that has been left untouched for far too long.” 10:00 Why are we still in the early stages of COPD Care Delivery Innovation? 11:00 Employer-sponsored plans will not drive digital health innovation for improved COPD management – it must be driven by ACOs and MA plans. 12:00 Geoff speaks to the advantages of virtual-first COPD care in a risk-based payment model. 12:30 75% of the total direct COPD cost is tied to exacerbations -- how can chronic care management programs work to more effectively manage COPD patients? 14:00 Dr. Abi speaks about the challenges of health systems and ACOs developing a robust infrastructure for COPD virtual care. 15:30 43% of patients with COPD exacerbation will die within one-year of being discharged from hospital! 16:00 How the Wellinks Virtual COPD Management Solution approaches patient behavioral change. 17:30 The difference in approaches between “Pulmonary Health” and “Pulmonary Rehab” and how SDOH-based interventions can improve COPD management. 19:00 Health system attempts to help COPD patients self-manage their disease will fail if it is a “hero project” tied to temporary grant funding. 20:00 “Our call to action is to explore what can be done beyond the standard COPD care management playbook to improve patient outcomes and experience.” 21:00 99% of COPD patients have 1 comorbid condition, 87% have 3+ comorbidities! 22:00 Dr. Abi explains why COPD is a complex disease to manage and why addressing comorbidities alone will not be enough to reduce COPD exacerbations. 23:00 Behavioral health challenges associated with ...
As we look around to see what is enduring in our society, it is the work that was accomplished through loving relationships and mutual understanding. The power of love-driven leadership has the potential to change the world; and in healthcare, it can transform the lives of people undergoing immense suffering. Healthcare leaders must collaborate on solutions to overcome barriers in health equity through a deeply rooted commitment to social justice and love to improve the human condition. Leaders in population health must be willing to step forward – even if it is uncomfortable – to build a community of love that will last forever. On the Race to Value this week, we interview Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development. This is a conversation that all healthcare leaders should hear. Geoffrey engaged this interview with utmost authenticity as leader with a willingness to get in “good trouble” for speaking about the issues that many would prefer to ignore or not accept as real. In this podcast, you will learn about the power of community partnerships in improving health equity to overcome the “political determinants of health” that prevent societal progress. You will also learn about the paramount importance of workforce development and scalable educational solutions in catalyzing a transformation in care delivery and culture change that values the moral imperative of value-based care. The empowerment and education of our workforce holds the key to eliminating workforce burnout and moral injury! And lastly, you will gain perspective on love-driven leadership that can overcome toxic tribalism and hyper-polarization in our society. Geoffrey is a proponent of love-driven leadership and advocacy for our most vulnerable in society, and his leadership in health equity has been recognized at a national level. If you need inspiration to overcome the inertia in your health system towards real and impactful change, don’t miss this very important conversation! Episode Bookmarks: 01:30 Introduction to Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development. 04:00 Collaborating on solutions to overcoming barriers in health equity is informed by a deeply rooted commitment to social justice. 05:30 Geoffrey speaks about his early leadership work at Lehigh Valley Hospital-Pocono taking sojourns into homeless encampments in East Stroudsburg, Pennsylvania. 07:00 Leadership from a Hospital CEO and social justice warrior – how that led to an authentic impact in the population health of underserved communities. 08:00 Serving as Chair of the Commission’s Advisory Board to deal with homelessness – how that taught Geoffrey the “power of partnerships” 08:30 Uniting community stakeholders to eliminate stigmas and facilitate a better understanding of homelessness. 09:30 As a population health leader, you’ve got to be willing to step forward – even if it is uncomfortable. The community of love that you is built will be something you treasure forever.” 10:30 “The Health Equity Tracker” – a tool that aims to give a detailed view of health outcomes by race, ethnicity, sex, socioeconomic status, and other critical factors. 12:00 Geoffrey’s service on The National Health Equity Task Force under the leadership of Dr. Rachel Levine. 12:30 Participating in a national advocacy effort to address the disproportionate health outcomes of the COVID-19 pandemic. 14:30 The Health Equity design sprint led by Karen DeSalvo and Google to examine COVID-19’s impact on vulnerable populations. 15:00 What would it look like if we lived in a society without health disparities? – Geoffrey speaks about the power of data to knock down silos in healthcare that prevent equity. 16:00 The Leadership of David Satcher and Daniel Dawes in addressing disparities through holistic approaches to data, community, intersectionality, policy,
In this episode, we are going to discuss the impact of diagnostic errors on health equity. For patients of color, the unequal medical care and quality of the diagnosis received isn’t due to just location, education, or income. It’s also at times due to healthcare professionals’ cognitive biases, along with decades of clinical studies that examined only white, male bodies, and a lack of understanding about the social determinants of biological illnesses. The causes of poor quality diagnosis for people of color is multifactorial and is not just related to explicit or implicit racial bias, however -- lack of trust, missing data, and reduced data at the point-of-care are just a few of the other contributing factors. Although health inequities within communities of color have persisted for hundreds of years, many are just now waking up to the problem. There is now an elevated sense of awareness of health inequities in our country due to the exacerbated health outcomes triggered by COVID-19 and preexisting disparities that have been magnified under the microscope of the pandemic. If one studies history, you can easily find preexisting health inequities that took form long before COVID. It is widely accepted that the first kidnapped Africans to reach European colonies in the Americas for the purposes of slavery did so in 1619 – meaning Black health was ignored from or country’s beginning with health disparities persisting through the next 400+ years. The very foundation of the transatlantic slave trade is false medical theories of black inferiority and physical differences between blacks and whites. To better how the patient safety movement aligns with health equity, healthcare professionals should listen to Dr. Ronald Wyatt. Dr. Wyatt is one of the most renowned patient safety experts and health equity champions in this country. He is Vice-President and Patient Safety Officer at MCIC Vermont, a risk-retention group, where he leads multiple patient safety initiatives for several leading academic health systems. He is an internationally known equity, safety and quality improvement/implementation expert. Dr. Wyatt was the first co-chair of the Institute for Healthcare Improvement (IHI) Equity Advisory Group and is faculty for the IHI Pursuing Equity Initiative. After serving as the Medical Director for the US Defense Health Agency/Military Health System Patient Safety Analysis Center, he became the first medical director of The Joint Commission (TJC) Office or Quality and Patient Safety and the first patient safety officer for The Joint Commission. While at TJC, Dr. Wyatt led the team that wrote the Patient Safety Systems Chapter, contributed to Sentinel Event Alerts and created the Quick Safety publication. He served as technical advisor on the RCA2 document that has been widely adopted as a guide to completing a root cause analysis. Dr. Wyatt is a member of the ACGME Clinical Learning Environment Review committee, as well as faculty on the ACGME Disparity Collaborative. He also serves on several boards including the IHI Certified Professional in Patient Safety, the Society to Prevent Diagnostic Error and the Consumers Advocating for Patient Safety. Currently, he is faculty/advisor/coach on multiple health equity collaboratives including BCBS Massachusetts/IHI, ACGME BCBS Illinois Equity Matters, KC Learning Action Network and the Providence health system equity collaboratives. Dr. Wyatt has written and published many articles, blog pieces and chapters on patient safety, health equity/disparity and process improvement.
Episode Bookmarks: 01:30 Introduction to Dr. Ron Wyatt 04:30 The human cost of diagnostic error (patient deaths due to a diagnostic error are estimated at 40,000-80,000 per year!) 06:00 “To make the right diagnosis in a timely manner is a core quality component.” 06:30 Dr. Wyatt discusses how correct diagnoses are the link between patient safety and healthcare quality.
When you hear about value-based care, do you get tired of hearing about concepts without tangible best practices? Do you ever wish you could just acquire insights from a leader who navigated a successful value journey? If you want to learn from one of the best in the “value game”, look no further than Dr. Bill Wulf, the CEO of Central Ohio Primary Care (COPC). Dr. Wulf is a respected leader in the value movement and leads the largest physician-owned primary care group in the United States. During his leadership tenure, COPC has grown to over 480 physicians and 83 locations in central Ohio. The growth of the practice has empowered a successful value journey, with COPC caring for 75,000 senior patients in full-risk arrangements with Medicare Advantage and ACO REACH in partnership with Agilon Health (and the current move to full-risk in commercial plans with employers in partnership with Vera Whole Health). Dr. Wulf describes a value journey that has been over two decades in the making. It started with a merger in the late 90’s to create a fully-integrated primary care practice platform. And then in 2010, a Patient-Centered Medical Home (PCMH) transformation led to unprecedented success in full-risk Medicare Advantage. COPC has built upon their MA success to now partner with large employers in full-risk programs, and they are also one of the new participants in the ACO REACH program. In this interview, Dr. Wulf goes into great depth on the care delivery innovations that were made possible by prospective payment and capital investment. He discusses hospitalist and ER care coordination programs, home-based care delivery, after-hours primary care access, telehealth, onsite clinics at employer locations, and the importance of data-driven insights from a unified EHR. You will also hear about how COPC has benefited from successful partnerships to build an even more effective infrastructure for population health outcomes. Most importantly, you will hear how COPC playing the “value game” helps their independent physicians take better care of patients! Episode Bookmarks: 03:30 The origin story of Central Ohio Primary Care (COPC) – the nation’s largest independent primary care practice that is leading in VBC 05:30 Dr. Wulf describes how a practice merger in the late 90’s led a successful hospitalist program, contracting strategy, and ancillary services model 07:00 Post-merger growth of practice because of better contracting rates and ancillary services revenue 07:30 “Our growth in the last 10 years has been a result of us playing the “value game” in helping physicians take better care of patients.” 08:00 This year COPC is integrating 3 practices (30 physicians) at a time when there aren’t as many independent PCPs available. 09:00 COPC’s commitment to physician independence, where physicians have the freedom to care for their patients without interference. 09:30 Beginning the value journey through the decision to transform into a Patient Centered Medical Home (PCMH) 11:00 How physician independence leads to freedom to make data-driven referrals that improve population health outcomes. 12:00 A unified Electronic Health Record (EHR) led to the identification of the “best” doctors in the practice. 13:00 “The best physicians in the practice were not the busiest ones…but these physicians (pre-value journey) were making the least income.” 13:45 “Our best physicians were creating value for the payer, employer, and the government, but they were not recognized for value in a FFS world.” 14:30 Dr. Wulf describes how Level 3 PCMH recognition led to value creation (“a stepping stone”) 16:00 PMPM payments from commercial and MA plans led to programs that improved outcomes with high-risk patients. 16:30 COPC’s Hospitalist Program (100 physicians) and ER Care Coordination Program 17:00 Nursing care coordination that leads to effective post-discharge planning and transitions of care from the hospital.
In the uncertainty of today’s healthcare industry, we must continue to persevere towards our true north. The moral imperative to improve the quality of care for patients through better care coordination, including those are underserved, can only be achieved by the realities of the digital age. This transformation will require the medical profession to create a modernized Hippocratic Oath that extends to the broader health ecosystem. The proliferation of interoperable technology and digital health tools has the potential to catalyze value-based care delivery innovation and transparency. However, it must come along with an ethical commitment to guide data sharing, integration, and technical processes. True North will ultimately prevail in connecting value-based networks to those most in need; however, it will take continued progress in amplifying the demand signal for value-based care. On the Race to Value this week, you will hear from one of the top healthcare revolutionaries in our country. We are honored to bring you, the one and only,Aneesh Chopra - the first chief technology officer of the United States who was appointed by President Obama and the Co-Founder and President of CareJourney. In this episode, you will be party to a powerful conversation on the promise of the digital age in healthcare. You will learn about how health policy and innovation is ushering in a new era of data flow and interoperability, consumer-driven innovation, price transparency, and clinically-relevant analytics for the future of value-based care delivery transformation. Aneesh Chopra also explains why he feels so strongly why ACO REACH will help us reach True North. Episode Bookmarks: 01:30 Introduction to Aneesh Chopra - - the first Chief Technology Officer of the United States and Co-Founder and President of CareJourney 04:00 The need for the medical profession to galvanize around the immense opportunity to transform care delivery by embracing the realities of digital age. 06:30 Why do we need a digital Hippocratic Oath to transform medicine? 08:00 The gap between patients being seen on a given day and the 98% of the patient panel that are not. 08:30 Designing database queries and algorithms to Identify patients in need of care. 09:30 Creating a compact between analytics communities and physicians to ensure patients are getting appropriate care. 10:45 The self-imposed barriers to technical and semantic interoperability that come from our current FFS model. 12:00 How the HITECH Act manifested in technology gaps, despite widespread EHR penetration. 14:00 “The delay in the demand signal for value-based care resulted in the de-prioritization in the market for interoperability.” 15:30 The regulatory goals of the 21st Century Cures Act to scale interoperability and eliminate information blocking. 16:45 Cures Act regulatory emphasis on population health is now reaching the market. 17:00 FHIR Interoperability Standards will ultimately deliver on the promise of population health through widespread data exchange and API-led connectivity. 18:00 Ensuring value-based care organizations a “plug and play” approach to unify electronic health records. 19:00 The promise of widespread data exchange in value-based care delivery and how it parallels with the consumer banking industry. 20:30 Similarities between Dodd-Frank Act (banking sector) and the Cures Act (healthcare sector) in regard to consumer data protections. 22:30 JPMorgan cutting off access to Mint because screen-scraping was far less secure than API connectivity. 25:00 If value-based care became the dominant delivery model, the industry wouldn’t need so much regulatory oversight. 26:00 The Cures Act is beginning to reverse FFS-driven market failures in order to create a much more rational economic model. 27:00 Referencing the opinion piece in STAT by Aneesh Chopra and Seema Verma about the new price transparency regulations in healthcare.
The Institute for Advancing Health Value has recently released two new Intelligence Briefs highlighting two major impactful events in the movement to value-based care.
2021 MSSP Performance Results Analysis: The Institute analyzes 2021 performance data, sharing high-level program performance and examining savings across participation tracks, by the provider type, size and location of ACOs, and their experience in the program, and reflects on the future of the MSSP in light of the recently proposed changes to the program and the beginning of CMS’s new capitated total cost of care model, ACO REACH. The ACO REACH Final Cohort: The Institute analyzes the incoming final cohort of provisionally-accepted REACH ACOs within the context of the model’s history, analyzing the roster relative to GPDC’s current participants, and sharing expectations for the future. (This Intelligence Brief was sponsored by Bamboo Health.)
Check out this special bonus episode where Eric and Dan interview Kate de Lisle on her research analysis on these recent CMS announcements. You may also download these Intelligence Briefs at https://www.advancinghealthvalue.org/analysis-of-mssp-2021-and-aco-reach-2023/ Episode Bookmarks: 01:30 Download the new Institute intelligence briefs on the 2021 MSSP Performance Results and the ACO REACH Final Cohort 02:30 Background on Kate de Lisle, Senior Manager of Payment & Delivery Transformation at Leavitt Partners 04:00 Recently announced MSSP Results as an important bellwether for the success of the value movement 05:30 Total program savings of nearly $5.4 billion over the model’s lifetime 06:30 5th consecutive year of net savings – has the MSSP demonstrated proof of concept? 07:00 Was 2021 a good year for the MSSP since the net savings wasn’t quite as large as the year prior? 07:30 The average per beneficiary PMPM savings amount was $164 (double what it was in 2019) 08:00 81% of ACOs generated savings and 58% earned a Shared Savings bonus. Quality scores were also high. 08:45 89% of ACOs taking downside risk generated savings (compared to 76% that saved in an upside-only track) 09:15 Risk-bearing ACOs generated $5.3M per ACO (compared to $2.9M for non-risk bearing) 09:45 ACOs led by physician groups realized the most savings. 10:00 Hospital-led ACOs realized a decline in savings. 10:30 Years of experience in the MSSP is no longer a straightforward predictive indicator of performance success. 14:00 Last month, CMS released the names of the 110 provisionally-accepted organizations selected to join the ACO REACH model starting in 2023 15:30 Only 47% of REACH applicants were provisionally accepted. 17:30 New cohort had similar profiles of selected groups accepting Global and Professional Risk. 18:00 New entrants are serving vulnerable and high-risk populations. 19:00 Groups moving from Next Gen ACO to ACO REACH 20:30 Far fewer payer-led ACOs in the new REACH cohort 21:30 What considerations did CMS take into account when selecting for participation in the new REACH program? 22:00 Sustained interest in ACO REACH from VBP enablement companies (e.g.Aledade, agilon health) 23:30 Provider-owned enablement companies participating REACH (e.g. Castell Health) 24:30 Upstart primary care companies accepted into ACO REACH (e.g. Oak Street Health, Iora Primary Care, ChenMed, Cano Health, Cityblock, ConcertoCare) 25:00 ChenMed (a leading full-risk MA primary care practice in the country) is included in the new ACO REACH cohort. 25:30 OneMedical has also been accepted into the program. 26:30 The Institute for Advancing Health Value has a complimentary membership for provider organizations! 27:00 Will CMMI be sunsetting various APMs, including specialty care models like BPCI and CJR programs? 28:30 Kate speaks about the “weak signals” being broadcasted by CMMI around the future of the APM portfolio. 30:00 What impact will ACO REACH have on the CMS 2030 Goal?
Fee-for-service healthcare has destroyed the physician-patient relationship by de-personalizing care delivery. Patient encounters are looked at as transactions, instead of as opportunities to forge long-term healing relationships. Consequently, the healthcare system delivers inexorably bad cost and quality outcomes, and primary care is marginalized in lieu of high cost specialists who perform procedures. This has created a perfect storm for physician burnout and moral injury, and we can only regain the humanity of health care by reinstating the primacy of the physician-patient relationship and empowering independent primary care physicians. Dr. David Pak is an entrepreneurial Internal Medicine physician leader with over 25 years of direct patient care. His medical practice (Pak Medical Group) is a leading example of a patient-centered, holistic, relationship-based, tech-enabled model that is transforming the lives of seniors. Dr. Pak is an entrepreneur with masterful skill at aggregating local market physicians to build value-based models of care. He has formed an ACO and Medicare Advantage risk-bearing entity (Zenith Independent Physicians Network) that is moving primary care practices to fully-capitated risk. Dr. Pak is passionate about the personalization of primary care, technology enablement through remote patient monitoring, perpetuation of physician independence through value-based programs, and the creation of Human AI staffing support models that can transform care delivery and physician culture. While he is an expert on value-based care and care delivery innovation, he is also a proponent of medicine revisiting its roots to a more simpler time where relationships were paramount. This episode is a must-listen for entrepreneurial primary care physicians who seek independence through value-based care. By following Dr. Pak’s approach, they can reclaim their joy in medicine and propel their practices to business success in the race to value. Episode Bookmarks: 01:30 Introduction to Dr. David Pak and his healthcare ventures (Pak Medical Group, Zenith IPN, and Eleos Staffing) 04:30 Dr. Pak’s early success as a physician entrepreneur that resulted in his practice to Humana 05:30 Dr. Pak speaks to his career as an entrepreneur in creating value-based, innovative care delivery models for seniors 07:00 “Fee-for-service is a broken model that rewards bad behavior that is not conducive to good outcomes.” 08:00 Holistic patient care only occur in a full-risk medical practice. Will this lead to mandated APMs? 10:00 The explosive growth and enrollment trajectory of Medicare Advantage. 11:00 Learning how to succeed in Medicare Advantage from more advanced models in Florida. 12:15 Identifying vulnerable populations in Medicare Advantage through appropriate risk adjustment coding. 13:00 Delivering customized care delivery care models for different segments of the MA population. 14:30 The need for primary care physician autonomy and independence to overcome current financial challenges. 15:30 Is a massive corporate takeover of primary care necessary for PCPs to succeed in capitated revenue models? 18:00 Comparing PMPM reimbursement to traditional FFS reimbursement and overcoming the physician “education gap” in risk 18:45 The importance of physician leadership and education in value-based care 20:00 It is possible for PCPs to get off the “hamster wheel” (and it doesn’t require a corporate takeover) 21:30 The need for independent physicians to take on a capital partner to support their value journey. 23:00 Dr. Pak explains the importance of physician education and a robust risk-based contract portfolio. 24:00 The aggregation of primary care physicians in local markets. 25:00 “The road to value-based care should be paved by physicians…especially primary care physicians.” 25:30 The difficulties in meeting ROI expectations from PE investors and why physician aggregation is crucial to success.
Many roads will bring us to health value, but some roads will get us there faster than others. As we reimagine our nation’s healthcare system, we must build alternative avenues to value beyond the conventional fee-for-service approaches to transformation. In building a superhighway that fully unleashes the power of independent and accountable physician groups, we will produce faster and better results. Joining us this week on the Race to Value is Susan Dentzer, the President and Chief Executive Officer of America’s Physician Groups (APG), the organization of more than 335 physician practices that provide patient-centered, coordinated, and integrated care for patients while being accountable for cost and quality. APG members provide care to nearly 90 million patients nationwide and are leading this nation’s superhighway in the race to value. In this podcast episode, we discuss advanced primary care transformation, restructuring of payment models to reach scalability and impact, health policy reforms, PCP employment trends, the M&A landscape in provider consolidation, Medicare Advantage, and the power of tech-enabled asset-light care delivery.
Episode Bookmarks: 01:30 Introduction to Susan Dentzer, President and Chief Executive Officer of America’s Physician Groups (APG) 04:30 More than 60% of health care payments in 2020 included some form of quality and value component 05:30 Despite traction, moving to value at a glacial pace (reference recent surveys fromMGMA and HCP-LAN) 06:30 Susan discusses the entrenchment of FFS and how difficult it is to change the payment edifice in U.S. healthcare 09:00 Overcoming the extraordinary backlash and resistance to realigning payment incentives in American healthcare 12:00 How APG is approaching the national transition to value 13:30 The need for advanced primary care in helping CMS achieving its 2030 goal to drive accountable care 14:45 The systematic undervaluing of primary care and overemphasis on hospitalizations 16:00 How the payment structure was hijacked by proceduralists and specialty care 16:30 Clinton era health policy reforms that attempted to restructure Medicare payments to primary care 17:30 Where would we have been if we tackled primary care reimbursement and workforce challenges in the 1990’s? 18:30 Limited progress in voluntary innovation models to advance primary care effectiveness (e.g. PCMH, team-based care) 19:30 How the NHS in England created state-of-the-art primary care through 24/7 access 20:45 The private sector stepping up to modernize care delivery access and infrastructure where public policy failed 21:30 Investment in primary and secondary prevention to address chronic disease 22:00 Transitioning from a cottage industry to a well-funded, risk-based primary care strategy to improve population health 24:00 PCP employment by hospitals often not an driver of value-based care due to referral maximization objectives 24:30 Independent PCPs will need to find investment partners to advance risk-based transformation 24:45 Susan discusses the success of Central Ohio Primary Care’s partnership with agilon health 29:00 Medicare Trust Fund solvency will be depleted by 2026, but APM adoption could help avoid this fate. 30:30 “Many roads can bring you to value, but some roads will get you there faster than others.” 31:00 MACRA legislation created MIPS and APMs using the current fee-for-service chassis 31:45 The importance of the 5% bonus/incentive payments to QPP participants that are a part of Advanced APM models 32:30 Hospitals pocketing APM incentive payments for employed providers will not accelerate path to value. 32:45 Results comparison between physician-led and hospital-led ACOs 34:00 Susan explains why America’s physicians are the superhighway to Value Transformation 36:00 Capitation within the ACO REACH model as a continuation of full-risk success in Medicare Advantage 38:00 “Alternative avenues to value – beyond the conventional F...
One of the silver linings of the pandemic has, in fact, been, the expansion of telehealth services and virtual care delivery. The pandemic has also accelerated the healthcare industry’s transition from fee-for-service to value-based care. The continued growth of telehealth is fueled by providing incentives for care delivery in the lowest cost settings, identifying and interacting with highest-risk individuals before disease onset, managing care teams with more efficient workflows, and taking advantage of digital remote technologies. Virtual care is an easy and cost-effective path to achieve value-based care, thereby improving health outcomes and patient satisfaction across a broader population of patients. Our guest this week, is Dr. Carrie Nelson, the Chief Medical Officer for Amwell, a leading digital care and telemedicine company. Dr. Nelson is a seasoned physician leader committed to healthcare transformation. She has demonstrated success in innovation and change management, physician engagement, solution development and deployment, value-based care, managing and coaching other leaders and delivering results. Before joining Amwell as Chief Medical Officer and President of their Amwell Medical Group, she served as the Senior Vice President and CMO for Population Health and Health Outcomes at Advocate Aurora Health. She also served as the Chief Clinical Officer for Advocate Physician Partners, a benchmark organization known internationally for delivering value-based care in collaboration with about 5000 employed and independent physician practices. With more than 28 years’ experience as a Family Medicine provider, Dr. Nelson is an innovative physician leader with a proven track in quality improvement, patient safety and population health.
Bookmarks: 01:30 The silver lining of the pandemic is the expansion of telehealth services/virtual care delivery and the acceleration to value-based care. 02:15 Introduction to Dr. Carrie Nelson, the Chief Medical Officer for Amwell, a leading digital care and telemedicine company. 05:00 Dr. Nelson’s recent career transition from Population Health leadership at Advocate Aurora Health to a national leadership role in digital transformation and virtual care enablement. 06:00 A career in driving healthcare transformation in population health, quality, and patient safety. 06:30 The influence of “Crossing the Quality Chasm” and “To Err is Human” on awakening a healthcare transformation. 07:00 The pace of change across the country is still insufficient due to over-dependence on fee-for-service. 08:00 The consequences of poor disease control during the pandemic as a result of ineffective healthcare delivery. 08:30 The multifactorial limitations in the capacity for healthcare systems to change (e.g. culture, failure to adapt to technology) 09:00 Strong technology partnerships needed to prevent health systems from regressing back to their pre-pandemic care delivery model. 09:30 Workforce burnout in healthcare prevents sufficient time to think about system transformation. 10:30 Telehealth improves patient health, reduces overall costs of care, and improves health equity in medically underserved communities. 11:00 The plunge of telemedicine usage since the peak of the pandemic. 12:00 “During the pandemic, we largely moved brick and mortar care to online. If that is all we ever achieve, we will have fallen far short of the potential for a technologically-enabled model.” 12:30 Shawn Griffin (President and CEO of URAC) and his analogy of COVID-19 telehealth deployment to only “watching the dancing baby online” when launching the Internet. 13:00 Dr. Nelson discusses Amazon Care’s recent departure from telehealth and itsrecent acquisition of OneMedical. 13:30 Wider uses cases for telehealth and recent trends in claims activity. 14:30 Inserting new tools into the virtual visit creates healthcare transformation th...
Oprah Winfrey began her crusade to change the healthcare system when COVID-19 elevated our national awareness of health inequities in our country – a result of exacerbated health outcomes triggered by coronavirus infection across racial lines and the longstanding preexisting disparities that were already there. She launched The Color of Care education campaign to prepare current and future doctors, nurses and medical professionals to play an active role in combating systemic racism in the delivery of healthcare, as well as provide others with the necessary tools to advocate for and empower patients who experience these inequities. The Color of Care movement for more equitable healthcare in America began when Oprah Winfrey was inspired to take action following the death of Gary Fowler. In this episode, we discuss the tragic and unnecessary death of Gary Fowler inflicted by a grossly negligent and racist healthcare system. Multiple hospitals have the blood of Mr. Fowler on their hands; however, this is a story of hope in that his death started a national campaign for health equity. Oprah says the following about the death of Mr. Gary Fowler: “I read a story that haunted me…the story of the Fowler family. When Mr. Fowler became ill, three different hospitals turned him away. He went home, sat in his recliner, and died. I wondered how many different Gary Fowlers there are out there. What if I told you the biggest indicator of how long you are going to live is your zip code? What if access to lifesaving care for somebody that you love depended on the color of their skin? The COVID pandemic exposed a tragic divide in our healthcare system. We now need to stand up, and we need to do something about it. We need to change an entire system. This is something you start now! Together we can make it better.” The story of Gary Fowler’s death is the focal point of the recent documentary, The Color of Care that premiered on the Smithsonian Channel earlier this summer. From executive producer, Oprah Winfrey, this new documentary chronicles how people of color suffer from systemically substandard healthcare in the United States and how COVID-19 exposed the tragic consequences of this inequity. The Color of Care documentary traces the origins of racial health disparities to practices that began during slavery in the U.S. and continue today. Using moving testimony from those who lost loved ones to COVID-19 and frontline medical workers in overwhelmed hospitals, it interweaves expert interviews and powerful data to expose the devastating toll of embedded racism in our healthcare system. The Color of Care is produced by Harpo Productions with executive producers Oprah Winfrey, Terry Wood, and Catherine Cyr. The film is directed by OSCAR®-nominated and Emmy® award-winning director Yance Ford and produced by Kate Bolger and Yance Ford. After listening to this podcast, I urge you to watch the Color of Care to understand how the system was built, why it doesn’t work for everyone, and how together we can make it better! How to get involved and learn more!
Join the movement: https://www.thecolorofcare.org/ The Color of Care Documentary Trailer: https://www.youtube.com/watch?v=AwgNH2XsbKU Special PSA from Oprah Winfrey: https://www.youtube.com/watch?v=lD5Bpr5Qdco&t=30s Register to attend the Health Equity Virtual Summit hosted by the Institute for Advancing Health Value. We are screening The Color of Care on 11/30 and hosting a Health Equity Summit on 12/1!
https://www.advancinghealthvalue.org/population-health-equity-the-north-star-for-value/
Episode Bookmarks: 01:30 The tragic and unnecessary death of Gary Fowler inflicted by a grossly negligent and racist healthcare system. 01:45 How the death of Gary Fowler inspired Oprah Winfrey to start the The Color of Care movement for more equitable healthcare in America. 02:30 “We now need to stand up, and we need to do something about it. We need to change an entire system.
For anyone following healthcare transformation in our country, you have undoubtedly heard about ChenMed – a family-owned, primary-care physician run organization that serves a challenging patient population under a full-risk global primary care reimbursement model. This is a high touch primary care company that has become the gold standard for how healthcare should be delivered in our country. In a prior episode of Race to Value, “Changing the World through a Full-Risk Value-Based Care Model”, Dr. Gordon Chen discussed how ChenMed is delivering transformative primary care – at scale – with superior health outcomes. It was one of our best podcast episodes ever, and we invited him back to talk about the Chen family calling to care for the underserved. This week’s episode is focused on his new book (co-written with his brother Dr. Christopher Chen) entitled, “The Calling: A Memoir of Family, Faith, and the Future of Healthcare” – an inspiration for living a purpose-driven life in the attainment of value-based care. The ChenMed success story of providing care to the most vulnerable among us is really a story about an American journey of a family guided by Faith and Love. The Calling tells the inspirational story of the Chen family, which over two generations not only completed the American Dream, but also transformed American medicine. This is a story about the life experiences that shaped two generations of innovative leaders in healthcare that made ChenMed the beacon for value-based care in our nation.
Episode Bookmarks: 01:30 Introduction to ChenMed and Dr. Gordon Chen (referencing prior episode of Race to Value, “Changing the World through a Full-Risk Value-Based Care Model”) 02:30 “The Calling: A Memoir of Family, Faith, and the Future of Healthcare” – an inspiration for living a purpose-driven life in the attainment of value-based care. 04:30 Inspiration from John C. Maxwell and “The 5 Levels of Leadership” 06:45 Positional leadership is the current state of the majority of physicians in healthcare currently. 07:15 Leadership is influence – how Drs. Chris and Gordon Chen adapted their leadership to influence broad growth in others to achieve service excellence. 08:45 How Value-Based Care magnifies physician leadership 10:00 The Chens find meaning in their value-based care mission through their connection to Family and Faith 11:00 “There is no line separating our Family, our Faith, and our work at ChenMed. It all blends together in a beautiful synergy.” 12:30 “Healthcare needs to be transformed, and you must start with those in greatest need.” 13:30 How the Chen Family transcended suffering during their journey to America, experiences with poverty and homelessness, and a false cancer scare 15:45 Finding the beauty in suffering through a faith-based perspective 17:00 “Struggle produces perseverance, perseverance leads to mature character, and mature character offers hope.” 18:00 The ancient wisdom of the Chinese saying —“One to grow, one to maintain, one to lose.” 20:00 Dr. Chen on the importance of living up to one’s God-given potential. 21:00 The Chris and Gordon Chen relationship —“Iron sharpens iron, and one man sharpens another.” 22:00 The business model for ChenMed as a high-touch, relationship-based, tech-enabled primary care practice. 23:00 The early work of Dr. James Chen as an early pioneer of value-based care. 25:00 How the early struggles and suffering of Dr. James Chen shaped the ChenMed focus on serving our most vulnerable. 27:00 What is the core essence of the ChenMed model and how does relationship-based care improve care outcomes? 28:00 An excerpt from a letter written by a ChenMed physician who had recently left the fee-for-service matrix 30:00 A Physician Culture that is "A.L.L. in”—Aligned with mission, vision, and values and has Learning agility and Learning humility. 30:30 How the open learning mindset of medical students changes once they enter into practice.
If you are looking for the most egregious profiteering and fleecing of American consumers of healthcare, there is no better example than that of the giant industry of middlemen called pharmacy benefit managers – PBMs for short – that are systematically gouging American businesses. Most people are familiar with the few bad actors in the pharmaceutical industry. For example, we think of the infamous “pharma bro” Martin Shkrelli that jacked up the price of his company’s drugs – and then smirked his way through subsequent court proceedings. However, the inner workings of the drug pricing game fostered by the non-transparent PBM industry is actually a far worse scenario that it is million times bigger – and more expensive – than the games of the pharma bad actors. PBMs who collectively manage pharmacy benefits for 266 million Americans, routinely fleece American businesses using clever shell games that are the absolute antithesis of Value-Based Care. But there is good news…there is an upstart PBM – Capital Rx – that provides a more transparent, sustainable, consumer-centric, and ethical model in the administration of pharmacy benefits. Joining us this week is A.J. Loiacono, the CEO and co-founder of Capital Rx. A.J.’s company is the fastest-growing healthcare company in the country, serving more than one million lives across its customer base of payor entities, employers, unions, health systems, and municipalities. It grew by 400% in 2020 and doubled in size in 2021. Capital Rx are the “good guys” in the PBM industry – they offer a pharmacy benefits spending platform that links providers, patients, pharmacies and plans to bring cost-effective care to employers and their workforce. On average, Capital Rx saves its clients 27% on drug costs, mainly by refusing to use the industry standard model for drug costs: average wholesale price. As a result, Capital Rx has achieved a 96 NPS score, compared to the industry average of 14 in healthcare. A.J. is a visionary leader in the health value movement and was recently named an Entrepreneur Of The Year® 2022 New York Award finalist by Ernst & Young. Under A.J.’s leadership, Capital Rx is modernizing our healthcare infrastructure to reduce costs and deliver superior care, and they have the highest satisfaction scores in the industry. In this episode, A.J. provides you with an unfiltered perspective on our need to reimaging pharmacy benefits in our country. Episode Bookmarks: 01:30 Pharmacy Benefit Managers (PBMs) – the traditional PBM model is an egregious example of healthcare profiteering and consumer fleecing 02:00 The drug pricing game and non-transparent PBM industry has a far worse negative impact on society than “bad acting” in Big Pharma 02:30 Introduction to A.J. Loiacono and Capital Rx (the “good guys” in the PBM industry) 04:30 Prescription drugs are the fastest growing healthcare expenditure and consistently outpace other health spending. 05:30 Some employers devoting >30% of their health plans’ total cost of care on pharma! 06:00 Half of patients with chronic conditions take their medications as prescribed due to high drug costs. 07:45 The slow compounding effect of incremental drug price increases year over year 08:00 The higher base of drug prices in the US (compared to other nations) and how R&D is recouped by fleecing American consumers 08:30 The opaque and inefficient PBM industry as another reason for escalating prescription drug costs 09:00 Consultant and broker compensation models are misaligned with goals of cost containment. 09:30 The three largest PBMs (CVS Caremark, Express Scripts, and OptumRx) manage 80% of all prescriptions and provide no transparency. 10:00 PBMs are making sick profits from rebates and “the billing spread” 11:00 A.J. provides a comprehensive explanation of what a PBM really does and why they are more than just middlemen 13:30 “PBMs are a problem because of the non-transparent pricing model they use – not because of the inv...
Creating a value-based healthcare ecosystem with the highest quality outcomes at a reasonable cost for employers and their healthcare consumers requires collaboration. In the state of Connecticut, a grassroots community has formed with the mission to create a value-based healthcare ecosystem. The Moving to Value Alliance is a multi-stakeholder community composed of individuals, practices, and organizations deeply rooted in Connecticut’s healthcare environment. They believe that collaboration is the key to solving complex problems and are leading the way to transform healthcare delivery in their state. Joining us this week are two leaders involved in this important movement to employer-based healthcare transformation in Connecticut. With more than 35 years in the health care sector, Jeff Hogan is a consultant to payers and large provider groups for product development and launch and a resource to employers desirous of implementing strategies to manage their health spend. Lisa Trumble is the President and CEO of the Southern New England Healthcare Organization (SoNE HEALTH), a clinically integrated network comprised of six hospitals and 1,700 physicians, which is a for-profit entity owned jointly by Trinity Health Of New England and its employed and independent physicians. In this episode, we talk about healthcare transformation in the state of Connecticut, vertical and horizontal consolidation in the industry, the dysfunctional health benefits market, the need for employer alliances, leading innovators in the marketplace, value-based insurance design, prescription drug costs, healthcare consumerism, and bundled payment innovation. The time to move to value is now! We can create a transformed healthcare ecosystem through industry collaboration. Thank you, Lisa and Jeff, for showing us the way.
The need to strengthen and empower primary care, like the drive towards health equity, is one of the great causes célèbre of American healthcare. As David Blumenthal and Lovisa Gustafsson recently wrote in the Harvard Business Review: "America's health care system seems, paradoxically, both endlessly innovative and profoundly dysfunctional. On the one hand, we hear almost daily about flashy new ventures like, most recently, Amazon's recent purchase of One Medical, a large provider of primary care, that promise transformative improvements in health care efficiency, quality, and service.
On the other hand, the day-to-day performance of the U.S. health care system is an international embarrassment. The United States spends twice as much as any other high-income country on health services while its maternal mortality, infant mortality, preventable mortality, overdose deaths, levels of chronic illness, levels of obesity, and deaths from Covid-19 put it at the bottom of the pack in the developed world. The American public is awash in personal medical debt, andeven the best-connected struggle to find a primary care physician." In this week’s episode of the Race to Value, we are going to highlight the plight of primary care in the US and share real-time updates of what is actually happening in the marketplace. This important dialogue will help us understand how to improve the role, standing, supply and compensation of primary care practitioners in the US. Joining us the week is Don Crane, Former President and CEO of America’s Physicians Groups. Don recently served as the Co-Chair of the National Primary Care Transformation Summit that occurred on July 25-29th, and we will be discussing with him the key insights from this important meeting. This was an event that the Institute for Advancing Health Value proudly sponsored, along with other key groups such as the Commonwealth Fund, Heritage Provider Network, Upstream, PCORI, Equality Health, Signify Health, and other important organizations leading in the value movement. This event was made possible by our mutual friend Peter Grant, and Don served as a co-chair along with other healthcare luminaries Francois de Brantes, Dr. Clive Fields, Anne Greiner, Shawn Martin, and Elizabeth Mitchell.
Episode Bookmarks:
01:30 The need to strengthen and empower primary care, like the drive towards health equity, is one of the great causes célèbre of American healthcare.
02:00 “The American public is awash in personal medical debt, and even the best-connected struggle to find a primary care physician." (Amazon’s Foray into Primary Care Won’t be Easy)
03:00 Introduction to Don Crane, Former President and CEO of America’s Physicians Groups and the recent National Primary Care Transformation Summit
04:00 The PCT Summit had over 4,800 registrants, with 33 mini-summits, 26 plenary sessions and 150 faculty that were a veritable Who’s Who in American Healthcare!
05:00 “Staying the same is the first step to getting worse. We must change the way we do Primary Care, and the crazy ideas of today will be the genesis of breakthroughs tomorrow.” - Dr. Richard Merkin
05:30 Primary care is that no longer in the backwaters of medicine; it is now being seen as the backbone of the value movement.
06:30 Types of Primary Care: Suboptimal, Fragmented PPO Model vs. Optimal, Integrated HMO/Capitated Model
07:00 Reflections from Dr. Christopher Chen on the need for Primary Care Transformation
08:00 Primary Care Demand-Side: 96% of Medicare spend relates to individuals with multiple chronic diseases.
09:00 The need for coordination processes in primary care to improving quality and moderating costs.
09:30 Care Variation and Waste: 35% of healthcare is related to unnecessary, avoidable care that is wasteful.
10:00 The Improvement of Health as the Ultimate Goal: Better, Personal, Whole-Person Care to Prevent and Predict Disease to Reduce System Demand
There is a need for hope and innovation in the delivery of value-based oncology care. Cancer costs are on an alarming trajectory due to the aging and growth of our population. Oncology is currently the 3rd most expensive specialty, but it is growing 3X faster than the top 3 specialties. Unless we find a way to replicate and scale value-based oncology care, it will be soon be the #1 most expensive specialty! Value-based transformation in oncology is especially needed due to the high variability in cancer costs from state-to-state, as we see a 2-3X cost differential multiple between regional markets, with no correlation between cost and quality. Eliminating cancer care disparities would prevent 34% of all deaths and save $230 billion in direct medical costs and $1 trillion in indirect costs to society. Furthermore, we are seeing financial toxicity in cancer care that results in 1 in 4 patients declaring bankruptcy within 2 years of diagnosis. And on top of that, 1 in 3 Medicare patients are refusing to fill lifesaving prescriptions due to high out-of-pocket costs. This financial toxicity in cancer care is disproportionately impacting minority and low income communities, leading to increased mortality, decreased quality of life, and lower survival rates.
To find hope and innovation amidst these grim statistics, look no further than The Oncology Institute of Hope and Innovation (TOI). Their highly specialized, value-based cancer care practice delivers cutting-edge, evidence-based cancer care to a population of approximately 1.6 million patients. Oncology patients undergoing value-based care at TOI experience 40% fewer inpatient admissions, 75% fewer ER admissions, with patient satisfaction scores that are 14% higher than traditional oncology care. Joining us in the Race to Value this week is Brad Hively (CEO) and Dr. Daniel Virnich (President) from TOI – the largest oncology practices in the US. They discuss the importance of patient-centered high-quality, outcomes-based cancer care; emerging value-based oncology payment models; patient engagement and care coordination; clinical care pathways; physician compensation methodology; the importance of physician leadership in value transformation; and how to replicate growth at scale when delivery value-based oncology care.
Episode Bookmarks:
01:30 Introduction to the Oncology Institute of Hope and Innovation (TOI), Brad Hively, and Dr. Dan Virnich
03:00 TOI is the first specialty value-based care company to go public (November 2021) and has become one of the largest oncology practices in the US
04:00 The unsustainable financial trajectory of American healthcare with annual costs of cancer care ballooning to $209 billion due to aging and growth of US population
06:00 “Oncology is the 3rd most expensive specialty in the senior population, but it is growing 3X faster than the top 3 specialties. It will soon be the #1 most expensive specialty.”
07:00 “From state-to-state, there can be a 2-3X multiple difference in oncology care costs, and there is no correlation between the cost and the quality.”
07:45 How do you replicate high value oncology markets across the country? (TOI is achieving 25% lower costs in oncology care.)
08:30 85%+ of oncology revenue comes from drugs (fee-for-service practices reimbursed at cost + 6% which creates a misalignment of financial incentives)
10:00 Medicare’s new value-based Enhancing Oncology Model (EOM) that is replacing the Oncology Care Model (OCM)
11:30 Brad explains why the voluntary Oncology Care Model has not generated as much savings as Medicare initially envisioned.
12:30 Brad discusses TOI’s participation outcomes in the OCM and how they are looking forward to EOM.
13:00 EOM will be slightly more limited (e.g. few cancer types included in the program, lower upfront care coordination payments).
14:00 The enhanced focus on health equity and patient navigation with the new EOM payment model.
Primary Care in the United States is flawed, especially for our most complex patients in the Medicare program. We have built this incredibly expensive primary care model around a fee-for-service system that is incredibly fragmented and uncoordinated. There is now a need for a new model – one that yields a much better experience for patients and physicians. We now stand at the threshold a great dawning. An era is ending, and we are at the core of creation in reimagining a more idealized, value-based model for primary care – one that untaps a massive reservoir of healing capacity. This vision for “A New Primary Care Model” will transform community health for our most clinically complex and vulnerable populations. And it all starts with payment model innovation which, in turn, spawns care delivery innovation. Although we are in early days of full-risk Medicare Advantage and global capitation models in Medicare, there are leading indicators that show promise for the future of health. What exactly does a reimagined primary care model look like and how can it scale? Look no further than agilon health – a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program.
On the Race to Value this week, we are joined by Steve Sell, the Chief Executive Officer and a member of the board at agilon health. Steve leads agilon health as an experienced, mission-based CEO known for transforming organizations through partnerships, product innovations and talented, collaborative teams. With over 25 years of experience in value-based care in the health plan environment, Steve Sell is building a new model of primary care for the future. Under Steve’s leadership and guidance, agilon health is transforming health care delivery through a technology enabled, full risk value-based care model that places the primary-care physician as the quarterback of patient care. And they are doing this at scale, in geographies that have operated in a fee-for-service environment. If you are want to know more about how we can transform primary care at scale, this week’s podcast episode is a must-listen!
Episode Bookmarks:
01:30 Introduction to Steve Sell and agilon health
04:00 agilon’s growth to over 250k Medicare Advantage members and over 90k attributed Direct Contracting beneficiaries
06:30 “Primary Care in this country is really flawed. It’s been built around a FFS system that is incredibly fragmented and uncoordinated.”
07:00 The vision for “A New Primary Care Model” to transform community health that is empowered by payment model and care delivery innovation
08:00 Steve discusses the rapid growth of agilon health since its founding in 2016 (1% of all PCPs in the country, 23 communities in 12 states) and how PCP trust is built over time
09:00 Partnering with physicians to support scale and alignment in markets that have been historically dominated by FFS
09:45 “We believe that full-risk, value-based care is the best way to organize an entire community. PCPs can then move to the top of the overall delivery of care.”
10:15 The Speed of Transformation -- agilon’s intensive 12-month implementation period
10:45 Win/Win/Win (Patients, Doctors, Communities) – transformed health outcomes, satisfied primary care providers, high industry-leading Net Promoter Scores
12:00 The consumer-centric innovation opportunity in fully-delegated, capitated Medicare Advantage plans
13:30 How changing demographics and an aging population fuels Medicare Advantage Growth
14:00 The economic challenges of a shifting payer mix in primary care, i.e. less concentration of commercial business when a population ages
14:45 “The reform of payment models are the key to starts the process of transformation in primary care practices.”
15:00 The early days of full-risk MA and global capitation models in Medicare as an indicator for future...
Democratization of value can only happen through the replication of full-risk APM adoption in primary care. As a country, we must accelerate primary care progression towards fully-capitated risk by thoughtful health policy and payment model redesign. Change is underway -- primary care is already moving to a capitated model of reimbursement, and ACO REACH is our first real test of realigning financial incentives to improve care of patients living with chronic conditions. Furthermore, this inflection point in the value movement is finally bringing much needed emphasis to those living in underserved communities facing health inequities. So how do we operationalize primary care transformation at scale? Is it possible to replicate a ‘clinical flywheel’ that provides RN care coordination, home-based care, embedded pharmacists, and floating health concierges to close care gaps and addressing health inequities?
This week we are joined by two executives from UpStream, a billion-dollar, full-risk health services organization that embeds clinicians into participating doctors' offices as an advanced, full-risk Medicare program for network physicians. By focusing on patients living with chronic conditions, and physically embedding highly trained prescribing pharmacists and coordination nurses at each primary care physician office, UpStream partners with its client practices to create the right infrastructure and resources for the whole-person care experience. Their approach has been to fully invest in primary care delivery models accountable for Total Cost of Care, whereby reducing care fragmentation for chronically ill patients while also achieving the best clinical and financial outcomes.
Dr. Sanjay Doddamani (CEO and Co-Founder of Upstream) and Valinda Rutledge (Chief Corporate Affairs Officer of Upstream) are two of the biggest thought leaders in the value movement. In this episode, they talk about the transformation opportunity of massively powerful primary care, the impact of COVID-19 on the value movement, technology innovation, health equity, capital investment in primary care infrastructure, collaborative care models, and the new ACO REACH payment model. Together they are leading one of the most innovative companies out there supporting primary care physicians in the Race to Value!
Episode Bookmarks:
01:30 Upstream – the fastest-growing healthcare solution provider in the country
02:30 Introduction to Dr. Sanjay Doddamani and Valinda Rutledge
04:00 The transformation opportunity of massively powerful primary care within a value-based purchasing construct
05:00 Can we reach a “Win-Win-Win” for patients, primary care physicians, and patients?
06:00 Valinda on the impact of the pandemic on the value-based care movement and how it unleashed tech-enabled consumerism in primary care
08:00 Payment reforms and looming insolvency of Medicare and how it will impact the independent Primary Care landscape
09:00 The development of ACO REACH as a model for capitated primary care reimbursement
09:30 Sanjay speaks to the challenges of the post-pandemic environment and the ‘Great Resignation’ on physician networks
10:00 “Primary Care physicians influence 90% of all medical costs.”
11:00 PCP burnout and recent findings on how family medicine is one of the five most stressful specialties
13:00 “If you continue to practice in a fee-for-service environment, it is like being on a hamster wheel with no way to get off.”
13:30 Sanjay speaks about the need to reallocate investment dollars to build primary care infrastructure for the 21st century
15:00 Critical Success Factors: Pharmacy integration, home-based primary care, and advanced data science capabilities
16:00 Valinda speaks to the challenges of decreasing PCP panel size when there are access barriers in underserved communities
18:00 Population health infrastructure requirements as the table stakes needed to play the game of value-based ...
Community-based health transformation can be unleashed by uniting traditional allopathic medicine with lifestyle medicine. To achieve a vision for population health, we will never change things by fighting the existing reality – we must instead innovate to render that old model obsolete. On a mission to flatten the curve of healthcare costs, James Maskell has spent the past decade innovating at the cross section of functional medicine and community. To that end, he created the Functional Forum, the world’s largest integrative medicine conference with record-setting participation online and growing physician communities around the world. His organization and bestselling book of the same name, Evolution of Medicine, prepares health professionals for this new era of personalized, participatory medicine. His new project, HealCommunity, follows his second book "The Community Cure", makes it easy for clinics and health systems to deliver lifestyle focused care effectively and frictionlessly. He is a high-demand speaker and impresario, being featured on TEDMED, HuffPostLive and TEDx, as well as lecturing internationally.
In this episode, you will learn about the impact of social isolation on chronic disease, functional group medicine, the development of a community layer as a foundation to the population care pyramid, Empowerment Group models, Human Social Genomics and precision medicine, behavior health and psychedelic therapies, and the power of lifestyle-enabled value-based care. Tune in this week to hear from a leading population health economist on a mission to win the Race to Value!
Episode Bookmarks:
01:30 Introduction to James Maskell (Community Builder and Healthcare Entrepreneur)
02:00 Books (Evolution of Medicine and The Community Cure) and theHealCommunity project
02:30 “Community is the most powerful force to transform health. And Medicine has been slow to adapt to this reality…”
04:30 R. Buckminster Fuller: “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”
05:00 Blue Zone Regions and the Roseto Effect
06:00 Is Chronic Disease Reversible?
06:45 “The biggest driver of all-cause mortality is loneliness and social stress.”
08:00 “The combination of Lifestyle Medicine and Group Medicine are the potential foundation of the population care pyramid.”
08:30 How can insurance be restructured to rebuild the community layer?
09:30 Honoring our ancestry by resolving the isolation of modern living
09:45 The thesis by Raghuram Rahan that technology has ripped apart the fabric of traditional communities
12:00 Inspiration from Dr. Jeffrey Geller and his work with Empowerment Group Models, delivering care and providing social support to underserved populations
14:30 Innovation of medicine at the cross section community and health empowerment (the solution to loneliness)
16:15 Billing, reimbursement, and privacy challenges in implementing group visits
17:30 Value creation and the elegance of the empowerment group model
19:00 The social paradox: people’s willingness to share private information on Facebook rather than within a community health model
19:30 Development of skills and competencies for Group Medicine
21:00 The collective trauma of the pandemic has changed the way people engage together
22:30 Removing friction points in group medicine through virtual visits
23:30 The impact of human social genomics in precision medicine, disease prevention, and personalized care pathways
24:45 George Slavich, PhD and his work in Human Social Genomics
25:00 The cellular-level impact of stress and depression related to the loss of a social community
26:00 Is Group Medicine really the opposite of Precision Medicine?
27:30 The vision for Precision Public Health and the work of Dr. Christopher Mote
30:30 America’s Behavioral Health crisis and recent Mass Shootings
The COVID pandemic has taken the lives of 1 million Americans in two years (more than twice the amount of Americans who lost their lives in WWII in four years). This grim statistic came about because of a fundamentally broken, fragmented, expensive, inequitable, and occasionally unsafe healthcare system. If the mission of our $4 trillion healthcare system is to improve health and prevent death from disease, we could look to no greater example of failure than the COVID-19 pandemic.
Global pandemics are always horrific, but they also represent wonderful opportunities to learn by taking advantages of the crises invoked. The COVID crash of American healthcare is not unlike an airline crash. Failure to learn and overcome our structural and cultural flaws will have calamitous results. The airplane (American healthcare) will continue to crash again and again. We would never tolerate these failures in aviation, but why do we accept them when it comes to healthcare? The answer ultimately comes down to misalignment of financial incentives (fee-for-service medicine) and cultural headwinds related to structural racism, American exceptionalism, lack of trust, and tribalism.
On this week’s episode of Race to Value, we interview Dr. David Nash about his new book co-written with Charles Wohlforth, “How COVID Crashed the System: A Guide to Fixing American Health Care.” Dr. David Nash is among the world’s most respected experts on health care accountability, quality, and leadership. He is the founder of the Jefferson College of Population Health in Philadelphia and remains its founding dean emeritus. In this interview, we do a deep dive on his new book explaining what went wrong as it relates to COVID and health care delivery. This is a must-listen podcast as you will hear the unfiltered truth about the pandemic from the nation’s foremost prophet of population health. This podcast will make you angry and sad, but it will also leave you with optimism for the future of value-based care and population health management. We can get better and do better by those we serve – we can win this Race to Value.
Episode Bookmarks:
01:30 The opportunity to learn and take advantage of the COVID-19 pandemic so we may heal a broken healthcare system
03:00 Introduction to Dr. David Nash, one of the world’s most respected experts on health care accountability and population health
05:00 America’s COVID crash and the realization of a broken, fragmented, expensive, inequitable, and occasionally unsafe healthcare system
07:00 Dr. Nash provides perspective on the 1 million American citizens that died
08:00 “Half a million Americans died fighting WWII over a period of 4 years, and it is mind boggling to see how COVID-19 killed twice as many in half the time.”
08:30 Recognition of the fragility of the healthcare system pre-pandemic
08:45 “If the mission of a $4 trillion a year healthcare system is to improve health, we are not doing such a good job.”
09:00 The Four Horses of the Pre-Pandemic Healthcare Apocalypse: 1) Depression, 2) Opioid Abuse, 3) Alcoholism, 4) Suicide Ideation
09:30 “The Baby Boomer Generation is going to end up living longer than the Millennial Generation if we don’t do something about our healthcare system.”
10:30 Investigating the COVID crash like we would an airplane crash
11:00 “The pandemic shined a spotlight on structural failures, social determinants of failures, and the failure of our healthcare system to have a clear mission to improve health.”
11:30 American exceptionalism and the hubris of political leadership
13:30 Failures of government: lack of communication, lack of understanding, and a lack of transparency
14:30 Early warnings from Italy in early December 2019 telling us that the pandemic was coming
15:00 President Trump’s pathetic goal to re-open the economy by Easter Sunday 2020
15:30 Failure at all levels of government (ex: White House, FDA, CDC, HHS)
While there have been meaningful improvements in healthcare delivery over the last decade, they have not catalyzed the transformation necessary to advance health value and equity. The promulgation of health policy and the implementation of new alternative payment models have created a landscape for experimentation in value-based care, yet the seismic shift needed to facilitate long-term and sustainable improvements has yet to occur. The key enabler for the future of our industry is workforce readiness to deliver on the promise of high-value, high-quality care that delivers equitable outcomes for all.
This week on the Race to Value podcast, you are going to hear from a distinguished panel of industry experts on the importance of workforce development in value transformation. Workforce development will drive success in value-based care by ensuring industry capability, and it will help underserved communities thrive through population health interventions that improve societal outcomes and reduce inequities.
As you listen to this discussion with Dr. Jim Walton, Christina Severin, Dr. Joy Doll, and Dr. Richard Walker, think about how the scale and impact of workforce skill and knowledge is either a force multiplier or an impedance for change. If you want to learn more about affordable educational pathways for reskilling and upskilling in preparing for risk-based payment after hearing this discussion, please reach out to the Institute for Advancing Health Value – your partner in developing a competent workforce to win this Race to Value!
Episode Bookmarks:
01:30 The key enabler for the future of our industry is workforce readiness to deliver on the promise of high-value, high-quality care that delivers equitable outcomes for all.
02:00 Workforce development will drive success in value-based care by ensuring industry capability, and it will help underserved communities thrive through population health interventions.
03:00 The Institute for Advancing Health Value – your partner in developing a competent workforce for the future of value-based care
03:30 Introduction to expert panelists: Dr. Jim Walton, Christina Severin, Dr. Joy Doll, and Dr. Richard Walker
06:00 The imperative to ensure health equity and reduce disparities in our most vulnerable populations
07:00 Dr. Walker shares the vision to serve underserved populations through reengineered primary care
08:45 How TVP-Care access to care with both a “high touch” and “high tech” model that reaches patients in their homes
09:30 Dr. Doll on how CyncHealth addresses health equity through data democratization within a longitudinal health record and community-based SDOH support ecosystem
10:30 Dr. Walton speaks to the importance of building an engaged ecosystem and how GPG realizes that “equity is a valuable business model for the future of private practicing physicians”
11:00 The impact of burnout and moral injury and how that will become a “self-fulfilling prophecy” without a value-based business model and workforce strategy
12:00 “We must have an ROI attached to social interventions; otherwise, we are just tilting at windmills.” (Harnessing AI/ML for predictive risk stratification of the patient population)
13:00 Christina Severin on how C3 approaches team-based care, social interventions, behavioral health in its FQHC network
14:00 Establishing a diversity, equity, and racial justice committee and building a data infrastructure to drive health equity
16:00 How CMS is integrating health equity in every stage of payment model development, including the new ACO REACH program
17:30 Christina Severin discusses on ACO REACH is a great step forward in program redesign to have a more adequate benchmark that represents the complexity of the population
18:30 Taking the time to understand the legacy of white supremacy in this country and how it impacts healthcare delivery
20:00 Dr. Walker on the importance of developing trust wi...
It’s no secret that the Black community tops the list of groups afflicted by hypertension, stroke, diabetes, heart disease, kidney failure, and cancer. What the statistics do not show is the pain, misery, and despair that these conditions create—not only for the individual, but also for family and friends. As an African-American doctor, Dr. Richard Walker has studied these conditions among his patients for many years. Now, in his new book, “Black Health Matters”, Dr. Walker offers a number of commonsense ways to prevent, manage, and possibly eliminate these killers, turning the tide of African-American health. And he not only provides us with a construct for thought leadership in population health equity, he practices this type of care at his home-based primary care practice TVP-Care in Houston, Texas.
Dr. Walker has spent considerable time in researching the health and healthcare journey of African captives into slavery and understands what current African Americans now to need to do to survive nutritionally and culturally. He is truly on a mission to overcome the chronic ill health and early death that is so pervasive in Black communities. Most importantly, however, Dr. Walker is a leader in the value movement that believes traditional medicine should be merged with lifestyle medicine. He understands that African Americans can turn their health around by understanding and incorporating better nutrition, nutritional supplements, exercise, and regular healthcare checkups into their lives. In this important podcast discussion, we you will learn from a leading clinician and entrepreneur how we should go about improving Population Health Equity within African American communities in this Race to Value!
Episode Bookmarks:
01:30 Introduction to “Black Health Matters” and the work of Dr. Richard Walker in the health value movement
03:30 What does the use of the word “value” mean when it comes to community health?
05:00 Dr. Walker discusses his upbringing in Spanish Harlem and how that experience led him to become a physician leader seeking to advance health equity
07:00 The “mystery” of excessive hospitalizations due to sugar consumption and how that led to an epidemic of Type 2 Diabetes in the African American community
09:00 The misperception in the African American community that most common chronic diseases are genetic (instead of caused by environmental of lifestyle factors)
10:00 Dismantling the informational disadvantage that leads to a misunderstanding of Social Determinants of Health
12:00 The impact of the murder of George Floyd and the BLM social justice movement and how that inspired Dr. Walker to write “Black Health Matters”
14:30 How the collective experience of African Americans over the last 400+ years has been based on “waiting” (e.g. slavery, citizenship, civil rights)
16:00 “Taking care of your own life is all about taking charge of the environment by understanding the root causes that lead to disease.”
16:30 How poor nutrition in the African American community stems from the slavery era and persists to this day
17:30 The inadequate training of the healthcare workforce further exacerbates preexisting issues of poor health among African Americans
18:30 “Black Health Matters” is all about understanding the progenitors of chronic disease that are not genetic, and how to mitigate them in African American communities.
19:00 Environmental hazards and chemical toxicities are more common in underserved, minoritized communities
20:30 Research that confirms the presence of systemic issues in the healthcare industry related to institutional racism
22:00 “The concept of value-based care is transformational because it has the potential of changing the course in healthcare by recognizing the true value of the individual.”
23:30 Will value-based care bring us to the “Quintuple Aim” that includes health equity?
24:30 How the founding vision of Dr. Walker’s value-based,
A bright future for the nation depends on the health and prosperity of rural America, and unfortunately, we are at a moment in time where life is not ideal in the rural heartland. Although most rural Americans are generally satisfied with the overall quality of life and see their communities as safe, we are reaching a crisis when it comes to financial insecurity, trouble accessing affordable, high quality health care, a lack of high-speed internet access, housing problems, and isolation/loneliness. When it comes to health care, even though most rural Americans have health insurance, about one-quarter say they lack adequate health care access, as they have not been able to get the care they needed at some point in the past few years. Consequently, potentially preventable deaths from the five leading causes are consistently higher in rural counties, especially with heart disease. (Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.) All of this has culminated into a mistrust of the traditional, fee-for-service dominated healthcare system and created a “shadow population” of underserved minorities and the socially isolated who are dealing with significant cardiovascular metabolic disease.
The Arkansas Lincoln Project is an important population health program focused on improving cardiovascular health in highly underserved, under-resourced areas of the Arkansas Delta Region where economic and health disparities have life altering consequences for rural residents. Joining us this week, we have two population health leaders sharing their insights about their work in deploying community-based cardiovascular health interventions led by community health workers. Chip Purcell is the director of cardiology research at the University of Arkansas Medical Sciences and the principal investigator of the Arkansas Lincoln Project. Joining him is Dr. Jessica Barnes, the co-founder and CEO of 20Lighter, LLC – an award winning cardiometabolic health program, delivering dramatic reductions in inflammation and visceral fat. Together they are winning the “Race to Value” by fighting cardiovascular metabolic disease in the Arkansas Delta, the worst region in the nation for healthcare quality and population health outcomes.
Episode Bookmarks:
01:30 The challenges of obesity and cardiometabolic disease disparities in Rural America
02:00 Rural Americans facing financial insecurity, poor healthcare access and hospital closures, a lack of high-speed internet access, housing problems, and isolation/loneliness
02:45 “Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.”
03:30 Introduction to Dr. Jessica Barnes (CEO of 20Lighter, LLC) and Chip Purcell (UAMS Cardiology Research and the principal investigator of the Arkansas Lincoln Project)
05:00 “Rural Americans tend to have higher rates of cigarette smoking, hypertension, and obesity, and report less leisure-time physical activity than their urban counterparts.”
06:20 The US News & World Report ranks Arkansas 50 out 50 states for overall healthcare quality with higher-than-average obesity rates and overall preventable hospital admissions
07:00 “Arkansas is the worst of the worst in health outcomes, and that is where we can make a difference.”
08:00 Mistrust of the healthcare system is pervasive in the Arkansas Delta Region
09:30 The exponential growth curve in building trust through improvement in individualized patient outcomes
10:00 Studying out-of-hospital, premature natural deaths as a proxy for determining population health needs in Eastern Arkansas (how the Lincoln Project began)
12:30 The use of geospatial mapping to identify the highest risk communities to target with cardiovascular health interventions led by community health workers
16:30 The economic challenges of Phillips County,
The arc of the future bends in the direction of person-centered care. While payment reform is critical, our nation must also deliver whole-person care models that are exquisitely attuned to both medical and non-medical needs and intentional about addressing unique problems facing racial and ethnic minorities. The entrenched interests perpetuating the status quo of the fee-for-service, medical-industrial complex are immense; however, the pandemic is a catalyst for consumer-driven, value-based payment reform.
In this week’s episode of Race to Value, you will hear from Dr. Mark McClellan, former CMS Administrator and current Director of the Duke Margolis Center for Health Policy. As one of the leading physician economists and health policy leaders in our country, he discusses the future of health reform and value-based care. We cover such topics as health policy and alternative payment models, COVID-19 impacts on healthcare, advanced primary care that goes upstream in the detection and treatment of chronic disease, technology-enabled care delivery transformation, health equity and social determinants of health, specialist integration in person-centered care models, and the path forward to comprehensive value-based care in our country.
Episode Bookmarks:
01:30 Introduction to Dr. Mark McClellan
03:00 Launching Medicare Part D, Medicare Advantage, and the ACLC (now the Institute for Advancing Health Value)
04:00 “While payment reform is critical, there are other essential steps that go along with it.”
05:30 “In this journey to value that we need to bring all patients along. That means explicit and intentional attention to equity and the special problems facing racial and ethnic minorities.”
06:00 Achieving a whole-person approach to health reform through patient engagement and “going upstream”
07:30 Upstream opportunities to address the prevention and management of cardiovascular disease
09:00 The impact of the COVID-19 pandemic on Value-Based Care and the recent advancements in biotechnology and clinical treatment
12:00 The parallel transformation in care delivery and organizational culture that happens in value-based payment reform
14:00 How innovation in through emerging medical technologies and virtual care technologies will delivery value (even if costs increase)
15:00 Digital apps, home based care, and community-based care to address upstream non-medical factors that the social drivers of poor health
16:00 The limitation of current reimbursement models in addressing the social factors that influence health
16:40 “Payment reform remains an important component of making faster progress in achieving value and achieving equity in our health care system.”
17:00 The work that Drs. McClellan and Mark Harrison from Intermountain are doing as co-chairs of the Health Care Payment Learning Action Network (HCP-LAN)
18:30 The current pace of the value movement and how “accountability for results and value at the person level is really the core theme behind payment reform”
19:20 “The arc of the future for medical care bends in the direction of person-centered care.”
20:00 Perspective on value-based reform success between Medicare, Medicaid, and Commercial plans
20:45 The importance of measuring race and ethnicity reliably and then incorporating a focus on equity for traditionally underserved populations
21:30 Healthcare revenue disruptions during the pandemic as a recognition for the need of value-based payment reforms
23:30 How organizations that were further along in adopting advanced payment reforms experienced less financial disruption during COVID-19
24:30 The newfound appreciation that the American public has for convenient, virtually-enabled, person-centered care models
26:20 Referencing the Duke Margolis Center for Health Policy report, “Value-Based Care in the COVID-19 Era”
27:30 The new CMMI Strategy Refresh that focuses on both Accountable Care and Healt...
As we talk about the current zeitgeist moving us towards value and equity, we also have to think about how polarized our country is politically. Democrats and Republicans live in separate worlds, or “echo chambers,” with each side prone to bias or “motivated reasoning.” This has created an existential threat of tribalism where partisanship has turned Americans against one another. The term that best describes our strife is “political sectarianism,” or the tendency of political groups to align on the basis of moralized identities rather than shared ideas or policy preferences. However, the promise of value-based care is something that we should all agree on in a bipartisan way. The Race to Value is both an economic and a moral imperative, and it can be actualized through relationship-based care, collaborative health models, and the power of advanced analytics.
In this week’s episode, we interview Michael L. Millenson, an internationally recognized expert on making American health care better, safer and more patient-centered. As a leading expert on health policy, quality improvement, and patient-centered care, he provides a deeply informed and unfiltered perspective on how to defeat political sectarianism to achieve analytics-based value innovation. This intellectual conversation leaves nothing unsaid and will provide you with an enhanced understanding of the political challenges of value transformation and how analytics will drive collaborative health in the Information Age.
Episode Bookmarks:
01:30 Introduction to Michael Millenson
03:30 The “Race to Value” — is this a revolution?
06:00 “Value-based care is the ethically right thing to do.”
06:45 Confusion about value in health. (Public perception equates the term “value-based care” to fast food.)
07:30 Referencing Walter McClure, Ph.D and the ‘Buy Right’ strategy of health care reform
08:00 “Value-based care is the most important transformation of American medicine in our lifetimes.”
10:30 The dilemma of VBC (you must first recognize that poor quality exists currently to realize the potential for value)
12:00 Political sectarianism – how tribalism and entrenched interests hinder health policy
13:30 Winners and Losers in health policy reform and how “motivated losers” fight back!
15:30 How social media and suspicion stifles value-based payment innovation and the promise of bipartisan reform
16:30 Authentic healthcare leaders realize the need for value (there is hope!)
18:30 How do you engage providers to root out clinical variation and unnecessary care?
20:00 The need for Patient Safety and Quality Improvement in Healthcare
21:00 Referencing Michael’s book, “Demanding Medical Excellence: Doctors and Accountability for the Information Age”
22:00 “Hospitals often do not do what it takes to be as safe as possible because there is no return on investment.”
24:30 Referencing Michael’s article “Why We Still Kill Patients: Invisibility, Inertia, and Income”
26:00 The moral challenges of bureaucratic medicine and misaligned economics and how it creates preventable harm
29:00 The disconnect between Cost and Quality
31:00 The ethics of value-based care and the travesty of physicians not speaking up (Referencing Michael’s article “The Silence”)
33:30 The promise of “Analytics” in the future of healthcare (and the similarities to the “Plastics” scene in The Graduate)
34:30 Enhancing clinical outcomes through semantic interoperability, AI, and predictive analytics
37:30 The misperception that population health analytics will impinge on clinical autonomy
39:30 Smart phone technologies and “proactive benefits” to engage patients in getting well
41:15 “Analytics is the key to the Information Age of Medicine.”
43:00 The limitations of human cognition in healthcare and how unleashing analytics can foster empathy and compassion in medicine
44:30 How open APIs and the FHIR interoperability standard will emp...
Healthcare costs due to Chronic Obstructive Pulmonary Disease (COPD) is in excess of $32 billion due to high rates of re-hospitalizations and ED visits, complex and inefficient clinical pathways during transitions of care, and intensive resource burden on clinical and administrative staff. The average cost per COPD patient readmission in the U.S. typically falls between $9,000 and $12,000. Unlike other high cost chronic conditions like CHF and diabetes, it seems that many ACOs are not as purposeful in their targeting of COPD as part of their population health playbook. This is a massive unmet need with many COPD patients experiencing fragmented and inconsistent care that drives poor clinical outcomes and high economic burden. Consequently, COPD now represents the 3rd leading cause of death and the 5th most costly chronic disease in the US. What is it about this particular chronic condition that makes it so less prone for population health management with ACOs and other risk-bearing entities? Why is this chronic disease so universally undiagnosed? How can we implement chronic care management programs that actually make an impact on patient lung health and clinical outcomes?
For anyone that wants to know more about “Effective COPD Management to Achieve Value-Based Care Goals”, look no further than this week’s episode with Dr. MeiLan Han. She is Professor and Chief of Pulmonary and Critical Care Medicine at the University of Michigan who is widely known for her expertise on Chronic Obstructive Pulmonary Disease. Dr. Han is a leading pulmonologist, researcher, lung health advocate, consultant, and national volunteer spokesperson for the American Lung Association. She is also the author of the new book, “Breathing Lessons: A Doctor's Guide to Lung Health.”
Episode Bookmarks:
01:30 Introduction to Dr. MeiLan Han (pulmonologist, COPD researcher, lung health advocate, author, and speaker)
05:30 Origins in rural, small town America that led to a career in pulmonary medicine and research
07:00 “Many people that have lung damage and don’t know it. We don’t do a good job of diagnosing lung disease in this country.”
07:30 Only half of the 25-30M Americans with COPD even have a diagnosis!
08:00 Undiagnosed lung disease led to server morbidity and increased mortality during COVID-19 pandemic
08:30 Research continues to be under-funded due to lack of awareness of lung health importance
09:20 11M Americans suffering from long-haul COVID
09:40 Societal threats to lung health (ex: air pollution, hazardous chemicals, plastic microparticles in lungs)
10:00 “The pandemic was a golden opportunity to raise awareness for lung health, but now people are starting not to listen.”
12:00 The impact of race and socioeconomic status on COVID death rates, and overall poor lung health in marginalized communities
13:30 COPD is more common in rural communities where there is less access to care
14:20 Virtual care is not a perfect solution in areas where there is a “digital divide”
16:00 Half of adult Americans have at least one chronic condition and more than two thirds of Medicare patients have two or more.
17:00 Ambulatory Care Sensitive Conditions as an opportunity for ACOs to achieve cost savings
18:30 The challenges of developing and implementing COPD Quality Improvement Measures
19:00 Difficulties in collecting data from spirometry and PFTs in the Electronic Medical Record
20:00 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations and the difficulties of tracking symptoms and exacerbations
22:00 The lack of reporting requirements on COPD has limited progress of health systems and EHR companies
23:00 The relative ease of collecting Blood Pressure and A1c results and why capturing data related to COPD is so much more difficult
24:45 Diagnosis gaps of COPD in the early stages due to “therapeutic nihilism”
26:15 Lack of spirometry testing possibly due to the ...
This week we are talking about how value-based care transformation is related to the “Hero’s Journey” monomyth that was initially described by Joseph Campbell, an intellectual known for his work in comparative mythology and religion. Campbell studied religions, all of the greatest literary achievements, mythologies, folklores, and fairytales and discovered that they all involve a hero who goes on an adventure, is victorious in a decisive crisis, and comes home changed or transformed. Leaders in healthcare transformation are on a Hero’s Journey, not unlike Jesus, Buddha, Krishna, Apollonius of Tyana, Odysseus, Superman, Luke Skywalker, and Harry Potter! We all have one thing in common -- we follow our bliss in becoming captivated by population health and health equity and then reach for the stars!
Joining us this week in the Race to Value is the one and only Dr. Zubin Damania. Dr. Damania (aka “ZDoggMD”) is a physician Leader, internet personality, and healthcare influencer with 2.5M Facebook followers and 75M YouTube views. In this special podcast episode (a recording from the closing keynote at the Advancing Health Value Summit), Zubin discusses the transition to Health 3.0 through the monomyth of the Hero’s Journey. In this podcast, we pay special attention to the issues of burnout and moral injury in the healthcare workforce and how we forge a new way for delivering care that is compassionate, relationship-based, and technology-enabled. Can our nation’s healthcare industry successfully make the transition from Health 2.0 to Health 3.0 in this Hero’s Journey? Will health leaders heed the call for adventure and come back home completely transformed? Meet Dr. Damania, your mentor in this journey to provide you (the Hero) with guidance and inspiration to dispel your doubts and fears, while also giving you strength and courage to begin the quest.
Episode Bookmarks:
03:00 Introduction to ZDoggMD (and how Eric first met him at a 6-day silent mediation retreat!)
05:00 “We are all trying to forge a new way of being in the world when it comes to health care.”
05:20 COVID-19, system fragility, and workforce burnout
06:20 An opportunity for optimism and the two sides of “hero’s work here”
07:30 The Hero’s Journey in healthcare (Health 1.0 à Health 2.0 à Health 3.0)
08:20 Zubin explains “Health 1.0” as a way physicians practiced holistic medicine based on relationship and intuition
10:15 Physician paternalism in Health 1.0 began the Hero’s Journey (just like Luke Skywalker on Tattooine deciding to forge a new path forward)
11:00 The excessive utilization, care variation, and escalating costs of Health 1.0
12:00 The dominator physician hierarchy of Health 1.0 and how that relegated nurses to a lower status
13:30 The origins of “Health 2.0” – a technology-enabled, data-driven business model
15:30 Right-brain (holistic care) vs. Left-brain (reductionist care) that led to a clash in medicine between 1.0 and 2.0
16:30 The shadow side of Health 2.0 (reductionist de-humanization, commodification, and de-personalization) due to the dominator administrator hierarchy
17:30 “Burnout is like renal failure. You are being dialyzed due to chronic moral injury.”
18:00 What is moral injury and how does it apply to healthcare?
19:00 The suffering created by Health 2.0 and how looking inward can help the workforce find equanimity (Awakening)
20:00 The negative feedback loop caused by a flawed system and how that contributes to moral injury
20:20 The Empire of 2.0: How de-personalized EHR systems defeat healthcare heroes by turning them into data entry clerks
22:00 How Zubin reached the apex of 2.0 due to pressures to practice medicine on an assembly line
23:30 Health 1.0 is the old shore, Health 2.0 is the boat we're in, Health 3.0 is the shore we're trying to get to.
24:00 How Zubin found inspiration from “The Happiness Hypothesis” by Jonathan Haidt
George Halvorson is a retired American healthcare executive who served as CEO of six health plans over the last 30 years. From 2002-2013, he was the CEO of Kaiser Permanente and was listed several times on Modern Healthcare‘s “Most Influential People in Healthcare”. During his tenure at Kaiser Permanente, he led the nation's largest nonprofit health plan and hospital system, which is also a leader in the adoption of technology to advance community health outcomes and reduce health inequities. Under Halvorson's leadership, Kaiser Permanente's investment in electronic medical records and physician support systems resulted in diminished infection rates and scalable population health outcomes within partnering communities.
Since his retirement from Kaiser, George Halvorson has devoted his time to promoting the benefits of early childhood education and to addressing social difference and tensions through his own Institute. George Halvorson is currently the Chair and CEO of the Institute for InterGroup Understanding, a nonprofit organization that works on issues of racism, prejudice, discrimination and intergroup stress and conflict by facilitating a collective understanding of what children need to achieve safe and productive lives. George is someone who leads with a passion to help create intergroup Peace for our nation so that we may intellectually overcome our more negative and damaging instinctive behaviors.
In this episode, you will learn the truth about the Medicare Advantage program from one of the leading intellectuals in healthcare. We also discuss Health IT transformation and the power of organizational culture to reshape care delivery. In the last 20 minutes of the interview, George Halvorson also discusses his mission to improve the culture of our world by helping others overcome negative and instinctive behaviors that lead to intergroup conflict. This is a powerful discussion about the impact of tribalism in our world and how we have a collective and ethical obligation to help each child from every ethnic, economic, cultural, and racial group in America to overcome the hardwiring of societal conditioning that leads to “us versus them” intergroup conflict. “We need to steer ourselves away from the easy abyss of anger through tribalism, into a higher level of interaction. This is a just-in-time learning opportunity.”
Episode Bookmarks:
01:20 George Halvorson’s legacy as a healthcare executive and former CEO of Kaiser Permanente
02:20 The Institute for InterGroup Understanding, a nonprofit organization that works on issues of racism, prejudice, discrimination and intergroup stress and conflict
03:10 George’s extensive experience in international healthcare reform and his authorship of several books related to healthcare reform and intergroup peace
04:20 “The fragmented nature of care delivery and siloing of data creates an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited microsystems, each performing in ways that too often create suboptimal performance”
06:30 “We are on the cusp of the golden age of healthcare delivery, and it’s going to be made golden by information, data, and systems.”
07:15 Innovation at Kaiser Permanente led to a 40% reduction in congestive heart failure crisis events
08:15 Leveraging biometric data and predictive algorithms for disease detection and prevention
09:45 George Halvorson as a national leader in mitigating health disparities and his 2013 book, “Ending Racial, Ethnic and Cultural Disparities in American Health Care”
11:15 Medicare Advantage has become a successful social services program for millions of people (and our most important vehicle to reduce health inequities)
12:15 How Kaiser Permanente reduced prostate cancer death rates for Hispanic Americans
13:30 “I believe that we should deliver better care to every single American, and we have done a pretty miserable job for many subsets of ou...
This week is Nurses Week – a time for all of us to reflect on the contributions that nurses make to our society. During this important time of observance for one of our most valued professions in caring for those most in need, we invited Dr. Sharrica Miller to join us for an important conversation. Dr. Miller is a Cal State University, Fullerton nursing professor who teaches several nursing classes, including pediatrics, writing, research, and mentoring. But she brings more into her classroom than just her vast knowledge and experience in nursing; Dr. Miller also shares the 12 years she spent in the foster care system.
This period left an indelible impression on her, and she decided that once she made it out of the foster care system, she would reach back and help others. To that aim, she has become a national leader in helping nurses use their platform to advocate for vulnerable populations in the community. Casey Family Programs recently awarded Dr. Miller with the 2021 Casey Excellence Award, a national recognition for her work with foster youth in several organizations, including California Youth Connection. Dr. Sharrica Miller is not only a nurse educator, renowned public speaker, and DEI strategist --- she is a servant leader and advocate for the most vulnerable in our society.
Episode Bookmarks:
01:25 Reflections on Nurses Week and Introduction to Sharrica Miller, PhD, RN
02:25 National recognition for her service in helping children transition out of foster care
03:25 The hardship and instability of Dr. Miller’s childhood and how she broke the intergenerational cycle of disadvantage
05:35 Determination to take control of her life once emancipated from the foster care system
06:20 A mission in service to others as an advocate began when gaining custody of her siblings as a young adult
07:30 Lessons in mentorship that inspired her to “speak for those who can’t” and how COVID-19 impacted the foster care system
09:20 The promise of education in breaking the cycle of poverty and despair (“Education was my ticket to freedom.”)
11:00 How the learning environment and minority representation at Howard University propelled her to success
12:00 The importance of mentorship and creation of “safe spaces” on college campuses for minority nursing students
12:40 “Nursing programs need to be actively anti-racist to identify structural barriers. It is not enough to just value diversity.”
14:00 Why representation from minorities is so important in Higher Education
15:00 Overcoming a victimhood mindset brought about by old emotional pain through hardship
16:30 “You must develop an internal locus of control. You can either change your perspective of a problem or change your situation.”
18:40 Inspiration from Eckhart Tolle in overcoming a victim mentality by stopping "pain-bodies"that control our thinking.
19:40 The dangers of over-internalizing success or failure
21:30 “In preparing to lead transformational change, you must first do the work inside. That allows you to show up with the stamina to fail forward.”
23:20 Using failure as a learning opportunity to adapt one’s approach to change management
24:30 The plight of racial injustice in our society and the disparities that are built into the American healthcare system
26:00 “Minorities are expected to be majority by 2050. We need to think about this in preparing the healthcare workforce for tomorrow.”
28:00 “Teaching nursing students about Social Determinants of Health can actually do harm if we only teach at the surface level.”
29:00 “Racism is a social determinant of health.”
30:00 A recent study confirming that racism exists in nursing (63% of nurses have experience acts of racism in the workplace)
31:30 Dr. Miller discusses the history of racism in nursing and how leadership should addresses reported incidents of “Nursing while Black”
35:00 Addressing the “race card” response when attempting to...
As leaders in the value-based care movement, we must think about the synergism between lifestyle medicine and traditional Western medicine. The tenets of lifestyle medicine force us to think more holistically about medical treatment and prevention. Under this construct, “Sleep is Medicine” because poor sleep is linked to obesity, heart disease, stroke, cancer, and dementia. “Exercise is Medicine” because of its impact on a healthy heart, mind, and body. “Love is Medicine” because mindfulness and gratitude is the key to peace and equanimity. And lastly, “Food is Medicine” because a whole food plant-based diet is proven to improve every aspect of health. These four time-tested tenets encompass the SELF Principle of lifestyle medicine promoted by Dr. Sean Hashmi.
Sean Hashmi, MD, is the adult weight management lead for Southern California Kaiser Permanente. He is a board certified Internist, Nephrologist and Obesity Medicine Specialist practicing at Kaiser Permanente, Woodland Hills, California. In this role as Regional Director for Clinical Nutrition and Weight Management at Kaiser Permanente, Southern California, he’s responsible for developing a comprehensive obesity management strategy involving lifestyle medicine and obesity medicine for the 4.6 million members that Kaiser Permanente serves. He is driven by a lifelong commitment to be of service to others. He also provides evidence-based health, nutrition, and wellness research through his nonprofit organization, SELF Principle.
In this episode, you will learn how Sleep, Exercise, Love, and Food (SELF) translate into hope. And hope is the most powerful thing we can possibly have in health care. With hope, we can transform our broken “sick care” system to a true health care system. And in doing so, we will win this Race to Value.
Episode Bookmarks:
01:30 Background and Introduction to Dr. Sean Hashmi
04:30 Life-defining experiences and personal challenges that led to the practice of lifestyle medicine
06:30 Dr. Hashmi’s Personal Why: HOPE
08:30 “The greatest way to be selfish is to do something kind for someone.”
09:00 How a lack of financial resources led to a lack of healthcare access for Dr. Hashmi’s sister
09:45 Lessons in lifestyle medicine learned from his own wife’s health issues
10:45 The American College of Lifestyle Medicine and Dr. Hashmi’s SELF Principle
11:00 “Sleep, Exercise, Love, and Food translate into hope. And hope is the most powerful thing we can possibly have in health care.”
13:30 “Lifestyle medicine needs to be looked at synergistically with Western Medicine. Everything in health begins and ends with lifestyle.”
14:30 The impact of lifestyle medicine on chronic disease (ex: dialysis treatment coupled with plant-based eating)
16:30 Healthcare providers need to learn more about evidence-based lifestyle medicine
17:00 How lifestyle medicine can improve life’s “moments” (quality of life and longevity)
17:45 Incorporating lifestyle medicine into everything we do (instead of it being a standalone program), e.g. prevention of 30-day rehospitalizations
22:00 Is the heart healthy benefit of eating vegetables only when they are consumed in raw form?
24:20 The Healthy Plate Model: 50% fruits and vegetables, 25% complex carbohydrates, and 25% protein (tofu, beans)
25:20 Consumption of whole fruits will lower HgbA1c results in diabetics in the long-run.
26:20 “Healthy” plant-based eating lowers incidence and prevalence of kidney disease.
27:00 The problems with plant-based meats and why whole vegetables are always preferable
28:20 Why the Blue Zones have such healthier people that live longer
31:00 Dr. Hashmi explains his work in obesity management at Southern California Kaiser Permanente
32:00 How clinicians can effectively counteract societal influences that lead to poor eating and other unhealthy lifestyle choices
34:00 The benefits of bariatric surgery will be undermined ...
Have you ever had an idea that you just had to make real? No matter what it took… no matter what obstacles were in your way… no matter how many times people told you no… you just couldn’t stop until it existed? Well, this is one of those stories. It begins with an idea in 1988 and leads to the first-ever autonomous AI to be approved by the FDA for diagnosis without physician input.
Dr. Michael Abramoff, MD, Ph.D. is the Founder and Executive Chairman of Digital Diagnostics, the autonomous AI diagnostics company which was the first in any field of medicine to get FDA authorization for an autonomous AI. Dr. Abramoff is a neuroscientist, a practicing physician, and holds a Ph.D. in Artificial Intelligence and Machine Learning. In 1988, Michael was working on artificial intelligence during his residency and began to think a computer could diagnose diabetic retinopathy. Given the technology available at the time, this idea may have been a bit of a stretch. Still, Michael set out to prove it could be done.
Joining him in this interview is Seth Rainford, the President and COO at Digital Diagnostics. Seth focuses on expanding market opportunities and driving operational excellence within the company. He brings more than a decade of executive experience to Digital Diagnostics including the successful management of large-scale P&L’s, strong organic & inorganic business development expertise, as well as complex multi-site operations leadership within the healthcare industry.
In this episode, we talk with Dr. Abramov and Seth about the 30-year journey that led to the founding of Digital Diagnostics, and the first-ever FDA-approved Autonomous AI in healthcare. Plus, we explore the challenges they continue to work through as they commercialize their product to support organizations looking to win in value-based care!
Episode Bookmarks:
01:30 Introduction to Dr. Abramoff and Seth Rainford and how the first-ever autonomous AI solution became FDA-approved for diagnosis without physician input
03:30 The scalability of Artificial Intelligence in healthcare and the recent failure of IBM Watson Health
06:00 “We are at an inflection point with AI…specifically with Autonomous AI.”
06:30 The parallel paths between AI and the discovery of DNA and its eventual use in the courtroom.
07:45 Why should we limit diagnosis to human cognition when autonomous AI has been proven to be safe and effective?
08:45 An overview of the history of AI, from advancements in neuroscience and sensory processing, ML, artificial neural networks, to autonomous AI in healthcare.
10:45 Where IBM Watson failed – it started with “glamour AI” (i.e. winning at Jeopardy) instead of trying to solve problems in healthcare
12:00 Most of what we hear about in healthcare is assistive AI -- not autonomous AI.
13:20 There is no need for human oversight in autonomous AI for making FDA-approved diagnoses in healthcare.
15:15 Referencing a recent NEJM Catalyst Op-Ed that criticizes autonomous AI in healthcare
16:30 Lessons learned from the challenges of assistive AI and how the develop of a completely autonomous AI solution started with FDA approval
18:30 “In considering the best ways to improve population health outcomes, we must include autonomous AI.”
19:00 Humans are not necessarily better than AI when it comes to diagnosis of diabetic retinopathy
19:20 Referencing NEJM study using assistive AI diagnosis of breast cancer and how radiologist involvement with AI didn’t improve outcomes
22:00 Health inequities with diabetic retinopathy in various minoritized populations
23:00 Recent CMMI focus to advance health equity in value-based care
23:45 “Diabetic Retinopathy is the main cause of blindness and this is disproportionately impacting minorities and rural populations due to lack of access to care.”
25:00 The importance of the diabetic eye exam and how to make testing more accessible through autonomous AI
The impact of investment activity on our industry cannot be overstated, with the velocity of capital pouring into the health sector reaching stratospheric proportions. The valuation of private equity deals in the US health care sector is nearly $100 billion dollars—a twentyfold increase from 2000 (when it was less than $5 billion). Before COVID-19, we were already seeing mass provider consolidation, expansive funding in digital health, and significant M&A activity…and the appetite for capital investment in healthcare has only increased in recent years. The amount of capital being poured into the health sector, and the velocity at which it has been deployed, is reshaping the landscape and a driving force in the future of value-based care.
Joining us this week is Don McDaniel, the CEO of Canton & Company. Don engages with pioneering healthcare firms across the industry, all striving to win in the new health economy. A true market-maker, he focuses on advancing innovation, elevating market positions, and connecting complementary players to disrupt and reshape the industry. Don McDaniel is a healthcare visionary, master economist, serial entrepreneur, and lover of a good debate. In this episode, he will provide insight into the continued increase in the appetite of private equity and other institutional investors. He will discuss whether this interest is good or bad for consumers, patients, providers, payers and other stakeholders. He will also overview the interest level and forecast of investment activity, explore pros and cons from various stakeholders’ perspectives, and consider the implications of such investment on the value movement. If you are a business leader trying to understand current investment trends and whether or not institutional equity actually improves the overall industry health of healthcare, this episode is for you!
Private equity (PE) has been ramping up investments in healthcare over the last several years. Read this brief to learn more about the intersection of PE and value-based care, including potential negative and positive impacts, and recommendations for industry stakeholders.
https://institute.smallworldlabs.com/files/354
Episode Bookmarks:
01:30 The valuation of private equity deals in the US health care sector is nearly $100 billion dollars—a twentyfold increase from 2000 (when it was less than $5 billion).
02:45 Introduction to Don McDaniel, the CEO of Canton & Company
04:45 The number of healthcare services deals among institutional investors has more than doubled in the last six years, with 356 deals in 2015 and a whopping 733 deals in 2021.
06:30 “The system is broken.” – Investment fervor is based on the “train wreck” that is American healthcare.
07:20 The arbitrage opportunity for capital investment based on historical spending and inefficiencies
08:10 Referencing Jim Collins: Confront the Brutal Facts (from Good to Great)
08:30 How negative labor productivity in healthcare contributes to dysfunction
09:30 “If the airline industry had the safety record of healthcare, no one would get on a plane.” (iatrogenic errors creating bad outcomes)
10:00 “Healthcare lacks true consumer sovereignty.”
10:30 Adam Smith’s “invisible hand” has been missing from healthcare since 1965.
11:30 Consumer dissonance drives system inefficiencies and how that is attractive to investors.
12:10 “Healthcare is a credibly inefficient business backed by massive tailwind demand.”
12:30 The impact of an aging population on our nation’s healthcare system
13:45 Opportunities with massive consumerization and privatization of Risk
14:30 Private Equity investment activity at an all-time high
15:20 The international opportunity for healthcare disruption across the globe as the American system undergoes transformation
15:40 Early indications of inflationary pressures and other macroeconomic factors on private equity investment activity
ChenMed is a family-owned, physician-run organization that was created to better serve low-moderate income elderly patients. Starting in 1985, Dr. James Chen created ChenMed as a one-stop shop where physicians are held accountable for their patients, and now ChenMed operates over 100 senior health centers across the US. The full-risk, capitation model of ChenMed aligns economic incentives where preventative value based care is the foundational framework. However, what really allows ChenMed to transform care delivery in the U.S. is how they honor the sacred nature of the physician-patient relationship. The ChenMed model for primary care exemplifies the power of the provider-patient relationship and realigns physicians with their altruistic calling. In doing so, clinicians are able to address the moral determinants of health that lead to improved health equity and social justice in our society.
Joining us this week is Dr. Faisel Syed, the National Director of Primary Care at ChenMed. Dr. Syed believes a physician-led culture can improve primary care influence and lead to a new era of transformation in the United States. He is on a mission to restore the intimate and sacred nature of the doctor-patient relationship and, in doing so, create care models that can replicate at scale. In this episode, Dr. Syed discusses how ChenMed honors seniors with affordable, VIP care that delivers better health. He shares how this moral consensus has an enormous impact on patients and the health of communities. A physician-led culture in primary care, coupled with trusting relationships, can truly change the world!
Episode Bookmarks:
01:30 Background on Faisel Syed, M.D. and the full-risk capitation model of ChenMed
03:30 The ChenMed model as “old-fashioned medicine with technology that treats patients like family”
04:30 How family influence and emerging technologies created a calling to practice medicine
07:15 “We should restore the intimate and sacred nature of the doctor-patient relationship.”
09:20 Don Berwick’s article on “The Moral Determinants of Health”
10:20 “ChenMed starts with the mission to honor seniors with affordable, VIP care that delivers better health. That is our moral consensus.”
11:00 Healthcare as a right – everyone deserves access to primary care, especially those in underserved communities
12:45 Referencing Michael Marmot’s book, “The Health Gap: The Challenge of an Unequal World” and the impact of income inequality on health
14:30 “Understanding pathophysiology alone is not enough to improve health. We must address social determinants of health.”
15:30 Faisel provides an excellent overview of SDOH and how ChenMed’s relationship-based care model improves population health outcomes
18:30 1 out of 5 Americans (over 51 million) are living with a behavioral health condition and 20 million individuals have a substance use disorder
19:30 How a holistic (non-transactional) approach to primary care with aligned financial incentives impacts behavioral health outcomes
22:00 The sacred nature of healing relationships that goes back to the roots of shamanism (and how transactional economics limits healthcare effectiveness)
24:00 Reflections on how the ChenMed model supports healing through trusting relationships
25:00 How openness and trust between a doctor and a patient prevents avoidable ER visits
28:30 How a famous clip from “I Love Lucy” sums up physician burnout that results from the culture of a fee-for-service system
29:30 How ChenMed allows physicians to truly fulfill their purpose in practicing medicine (and how that prevents the burnout all too common in FFS)
32:30 Referencing the article “Primary Care, Specialty Care, and Life Chances” and how PCPs in a given geography correlate with lower mortality and improved societal health
34:00 Primary care doctors need “influence and leadership” to catalyze a national transformation of healthcare in our country
We have reached a milestone moment, as we are celebrating 100 episodes of the Race to Value – the nation’s leading podcast on value-based care transformation in the country!
In this special episode, Dr. Eric Weaver and Daniel Chipping conduct a countdown of the Top 10 episodes so far, playing select clips from the most downloaded Race to Value episodes. They also discuss the recent launch of the Institute for Advancing Health Value (formally known as The Accountable Care Learning Collaborative).
The Race to Value and the Institute bring together the nation’s leading accountable care organizations, top performers, and industry leaders who know what it takes to succeed in the value-based care environment. We are committed to advancing health value, not only through industry collaboration but through education and workforce development as well!
Episode Bookmarks:
01:30 Eric and Daniel reflect on the 100th Episode milestone of the Race to Value
02:20 The announcement of the newly-launched Institute for Advancing Health Value (formerly the ACLC)
03:10 Register now to attend the Advancing Health Value Virtual Summit on May 5th, 2022
04:00 #10: “Creating Optimal Post-Acute Care Networks in the New Value Paradigm” with Ian Juliano
06:30 Other PAC insights in prior episodes featuring Dr. Stephen Bekanich, Andrew Croshaw, and Dr. Tim Ihrig
07:00 #9: “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity” with Susan Hassmiller and Janelle Sokolowich
11:00 Other VBC workforce insights in prior episodes featuring Christina Severin, Cheryl Lulias, Lisa Trumble, and Dr. Gordon Chen
12:00 #8: “The Path of Hope for Human-Centered Care Delivery” with Dr. Zeev Neuwirth
14:40 Other “Big Thinkers” in prior episodes featuring the Honorable Dr. David Shulkin, Dr. Robert Pearl, and Dr. Elizabeth Teisberg
15:00 #7: “The Role of Direct Primary Care in the Value Movement” with Dr. Gaurov Dayal
17:40 Other transformational insights in prior episodes featuring Dr. Tom Davis, Farzad Mostashari, and Harris Rosen
18:10 #6: “Care Beyond Medicine: Addressing SDOH and Health Inequities in Marginalized Communities” with Mike Radu and Dr. Greg Foti
19:40 Other Health Equity insights in prior episodes featuring Dr. Lerla Joseph, David Smith, Dr. Jesse James, Akil McClay, and John Bluford
21:00 #5: “The Future of Value: Lifestyle Medicine and the Reversal of Chronic Disease” with Dr. Dean Ornish
24:30 Other unique insights in prior episodes featuring Dallas Ducar (gender-affirming care), Ginger Hines and Dr. Sheryl Morelli (pediatric VBC), Dr. Keith Smith and Sean Kelley (cost transparency), Dr. Debra Patt (oncology VBC), Dr. Angelo Dilullo (mindfulness and resilience)
25:40 #4: “Analyzing the New ACO REACH Model” with Rick Goddard and Joe Satorius
27:50 Other health policy insights in prior episodes featuring Jeff Miklos, Michael Leavitt, Dr. Mark McClellan, Micky Tripathi and Liz Fowler
28:20 #3: “The Geisinger Value Journey” with Dr. Jaewon Ryu
30:50 Other insights from industry leaders in prior episodes featuring Dr. Clive Fields, Jen Moore, Dr. Stephen Klasko, Dr. Tim Peterson, Dr. Paul Grundy, Dr. Mark Gwynne, and Dr. David Carmouche
31:30 #2: “COVID-19 & SARS-CoV-2 Delta Variant: Scientific Insights from a Leading Virologist” with Dr. Rodney E. Rohde
33:50 #1: “Value-Based Care: A Superior Technology to Create Trusting Relationships” with Dr. Griffin Myers
37:40 Parting thoughts on the future of the R2V podcast and the launch of the Institute for Advancing Health Value. Thank you for tuning in and supporting us!
Jeff Micklos is the Executive Director of the Health Care Transformation Task Force, an industry consortium that brings together patients, payers, providers and purchasers to align private and public sector efforts to clear the way for a sweeping value transformation of the U.S. health care system. Under Jeff’s leadership, the Task Force provides a critical mass of business, operational and policy expertise from the private sector that, when combined with the efforts of the Centers for Medicare & Medicaid Services and other public and private sector stakeholders, can accelerate the pace of delivery system transformation.
Jeff is a great ally in this Race to Value, and the Task Force is doing its part to catalyze value-based payment adoption. In January 2015, the task force was formed based on a commitment to the triple objective of better care, better health and lower costs. As a unique private sector coalition under Jeff’s executive leadership, the task force has an unrelenting vision to accelerate the pace of value-based care transformation. Consequently, they have set the goal for payer and provider members in the Task Force to have 75% of their business in value-based payment arrangements by the end of 2025.
Listen to this episode to learn everything you need to know about the health policy landscape, strategic implications for payment and delivery transformation, and how redesigned payment models will help us seek sustainable improvements in health equity, patient outcomes, and consumer experience.
Episode Bookmarks:
01:40 Introduction to Jeff Micklos and the Health Care Transformation Task Force
03:30 The grim stats on the U.S. health system and the need to accelerate value-based care transformation
05:00 “Change is hard. And change is even more difficult when the status quo is so lucrative in fee-for-service medicine.”
05:30 30% of fee-for-service healthcare is related to low-value care (changing this is a major opportunity to sustain in the long-term!)
05:45 Changes to payment models and the market-driving force of Medicare reforms in healthcare transformation
06:00 HCTTF Transformation Goal: 75% of members operating under value-based payment arrangements by 2025 (progress made by reaching 61% in 2020)
06:55 CMS Innovation Center (CMMI) Strategy Refresh Target Goal: All Medicare FFS beneficiaries in a accountable care relationship by 2030
07:15 “A financial spend metric (in and of itself) is not an indicator of success in value transformation.” (qualitative measures just as important!)
08:20 COVID-19 has only emphasized the need for significant payment and delivery transformation
09:30 The uncertain political climate and how that is shaping current delivery system reform efforts and private sector momentum for value-based transformation
10:00 Extension of the MACRA 5-percent Advanced APM incentive payment (currently scheduled to sunset in 2024)
11:00 The Build Back Better Act and its potential impact on improving health care and lowering costs
11:30 Increased coverage in the ACA marketplace exchanges as a success of the Biden Administration
11:50 The impact of the Russia-Ukraine situation on advancing health policy objectives in the near term
12:00 The upcoming midterm election and how the projected electorate change towards full GOP control may shift the political dynamics of the value movement
12:45 The CMMI Strategy Refresh as a guidepost for the future direction of the value movement
15:00 Reflecting back on the 1st 10 years of the CMS Innovation Center and lessons learned from theMedicare Shared Savings Program (MSSP)
15:50 “ACOs overall have played a key role in transforming the health care system by creating incentives for providers to deliver high quality, cost efficient care.”
16:10 Leveraging MSSP as a platform to scale provider adoption of other APMs
16:45 The failure to reach rural areas with APMs and the need for continued investmen...
The Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) is a statewide ACO in the Medicare Shared Savings Program that has saved the Medicare Trust Fund more than $199 Million to-date. It is a physician-led partnership in operation since 2013 that supports more than 5,000 providers serving approximately 60,000 Medicare beneficiaries. P.O.M. ACO aligned with the University of Michigan Health System, whose Faculty Group Practice participated in a Medicare demonstration project that paved the way for ACOs under federal health care reform years ago. This is an outstanding Accountable Care Organization led by Dr. Tim Peterson and Kendall Cislo who are featured in this week’s episode of the Race to Value.
In this interview, you will learn how P.O.M. ACO has been successful by enabling localized solutions, in partnership with their provider network and beneficiary population, to improve care outcomes. We discuss how the ACO engages their beneficiaries through committee and Board participation, how primary care providers and specialists work together to build “localized” population health programs, and how care management interventions can provide meaningful outcomes in both rural and urban settings. This is an important interview for ACO leaders to listen to who are looking to establish improved relationships with both providers and patients to drive more effective care management interventions in caring for seniors and underserved populations.
Episode Bookmarks:
02:00 Physician Organization of Michigan Accountable Care Organization (P.O.M. ACO) -- a statewide ACO that has saved more than $199 Million
02:40 Introduction to Dr. Tim Peterson (Population Health Executive for Michigan Medicine and ACO Executive and Chairman for P.O.M. ACO) and Kendall Cislo (Chief Operating Officer at P.O.M. ACO)
05:30 How ACO success has been determined by collaboration between a faculty academic practice and groups of independent physicians
10:00 Dr. Peterson discusses some of the unique public health and chronic disease challenges facing urban and rural Michiganders and how medical management programs of P.O.M. ACO meets patient needs
12:00 “Part of our ACO success has been the enablement of local solutions to address local problems.”
12:45 Recent study on patient perceptions of ACOs: Only 7 percent of 55- to 64-year-olds and 4 percent of those over 65 reported ever hearing about value-based care!
13:40 How beneficiary engagement and “the voice of the beneficiary” impact quality improvement and the Triple Aim
15:30 Why the economics of value-based payment shouldn’t matter to patients (focus on quality care and out-of-pocket burden most important)
17:30 Utilizing a beneficiary engagement advisory committee as a key strategy for performance success
21:40 “The goal of our ACO is not to build a centralized infrastructure – it is instead to build localized solutions with our network of providers.”
24:30 Engaging patients to raise awareness of high cost (low value) specialists in the area
25:40 Partnering with dialysis centers to more effectively engage patients with kidney disease
28:30 “The key message to remember in healthcare is that we do everything for the patient. What would you do for a patient if it was your Mom.”
31:20 Engaging physicians to more effectively collaborate with them in population health and quality improvement strategies
34:30 Collaborative conversations to improve risk adjustment coding documentation to more adequately reflect burden of illness in the patient population
38:00 Building local market capabilities for pharmacy integration in rural primary care practices
40:30 Annual Wellness Visits as opportunities to address what is most important in a patient’s life and how that has transformed the ACO
44:30 The importance of clinical integration in improving care coordination and why specialist participation in an ACO is a performance adva...
On February 24th, the Centers for Medicare & Medicaid Services (CMS) revealed the highly-anticipated fate of the Innovation Center’s (CMMI) Direct Contracting model options, announcing a redesign of the Global Professional Direct Contracting (GPDC) Model and the permanent cancellation of the Geographic Direct Contracting (“Geo”) Model. The revamped and rebranded GPDC model—now called Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH)— aims to better reflect the agency’s vision and Administration’s priorities for system transformation. The new ACO REACH model has incorporated stakeholder feedback to alleviate the concerns of GPDC’s critics while maintaining the key features of the model and building on the momentum of the accountable care movement. ACO REACH also adds in exciting new components aimed at closing health equity gaps in keeping with the Innovation Center’s Ten Year Plan released late in 2021.
This special podcast episode offers a short background on the model’s history and recent controversies leading up to the announcement, summarizes the major provisions of the new ACO REACH Model, outlining the key changes from the GPDC design, and considers potential implications for the Direct Contracting Entities (DCEs) currently participating in the GPDC model as well as the broader value movement.
Joining this week we have two leading strategists in value-based care, Joe Satorius and Rick Goddard. They come to us from Lumeris - an accountable care delivery innovation company that enables health systems to deliver value-based care through advanced technology, risk-management, and outcome-based managed services.
The ACLC and Lumeris have partnered to bring you the most in-depth information on the ACO REACH model. In addition to this episode, please download our free Intelligence Brief.
Episode Bookmarks:
02:00 Background on the new ACO REACH payment model and its focus on health equity
03:00 Don’t forget to download the Intelligence Brief on ACO REACH released by the ACLC in conjunction with this podcast episode!
04:00 Background on Joe and Rick and their work at Lumeris
05:00 The complete redesign of the Global Professional Direct Contracting (GPDC) model
07:00 Rick and Joe provide perspective on the future of the Value-Based Care movement and the unsustainability of fee-for-service
08:30 CMMI’s Goal to have all Medicare beneficiaries in an accountable care relationship by 2030
11:00 Joe discusses CMS’ newly-refined eligibility criteria and why that matters when it comes to advancing health equity, promoting provider leadership and engagement, and enhancing beneficiary protections
12:00 The new ACO REACH requirement for 75% board representation from participating providers.
13:00 How ACO REACH incentivizes providers to address social disparities with underserved beneficiaries
15:00 The progression of capitation options in the ACO REACH model
16:30 Rick provides an extensive overview of the professional and global tracks of ACO REACH and the various capitation options that drive economics
20:00 The strategic implications of Total Care Capitation (TCC) and how network curation and design can support performance success and aligned behavioral economics
22:00 The Primary Care Capitation (PCC) + Advanced Payment Option (APO)
22:45 The importance of assessing risk appetite and value-based care readiness
25:00 Rick discusses the Health Equity Benchmark Adjustment – a new change to benchmarking methodology in the ACO REACH model
29:00 Providing greater and more equitable access to underserved communities, while leveraging telehealth and other value levers
32:00 Joe discusses risk adjustment methodology within ACO REACH and addresses concernsabout risk score gaming and over-coding
34:00 The 3% cap, the coding intensity factor, and demographic adjustments that serve as guardrails to inappropriate risk score increases
This week, we have as your guest the legendary Dr. Robert Pearl, a Stanford University professor, Forbes contributor, bestselling author and former CEO of The Permanente Medical Group. Coming off of his bestselling book, “Uncaring: How the Culture of Medicine Kills Doctors and Patients” and a series of articles in Forbes about “Breaking the Rules of Healthcare”, Dr. Pearl describes the key economic and cultural forces that will reshape healthcare in the post-pandemic era. He highlights the flawed system design of our fragmented industry and how that has perpetuated economic status quo in the decades preceding the pandemic. Dr. Pearl describes a better future for our healthcare system once we move from fee-for-service to capitation. In this podcast he provides thought leadership and sets a bold direction for a better tomorrow, while sharing lessons learned from his leadership experience at Kaiser Permanente and how COVID-19 will serve as a strategic inflection point to bring scalability to value-based care.
Episode Bookmarks:
01:45 Introduction to Robert Pearl, M.D.
03:50 COVID-19 as a strategic inflection point and how rules of industry (and society) are changing
05:40 System vs. Culture in medicine and the impossibility of separation
06:00 The consequences of cottage industry design and fee-for-service incentives in American healthcare
08:00 The trajectory of rising healthcare costs over the next decade and missed opportunities for social investment
09:45 How COVID-19 will change the rules of physician culture
11:00 A medical history lesson (ex: Ignaz Semmelweis and the pioneering of antiseptics) and how it relates to lack of progress in the modern-day
14:00 Why medical culture is holding back innovations that improve care outcomes (and how COVID-19 has exposed cultural flaws in the profession)
16:45 The positive aspects of physician culture and the heroism of physicians during COVID-19
19:30 The need to value primary care and prevention (over specialty care and intervention) and the impact on primary care on life expectancy
20:00 Why were Black patients 2-3X more likely to die from COVID-19 than White patients?
21:00 How physician culture tolerates low value care and the high frequency of personal bankruptcies of patients seeking care
23:00 How COVID-19 accelerated the adoption of virtual care (and why the culture of medicine continues to oppose it)
26:00 Why capitation is a better economic model to improve care outcomes
27:00 The impact of Private Equity on value-based care and digital transformation
29:00 How post-pandemic economic pressures will reshape care delivery and support VBC adoption (i.e. virtual systems of care, employer-led initiatives)
32:00 Dr. Pearl reflects on the Haven venture and future steps to be taken in healthcare by Amazon
33:00 The anger, denial, bargaining, and depression that will be experienced during the process of reshaping American healthcare
34:00 “Acceptance of change will be the opportunity to make American healthcare once again the best in the world.”
36:00 How digital transformation, AI and interoperability can eliminate friction in the healthcare value chain and create a new era of patient consumerism
39:00 The advancement of medical devices and wearables that will support advanced analytical capabilities in diagnostics
43:00 “The key step to reshaping healthcare will be moving from fee-for-service to capitation.”
50:00 Lessons from Kaiser Permanente’s success and why their full-risk model hasn’t shown scalability at a national level
52:30 How post-pandemic disruptions and virtual care models will bring scale to value-based care
53:30 Dr. Pearl explains how the government push towards value-based care actually began in 1932! (and how the AMA quashed the move to capitation)
Joining us on the podcast this week is Dr. Clive Fields, the Co-Founder and Chief Medical Officer for VillageMD. Dr. Fields is a leader of high influence in the value economy, having been named to Modern Healthcare’s lists of the 50 Most Influential Clinical Executives and the 100 Most Influential People in Healthcare. His company, VillageMD, is a leading, national provider of value-based primary care services that partners with physicians to deliver high-quality clinical care and better patient outcomes, while reducing total cost of care. In the years since Dr. Fields co-founded the company, VillageMD has grown to 15 markets and is responsible for more than 1.6 million patients. In 2021, VillageMD received a $5.2 billion investment from Walgreens Boots Alliance, which is looking to expand its healthcare offerings with VillageMD as a partner. This significant multi-billion investment will accelerate the opening of at least 600 Village Medical at Walgreens primary care practices in more than 30 U.S. markets by 2025 and 1,000 by 2027, with more than half of those practices in medically underserved communities.
The Race to Value is honored to have Dr. Fields share his perspective on the opportunity for consumer-centric care delivery in our country. We discussed important issues such as health equity, digital transformation, integrated pharmacy, home-based care delivery, multipayer contracting, health policy, and employer healthcare costs. Don’t miss out on this important interview so you can learn what it takes to succeed for the future of value-based care!
Episode Bookmarks:
01:40 Introduction to Dr. Clive Fields and VillageMD
05:00 The intersection between value-based care delivery and consumerism
07:00 “Value-based health care success requires affability, availability and ability.”
08:40 Using a team-based, proactive, risk-stratified approach to care to deliver the best outcomes
09:00 Are we using the term “value” incorrectly in the industry?
10:00 VillageMD’s recently announced partnership with Walgreens and how it will provide scalability
12:00 How outcomes-based reimbursement can improve health equity in underserved communities
13:00 The transformative impact of the value movement on primary care
16:00 The acceleration of virtual care and the role it plays in a consumer-centric care delivery
18:00 What will virtual care look like in the post-pandemic era?
18:45 How the economics of global capitation drives improved health outcomes
20:00 The role that pharmacy integration plays in value-based care
21:45 Dr. Fields discusses how pharmacists should be utilized in the ambulatory care setting
23:00 Lessons learned from pharmacy integration and how that informed VillageMD’s collaboration with Walgreens
24:20 How pharmacist intervention can improve both provider and consumer experience by switching to formulary-equivalent drugs
26:45 Referencing recent McKinsey & Company study that projects up to $265B in facility care shifting to the home setting by 2025
27:45 Village Medical at Home – a leading example of home-based care delivery
28:40 “The lack of home-based care is partly related to the hubris of physicians.”
29:30 Dr. Fields reflects on how office-based care contributes to a misinterpretation of social barriers
31:45 Care in the home as the safest and most comfortable option
34:00 How VillageMD has cares for all patient populations (not just particular high-risk segments)
36:20 “We built a model that actually expands doctors’ panels – not limiting them to a certain product or payer.”
37:45 Managing risk across different populations with segregation by SDOH and risk determination (not payer status)
39:30 Referencing Dr. Fields’ most recent Op-Ed in Modern Healthcare addressing the criticisms of the Direct Contracting model
40:30 Dr. Fields provides commentary on the hyper-politicized debate related to public-private partnerships in the Medica...
Patient Engagement is of paramount importance in value-based care. Healthcare organizations are increasingly turning to solutions that promise more targeted patient outreach, more coordinated care management, and more potential for patient self-support in between care episodes. These solutions fall under a broad umbrella that can be described as patient relationship management, or PRM – and despite its name, it’s much more than a rebranding of customer relationship management for healthcare. True PRM is not just a “CRM for healthcare.” It focuses on patients’ needs outside of the healthcare facility setting --in between care episodes -- as they live their everyday lives. It is more than improving engagement at the hospital bedside, more than making phone calls after hospital discharge, and more than launching a “portal of portals” to provide a unified engagement experience. A comprehensive PRM strategy can support value-based payment models by bridging the gap between the care setting and the patient’s home. In this episode, we interview Dr. Anil Jain (Chief Innovation Officer for Innovaccer) and Alex Lennox-Miller (Senior Analyst with Chilmark Research) to discuss how C-Suite executives should plan their future journey in PRM and digital transformation. Patient Relationship Management is key to unlocking the digital front door in the Race to Value! Episode Bookmarks:
01:45 Does patient engagement have more of an impact in value-based care than SDOH? What is Patient Relationship Management (PRM)?
04:45 The current state of dysfunctional patient engagement
05:30 How can a unified data platform create a more effective omnichannel approach to engaging patients?
06:30 Siloes of data and lack of consumer-orientation creating a less than ideal care journey for patients and families
07:15 PRM is not just for value-based care. Billable events in FFS are also an opportunity for providers.
08:00 More engaged patients have better clinical and cost outcomes, with providers seeing improved quality measure performance.
08:40 The positive impact of a PRM platform on providers, nurses, and staff (i.e. lower burnout, higher satisfaction)
09:45 “The use of actionable clinical information within a robust PRM solution can help interdisciplinary care team members practice to the top of their license.”
11:00 Understanding the “full context of a patient” (looking beyond the single patient record)
12:15 The use of clinical data in PRM (and how that differs from traditional CRM systems used in business)
12:45 Developing a patient engagement strategy for Congestive Heart Failure (based on clinical data and risk stratification)
13:45 “Clinical data can help create stratifications around risk. However, that data needs to also be coupled with non-clinical data to determine how best to motivate and engage patients.”
16:00 Only 15% of hospital patients and 30% of medical practice patients access their health records electronically!
17:00 Will the 21st Century Cures Act create a more vibrant ecosystem of information exchange brought about by native APIs?
18:30 The limitations of legacy patient portals due to lack of robust data consumption and integration
19:45 How COVID-19 has reshaped patient engagement through experiments in virtual care
20:45 “A platform with rich APIs is critical to building a comprehensive Patient Relationship Management strategy.”
22:00 Patient recognition during COVID-19 that care delivery is grossly deficient in managing effective consumer relationships
25:30 Effective Patient Engagement versus Ineffective Patient Inundation (the need to integrate communications within provider organizations)
28:30 The potential for PRMs to revitalize patient engagement and provide more consumer-centric care based on optimal data integration.
31:00 Using non-clinical factors to develop open APIs, systems, and algorithms to match patients to resources in the community
Allison Brennan is the Senior Vice President of Government Affairs for the National Association of ACOs (NAACOS) in Washington, D.C. where she helps develop and advocate for policies to benefit ACOs.
In this special bonus episode, she provides an extensive update on health policy and directly addresses the critics of the Global and Professional Direct Contracting (GPDC) Model. This episode was recorded and released on February 16, 2022 in order to address the alarming concerns related to the potential cancellation of the Direct Contracting program.
Check out this episode for the latest health policy updates and to learn more about this controversial GPDC issue in the value-based care movement!
Episode Bookmarks:
01:30 Introduction to Allison Brennan, NAACOS Senior Vice President of Government Affairs
03:00 Controversary and panic around the rumored cancellation of the Global and Professional Direct Contracting model (or GPDC) model!
05:30 The history of the ACO program as the premier payment model in the shift to value-based care
07:00 The recent trend of flat or declining growth of ACOs
08:00 Allison provides her perspective on the value movement as it relates to the growth of ACOs and other APMs
09:30 Recent changes in ACO policy and the importance of not defining “risk” as the same as “value”
11:00 The integration of health equity in all CMMI payment models and the need for upfront funding
13:00 Allison discusses the need to support providers (e.g. data, tools, education) in order to address SDOH and equity requirements of APMs
17:00 Prior success with the ACO Investment Model (AIM) and other provider investment programs to support APM adoption
18:30 Benchmarking methodology and the importance of focusing on inequities
20:00 An outline of value-based care legislative priorities contained within the “Value In Health Care Act of 2021”
22:30 Incentives for MSSP ACOs adoption and the extension of the 5% Advanced APM bonus as a top priority for NAACOS
29:00 Allison reflects on her work with the current Administration and the continued leadership needed
32:00 Allison explains the challenge with the “Rural Glitch” and the importance of fixing the MSSP Benchmarking Methodology
37:00 An overview of the Global and Professional Direct Contracting (GPDC) model
39:00 Allison explains NAACOS’ support of the Direct Contracting model and the differences between the three DC options (Global, Professional, and Geographic)
42:00 Recent criticisms of GPDC and the need for the model to be more “provider focused”
43:00 Approaches to capitation models and benchmarking for DCEs
45:30 The deeply partisan arguments against the Direct Contracting program and rumors of its pending cancellation (e.g. Physicians for a National Health Program, Senator Warren)
49:30 Allison provides a real-time, in-depth perspective on the recent GPDC controversy
54:00 “Cancelling the program would shatter the confidence of the provider community in the shift to value” and why outright cancellation of GPDC is unlikely
57:00 Parting thoughts from Allison on the state of the value movement (Is health policy heading in the right direction and moving fast enough in this Race to Value?)
This week we are honored to have as our guest, the legendary John W. Bluford III. Mr. Bluford is a nationally known healthcare innovator who has been recognized by Modern Healthcare and Becker’s Hospital Review as one of the Most Influential People in Healthcare. Mr. Bluford is the Founder and President of the Bluford Healthcare Leadership Institute (BHLI) – a nonprofit organization focused on value-based care leadership to eliminate health care disparities. BHLI provides an intense professional development program designed to expose undergraduate scholars with exceptional leadership potential to today’s challenging healthcare landscape, cultivating them for future leadership roles where they will serve to eliminate disparities in healthcare. This Institute was created by John Bluford as a way to advance health equity in today’s healthcare system by sponsoring, mentoring, and coaching underrepresented talent for healthcare leadership and creating opportunities for the emerging leaders to improve health outcomes for minority and vulnerable populations. In this episode, you are going to learn from John Bluford how “Culturally Competent Leadership to Eliminate Disparities in Healthcare.” Mr. Bluford currently serves on the Board of Trustees for Western Governors University – the leading online university in the country with a College of Health Professions that is deeply involved in the provision of workforce readiness to deliver on the promise of high value, high quality care that delivers equitable outcomes for all. https://www.blufordinstitute.org
Episode Bookmarks:
01:45 Introduction to the legendary John W. Bluford III, MBA, FACHE
03:10 The Bluford Healthcare Leadership Institute (BHLI) program’s commitment to culturally competent leadership
07:45 Lessons learned from a 6-week experience at Harvard University that informed a new way of thinking about healthcare
09:00 The rewarding experiences as a mentor while serving as a preceptor for graduate students
10:00 Mr. Bluford never mentored minority students in 12 years as a preceptor because there weren’t any at the time!
11:00 A vision to create a more diverse pipeline of healthcare administration students
12:00 “Our mission is to create leaders of the future that will eliminate health care disparities among minority and vulnerable patient populations over the next two generations.”
13:00 The impact of BHLI alumni leaders who have completed the program
16:00 The observance of Black History Month and the cultural zeitgeist for civil rights and social justice has been awakened in the collective consciousness of all ethnicities
17:30 Why institutional racism will take generations to fix because it is so deeply embedded in our country’s history
18:40 “The accomplishments of Black Americans should be celebrated routinely just like everyone else. Black history is American history and should be treated as such.”
20:45 How the CMS Innovation Center is integrating health equity into the design and reengineering value-based payment models
22:15 The elevation of national consciousness regarding the existence of health disparities
22:45 “We can’t fix the problem without realizing that there is a problem. Health care disparities do, in fact, exist.”
23:00 The need for strong, pervasive leadership in healthcare, society, and government to overcome the systematic perpetuation of racism
24:20 The role of hospitals in addressing health equity and population health in the communities they serve
26:45 Mr. Bluford discusses the importance of culturally competent leadership, reflecting on lessons learned from his hospital administration career
28:00 Understanding the culture of communities and how socioeconomic determinants of health impact care outcomes
29:50 Love, hope, and compassion needed in population health leadership
30:30 Case management of patients with chronic disease is more effective when you understand SDOH barri...
Our guest this week is Micky Tripathi, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, where he leads the formulation of the federal health IT strategy and coordinates federal health IT policies, standards, programs, and investments. As the Office of the National Coordinator (ONC) chief, Micky Tripathi is advancing healthcare interoperability to support value-based payment and improved health equity. Before taking the helm of the ONC a year ago, Micky served as chief alliance officer for Arcadia, a population health management and healthcare intelligence platform company.
Our conversation with Micky covers the ONCs efforts in COVID-19 response in support of public health, aligning with federal partners, improving health equity through purposeful and intelligent HIT design, improving EHR and interoperability, TEFCA standards adoption, information blocking, FHIR APIs, and the development of a robust apps ecosystem to improve population health.
This episode is sponsored by Arcadia, the only healthcare data and software company dedicated to healthcare organizations achieving financial success in value-based care, and recognized as Best in KLAS in Value-Based Care Managed Services three years in a row.
Episode Bookmarks:
01:50 Introduction to Micky Tripathi - the National Coordinator for health information technology with the ONC
02:20 This week’s sponsor: Arcadia - Recognized as Best in KLAS in Value-Based Care Managed Services 4 years in a row
04:15 Visit arcadia.io/theschema to explore how we can use data to improve the current and future state of healthcare
05:00 There are 40 times more bytes in the digital universe than there are stars in the observable universe!
07:20 Micky provides perspective on how to begin getting more visibility into data and analytics in order to transition from volume to value
08:10 How the data explosion and exponential growth of computing power requires data liquidity and fluidity
09:00 The increasing competition for data science expertise – how does healthcare compete with tech companies and financial industries?
10:20 The self-imposed industry barrier of cleaning and wrangling data and the need for authorized aggregation of health data
11:20 Rethinking what access to data means in light of the information blocking rules within the 21st Century Cures Act
12:15 Micky references his tenure with Arcadia and how the information sharing landscape is changing population health management
12:40 Making both structured and unstructured data available and how/why unstructured data is valuable
14:30 The implications of SDOH on health equity and the concept of “health equity by design” where SDOH can be a core feature of Health IT
16:50 Micky explains how the ONC is influencing “health equity by design” through the trajectory of Health IT
18:00 Accessing data to identify outcomes disparities in communities and the heterogeneity of data collection (e.g. OMB and CDC classifications)
20:00 Deploying data-driven, upstream interventions for social determinants of health (e.g. UT Dell Med Community-Driven Initiatives)
21:40 Streamlining consistency and focus in the collection of race, ethnicity, and language data to lower friction in healthcare
23:00 How lack of “health equity by design” contributed to the development of modern-day EHR systems
25:00 How an event notification algorithm design flaw caused failure in providing appropriate population health interventions
27:20 “Value based care is critically important and it is a key driver of interoperability. We need to move from basic information exchange to apps that will use the whole portfolio of interoperability capabilities.”
28:00 FHIR-based CDS Hooks – an HL7 specification for clinical decision support
29:20 “The business case for Value-based Care is a key driver of interoperability in the marketplace.”
This week on our show we have Dr. Terry Knapp – Founder, Director, and Chief Medical Officer of CareSpan Holdings, Inc. Dr. Knapp has a storied 50-year record of achievement in health care and business. His company CareSpan provides a comprehensive, integrated digital healthcare “Clinic-in-the-Cloud” solution by creating unfettered access to care for the underserved, with an emphasis on the care of chronic illness. Dr. Knapp has devoted his life to working with native peoples throughout the world and deeply understands the health problems and impediments to better healthcare that afflict Native Americans. In this episode, he is here to share his views in order to raise awareness for the plight of indigenous peoples in our country who are receiving sub-standard care.
There are some deeply emotional moments in this episode, as he discusses the failures of healthcare delivery as promised by the U.S. government more than 100 years ago. He describes American Indians that are dying a slow and agonizing death. Their land – a reservation – is a concentration camp where they are treated as third-class “citizens” by receiving medical care that is killing them. He talks about the bureaucracy of the Indian Health Service, the failure of the IHS to provide enough good doctors, the lack of choices by patients, and the lack of respect for Native American ways by a health system that ignores their culture. He discusses the denial of access to modern medical care and posits that the Indian Health system actually makes them sicker by exacerbating psychological trauma and socioeconomic challenges associated with their physical imprisonment (as seen by rates of substance abuse and mental illness). The inhumane treatment that Dr. Knapp has observed firsthand has made him speak out about what he sees as a slow-moving but progressive bureaucratic genocide of our Indigenous peoples.
The Native American phrase Mitakuye Oyasin means “all my relations”. This is said at the end of every prayer in the Lakota Nation, and it reminds us at all times to honor all of our relations – past, present, and future. This transcends our human relatives and includes our relation to all of creation – the water, the plants, the animals, and the Creator. Indigenous people think intergenerationally as well, by honoring those in the past, present, and future. In thinking of value-based care, how can we consider all of our relations – which includes Native Americans who have suffered irreparable harms from a deeply flawed healthcare system?
Episode Bookmarks:
02:00 Introduction and Background to Dr. Terry Knapp
03:50 Dr. Knapp is speaking out after seeing firsthand the inhumane treatment of our Indigenous peoples by the healthcare system
05:20 The Native American phrase Mitakuye Oyasin (“all my relations”) as a reminder that value-based care must consider all of our relations – including Native Americans who have suffered irreparable harm
07:10 Dr. Knapp discusses his medical training and life’s work to make a social impact as a surgeon, inventor, and entrepreneur
13:00 Insights as a cancer patient led him to develop a “clinic in a cloud” integrated digital care company (CareSpan Health) that leverages technology to enable health equity
14:45 The catastrophically high rate of COVID-19 cases and deaths in the Native American population (and similarities to the 1918 flu pandemic)
15:15 Tribal healthcare facilities are underfunded (in 2017, US healthcare expenditures were $9,207 per capita but only $3,332 per capita for Indian Health Services)
15:50 Unethical medical practices of the past (e.g. Native American women undergoing forced sterilizations in the 1960s and 1970s)
16:20 Dr. Knapp’s early experiences in treating the Yurok and Hupa tribes in California as a medical resident
18:00 Treatment of disadvantaged people in Mexico, Peru, Ecuador, Columbia, Chile, and other parts of Central America
In a career focused on improving global health value through systems transformation, relationship-based primary care has been at the heart of Dr. Paul Grundy’s crusade. Dr. Grundy is a data transformation advocate, active writer, social entrepreneur, speaker on global healthcare transformation, humanitarian, diplomat, and trusted healer. He has traveled the world more than any other physician that has ever lived and seen how other country’s deliver health care. Dr. Grundy is such a transformational force for social change that Nelson Mandela even called him a “good troublemaker” as someone who is always looking for innovative disruptions to benefit humankind. We often reflect on those great leaders in American History who challenged us to be better…from JFK asking individuals to step up, and Ronald Reagan admonishing communists to join the free world, to Martin Luther King, Jr. who provided us with a powerful anthem for change with his work in advocating for civil rights. In the healthcare history books Dr. Grundy will be known as a crusader with his own version of the “I have a Dream” vision for transformation!
Our guest this week is Dr. Paul Grundy, commonly known in industry as “The Godfather of the Patient Centered Medical Home.” Although he didn’t invent the medical home model, he gave it a voice, definition, structure, and made it real. The model is focused on that which is most important – the cultivation of a trusting patient relationship. Whether you call it a milestone or the finish line, that trusting relationship is critical in the race to value.
Episode Bookmarks:
02:00 Introduction to Dr. Paul Grundy – a humanitarian and healthcare legend in patient-centered care models and value transformation
04:30 Referencing Dan Pelino’s book, “Trusted Healers” that was written about Dr. Grundy’s worldwide crusade for better healthcare
05:00 Dr. Grundy’s international healthcare experiences as a humanitarian and diplomat that has traveled more air miles than any physician in history!
06:00 Dr. Grundy’s work with Nelson Mandela and how he become known as a “good troublemaker” looking for innovative disruptions to benefit humankind
07:00 How growing up in Africa informed Dr. Grundy of the importance of a traditional healer in creating relationships that drive better patient outcomes
07:30 “A relationship of trust must be the basis for an accountable health care delivery system that works.”
08:00 Reflections from observing health systems all over the world and how Denmark is the leading example of relationship-based primary care
08:45 Research showing that relationship-based primary care reduces both healthcare costs and mortality rates
09:10 Dr. Grundy speaks about his prior work at IBM and how IBM viewed the Patient-Centered Medical Home as foundational for “system integration”
09:30 The history of the Patient-Centered Medical Home and how shared data underpins the success of the model
10:15 Accountable Care begins at the intersection of trusted healing (relationships) and systems integration (coordinated data sharing)
11:00 Formative experiences growing up in the African bush and how that enabled Dr. Grundy to understand and apply deeply held tribal beliefs into his own life
13:00 Dr. Grundy discusses how Quakerism and The Eight Laws of Social Change has been his guiding light to seek social impact through global health reforms and value-based care
16:30 How early followers are just as important as revolutionary leaders in creating social change
17:00 “The current healthcare delivery system is a form of violence when an episode of care is what is valued – whether that episode of care is necessary or not. We need a cultural shift away from an episode of care to managing population health.”
18:00 The importance of accessing data at the point-of-care to improve population health outcomes
19:00 Eric engages Dr. Grundy on his leadership in the Patient-Centered Medica...
This week we have the great honor of hosting one of the most respected American political leaders over the last few decades, a visionary who ushered in a new era of value-based care in our country during his tenure at HHS. Someone who is known for a strong track record of building collaborative relationships that achieve measurable results, who also is an entrepreneur at heart. Of course, we are talking about no other than the legendary Michael O. Leavitt!
As the former Secretary of Health & Human Services and a three-time Governor of Utah, Michael Leavitt earned a reputation for leading change through collaboration. He is one of the most influential leaders in the value movement because he sees how it can balance human compassion with the need for global economic leadership. Michael Leavitt is also an early pioneer in competency-based education and co-founded Western Governors University – the leading nonprofit online university in the country, serving over 100,000 students with over 250,000 alumni. This week marks the 25th Anniversary of WGU’s Founding, and we spend considerable time honoring Michael Leavitt’s legacy by discussing both his leadership in value-based care and his vision for competency-based education to drive workforce development in health value transformation.
Additional resources on the future of workforce development for value-based care:
Why Workforce Development for Value-Based Care is a Vital Issue to Address Value-Based Care Certificate program at WGU WGU College of Health Professions The Accountable Care Learning Collaborative (ACLC)
Episode Bookmarks:
01:40 An introduction to the legendary Michael O. Leavitt and his storied leadership in value-based care
03:10 Balancing human compassion and Global Economic Leadership to ensure compassionate delivery of healthcare
04:00 Gov. Leavitt’s cofounding of Western Governors University on January 15th, 1997 (this week marks the 25th anniversary!)
05:05 “The language of health is heard by the heart. The richest and poorest of us are bound together by the uncertainty of our mortality, the health conditions of those we love and, in some cases, the desperation of our pain.”
06:30 Michael Leavitt provides an extensive history of the U.S. healthcare system and how poor system design led to high cost, low value care
10:40 How high healthcare costs (as a percent of GDP) compromises global competitiveness for the United States
11:30 “Value-Based Care” entered into the healthcare lexicon during Leavitt’s tenure as HHS Secretary
12:40 “We are in a race to make value work. If we can, we’ll have the kind of compassionate care we want to provide and maintain our economic leadership.”
14:20 “Health is going to be one of the fields of competition between economic competitors, and getting our health system right will be critical to that. And value will be the means by which that can occur.”
15:30 Leavitt explains how the adoption of value-based contracts has been impacted by the COVID-19 pandemic
17:20 Leavitt describes his proactive leadership during the H5N1 pandemic as HHS Secretary and the influence of “The Great Influenza: The Story of the Deadliest Pandemic in History”
19:20 The failure of human beings to realize that pandemics as a part of natural history and how that leads to lack of preparedness.
22:00 “When it comes to pandemics, anything you say in advance sounds alarmist. Anything that you have done after it starts is inadequate.”
24:20 “Moving to value will require us to learn and change. You can fight this change and lose, you can accept this change and survive, or you can lead this change and prosper.”
26:10 Solving complex problems through collaboration and how cooperation only seems to come about in times of great exigency.
28:50 Referencing his book, “Finding Allies, Building Alliances: 8 Elements that Bring—and Keep—People Together”
29:45 Building an alliance of 19 U.S.
As it is entering its second decade, the Center for Medicare and Medicaid Innovation (CMMI) has launched a bold new strategy for achieving equitable outcomes through high quality, affordable, person-centered care. To achieve this vision, the Innovation Center has organized around five objectives: Drive Accountable Care, Advance Health Equity, Support Innovation, Address Affordability, and Partner to Achieve System Transformation. Over the last decade, CMMI has been the driving force for value-based care at the federal level and launched more than 50 alternative payment models. In the next decade, CMMI will apply lessons learned in establishing this strong foundation to lead the way towards broadened and more equitable health system transformation in our country. The ultimate goal is to have all Medicare beneficiaries in a care relationship with accountability for quality and total cost of care by 2030.
Our guest this week is Liz Fowler, J.D., Ph.D., the director of the Center for Medicare and Medicaid Innovation (CMMI) and deputy administrator of the Centers for Medicare and Medicaid Services at the U.S. Department of Health and Human Services. She is leading CMMI in an effort to streamline the model portfolio and reduce complexity and overlap, and to help scale what works. From reengineering payment policies, to overcoming the complexities of model design that impede scalable transformation, and considering equity in all stages of model development – it is clear that health value remains a top priority for the Biden administration. Join us this week as we explore model design, equity, benchmarking, capital investment, beneficiary engagement and more. Dr. Fowler is truly leading the charge in the race to value!
Read the transcript here.
Read the CMS Innovation Center Strategy Refresh here.
Episode Bookmarks:
02:00 An introduction to Liz Fowler’s background in health policy leadership and industry transformation
03:00 Referencing the Innovation Center Strategy Refresh, a bold new strategy with the goal of achieving equitable outcomes through VBC
04:00 The need to reexamine the CMMI portfolio of APMs
06:40 Applying lessons learned over the last decade of CMMI to inform future payment models
07:00 “We have to have a cohesive articulation of a model portfolio, and explain how all the CMMI payment models fit together. That’s what we’re trying to do with our new strategy.”
07:30 Do the models support objectives? (i.e. drive accountable care, advance health equity, support innovation, address affordability, or achieve system transformation)
08:50 Healthy People 2030 defines health equity as “the attainment of the highest level of health for all people.”
10:15 Dr. Fowler describes how CMMI is embedding health equity into all aspects of payment model design (“Advancing health equity has become one of the most important areas of focus for the Innovation Center, and for CMS and HHS more broadly.”)
12:50 Dr. Fowler discusses how CMMI’s strategy to focus on equity to promote accountable care extends to Medicaid.
14:15 Referencing the CMMI Health Equity Roundtable last month (download slides here)
14:30 Conducting focus groups with providers and patients to better understand what equity means to them
16:40 Dr. Fowler discusses how CMMI will moving more Medicaid and Medicare Advantage beneficiaries into accountable care relationships (CMMI’s 2030 Goal)
18:20 Engaging local leaders to provide more care at the community level in addressing social needs (Accountable Health Communities Model)
19:30 The importance of creating the right incentives to address social determinants of health and the right tools to remove them as well
19:50 Data collection and measurement to assess health equity performance in value-based payment
22:10 Dr. Fowler discusses the importance of capital investment for providers to succeed in taking downside risk.
Joining us this week, we have the legendary Dr. Dean Ornish who will be discussing his most recent book, “Undo It! How Simple Lifestyle Change Can Reverse Most Chronic Conditions” which just came out on paperback. Dr. Ornish is “The Father of Lifestyle Medicine” which is the fastest-growing trend in medicine today. With its impact on both health costs and population health, lifestyle medicine is the future of value-based care!
For more than four decades, Dean Ornish, M.D. has directed revolutionary research proving, for the first time, that lifestyle changes can often reverse—undo!—the progression of many of the most common, costly, and disabling chronic diseases and even begin reversing aging at a cellular level. This often occurs in just a few weeks or less—and at any age.
Medicare and many insurance companies are now covering Dr. Ornish’s lifestyle medicine program for reversing chronic diseases because it consistently achieves bigger changes in lifestyle, better clinical outcomes, larger cost savings, and greater adherence than have ever been reported—based on 40 years of clinical research published in the leading peer-reviewed medical and scientific journals.
Today, January 4th, 2022, the “Ornish diet” has again been rated the “Best Heart Healthy Diet” by a panel of experts at U.S. News & World Report (and has been for the last ten years). He is the author of seven books, all national bestsellers, including UnDo It! (co-authored with Anne Ornish).
Dr. Ornish was the “inaugural recipient of the American College of Lifestyle Medicine Lifetime Achievement Award” recognizing his extensive contribution to the field of Lifestyle Medicine – TheACLM is the sponsor of today’s episode!
Episode bookmarks:
02:00 The obesity epidemic that causes 300,000 premature deaths each year
03:15 Ayurvedic proverb: “When diet is wrong, medicine is of no use. When diet is correct, medicine is of no need.”
03:30 The storied background of Dr. Dean Ornish and his most recent book, “Undo It! How Simple Lifestyle Change Can Reverse Most Chronic Conditions”
06:00 Dr. Ornish was the inaugural recipient of the ACLM Lifetime Achievement Award” recognizing his extensive contribution to the field of Lifestyle Medicine.
06:15 Commercial message from our sponsor, the American College of Lifestyle Medicine
08:00 Lifestyle Medicine is the future of Value-Based Care
09:00 Eric cites healthcare cost estimates reflecting the impact of obesity and chronic disease on our nation.
09:45 Lifestyle medicine programs can reverse coronary heart disease, type 2 diabetes and obesity, prostate cancer, high blood pressure, and high cholesterol
11:00 86% of the 3.7 trillion dollars that we spend on healthcare is for treating chronic diseases
11:30 Very simple lifestyle changes that prevent or reverse chronic diseases: “Eat well, Move more, Stress less, and Love more”
13:00 Dr. Ornish describes how his research over the last four decades has proven that heart disease can be reversed
14:00 Dr. Ornish on how his work with hospitals and physicians is demonstrating that changes in lifestyle lead to better clinical outcomes, better cost savings, and better adherence
14:45 The importance of showing cost savings from lifestyle medicine interventions in the first year
15:00 Highmark Blue Cross Blue Shield cut healthcare costs in half in the first year of implementing the Ornish program for reversing heart disease!
16:00 Lifestyle changes can also reverse a wide variety of other costly chronic diseases, including cancer and diabetes
16:30 Referencing research collaboration with Craig Venter showing that lifestyle changes can modify gene expression
17:00 Dr. Ornish discusses his treatment of President Clinton and how his cardiologist overstated the role of genetics on his heart disease
17:30 Referencing research collaboration with Elizabeth Blackburn showing that lifestyle changes can reverse aging at a cellula...
We must remain steadfast in our desire as healthcare professionals to ensure that patients who lack access to safe and stable housing are not forgotten. In this special bonus episode of the Race to Value, you will learn how organizations can build alliances to serve the public good and build hope in marginalized communities through investments in housing. There is strong evidence characterizing housing’s relationship to health. Housing stability, quality, safety, and affordability all affect health outcomes, as do physical and social characteristics of neighborhoods. Lack of housing security leads to increased mortality (lower life expectancy); physical traumas, crime, and gun violence; long-standing impacts on psychological well-being (depression, anxiety, suicide); increased ED and inpatient hospital utilization; increased pediatric asthma and chronic disease burden; and substance use disorder. The impact of housing on health is now being widely considered by policy makers as it is one of the most researched social determinants of health. Needless to say, housing interventions by healthcare organizations and community partners is the future of value-based care!
In this episode, you will learn about how ProMedica (a non-profit health and wellness organization of 11 hospitals and a physician network of 2,600 physicians) formed a community-based housing investment partnership with the Green & Healthy Homes Initiative (GHHI). Their comprehensive, flexible approach to addressing unhealthy housing is being shown to improve health, academic success, job retention, neighborhood safety, and intergenerational wealth transfer all for a relatively low per-person cost. Joining us in this interview is Ruth Ann Norton (President & CEO, GHHI) and Rachel Krausman (Vice President, National Strategy and Partnerships, ProMedica). We invite every value-minded professional listening to this conversation to join in your own community effort to care for your most vulnerable patients. A healthy home leads to a healthy life!
This bonus episode comes from an ACLC Peer Learning Session - click here to watch the video with slides and download the Case Study: https://www.accountablecarelc.org/publications/investments-housing-health-and-equity-through-partnership-promedica-and-green-healthy
Episode Bookmarks:
02:00 How does value-based care and housing intervention go together?
04:00 Introduction to the Accountable Care Learning Collaborative
05:50 Introduction to Rachel Krausman and Ruth Ann Norton
06:45 Background on ProMedica, a non-profit health and wellness organization of 11 hospitals and physician network of 2,600 physicians
08:35 The ProMedica National Social Determinants of Health Institute and its focus on SDOH interventions (e.g. food insecurity, housing)
10:00 The ProMedica Impact Fund that has raised $1B over 8 years to drive innovation and scale in SDOH interventions that have a measurable impact on health
11:30 ProMedica’s Partnership with the Green & Healthy Homes Initiative (GHHI) to test ROI and clinical outcomes improvement associated with SDOH investments
12:20 The founding of GHHI in 1986 through a grassroots effort to end childhood lead poisoning due to unhealthy homes
13:30 Ruth Ann explains GHHI’s accomplishments in reduction of lead poisoning and how that led them to view health and housing more holistically
14:00 Elimination of fall risk injuries in senior population can save Medicare over $20k per beneficiary
14:15 Energy efficiency and weatherization services to reduce energy burden and improve air quality
14:45 Building a future for “intergenerational wealth transfer” through improved health outcomes
15:15 Influencing Medicaid payment policy in the states of New York and California to invest in healthy homes programs
16:40 30M families with housing-related health conditions (e.g. pediatric asthma, brain damage due to lead poisoning,
In a time of great need for our nation during the pandemic, Americans saw and celebrated an army of physician heroes. And in doing so, they overlooked an unforeseen reality that true heroism by physicians has actually yet to be realized. In the coming years, heroic physician leadership will be the crucible for the kindling of imagination to reshape our nation’s healthcare system through economic reform. However, for physicians to lead they will need an educational guide for navigating the business of medicine to optimize their leadership potential. Fortunately, for them, Dr. Ellis “Mac” Knight and his book “Healthcare Economic Reform: How and Why Physicians Must Lead Change Within Our Evolving Healthcare Economy” is their guiding light in the darkness!
Dr. Knight realizes that the time for physician leadership is now to salvage our economy, improve our nation’s health and wellbeing, and restore the humanity of medicine. To do this, physicians must provide more than just healing patients in front of them; they must be a reservoir for reimagining a system that can emphasize prevention over treatment. They must call for changes in a way that will lead to transparency, redesigned care delivery processes, lower costs, and improved patient outcomes. The call for physician leadership has never been higher, and the stakes have never been greater. For true healthcare economic reform to occur, we need physicians to demand change from both an economic and moral imperative.
Are you ready to take your first step in your hero’s journey as a physician leader? Or will you stay on the sideline, hoping for a top-down, political, all-encompassing solution to healthcare reform? After hearing this podcast, you will come to realize that building an idealized system can only occur via a bottom-up methodology that honors the voices of skilled clinicians on the frontlines to design care delivery. And it is Dr. Mac Knight that will be your North Star!
Episode Bookmarks:
01:45 Heroic physician leadership will be the crucible for reshaping our nation’s healthcare system through economic reform
02:15 Dr. Knight’s new book: Healthcare Economic Reform: How and Why Physicians Must Lead Change Within Our Evolving Healthcare Economy
04:25 “Physicians must be a reservoir for reimagining a system that can emphasize prevention over treatment.”
07:00 “The entire healthcare economy is in need of vast redesign”
08:40 What are the goods and services traded for in the healthcare economy?
09:30 Growing up seeing his dad as a solo practitioner and realizing how different that system is from today
11:00 “The healthcare economy is corrupted. It is selling the wrong goods and services and charging way too much for those things.”
13:00 The “glass wall” that is created in large health systems between physicians and administration.
14:00 The lack of accurate Cost Accounting in healthcare as a barrier to creating value (referencing the work of Michael Porter and Robert Kaplan)
16:00 The relentless pursuit of profit within the fee-for-service based healthcare economy
17:00 “The COVID-19 pandemic has really pulled back the veil and revealed the perverse nature of the healthcare economy.”
19:00 Moving the emphasis from profit maximization to value-based care is really going to require a change to the payer paradigm
22:00 The value equation and how definitions and measurements of quality create the perception of “cookbook medicine”
23:00 The Price-Cost disconnect in healthcare and the need to connect pricing to the actual true costs of providing services.
24:00 The flawed negotiation model between health plans and hospitals and how that leads to pricing variation in the marketplace
25:00 Accurate costing and the elimination of waste as an opportunity to drive value in healthcare
27:45 Payment reform is needed. Value-based reimbursements need to become real!
29:00 The movement to value-based payment driven mo...
Healthcare worker burnout has reached crisis proportions, and we must find real solutions to address the intense psychological suffering of our workforce. The seemingly endless intensity of work, the mounting death totals and the indifferent attitudes many Americans display toward COVID safety precautions has caused depression, burnout and moral injury for a growing number of physicians, nurses, and allied health professionals. For those of you out there feeling despair and pain on the frontlines of care delivery, an active meditation practice can bring you the peace and equanimity to transcend your suffering. In this week’s episode, we talk about realizing one’s unbound, undivided nature through meditation and how that can create a profound sense of liberation and enlightenment. If you are seeking a better understanding of how to experience a deeper sense of integrated realization that allows you to overcome an over-identification with ego that creates separation, isolation, and suffering, than this episode is for you!
Our guest this week, Dr. Angelo Dilullo, a practicing anesthesiologist and author of the book "Awake: It's Your Turn." I’ve invited him on to the podcast to provide us with a masterclass in breaking the illusion that we are separate from life, from ourselves, from everything that is. Given the suffering that is occurring in the healthcare workforce, there is something to be learned here about how we can live moment to moment and find resilience through equanimity. In this episode, Angelo discusses the process of Awakening (which he also wrote about in his new book and talked about on the ZDoggMD show) and how non-dual awareness can be applied to the context of emotional resiliency in the healthcare workforce to overcome burnout and moral injury.
Episode Bookmarks:
01:40 Eric discusses meeting Angelo during a recent 6-Day Semi-Silent Meditation Retreat and how his life has changed!
06:00 Angelo briefly discusses his Awakening journey and how he began to teach others
08:20 What Awakening is not as a starting point to understand what it is!
09:10 The end result of Awakening is the end of suffering
10:10 “Awakening is a huge reorganization in how you experience identity. It is a vast space of consciousness where one is completely at peace with one’s unbound Self.”
11:40 Awakening is the most important thing to someone once that state is fully realized. The process is self-validating.
12:30 “You didn’t realize the mental prison you were really in until you find the key, turn the key, and walk out the door.”
13:00 The paradoxical nature of Awakening and the experiential shift in spiritual insight
15:00 Thinking is a disease of the human mind that creates intense resistance to one’s true nature which, in turn, creates suffering.
17:00 Accessing the Peace and Equanimity that is already there through the elimination of incessant thinking!
19:00 You can’t fix stress and anxiety through thinking. There is a difference way to derive identity and find peace.
21:30 Feeling and experiencing as all of consciousness (instead of identification through thoughts)
22:00 Everything is “I” – a universal sense of Being
24:00 Experiencing equanimity as consciousness itself in the present moment (not through identification of past and future)
28:40 Presence is peace and equanimity at an intimate level…a complete sense of aliveness.
31:00 Awakening it is not some exalted state or spiritual enlightenment – it is a natural state of fluidity, unbound intimacy, and freedom
33:00 Anyone can wake up from the dream of separation if they are determined to find the root cause of suffering.
36:00 The mental health impact of the COVID-19 pandemic on the healthcare workforce (“psychological warfare” and nurses leaving the profession)
37:30 Depression and suicide in the medical profession due to burnout and moral injury (“a public health crisis”)
Sydney Townsend was diagnosed with cancer in June 2018, three months after giving birth to her first child. As a former boxer, she realized she was in the fight of her life and never gave up. After surviving her bout with cancer, her healing journey came full circle by joining the staff of Texas Oncology in 2021 (the practice that treated her cancer) as their Director of Virtual Care so she can provide care to others in the fight.
Joining Sydney in this episode is Dr. Kathryn Hudson, her hematologist and oncologist. Dr. Hudson is also the Director of Survivorship for the practice which allows her to extend the impact she makes as a clinician by improving supportive care models for cancer patients and survivors. When you hear from Dr. Hudson in this interview, you will immediately realize the power of the relationship she had with Sydney and how important this is in value-based oncology care.
Value-based care always starts with a deep and trusting relationship between a patient and provider. There is no stronger of an example of this than Sydney and Dr. Hudson. Together in this very special episode they discuss “Cancer Survivorship and the Power of Relationship-Based Care.” This is an interview that conveys triumph and inspiration for those either fighting cancer or seeking to provide truly patient-centered care!
Bookmarks:
01:40 An introduction to Sydney Townsend and her story of cancer survivorship
02:45 An introduction to Dr. Kathryn Hudson – hematologist, oncologist, and Director of Survivorship at Texas Oncology
04:30 Dr. Hudson provides a brief overview of the patient-centered model of care at Texas Oncology
05:30 Sydney explains how “telemedicine is more than just a tool for episodic care” and discusses how cancer survivorship is a “superpower”
07:00 Dr. Hudson discusses how her work as an oncologist and survivorship leader connects to her personal “Why”
08:15 Dr. Hudson provides a comprehensive overview of TXO’s cancer survivorship program
10:00 Sydney’s shares her heartfelt and deeply personal story of her cancer fight and healing journey over the last three years
15:20 The beautiful connection of motherhood between Sydney and Dr. Hudson and how that cultivated a deep and trusting relationship
17:30 Dr. Hudson discusses the deep empathy and personal connection she has for Sydney and how that informed her treatment decisions
20:30 Sydney describes the initial difficulties in establishing trust and how she eventually overcame her fear and suffering in the early stages
22:45 “Trust is something that takes time to build between a physician and a patient.”
25:15 Dr. Hudson discusses the importance of involving a patient’s family during cancer treatment
28:15 Sydney draws parallels between her bout with cancer with her prior experiences as a boxer
29:40 Dr. Hudson shares how inspired she was by Sydney’s mental fortitude during cancer treatment and survivorship
30:20 Sydney’s goal of getting back to the boxing gym in her “path to a new life”
31:30 Sydney describes her “ultimate Zen training” experience during chemotherapy and how mindfulness and meditation helped her to heal
33:15 How “being in the present moment” taught Sydney how to carry on through her survivorship (“I’ve been forged in fire, and it feels good!”)
35:20 Malnutrition during cancer is a main reason for avoidable ED visits and hospital admissions, and cause 1 in 5 cancer-related deaths
36:20 Dr. Hudson discusses the role that nutrition care plays in cancer treatment and how it lowers total cost of care and improves outcomes
39:10 Sydney discusses what she learned about nutrition during her cancer journey
41:45 Sydney explains how changes in telemedicine payment rules catalyzed adoption
42:45 How virtual care can be utilized to improve health equity and provide care in underserved areas
43:10 The challenges of “the digital divide” in the deployment of virtual care and how gove...
Mahatma Gandhi once said, “The true measure of any society can be found in how it treats its most vulnerable members.” The same can be said of healthcare organizations serving patients within their local communities. In value-based care, the truest measure of any healthcare organization’s success (from both an economic and a moral imperative) is how it treats its most vulnerable patients. It doesn’t get any clearer than that – serving the underserved…the 5% that drives 50% of medical spend…those that are dealing with serious illness due to chronic disease, mental health issues, or substance abuse is the most important focus we should all have as an industry. And with this intersection between vulnerability and minoritized populations, we have to start thinking about value-based care and health equity as one and the same. In this week’s episode, we are joined by two mavens, Michael Radu, CEO, and Dr. Gregory Foti, Chief Medical and Transformation Officer of AbsoluteCare. AbsoluteCare, is a leading innovator in patient-centered, value-based care. They are what I would call an integrated Chronic Care Patient Centered Ambulatory ICU that partners with health plans to care for only the most vulnerable complex patients. They are similar to other high-touch, relationship-based primary care centers; however, they don’t spread risk by accepting global capitation within the entirety of a normalized managed population, including caring for those who are relatively healthy. AbsoluteCARE sees only the sickest of the sick, and they are getting positive results with their comprehensive multidisciplinary care model by focusing on all aspects of a patient’s life issues – social, behavioral, substance use disorders and medical – to give patients the resources they need to fully change their lives. Listen today to learn from these leaders in the race to value! Episode Bookmarks:
05:00 The AbsoluteCare Care Model and its clinical and utilization impressive outcomes
07:00 Dr. Greg Foti explains his personal “Why” and how his disillusionment with FFS made him a champion for value-based care
08:20 Building trust with members as the “secret sauce” and why it is important for clinicians to take time to listen
09:45 How relationship-based care supports SDOH interventions and closing gaps in care
10:25 Mike Radu discusses how AbsoluteCare takes time with patients by lowering the patient panel per clinician and adding support teams
12:00 Promoting literacy and understanding of care plan and discharge instructions with post-visit follow-up from care team coordinator
12:50 Social workers and RNs as an additional wraparound support model to enhance member outcomes
13:45 “Beyond Medicine” and SDOH – an example of how AbsoluteCare helped a member overcome housing instability
15:45 Focusing on the top 4-6% of highest utilizers within the most vulnerable, complex, marginalized populations
16:50 Dr. Foti describes how AbsoluteCare provides housing interventions and build partnerships with communities and health plans
18:30 Addressing food insecurity through food bank partnerships and a “food as medicine” strategy
19:05 Helping members dealing with social isolation by building a community-based outreach structure
20:00 Mike Radu provides additional context on AbsoluteCare helps members dealing with food insecurity, housing instability, and health illiteracy
22:00 Using Member Rewards (re-loadable gift cards) that incentivizes members to engage in their own health
23:10 Dr. Foti discusses how innovative care delivery is only possible with value-based contracts that provide prospective funding for investments
24:30 “Dismantling the fence” in society to remove barriers (such as institutional racism and SDOH) that create inequities
27:00 Mike Radu provides perspective from his time with CMMI on how value-based care innovation is solving for health equity
29:30 The need for CMS to innovate Risk Adjustmen...
In recent years, the role of retail in health care has grown beyond the co-location of clinics and pharmacies, with many large retailers now expanding their care delivery practices to include full-service health centers, telehealth offerings, and home delivery of pharmaceuticals. Retailers like Walmart, CVS, Amazon, Walgreens, and Target are all pursuing a healthcare strategy. The opportunity to bring consumerism to the forefront in healthcare has never been more promising, and these retail companies are looking to deliver consumer-centric innovation in a way that the traditional healthcare system has been unable to. In addition to the provision of a high-touch, technology-enabled primary care delivered in existing brick-and-mortar facilities that are highly convenient and familiar to patients, these companies have begun to leverage other assets, including online platforms, robust supply chain and delivery infrastructures, and access to capital to grow their health care offerings.
In this episode, you are going to hear from three thought leaders with unique perspectives on this important topic. We have Dr. David Nash (Founding Dean Emeritus at Jefferson College of Population Health), Marcus Osborne (Senior Vice President of Walmart Health), and Darrell Moon (the Founder and CEO of Orriant).
Episode Bookmarks:
02:00 Retail companies (e.g. Walmart, CVS, Amazon, Walgreens) are bringing consumer-centric innovation to healthcare
03:15 Introductions to Marcus Osborne (SVP, Walmart Health), Dr. David Nash (Dean Emeritus, Jefferson College of Population Health), and Darrell Moon (CEO, Orriant)
04:30 The traditional American healthcare is one of the least consumer-centric models ever developed in a capitalist economy
06:25 Dr. Nash describes the current socioeconomic challenges of Philadelphia as a construct for how poverty contributes to adverse health outcomes
08:50 Dr. Nash reference the seminal article by Dr. David Kindig, “What is Population Health?” and how population health relates to SDOH and institutional racism
11:30 Is retail-based primary care the answer to improved population health through more effective patient engagement?
13:00 Referencing Fred Lee’s book, “If Disney Ran Your Hospital” in thinking about how we can optimize the patient experience and deliver personalized service
14:40 Marcus describes how supply and demand challenges of primary care in the effective management of chronic disease
16:30 “The biggest issue we face in healthcare is variation in care delivery.”
18:00 Technology, innovation, and interdisciplinary care teams as the ultimate solution to address population health challenges
19:00 The role of the “Professionally Nice Person” in consumer-centric care delivery and how Community Health Workers can be used to improve outcomes
20:00 Our challenge is getting the system comfortable with the reimagining of team-based care (not the patients!)
23:00 Darrell describes the importance of “massively powerful primary care” and the power of relationships
25:00 Nuka System of Care – Southcentral Foundation as a leading example of the “best healthcare system in the world” and how it emphasizes relationships, trust, and patient convenience
30:00 Marcus describes the absurdity of the “balanced interest” model in designing healthcare reforms (the interests of the consumers are all that matters!)
34:00 Dr. Nash on how unexplained clinical variation supersedes SDOH in importance when it comes to population health
35:00 Keeping only the wealthy healthy in a retail-based care model will perpetuate health inequities
37:00 Life expectancy is determined primarily by the zip code to which you live (e.g. SDOH disparities contributing to a 20-year variance in adjacent zip codes)
39:00 For-profit, private-equity backed SDOH companies are a driving force to community-based interventions
40:30 Marcus describes how Walmart Health is addressing social determinants ...
A special Thanksgiving message from Dr. Eric Weaver, host of the Race to Value, about gratitude, suffering, and the movement to value-based care.
Grief support and empathy education is so important in the context of value-based health care as it connects us to our own humanity. It speaks to why we entered into the altruistic practice of providing care, yet our fee-for-service model overvalues transactional activities without a whole-person orientation. This leads to medical professionals becoming detached from the grieving process of patients, families, and caregivers and results in our own moral injury along the way. Providers who lack an understanding in the grieving process or fail to adequately express empathy will also have patients with diminished clinical care outcomes. Moreover, doctors without empathy are more likely to get sued for malpractice compared to doctors who make the same mistake but do emphasize the human connection.
In this week’s episode, we invited one of the leading experts in grief and empathy, Lisa Keefauver to discuss a health system’s role in supporting patients, families, and caregivers through the grieving process. Lisa is the Founder & CEO of Reimagining Grief and is working to shift the narratives of grief at the individual, community, and organizational levels. Her wisdom as a grief and empathy leader runs deep and wide, rooted in her personal and professional experiences over the past 20+ years. You can find out more about Lisa’s work at her website: https://reimagininggrief.com/
Episode Bookmarks:
01:45 Introduction to Lisa Keefauver – a Speaker|Educator|Writer|Podcaster|Social Worker turned grief and empathy activist
03:30 Grief during the season of Thanksgiving and the important message of transcending it
05:30 Lisa shares the personal story of her harrowing experience with the healthcare system preceding her husband’s death from brain cancer
08:50 Lack of empathy and compassion from providers leads to missed information at the point-of-care
10:30 The assumption of clinical expertise at the expense of accounting for the humanity of patients
11:00 Anticipatory Grief - feeling of grief occurring before an impending loss, i.e. the forthcoming the death of someone close due to illness
11:40 Research shows that a direct correlation exists between anticipatory grieving and the caregiver's quality of life.
12:40 The importance of grief support and empathy education in the context of value-based health care and how anticipatory grief is so widely misunderstood
13:00 Pronounced anger and loss of control during anticipatory grief and how conventional medical misunderstanding pathologizes that behavior
14:00 Using tools (e.g. mindfulness, sleep, rest, and nutrition) to help patients, family, and caregivers with anticipatory grief
16:00 Stress-related health problems are responsible for up to 80% of visits to the doctor and account for the third highest health care expenditures, behind only heart disease and cancer.
16:30 Meditation programs could translate into health care savings as much as $25,500 per patient each year because of the lowered utilization of medical services and emergency room visits.
17:20 “As we move to value-based care, we need to think about covering mindfulness meditation as an integral service for patients, families, and caregivers.”
18:00 What mindfulness is (and what it isn’t) and the power of the present moment in eliminating stress and supporting emotional regulation.
19:45 Referencing Kristin Neff’s book, “Self-Compassion: The Proven Power of Being Kind to Yourself”
20:20 The need for mindfulness to be an important part of medical education training
22:15 Heart condition associated with grief - takotsubo cardiomyopathy (“broken heart syndrome”)
23:15 The role of social workers as part of an interdisciplinary team, particularly in the disease prevention aspect of grief counseling and support
26:40 How people of color can grieve differently and the reliance of human connectivity in BIPOC communities
29:00 The shared experience in dealing with the m...
How does a 3-physician practice sell for over $100 million dollars? The answer is simpler than it seems – full-risk contracting is better for providers and patients. Aligned incentives promote better outcomes for patients, and better reimbursement for those providing the care. It comes down to this - full risk unlocks the door to a true relationship with the patient, a relationship that provides more information than sophisticated AI models, risk coding and predictive analytics. And Medicare Advantage plans are the most accessible vehicle to achieve full capitation.
We are pleased to welcome back Dr. Tom Davis as our guest. Dr. Davis is an expert in value-based care, a family physician, angel investor, founder of 6 companies, consultant, and speaker. In this episode, he articulates how Medicare Advantage is a critical strength in the race to value. You can find more from Dr. Davis at his website: https://www.tomdavisconsulting.com/
Episode Bookmarks:
01:40 Introduction to Dr. Tom Davis
03:30 Dr. Davis started a small primary care practice that took full-risk Medicare Advantage (MA) and sold it for $132M!
06:30 Dr. Davis explains the “spectrum of value-based care” in MA and how he took the first full-risk contract in his market.
09:00 Analyzing cost drivers in patient population and how that prompted investment to capitalize on a site-of-service arbitrage
11:00 Implementing internal systems to optimize on physician workflow efficiencies in value-based care
12:00 Dr. Davis describes how it felt the first time he saw that he earned $1M+ in income as a primary care physician.
14:00 Dr. Davis explains “the offer we couldn’t refuse” when his full-risk MA practice was acquired.
14:40 “Value-based care under a full-risk Medicare Advantage model allowed me to be the family physician that I had always wanted to be.”
15:30 The enrollment growth trajectory in Medicare Advantage and the continued potential for rewarding economics for PCPs
17:15 “Devolving the financial consequences of the clinical decision down to the POS unleashes the most valuable asset in healthcare--the clinicians themselves.”
18:40 How to take full advantage of Medicare Advantage – Dr. Davis explains how to take full financial responsibility in a risk contract!
20:00 Full financial risk is only up to the attachment point of the stop-loss insurance.
21:00 The pool of capital in private insurance markets and the delegation of risk to both providers and the private liability market.
22:00 “Fee-for-service medicine sucks your will to live as a clinician.”
23:30 The economics of the MA Stars system and how it aligns with improved patient outcomes
24:45 Proxy Value vs. True Value in measurement
25:15 Full-risk contracts as the only true way to unlock value.
26:15 Moving from 3 to 5 Stars in Medicare Advantage equates to an 18% increase in practice revenue.
27:00 Deriving true value in MA contracts as the most sustainable and optimal ROI opportunity
28:30 The advantages and disadvantages of physician-led risk-bearing entities
29:45 “You will never learn to swim if you only stay in an ACO.”
31:00 Working with smaller MA plans because they are more likely to collaborate with physicians.
31:45 The rise of Direct Contracting Entities (DCEs) leaves no excuse for physicians to not up their risk profile.
33:00 The value of the patient relationship in driving business performance (versus short-term revenue generation to goose the bottom line in FFS)
34:40 Referencing the father of the modern container ship system in how we unlocked true value.
36:00 “Everything, everything, everything in your organization wraps around the value between the patient and the clinician.”
37:00 Dr. Davis shares a personal story of how a patient relationship supported colorectal cancer screening compliance.
38:00 How patient relationships trump sophisticated AI models and predictive analytics
39:00 The moral,
Health care is the largest employment sector in the US, and women account for 75-percent of the workforce. Gender equity in medical leadership is of paramount importance in value-based care to provide more meaningful and culturally-competent care with improved relational and clinical outcomes between patients and providers. Despite a female majority in the healthcare workforce, they are not proportionally represented within top leadership positions, where they account for less than 15-percent of executives. While women account for just over half of all medical school enrollments, they have consistently graduated from medical school at rates below their male colleagues, although that gap has narrowed in recent years. Further, only 18-percent of hospital CEOs are women.
Our special guest for this bonus episode is Dr. Charlotte Collins, Division Chief for The Center for Professionalism and Well-Being at Geisinger. Her work focuses on the provider experience to improve engagement, recruitment, retention, and communication, while benefitting patient care and experience, and reducing the risk for medical errors. The Center promotes cultural goals such as transparency, decentralized decision-making, and continuous quality improvement for the organization. In 2020, the National Business Group on Health awarded Geisinger with the platinum Best Employers: Excellence in Health & Well-Being Award for supporting the “enhancement and maintenance of personal and professional well-being” for staff.
In this episode, Dr. Collins shares insights garnered from her efforts to better understand women’s needs in the health care workforce. During this time of consistent burnout among clinicians, and heightened awareness of the need for improved equity, it is critical to recognize the opportunity for women to take a more prominent role in leading value-based care transformation. This discussion will provide you with important insights on gender and pay equity, creating a female-friendly workplace, empowerment, and workforce resiliency. The value proposition of gender equity in leadership is crucial in the transition to whole-person care models that deliver on improved population health outcomes.
This bonus episode is a recording of an ACLC Peer Learning Session – watch here if you would like to see Dr. Collins’ slides and hear the full audio.
Episode Bookmarks:
01:40 Referencing the ACLC Intelligence Brief on Women in Medicine and Introduction to Dr. Charlotte Collins
04:00 Kimberly Mueller explains the purpose of the ACLC in accelerating the transition to value-based care
05:00 Recent efforts in healthcare to support the advancement of DEI and Dr. Collins work at Geisinger
07:20 75% of the healthcare workforce is female, but there is an imbalance between men and women in leadership roles
08:30 The role that women leaders play in value-based care and how more women in medical leadership could improve clinical outcomes
09:30 The three pillars of Geisinger that inform population health and how the pandemic has impacted that work
10:15 The exodus of the healthcare workforce due to burnout and retirement, coupled with nursing shortages, has created a crisis
11:15 The development of the Geisinger Center for Professionalism and Well-Being and how it supports women in medicine
13:00 Overview of Geisinger’s survey on women-centered medicine and clinical practice
17:45 How patients have potentially been impacted by sexual harassment, and the opportunities to address burnout and workplace fairness
19:30 Pay equity and transparency within the workforce and the creation of a “female-friendly workplace”
21:10 Addressing workforce policies that disproportionately impact women
22:10 The choice that women face in being a “good Mom” or a professional in the workplace
24:00 Geisinger’s program to support workforce resiliency and emotional well-being (RISE - Resilience in Stressful Events)
The financial stats of healthcare are all too familiar – the 18% of GDP, $3 trillion spend, and the $11k per capita cost are frightening to consider. We are on an unsustainable financial trajectory, as those numbers are projected to increase. The costs for cancer care, which include both medical services and drugs, are no different. In 2015, national costs for cancer care were estimated to be $190 billion and just 5 years later, in 2020, the costs ballooned to $209 billion. The 10 percent increase is primarily attributed to the aging and growth of the U.S. population.
As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, there are many examples of practices participating in CMS’ Oncology Care Model (OCM) that have made impactful workflow changes to achieve cost and quality improvements. The OCM was the first cancer-specific alternative payment model for Medicare recipients as well as Medicare's first APM for outpatient specialty medicine. Despite several practices succeeding in the OCM, many have not. At this point, the overall results of the APM have been underwhelming. Since the OCM was originally implemented in 2016, the program has led to a $155 million net loss to Medicare. While originally set to expire this summer, to be replaced by Oncology Care First (OCF), the date was pushed back by a year. CMMI can apply lessons learned when launching the OCF, and Texas Oncology is where they can find oncology care that is thriving in the race to value.
Our guest this week is Debra Patt, M.D., PH.D., MBA, a practicing oncologist and breast cancer specialist in Austin, Texas. Dr. Pratt serves as the Executive Vice President for Public Policy, Payer Relations, and Strategic Initiatives at Texas Oncology, a network of 210 sites of service and 490 doctors, serving half of the cancer patients in Texas. In this role she advocates for effective cancer policy at the state and federal level, and advises on strategy for various initiatives, such as telemedicine, optimizing growth and development of advanced practice providers, development of service lines, informatics initiatives and contracting. Her research is in clinical decision support, predictive analytics, telemedicine, health economics and outcomes, tools for patient symptom management and quality improvement. As an expert in healthcare policy, she has testified before Congress to protect access to care for Medicare beneficiaries. She is the editor-in-chief of the Journal of Clinical Oncology- Clinical Cancer Informatics.
Episode Bookmarks:
01:45 Background information on Dr. Debra Patt and her work in Value-Based Oncology Care
05:00 The Country’s Financial Burden of Cancer Care – Why we need to transition from Volume to Value
07:00 The need to anchor our expectations for value differently based on the aging of the population and the advancement of treatment
08:15 Investments inpatient care and drug research is more like a “mortgage” instead of paying “rent”
09:00 How cancer care is bankrupting patients due to out-of-pocket burden
09:25 Many forms of cancer are now being treating like an acute illness instead of a chronic disease akin to HTN or diabetes
09:45 The societal and economic benefits of people living longer upon the initial diagnosis of cancer due to advances in care
10:10 Referencing the book, “The Great American Drug Deal: A New Prescription for Innovative and Affordable Medicines”
10:40 Other investments, outside of new innovations in drugs and therapeutics, that are still needed in value-based oncology care
12:00 The Oncology Care Model (or OCM) -- the first cancer-specific alternative payment model for Medicare recipients
12:45 The underwhelming results of OCM, a $155 million net loss to Medicare, largely due the model’s complexity
14:00 Correlating the assessment of OCM’s success to the value equations, i.e.
You are about to be inspired and challenged about how you think about value-based care. Since 1991, Rosen Hotels & Resorts has offered an innovative in-house healthcare program called RosenCare that has been improving lives for employees and the community, as well as saved the company approximately $450 million since its inception.
Our guests this week are Harris Rosen, businessman, investor and philanthropist who founded Rosen Hotels & Resorts and serves as the company's president and COO; Kenneth Aldridge, Director of Health Services for Rosen Medical Center, the onsite medical home and primary care ecosystem; and Ashley Bacot, President of Provinsure, an independent insurance consulting arm owned by Rosen.
The takeaways from this conversation are multi-faceted and can be applied to ACOs, health plans, and employers. This interview will allow you to re-think how local community engagement and partnerships fit into your healthcare strategy. RosenCare’s approach will force you to reconsider how you approach access, quality, service, costs, innovation. Saving costs and improving lives, this model is ripe for replication and needs to become the norm in our race to value. In the words of Mr. Rosen, “We need to, as a nation, build a much better health system. If we replicated the RosenCare program nationally, we would save over a trillion dollars annually! Let’s use that money to pay off our national debt. Health care can be the treasure that changes America.”
Episode Bookmarks:
01:45 Background on Rosen Hotels & Resorts and its innovative in-house healthcare program (RosenCare) that saved $450 million!
03:45 Introduction to Harris Rosen, Kenneth Aldridge, and Ashley Bacot
07:00 Rosen Hotels & Resorts spends 50% less per capita than the average employer (cost “per covered life” is ~$5,500)
08:20 Mr. Rosen explains how the military adages of the 6P’s and KISS guides his entrepreneurial vision
09:20 The birth of RosenCare in 1991 due to uncontrollable and rising health insurance premiums (Mr. Rosen)
10:00 Lowering healthcare costs 20% but still facing premium escalations…time to become a self-insured plan and build our own clinic! (Mr. Rosen)
14:20 “Our success wasn’t that complicated. Scary…yes. Uncertain…of course. But we did it, and we saved $450-500M in healthcare costs over the last 40 years.”
16:05 How Mr. Rosen leads others and built a such a strong culture that company associates want to be a part of (Ashley)
18:40 How working diligently to keep people healthy drives both good outcomes and a healthy bottom line (Mr. Rosen)
19:05 Social determinants of health and the challenges of keeping associates healthy (Kenneth)
20:20 “This is advanced, direct primary care on steroids!”
22:00 The strength of Rosen’s self-insurance plan, Third Party Administrator, and direct contracting model (Ashley)
24:00 Designing steerage into the benefit design (Ashley)
25:30 The unfounded fears by employers in redesigning health insurance benefits (Ashley)
27:30 An Overview of Rosen Medical Center, A Place for Healing and Wellness
29:00 The importance of relationship-based care at Rosen Medical Center (Kenneth)
34:30 How RosenCare addresses the issue of low value care with PBM formulary selection and surgery options (Kenneth)
36:00 How non-traditional treatment (e.g. medical marijuana) have a role to play in eliminating traditional options of treatment that are of lower value (Kenneth)
39:00 How RosenCare approaches direct contracting with hospitals (Ashley)
40:15 The importance of employers having the courage to be self-insured and the need for reforms in hospital reimbursement (Mr. Rosen)
42:00 “Hospitals must try to be fair and equitable. They should publish costs and outcomes online.”
43:20 The powerful hospital lobby and its concern for income preservation at the sake of ethical business behavior (Mr. Rosen)
45:00 The horrible financial situation that patients fa...
Every year, millions of Americans are overcharged and underserved while the health care industry makes record profits. We know something is wrong, but layers of complexity make it confusing and discouraging to do anything about it - it seems impossible for most.
Our guest this week is Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. Drawing on 15 years of investigating the health care industry, reporter Marshall Allen reveals the industry’s pressure points and how companies and individuals have fought overbilling, price gouging, insurance denials, and more to get the care they deserve and protect against the system’s predatory practices.
The key message is that we, the consumer, can take back control of our health care. It is up to the American people to equip ourselves to fight back for the sake of our families–and everyone else. Consumers must lead the race to value.
Episode Bookmarks:
01:40 An introduction to Marshall Allen and his work investigating the American healthcare system
03:35 The need for a grassroots consumer movement and employer-based disruption to reform a broken system
04:45 How Marshall’s work in investigative healthcare journalism was informed by his work in ministry
05:50 Marshall explains how the healthcare system’s business design violates the Golden Rule
08:15 “The business of medicine is conducted to maximize the profit for the industry, even at the financial harm of patients.”
08:30 Marshall’s new book: “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.”
10:00 The victimization of patients that occurs through flawed system design and the “normalized deviance” by those delivering care
11:30 The importance of reframing the health system to eliminate the exploitation of patients for profit
12:15 “Our healthcare system is allows for the exploitation of sickness for profit.”
13:00 Marshall discusses the lack of an ethical position to exploit consumers for non-discretionary choices
13:20 The escalating price of insulin as an example of how inelastic demand is exploited for profit
15:00 Marshall explains how employers and patients can demand better value by no longer tolerating profit maximization
16:30 Referencing the recent JAMA Study on Medical Debt showing that 1 in 5 Americans have medical debt in collections
17:00 Using Marshall’s new book as a step-by-step, tactical guerilla guide for patient and employer empowerment
19:30 The approval of non-effective drugs and pricing scams conducted by Big Pharma (e.g. the recent approval of Aduhelm)
20:20 Marshall explains how the specialty drug, Vimovo, is an egregious example of a Big Pharma profiteering scheme combining two common drugs with no additional therapeutic benefit (Marshall’s article on Vimovo)
24:00 Motivated to write book to help patients facing financial ruination by healthcare
25:00 185 million Americans in the employer-sponsored insurance market as an opportunity for grassroots reform
25:30 Marshall’s explains his family’s personal experience of financial exploitation by the healthcare system (the Introduction to his book)
28:30 The need for patients to gather evidence when disputing medical billing errors and upcoding
31:30 The effectiveness of small claims courts in empowering patients who are being financially exploited
34:00 Marshall provides guidance on how patients can avoid unnecessary care
37:00 Comparing the financial incentives between capitated models vs. fee-for-service
38:00 Always ask for the cash price as a patient! (you don’t always have to use insurance)
38:30 The massive price variation based on the site of service (e.g. MRIs in hospital vs. freestanding imaging center)
39:45 “You’re not getting more for your money when you pay extra for healthcare.”
42:00 Marshall explains his mission to help patients develop financial literacy by developing co...
This week on Race to Value, we are excited to celebrate Pharmacy Week – it is a time to recognize the invaluable contributions pharmacists and technicians make to patient care in hospitals, outpatient clinics, and other healthcare settings, and to raise patients’ and colleagues’ awareness about the vital role pharmacists play on the healthcare team. Our guests this week are mavens in aligning pharmacy and value-based care. In this episode, we discuss the importance of women in leadership, the impact of drug prices on minoritized communities, vaccine equity, the relationship between SDOH and medication adherence, pharmacy integration, and vaccine science and effectiveness research.
Melissa Murer Corrigan was founding Executive Director and CEO of the Pharmacy Technician Certification Board (PTCB) in Washington, D.C. from 1994-2011. Melissa’s leadership launched the PTCB program that has now certified over 600,000 pharmacy technicians working across the United States. Murer Corrigan embraced ambition, took risks, and was the only woman on the PTCB Board of Governors during her 17-year tenure as CEO.
In 2012 Melissa joined the ACT as Vice President of Social Impact and sits on the Board of Directors for the American Institute for the History of Pharmacy. Melissa has served as adjunct faculty with the University of Iowa College of Pharmacy since 2013. She has been named a Fellow of both the American Society of Health-System Pharmacists Association and the American Pharmacists Association.
Jacinda Abdul-Mutakabbir, also known as “JAM," is an Assistant Professor of Pharmacy Practice at Loma Linda University, School of Pharmacy and a Critical Care Infectious Disease pharmacist, and an Infectious Disease Pharmacokinetics/ Pharmacodynamics (PK/PD) Research Fellow at Wayne State University under the tutelage of Dr. Michael J. Rybak PharmD, MPH, PhD. Her dedication to improving public health has been recognized by the United States Public Health Services, as she was the 2017 recipient of the USPHS Outstanding Service Award. Additionally, her research has led her to be recognized by the European Congress of Clinical Microbiology and Infectious Diseases one of their 30 under 30 outstanding young scientists, for their ECCMID 2021 31st annual meeting.
Episode Bookmarks:
02:00 Introduction to Melissa Murer Corrigan and Dr. Jacinda Abdul-Mutakabbir (Dr.JAM)
04:00 The importance of National Pharmacy Week
05:30 Overcoming the dominant idea of patriarchy in business and medicine and honoring strong women by allowing them to lead
07:30 Melissa on the celebration of women in leadership and how men can serve as allies and advocates
08:30 Reflecting on women in pharmacy leadership (e.g. Rosalind Brewer, the CEO of Walgreens Boots Alliance)
09:20 Overcoming Imposter Syndrome to create a “growth mindset” within women
10:30 Dr. JAM on the steps taken to towards improving gender equity within the pharmaceutical workforce
12:00 Prescription drugs are the fastest growing healthcare expenditure and consistently outpace other health spending
13:00 Biden administration support for legislation to empower the government to negotiate Medicare drug prices with Big Pharma
14:00 Melissa on providing patients with the access to medications they need so they are “not making choices between treatment and buying groceries”
14:30 Dr. JAM on how drug prices impact individuals in minoritized communities
15:30 Utilizing the approach to equitable distribution of COVID-19 vaccines to the provision of lifesaving medications to underserved communities
17:00 The role that pharmacies have to positively impact and address the systemic health disparities in communities of color and low-income neighborhoods
17:30 Referencing AJMC research showing that Black individuals who received medication therapy management services from a pharmacist significantly improved their diabetes
18:30 Dr.
Our guest this week is Dr. Tamarah Dupervahl-Brownlee, Chief Health Officer for Accenture, and recently, Chief Community Impact Officer for Ascension. A Physician leader with 20+ years of experience practicing medicine, she has served in various healthcare leadership roles that focus on optimizing the physical, mental, and financial health and wellbeing of communities.
Dr. Dupervahl-Brownlee is fiercely determined to create and implement strategies for people to thrive and live healthy and well. Throughout her career, she has served as a champion for providing high quality healthcare and advancing health equity that has impacted thousands of lives. In recognition of that work, she was named by Modern Healthcare as one of the Top 25 Women Leaders in 2021 and one of the Top 25 Minority Leaders in Healthcare in 2020.
She is nationally recognized for her leadership in collaborating with partners across the industry and nonprofit community to advance community health improvement initiatives, with a particular focus on health equity. Her strong patient-centered approach to medicine, with a special interest in women, children, and underserved populations, makes her a clear leader in the race to value.
Episode Bookmarks:
05:30 Dr. Dupervahl-Brownlee speaks to her personal leadership journey
07:30 Lessons in servant leadership and the importance of “stepping out of one’s self” and investing in others
08:15 The influence of Dr. Dupervahl-Brownlee’s mother, an immigrant from Haiti, who laid a great foundation for her to pursue a career in medicine
11:00 “The pandemics of both COVID-19 and social injustice show us just how inextricably linked we are as people. This is the time to examine opportunities to improve health equity.”
13:20 The need to reposition the healthcare workforce to address human pain and suffering
14:20 “Profitability in healthcare has led us astray by ignoring vulnerable communities and creating opportunities to innovate.”
16:00 “If we all head a lens of equity, just think about we could do as leaders in healthcare.”
17:40 Dr. Dupervahl-Brownlee speaks about how value-based care and emerging payment models can be leveraged to improve health equity
18:20 The leadership of CMS Administrator Chiquita Brooks-LaSure to tackle health equity and better understand the social determinants of health through value-based care
19:30 Understanding how social risk factors and community-based investments to improve population health
20:45 The need for research in patient-reported outcomes to assess how healthcare can help patients thrive
22:40 Referencing her early beginnings practicing medicine in the South side of Chicago and how Social Determinants of Health prevented improvement in patient outcomes
25:00 How structural biases and racism negatively impact health in communities and the need for health policy reforms
26:30 The need for more curiosity and inclusivity in healthcare to know “the rest of the story”
27:45 How we can use data from outside the traditional healthcare system in improving the health of vulnerable populations
30:00 Dr. Dupervahl-Brownlee on the future of hospitals as healthcare moves more towards value and consumerism (“The hospital of today will be extinct in the future”)
31:00 The reordering of the healthcare solar system to patient-centeredness
32:00 Referencing her prior work in Patient-Centered Medical Home transformation
35:00 Dr. Dupervahl-Brownlee provides perspective on how our country can achieve better integration of behavioral health in the primary care environment
38:30 The irreparable harm of the pandemic on societal mental health and the use of digital health in integrated care models
41:30 Acknowledging the resilience and fortitude of healthcare heroes during these challenging times
42:30 The importance of physician leadership with a shared and lived experience in practicing medicine to create empowerment within the p...
Gender-affirming care offers a model for all of health care, one that is patient-centered and based on the human story. In this episode, you will learn about “The Truth and Beauty of Gender-Affirming Care” from a leading transgender health provider and value-based care thought leader.
Dallas Ducar is the founding CEO of Transhealth Northampton. In this role, Dallas brings experience constructing clinical, research, and education services in community-based, gender-affirming, healthcare systems. She combines this leadership experience with frontline clinical experience in emergency, inpatient, and outpatient care. Prior to assuming the CEO position, Dallas served as the Clinical Lead for Mental Health Services at the Massachusetts General Hospital Transgender Health Program, where she worked with an interdisciplinary team to provide novel gender-affirming care. In her career, she has advised international research groups in best practices and has carried out community-based participatory action research programs dedicated to empowering gender-diverse voices in a community setting. As a nationally recognized leader in transgender health, Dallas is on a personal crusade to improve the quality of care for gender-diverse individuals.
Topics covered in this episode include gender-affirming care, health equity, social determinants of health, mental health in the transgender community, culturally-competent care, mindfulness and meditation, telehealth expansion, pediatric transgender care, insurance barriers, and the recognition of transgender rights as civil rights.
Episode Bookmarks:
05:40 Overcoming gender dysphoria to realize “gender euphoria” as her truest self
07:40 Using her “trans superpowers” to become a more resilient human being
09:10 Dallas speaks about the period in her life when she was transitioning in Charlottesville, VA
12:00 Recognizing the opportunity to address trans rights in the healthcare arena
14:50 Dallas explains the concept of gender-affirming care and how it is an example of patient-centeredness and compassion
15:40 “What is gender-affirming care? It is patient-centered, whole-person care that addresses every part of one’s life that intersects with gender.”
16:40 “The simple truth and beauty of gender-affirming care is that it affords every human being the freedom to be who they are.”
17:10 Dallas explains the value-based care delivery model of Transhealth Northampton, the nation’s first independent comprehensive trans health care center
17:40 Gender-affirming care that delivers value (ex: improved behavioral health outcomes, less suicidality, more effective SUD treatment)
19:40 “Patients in a value-based gender-affirming care model have lower healthcare spending, higher patient satisfaction, and improved clinical outcomes.”
20:40 What is Health Equity? (a definition from the Robert Wood Johnson Foundation)
21:10 Transgender individuals are more likely to be in the lower income brackets with 44 percent of trans community living on an income of $35,000 or less
22:10 Published Reporting of trans discrimination in healthcare (Referencing the Center for American Progress Report)
23:40 Dallas discusses the observed impact of trans discrimination in healthcare and the interrelatedness of SDOH barriers
25:40 The importance of culturally-competent care and the provision of care by people with the same “lived experience”
27:40 Expanding access to gender-affirming care with telehealth
28:40 40% of the transgender community have attempted suicide in their lifetime (9X the attempted suicide rate of the entire US population)
30:10 Dallas speaks of the importance of behavioral health integration in the primary care setting
32:40 Dallas explains why providing care in a “celebratory and open-hearted queer-friendly healthcare environment” improves outcomes
34:10 The importance of families staying together within a gender-affirming care model
As one of the leading integrated health systems in the country -- serving more than 3 million residents throughout 45 counties in Pennsylvania and New Jersey with 30,000 employees, nine hospitals, 1,600 employed physicians, 13 hospital campuses, 70 primary care sites, two research centers, and a 550,000-member health plan -- Geisinger has become a standard for value-based payment innovation and care delivery transformation.
Geisinger was also an early adopter of value-based payment as a member of the Keystone Accountable Care Organization (ACO), which is a group of nearly 5,000 physicians and advanced practitioners and 9 hospitals who deliver over $800 million annually in coordinated healthcare services to more than 80,000 Medicare patients in Pennsylvania. Additionally, Geisinger has been engaged in Medicare’s Bundled Payment for Care Improvement program since 2014, and currently has more than $140 million in healthcare services delivered as part of Medicare’s Bundled Payment for Care Improvement Advanced (BPCIA) program.
Our guest this week is Dr. Jaewon Ryu, M.D, J.D, President and CEO of Geisinger. Dr. Ryu has led the system with a spirit of innovation and transformation, driving new approaches to some of healthcare’s most complex problems, including primary care redesign, home care and senior-focused, concierge healthcare centers for those 65 and older. His commitment to making health easier by improving outcomes, engagement and affordability are evident in his work and make him an exemplar in the race to value.
Episode bookmarks:
05:30 Dr. Ryu describes Geisinger’s Value Journey that has been taking place over the last 35 years
06:30 “Value-based care allows us to innovate around care models by marrying the payment with delivery.”
08:15 Dr. Ryu provides advice to other health systems looking to invest in an infrastructure for population health
11:30 Dr. Ryu discusses how “Primary care is the backbone of the delivery system” and why it is so important in managing chronic disease
13:10 The Abigail Geisinger Scholars Program that offers medical students entering the Geisinger Commonwealth School of Medicine free tuition if entering primary care
14:30 The importance of Geisinger physicians understanding its different care models (e.g. Geisinger 65 Forward, Geisinger At Home, LIFE Geisinger)
17:30 Dr. Ryu discusses the impact of the COVID-19 pandemic on frontline providers and staff and importance of workforce resiliency during challenging times.
19:00 How Geisinger’s Value-Based orientation positioned it favorably during the COVID-19 pandemic (e.g. upstream capabilities and care at home program)
20:00 How strong partnership with employers, school districts, and nursing homes created a pandemic response ecosystem to improve community care
21:00 “Our value-based care orientation provided us with a public health lens to better care for our communities during the pandemic.”
23:30 How the Steel Institute for Health Innovation provided human-centered design thinking, AI/ML, automation, and other innovations to further catalyze VBC at Geisinger
28:30 Dr. Ryu describes the importance of risk stratification and population segmentation in providing better care to seniors with chronic disease
29:30 Geisinger 65 Forward clinics that provide VIP-level personalized care and appointments, longer visits, one-stop shopping, and social and educational activities for seniors
30:45 Unlike other high-touch senior-focused primary care models, Geisinger 65 Forward is fully-integrated with the health system
32:40 How primary care redesign at Geisinger focusing on team-based care improved clinical outcomes
35:20 Dr. Ryu on how we need to move care away from “Field of Dreams” facilities (i.e. the “if you build it, they will come” model) towards a more asset-light model of care delivery
36:45 Geisinger At Home as a national example for home-based care delivery
40:30 Dr.
In this week’s episode, we spotlight the recently released Future of Nursing report, “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.” The report is a landmark consensus study supported by the National Academy of Medicine and the Robert Wood Johnson Foundation. It charts a 10-year path for the nursing profession, to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the US population in the 21st century.
The COVID-19 pandemic has exposed serious inequities in the nation’s healthcare system, with frontline healthcare workers often lacking the necessary PPE and other equipment to safely and effectively do their jobs, and the murder of George Floyd shined a spotlight on the structural racism that exists in the workplace and society at large. In the wake of these challenges, the Future of Nursing report provides us with a north star to guide the nursing profession over the next 10 years, with a particular focus on reducing health inequities and improving health outcomes in value-based care.
Our guests are both important thought leaders in nursing. Dr. Susan Hassmiller is the Senior Advisor for Nursing at the Robert Wood Johnson Foundation, and Senior Scholar in Residence for the National Academy of Medicine. Dr. Janelle Sokolowich is the academic Vice President and Dean for the College of Health Professions at Western Governors University. Their voices are united in sharing this important message: nurses are key to health, healthcare, and the future success of our healthcare industry, and educational programs that provide equity in access and learning will ensure our nursing workforce has both the cultural humility and clinical competence to address the needs for greater health equity and diversity.
Episode Bookmarks:
01:40 Introduction to the “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity”
04:40 The need for diversity in the nursing workforce and how to eliminate bias in teaching and learning
06:55 Historical contrasting between stories of Florence Nightingale and Lillian Wald with occurrences of racism in nursing (e.g. Black Angels)
07:20 Recognizing bias in nursing curriculum through population exclusion (e.g. transgender), stereotypes, colloquialisms, and standardized testing
09:00 The lack of training with nursing faculty on how to have uncomfortable, yet crucial, conversations on race and health equity
10:00 The importance of diversity and cultivating inclusive learning environments
11:00 Holistic recruiting and competency-based learning as an opportunity equalizer for students of color
11:30 “Health equity is our end goal, but in order to even achieve that, we have to create pathways to education.”
12:50 The “Diversity Tax” – dependence on faculty of color to do all of the mentoring for underrepresented minority students
14:20 Raising awareness for health inequities to bring about industry-level commitment to SDOH and health equity
15:20 The importance of holistic admissions, diversity, and cultural humility to build models for culturally-competent care
16:20 “Our goal as educators is to empower our students to have cultural currency in their communication so that they can provide competent care that is enhanced and enlaced with humility.”
17:00 The need for kindness and patience for others to elevate crucial conversations
20:00 Competency-based education in nursing as an opportunity to increase diversity in the workforce and improve health equity for populations
22:00 “Competency-based education is a promising way to integrate equity, social determinants of health, and population health into the nursing curricula all at one time.”
24:00 Confronting Institutional Racism in Nursing Practice and the need for more open conversations to overcome health inequities
25:00 “Inequities in this country lead to very poor outcomes.
Oak Street Health has an amazing vision to rebuild Health Care as It Should Be: Personal, Equitable, and Accountable. The business was launched with a belief in value-based care that was patient-centered, evidence-based, and ensured equal opportunity for good health outcomes across populations, despite the economics being unproven. The business model depends on global capitation and allows the best service for patients in some of the poorest and most vulnerable communities. The high touch, relationship-based, tech-enabled primary care model includes support with medications, transportation, social work, home visits, and more – the sickest 10% of patients receive 78% of Oak Street’s dollars.
This week, our guest is Dr. Griffin Myers, CMO and co-founder of Oak Street Health. In his own words, the challenge is not providing treatment but winning patients’ “trust and building relationships,” something Oak Street has demonstrated successfully with its ability to rapidly scale, to a network of 90 centers in 15 states. The Oak Street Platform is redefining Primary Care by bringing technology-enabled, value-based care to the seniors that represent the highest proportion of healthcare spending in the country. Winning the race to value will depend on many more following in the footsteps of these leaders!
Episode Bookmarks:
05:35 The “insane” journey of starting a company that takes full-risk on very sick populations
05:55 “The downstream microeconomics of fee-for-service reimbursement has created a janky, inequitable, low quality health care system.”
06:30 The importance of segmenting your patient population within a payment model that is better aligned with care outcomes
06:40 “We take care of community-dwelling older adults with multiple chronic conditions and adverse social determinants.”
06:50 Full risk, global capitation enabled the development of the Oak Street Health platform.
07:00 Oak Street platform: 1) Community-Based Primary Care Centers, 2) Proprietary Technologies, 3) Value-Added Services to Primary Care
07:35 Dr. Myers discusses how the culture at Oak Street, coupled with the power of global capitation, drives value-based care results.
08:45 Oak Street’s Results: 50% reduction of hospital admissions, 52% reduction of ED visits, 35% reduction in 30-day readmission rates, 5-star quality ratings, and a 91 NPS
10:40 Dr. Myers discusses the concept of relationship-based care and how it improves outcomes for underserved populations.
11:20 Referencing Viktor Frankl’s “Man Search for Meaning” and how deeply meaningful and trusting relationships provide purpose
12:05 “Trust is the core input to us being able to help patients navigate adverse social determinants.”
12:10 Critical Success Factors: 1) Spending more time with patients with a consistent presence from a longitudinal care team, 2) Deep sense of accountability (“a promise”), 3) Culturally-Competent Care
12:55 “Having people who live in the neighborhoods to which we serve that share a cultural connection with patients helps form trusting relationships.”
13:30 “A value-based model is simply superior technology compared to fee-for-service. Value allows you to incubate and foster relationships to drive outcomes.”
14:40 Inspiration from John Lewis (“Try to be the pilot light not the firecracker.”) when it comes to building a safer, higher quality, more equitable, more affordable health system.
17:35 Referencing the HBS Case Study: “Oak Street Health: A New Model for Primary Care”
17:45 The role of the Clinical Informatics Specialist at Oak Street
18:30 Dr. Myers discusses the evolution of EHR technology at Oak Street and the development of Canopy (winner of the 2021 EHR Innovation Award)
19:40 The Value Flow of the Canopy EHR: “Data, Insights, and Action”
20:15 Deep and long-term relationships between the patients and providers that allows for enhanced data capture.
Let’s face it - the healthcare system is broken. It will never be fixed unless we fundamentally redesign our industry towards a more consumer-centric model. That will require courageous leadership, and our guest this week provides "the path of hope for human-centered care delivery". Leaders must overcome the cultural malaise that has been formed after years being conditioned by the current model. We know that our healthcare system causes 200-400k avoidable deaths each year (which is like having two or three jumbo jets crashing every single day), however, we’ve become desensitized to the consequences of our flawed model for delivering care. Each and everyone in the system bears responsibility for other people’s lives and has a role to play in reimagining the future of healthcare. We clearly need urgency for change.
Dr. Zeev Neuwirth is the author of “Reframing Healthcare: A Roadmap For Creating Disruptive Change” and produces and hosts the popular podcast series, “Creating a New Healthcare.” He is currently serving as Atrium Health’s Chief Clinical Executive.Dr. Neuwirth is reorienting the way individuals and organizations think about healthcare, to catalyze movement towards an affordable, accessible, effective and safe healthcare system.His ultimate goal is to humanize healthcare for those who serve within the system, and especially for those who are served by the system.
Episode Bookmarks:
03:15 Referencing Dr. Neuwirth’s book: “Reframing Healthcare: A Roadmap for Creating Disruptive Change”
06:30 The challenges of practicing medicine in the pandemic era and recognition of those on the frontlines of care delivery
08:20 A shift in focus from Internal Medicine to care redesign, human-centered care delivery, and process improvement
08:50 Dr. Neuwirth explains his passion in seeking out people who are making a difference
09:40 “Creating a path of hope for health care delivery” by providing a platform for those transforming healthcare
11:30 “Health care transformation is already happening across the country. It’s just a matter of aligning payment to it.”
12:30 “Are we collectively ready to have the courage to change a system in fundamental ways? The answer is YES or NO – there is no in-between.”
13:00 The catalyst for Dr. Neuwirth’s work in health care transformation started twenty-five years ago (seeing the “inhumane” system).
15:00 “You cannot improve this system. You actually have to reframe it.”
16:00 Dr. Neuwirth explains how his mother died from a completely preventable hospital-acquired infection
18:00 Avoidable deaths due to medical errors happen to over 400,000 families a year!
18:30 Dr. Neuwirth discusses the human tragedy of a close friend and physician colleague who committed suicide
19:45 “I am going to go down fighting against a system that strips the humanity out of every single person who tries to do the best they can to help their fellow man.”
21:00 Dr. Neuwirth’s déjà vu “Groundhog Day” moment realizing that we keep talking about the same answers (but the system never changes)
22:30 “Technology is an enabler – no question about it. But it is not the transformative thing needed to create a new orientation.”
26:30 Courageous leadership to re-instill humanism in health care sometimes requires people to make sacrifices in their career.
27:20 “The people are not the problem in health care…the system is.”
28:00 “If there is an evil in health care, it is the fee-for-service payment model.”
29:00 When piecemeal payment and patient churning ultimately becomes the key performance indicator -- choosing to leave or live with it!
30:30 “We have turned physicians into visit vendors.”
31:30 “It is mind boggling that we continue to drag our feet In this shift from fee-for-service to value-based payment.”
32:00 Looking for collective courage in industry – why don’t CEOs link arms in solidarity for value-based care?
We’re excited to share this special edition episode with Dr. Tony Dale, an “Old World” doctor from England who has since become a successful healthcare entrepreneur in the United States. Despite practicing socialized medicine early in his medical career, Dr. Dale has become a champion for free market reforms to our nation’s healthcare system. As the founder and Chairman of The Karis Group and Sedera, he has brought cost transparency and consumerism to the forefront. Dr. Dale’s entrepreneurial vision has directly impacted the lives of millions of patients seeking the best possible care at fair and affordable prices. In this podcast conversation, we discussed his newest book “The Cure For Healthcare: An Old World Doctor’s Prescription for the New World Health System”. This episode was recorded in collaboration with the Point Health podcast and its hosts Steven Cutbirth.
Episode Bookmarks:
01:20 Intro to Dr. Tony Dale -- from practicing family medicine in London to his work as an American healthcare entrepreneur dedicated to affordable care
02:30 Early experiences with his father, a family doctor in Taiwan, who led him into a career in medicine
04:30 What Dr. Dale learned from his work as a physician in the UK’s NHS within a socialized model of medicine caring for the poor
06:30 Access to care in a socialized model does not necessarily mean access to quality
07:30 Seeing 40-60 patients per day, on top of doing home visits, led to bad medicine
08:15 Relocation to the United States with an inspiration to help doctors treat the “whole person” in a holistic way
10:00 How the British system prevented family medicine doctors from helping their patients who were hospitalized
10:45 Dr. Tony Dale’s new book, The Cure for Healthcare
11:10 Inspiration from “The Price We Pay” by Dr. Marty Makary
12:00 Fascinating examples of the “power of the free market” from his work with Sedera to provide medical cost sharing
12:45 Dr. Dale’s experience in influencing health policy and how that convinced him that a grassroots effort is really the true cure for healthcare
13:45 Albert Einstein’s famous maxim, “The thinking that got us to where we are is not the thinking that will get us to where we want to be”
14:30 The issues of waste, inefficiency, and outright fraud -- how current health policies enrich the very few, at the expense of the “ordinary American”
16:30 “The answer to changing the system isn’t incremental. It is dramatic.”
16:40 Parallels to the disruption of the transportation system from Uber/Lyft (ridesharing) and Priceline (airline and hotel booking)
17:40 How Cristen Dickerson (a radiologist in Houston) and her company Green Imaging is bringing “the Priceline model to Radiology”
19:30 Inspiration from radical change agents who bring a “stroke of genius” to fixing healthcare
20:30 President Obama and the passage of the Affordable Care Act that led to an exemption of Christian healthcare sharing ministries
22:45 Finding a way to make the medical sharing model (a non-insurance solution) mainstream through the founding of Sedera
25:00 The story of his founding of The Karis Group (now Point Health) to help patients shop for cash pay options for healthcare services
27:40 The exploitation of government regulations related to the Medical Loss Ratio in order to drive health insurance profits
28:30 “The system is working perfectly for what it is designed for. It is designed to let the big hospitals consolidate and drive up prices.”
29:20 The “smoke and mirrors” tactic of duping patients to pay more for urgent care by billing as an ER (paying 3X more for the same care!)
30:30 How a free market based on innovation and cash payment can improve the patient-provider relationship
31:40 Referencing the work of Dr. Keith Smith (Surgery Center of Oklahoma) in creating lower costs and transparent prices
32:30 The transformational potential of Direct Primary Care
Historically, health systems in low- and middle-income countries (LMICs) have taken a volume-based approach to health rather than a value-based one. The public sector has focused on coverage rates or access, and the private sector profits when it drives quantity of expensive, hospital-based care. Adhering to this path will create long-lasting structural flaws that increase costs without delivering desired results, similar to what we see in the US and many other developed economies.
Our guest this week is Dr. Chintan Maru, founder and executive director of Leapfrog to Value, a health initiative to advance value-based care in lower- and middle-income countries. Dr. Maru is a medical doctor and public health expert who has dedicated his career to maximizing the value of health systems. The race to value is not limited to fixing health care in the US – lessons learned and shared internationally will have world-wide impact, and will help lower- and middle-income countries leapfrog past hurdles and accelerate their own race-to-value. Join us as we learn from Dr. Maru about his efforts to leapfrog to value in Ghana, South Africa, Kenya and India!
Episode Bookmarks:
01:45 Low- and middle- income countries (LMICs) are at-risk of replicating system flaws from higher-income countries
02:10 The Leapfrog to Value strategy: Building a robust ecosystem for VBC experimentation
04:00 How Dr. Maru’s father dealing with Parkinson’s Disease provided a personal perspective on the work he does in value-based care
06:00 “In low- and middle-incomes countries now, quality has eclipsed access as a prime driver of outcomes.”
08:30 “There is a big focus in low- and middle-incomes countries on primary care and community-based health delivery, often via community health workers.”
09:15 How Value-Based Care differs In LMICs: focus on how to spend more on health to achieve universal health coverage!
09:45 “Instead of volume versus value, you are trying to get both volume and value.”
11:00 Ensuring localization by directing donor-funded programs for health system development with local stakeholders
13:15 Dr. Maru explains how the definition for “value” differs in LMICs when implementing universal healthcare
14:00 “The phrase ‘value-based care’ hasn’t really shaped the dialogue for universal health coverage for places like India or Kenya yet. It’s just coming into the conversation.”
14:15 How can payment models in LMICs prioritize health over healthcare?
15:15 Feasibility versus point of path feasibility in creating value-based care systems
16:30 “There is a ‘leapfrog to value’ opportunity in low- and middle-income countries to build a value-based health care system somewhere between the point of feasibility and the point of path dependency.”
17:00 Building new national health insurance models in Kenya, India, South Africa, and Ghana to experiment in value-based care
18:45 Dr. Maru cites mobile banking penetration in Nairobi as an example of how we can learn from the ingenuity of others when there isn’t already an entrenched ecosystem
20:15 Partnering with USAID Center for Innovation, the Gates Foundation, and the Rockefeller Foundation on the Leapfrog to Value flagship report
21:45 Getting buy-in from local stakeholders in LIMCs for value-based care experimentation and innovation
23:00 “Value-based care is partnership-driven.”
24:00 The role of global health donors in providing risk capital to cover the costs of value-based care pilots in LMICs.
25:00 Comparing climate change and the need for environmental sustainability to the value-based care movement
26:30 Determining appropriate hospital bed capacity in places like Mumbai, India, Lagos, and Nigeria
27:30 Sensitizing healthcare investors to take a bit of a civic-spirited point of view--perhaps even before any value-based payments really shape the market
28:45 Creating the right incentives for patients to be responsible for perso...
The traditional definition of post-acute care (PAC) represents the legacy of a fragmented approach to healthcare that segments care into “silos” and finances institutions to care for a “slice” of the patient instead of incentivizing whole-person, coordinated care. As post-acute care is the largest driver of overall Medicare spending variation, establishing a coordinated, whole-person care network across the PAC continuum is essential for organizations to successfully operate under value-based payment models and to optimize patient outcomes. However, without transparent, market-wide data with longitudinal analytics, a comprehensive network, and relationships with hospitals, it seems like an insurmountable challenge to overcome.
Our guest this week is Ian Juliano, founder and CEO of Trella Health. Trella Health, is dedicated to creating optimal care networks that yield superior outcomes and greater efficiencies. Employing sophisticated longitudinal analytics on its massive, proprietary database, Trella enables providers and payers to compete and thrive in the new world of Value Based Care. For Ian, value-based care and PAC network optimization is a personal calling. His individual commitment provides a clear path to follow in the race to value!
Episode Bookmarks: 05:00 Advocating the benefit of data democratization in VBC to Andy Slavitt 06:00 Working with Niall Brennan, the Chief Data Officer of CMS from 2010-2017 07:00 Building one of the largest proprietary databases of CMS claims data through a partnership with the CMS Virtual Research Data Center (VRDC) 08:40 “Transparency in data can lead to better treatment decisions that result in improved outcomes and lower costs” 09:40 How Trella’s massive database is helping hospital systems, post-acute providers, and ACOs make better decisions 11:30 The challenge of ineffective transitions of care post-discharge and the cost differentials between different PAC settings 13:00 Ian speaks about how hospital ownership of home health agencies or IRFs leads to inappropriate referrals post-discharge 14:40 “As a nation, we have been overly, myopically focused on the cost of a post-acute care setting versus the impact and cost trajectory of the patient.” 16:00 Ian provides an eye-opening example of how $1million in costs were saved (along with better outcomes) through appropriate transitions to home health instead of SNFs 18:30 Ian provides another example of a system saving $1-2M in spend by sending patients to on-time hospice at the end-of-life 21:00 “In some academic medical centers, over two-thirds of inpatient discharges that meet high-acuity guidelines receive no post-acute care whatsoever! And one-third of those patients are back in the hospital within two days, leading to higher costs.” 23:00 Ian speaks about how ACOs and DCEs can ensure access to outstanding SNF and home health agencies by aligning incentives 25:00 “Developing the right post-acute care provider network is not all about narrowing. It’s about finding the right network that meets all of the specialized needs, to get best-in-class care for all of the different categories of patients.” 25:50 The importance of physician training in building an optimized PAC network 26:20 Using data to look at patient flows, identify gaps in care, and monitor cost performance KPIs over time 28:40 Ian speaks about the future of the skilled nursing industry in relationship to value-based care 30:30 “If I were an ACO, I would be quite mindful anytime a hospital recommends a hospital IRF. I would make sure to see whether a SNF is more appropriate.” 31:30 How did occupancy rates in long-term care impact SNFs during COVID-19? 32:00 How do increased referral rates to home health instead of SNFs lead to lower adherence rates? How can home health agencies ensure that patients actually receive care? 34:40 Primary PAC Optimization Strategies: 1) Sending appropriate patients to SNF instead of IRF.
We are pleased to release a special bonus episode and do our part to address the nation's concerns around the pandemic and the COVID vaccine. As it stands right now, around 164 million people, or 50% of the total U.S. population, have now been fully vaccinated. Ultimately, with a large portion of the U.S. population still unvaccinated, it seems that COVID-19 is not going to disappear soon. The U.S. will continue to see outbreaks of the virus in communities with low vaccine uptake.
Our guest is Dr. Rodney Rohde, a virologist and clinical laboratory expert with 30 years of experience in Public health, virology, and zoonotic disease, and is a Professor in the College of Health Professions and Associate Director for the Texas State University Translational Health Research Center. This episode is for anyone who wants to hear a scientific discussion about SARS-CoV-2/COVID-19 to combat misinformation that is out there about the pandemic.
Episode Bookmarks:
04:30 Dr. Rohde shares a brief overview of the medical laboratory profession and the Clinical Laboratory Science degree programs
08:30 The impact of the pandemic on the medical laboratory staffing crisis
09:50 Dr. Rohde speaks about the importance of laboratory medicine in improving value-based care and health equity
13:00 Did SARS-CoV-2 originate from a laboratory leak at the Wuhan Institute of Virology? Or did the virus originate from a zoonotic spillover event?
18:15 Referencing Dr. Rohde’s recent article discussing how the US is split between the vaccinated and unvaccinated – and how the deaths and hospitalizations reflect this divide
20:00 Dr. Rohde discusses how “99.5% of all the people dying from COVID-19 in the U.S. are unvaccinated” and how to understand breakthrough infections happening with the vaccinated
22:30 How to eradicate a virus and why current immunization rates will not support disease eradication
24:50 "Viruses, especially RNA viruses, are the most diabolical microbes on the planet.”
25:30 Viral mutations that create infectious variants and the opportunism of infection
28:20 The global achievement of smallpox eradication
28:50 Dr. Rohde explains vaccine efficacy and what people should ask their physicians if debating whether or not to receive the vaccine
31:00 The low of mRNA vaccines
34:00 Dr. Rohde explains what the Delta variant is and provides a scientific overview of viral mutations
37:00 The changing pathology of the virus and how younger, unvaccinated people are now being affected by the Delta variant
38:00 Booster shots for immunocompromised individuals and the likelihood of boosters for the general population
39:20 The transmissibility of the Delta variant. what the R-naught number means in understanding viral contagion, and how Delta variant compares to Ebola transmission
45:00 Referencing the COVID-19 thought leadership and insights from Scott Gottlieb, Tom Frieden, and Peter Hotez
46:20 The three-year cycle of unchecked pandemics, the development of herd immunity, and the potential for an endemic transition in 2022
47:50 The significance of the landmark scientific achievement of developing a mRNA vaccine technology (the first time in history!)
50:00 Viewing public health as part of our public defense and why we need to learn that one lesson from this pandemic!
Employers are on the frontlines in the battle against rising healthcare costs. Legendary investor Warren Buffett said that rising health care costs, not the tax system, are the number one problem that American businesses face. “If you go back to 1960, or thereabouts, corporate taxes were about 4% of GDP. And now, they’re about 2% of GDP,” “At that time, health care was 5% of GDP, and now it’s about 17% of GDP.” In Buffett’s view, this says a lot of what’s playing a bigger role in hindering business activity in the economy. He is famously quoted as saying that “medical costs are the tapeworm of American economic competitiveness.”
Direct Primary Care (DPC) is a unique solution for employers to win the “race to value.” Our guest this week is Dr. Gaurov Dayal, the President and COO for Everside Health and a nationally recognized physician leader, who, in 2019, was selected as a finalist as the Director for CMMI to replace Adam Boehler. Everside Health is tackling employer healthcare costs head on by offering direct primary care services to employers. Their DPC model redirects health care from fragmented care sites such as inpatient and outpatient settings, specialists’ offices, ER and urgent care clinics into the optimized primary care setting. In the longer term, Everside works to deliver cost savings by diagnosing, treating efficiently, and managing the health of a covered population across 32 states with 350 health clinics located at or near the facilities of its employers, unions, and other benefit sponsor clients.
Episode Bookmarks:
02:25 Dr. Dayal shares his recent “once-in-a-lifetime” experience traveling to Iceland!
03:30 Recent APM delays and pullbacks from CMMI – what does this mean for the value movement?
05:05 “The progression to Value-Based Care is a fairly bipartisan issue.”
05:45 Is the COVID-19 pandemic detracting from the current health policy focus on value?
06:45 The deficiencies of the healthcare system highlighted by COVID-19
08:30 Dr. Dayal reflects on his experience interviewing for the Director of CMMI position in 2019to replace Adam Boehler
09:45 “There is a lot of passion at the federal level to push ideas that can improve care for the US population.”
10:40 The challenges of balancing stakeholder interests in the political process and the need for more clinical leadership and influence
13:45 Is capitation truly needed to have value-based care? Or can you pay for outcomes in a FFS model?
14:45 “The linkage of the payment to the delivery system creates value-based care.”
15:30 Dr. Dayal discusses the capitalistic model of healthcare and how FFS domination prevents large scale change
17:00 “In the history of companies, very few companies are able to successfully transform themselves from one business to another.”
17:30 “We are entering an era of new providers disintermediating in value-based care, rather than old incumbents successfully bridging the gap.”
18:00 Dr. Dayal discusses disruption in the Medicare Advantage space (e.g. ChenMed, Oak Street Health), employers collaborations (e.g. Everside)
19:00 The germination of specialty-focused companies in VBC (e.g. renal care, oncology, orthopedics)
19:30 Dr. Dayal compares the “race to value” to the automobile industry transitioning from combustion engines to electrical power
21:00 Referencing legendary investor Warren Buffett’s position on rising health care costs as the number one problem that American businesses face
22:00 Everside Health’s Direct Primary Care (DPC) model operating in 32 states with 350 health clinics located at or near the facilities of its employers
22:45 The average family spends $20k on healthcare at a time when working Americans are facing wage stagnation and looming inflation 23:00 The rising costs of healthcare benefits provided by employers and how the lack of transparency contributes to the problem
24:30 “Overutilization of healthcare services is as dangerous as...
Our guest this week is Dr. Jim Walton, President and CEO of Genesis Physicians Group. Dr. Walton was drawn into medicine at an early age – he followed his dad making house calls, going to nursing homes, and forging deep ties in the community. His clinical work throughout his medical career was focused in poor communities, coordinating care for complex patients from diverse backgrounds.
As an experienced and innovative physician leader, Dr. Walton provides executive leadership to more than 1,700 physician and allied health members in a North Texas independent practice association. He also established and leads the group’s ACO which is focused on creating physician-led risk-based solutions. Dr. Walton’s passion is engaging physicians to stay independent by providing them with a population health infrastructure for succeeding in risk. Add that to his passion for treating the underserved and caring for those living on the extreme fringe of vulnerability, it’s easy to see why he is an ideal leader in the race to value.
Episode Bookmarks:
05:05 Dr. Walton shares his prior experiences in treating marginalized populations
06:30 A personal patient story that had a profound impact on Dr. Walton’s career in service to the underserved
08:20 Establishing rural clinics to care for the uninsured and AIDS patients in the early nineties
10:00 Developing community medicine strategies to mitigate racial disparities in care
11:40 “The role of the profession of medicine is to design solutions to improve community health.”
14:00 Starting a value journey with a legacy model, fee-for-service physician IPA
15:40 Succeeding in a Medicare ACO provided confidence to take risk with Medicaid
18:20 The importance of solving community-based social issues and lessons learned fromMedical Home Network
19:30 Integrating both clinical and social determinants of health data to develop an AI-based predictive analysis
20:00 Building an infrastructure for social interventions to better care for Medicaid patients
22:00 Value-based care as an enabler of physician independence
23:00 Physician leadership involvement in the structure of financial rewards to incentivize practice transformation
25:00 Dr. Walton discusses how his physician-led risk-bearing entity is competing with PE-backed firms and hospital systems
25:30 “The joy of practicing medicine can be found in a team-based, physician-led model that promotes independent practices.”
27:30 Dr. Walton on how managed care contributes to physician burnout and why value-based care is different when built by physicians
30:30 Tapping in to both the intrinsic and extrinsic motivations of physicians to improve patient care
33:30 How diminishing fee-for-service rates creates a deleterious treadmill effect with doctors (unless they adopt value-based care)
36:00 Developing a compelling value proposition for payers
39:30 COVID-19 as the ultimate crucible for testing the resiliency of physicians
41:00 The siphoning of patients by urgent care facilities and retail primary care models
42:00 Primary care redesign of patient panels leading to specialization in chronic disease
43:00 Responding to emergent physician needs during the pandemic
43:45 “Prospective payment is the destination”
45:00 Dr. Walton discusses how the ACO Provider Relations team engages physicians
47:00 Tapping into the clinical intuition when stratifying risk in a patient population
48:30 Dr. Walton speaks about how younger physicians will find purpose in their practice of medicine
53:20 Parting thoughts about the inspiration of Dr. Don Berwick and the Triple Aim
55:00 “Value-based care allows us to reimagine our professional duty to improve quality, reduce unnecessary suffering, and eliminate health disparities.”
This is one of the most health challenging times in modern history. Healthcare systems and practitioners face dire circumstances in delivery of care to scores of citizens. A reverential ethic in healthcare leadership that promotes an informed and respectful approach towards life is key to health system success in population health. This core value is how Trinity Health, one of the largest integrated care delivery systems in the nation that serves more than 30 million people across 22 states, approaches their transition to value-based payment. They believe the “race to value” is a moral imperative to improve community outcomes and ensure health equity, instead of just a business opportunity.
Our guest this week is Akil McClay, System Director of APM Operations at Trinity Health. Akil is responsible for the implementation, deployment and operational CIN/ACO/APM activities across four states (Delaware, Pennsylvania, Indiana and New York) with approximately 290,000 covered lives. Additionally, Akil serves as the Executive Director for the Trinity Health Integrated Care MSSP Enhanced ACO and successfully led Trinity Health Integrated Care to achieve $45M in shared savings for performance years 2017−2019. Most importantly, Akil lives the value of reverence, and his insights spark a similar passion in each of us.
Episode Bookmarks:
04:00 Akil’s formative years that led him to understand the need for minority health and health equity
05:30 How charity care hospitals impact the health of vulnerable communities
06:30 How an educational path in neurosciences led to a healthcare administrative career
07:45 “When you are a healthcare leader, you have the opportunity to impact millions of lives across the country.”
10:00 “It starts with us. You need to have leaders that are reflective of the communities that we serve.”
10:30 Akil reflects on the presence of institutional racism in our country’s healthcare system and how Mike Slubowski is committed to DEI in leadership
11:15 Akil discusses the inequitable distribution of vaccines in the Philadelphia market and how Trinity was able to operationalize equity through a rapid-cycle innovation approach
15:35 How the VA system is an exemplar of value-based care innovation and why the private sector should learn from them as it moves to fully-capitated payment
17:40 A fully-capitated, total cost of care model gives us the best ability to care for our patients.”
18:05 How Trinity is moving to a fully-integrated EHR system across all of its markets
19:20 Engaging patients in healthcare by creating a community-based center (a lesson learned from the VA)
21:40 Akil discusses how Trinity Health has been able to navigate the COVID-19 pandemic
24:00 Trinity Health’s deployment of a unified telehealth platform
25:00 High-speed internet access as a social determinant of health
27:40 Trinity Health’s early beginnings in value-based care led by Rick Gilfillan and the aspirational goal of having 75% of revenue derived from the APM portfolio
29:00 The future of VBC is in risk-based payment and how early adoption of CMMI programs allowed for innovation
30:00 “We want to have the majority of our revenues come from value-based contracts because we believe that is what’s best for the patient.”
31:20 Do we need as many hospitals as we currently have in the United States? What is the impact of COVID-19 on the movement to VBC?
33:00 Akil discusses how Trinity Health is building out capabilities for risk coding and documentation to better reflect burden of illness in their patient population
37:40 Trinity Health’s approach to building an integrated EHR and digital health platform for patient engagement
42:00 EHR optimization through provider-led workgroups and use of internal teams to build a homegrown analytics platform
44:35 Overcoming the limitations of digital tools by listening to patients
Our guest this week, Matt Miclette, is military veteran and a psychiatric and mental health board certified registered nurse. He is the Senior Director of Clinical Operations at NeuroFlow – a digital health company that provides an industry-leading solution for Technology-Enabled Psychiatric Collaborative Care. Matt is also the Co-Founder and Executive Director of a nonprofit organization called Action Tank. As a recipient of the prestigious Pat Tillman military scholarship, Matt is living with the passion that Pat Tillman spoke of, “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits … A passion for life is contagious and uplifting.” Matt’s passion is bright and shines through in his service for people with mental health needs.
In value-based care, it is clear that primary care is at the tip of the spear in dealing with Ambulatory Care Sensitive Conditions like CHF, COPD, and diabetes that drive up costs. In that model for managing chronic disease, the position of primary care providers being upstream to specialists allows them to curb 80-90% of healthcare costs by preventing unnecessary specialist visits and avoidable inpatient stays and ED visits. With behavior health, it is a little bit different though. Behavioral health conditions (for the most part) can’t be addressed by specialists because there aren’t any access points for them to even be seen! Although 70% of primary care appointments include problems with significant psychosocial issues, less than half of those receive any mental health treatment at all, because there is a such a shortage of specialists. To put this in context, the Substance Abuse and Mental Health Services Administration estimates that by 2025, the U.S. will have a shortage of over 15k psychiatrists and 26k mental health counselors!
Research shows that a Psychiatric Collaborative Care Model (CoCM) is an effective and efficient way of delivering integrated care for more complex patient behavioral health needs – CoCM is a model that enhances “usual” primary care by adding two key services: care management support for patients receiving behavioral health treatment and regular psychiatric inter-specialty consultation to the primary care team. Join us as we consider this and other important solutions with Matt in this week’s race to value!
Episode Bookmarks:
04:45 “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits.” – Pat Tillman
05:40 Matt discusses the inspiration of Pat Tillman and his passion into lifelong learning
06:00 How caring for wounded warriors recovering from combat trauma drove Matt’s future work in treating the “indivisible injuries” impacting behavior health
07:00 Realizing the stigma associated with behavior health from his time leading a military psych unit in Fort Hood
07:50 Making an impact through facility-level hospital policy, e.g. 75% reduction in restraint use
08:10 Matt discusses his experience working in public health policy related to substance use disorder
08:30 A shared passion for “changing the world” with Christopher Molaro, CEO/Co-Founder of Neuroflow
09:30 Alarming stats about behavioral health and SUD in our country!
11:10 Matt on the recent CDC report showing that the U.S. hit the highest level of annual overdose deaths ever recorded (93,000) – a 30% increase from prior year!
11:45 “The shortage of mental health providers is most acutely seen in rural communities. Over 50% of the counties in the U.S. don’t have a single psychiatrist.”
12:05 Understanding the population and identifying which individuals have the most acute behavioral health needs through upfront screening and measurement-based care
13:00 Matt explains how we can more effectively use primary care and interdisciplinary teams to treat behavior health...
Our guest this week is driven by an inner purpose to alleviate suffering for those in the poorest of communities, recognizing that health care can only truly be transformative in providing superior health outcomes if it advances health equity. Over the years, he has used his voice to advocate for underserved communities in the belief that the equitable attainment to health is a human right.
Dr. Derek J. Robinson is Vice President and Chief Medical Officer for Blue Cross and Blue Shield of Illinois (BCBSIL) and is responsible for care management operations, clinical leadership and strategic oversight in providing high value health care to more than 8 million members. Dr. Robinson is also the founding chair of the Health Equity Steering Committee, which was established to develop health equity strategies across markets and lines of business.
For nearly two decades, Dr. Robinson has led community efforts to promote diversity and inclusion in undergraduate and post-graduate education at the local, state, and national level. He is a member of the Office of Diversity and Inclusion advisory committee at the Accreditation Council for Graduate Medical Education. Additionally, Dr. Robinson is vice-chairman of the board of trustees at Xavier University of Louisiana.
His deep experience in health care and education give him a unique and meaningful perspective, one that we will all do well to regard as we endeavor to advance in the race to value!
Episode Bookmarks:
04:30 Dr. Robinson discusses his journey in emergency medicine and what now drives him as a value-based care leader
06:15 Creating “impact at scale” in his work in clinical leadership and strategy at the health plan level
07:30 In 5 years, life expectancy fell for everyone except for non-Hispanic white Chicagoans (3,500 excess deaths for Black people in Chicago every year)
09:00 The impact of COVID-19 on highlighting disparities among racial lines and national trends in life expectancy amongst African Americans
09:30 Dr. Robinson discusses the root causes of social determinants of health (e.g. housing policies, racial segregation) that lead to racial disparities in care
10:45 Chicago has ~30-year life expectancy gap between neighboring communities (larger than any other American city)
11:00 Housing policies also impact infant and maternal mortality, elevated lead in children, etc.
11:15 “Your zip code is more important than your genetic code.”
11:45 Dr. Robinson explains how investments in community infrastructure and resultant economic development creates public health
13:30 Referencing landmark reports confirming the presence of racial and ethnic disparities within the care delivery system
14:00 “Opportunities for focus” by governments, corporations, philanthropic partners, and the healthcare community
16:30 Dr. Robinson describes the Blue Door Neighborhood Center to provide a community-based hub for health and wellness
18:00 Creating a social impact fund to help small businesses impact health in communities
18:30 Providing housing stability for those dealing with chronic conditions
19:00 BCBSIL investments in community benefit organizations and social services to improve health equity and SDOH in Chicago
22:10 Health disparities persisted prior to COVID-19, but the spotlight from the pandemic has served as an accelerant to addressing them
23:00 That health equity journey that BCBSIL is focused on through partnerships with 24 provider-led ACOs and 44 IPAs/PHOs
23:30 Dr. Robinson explains the $100M investment by BCBSIL in the Health Equity Hospital Quality Incentive Pilot
24:30 The importance of hospitals collecting data on race, ethnicity, language, sexual orientation, and gender identity to assess disparities
26:00 Expanding telehealth and bridging the digital divide amongst underserved patients
26:30 Addressing the underrepresentation of diversity in the physician workforce
While the health care system has been gradually transitioning to a more tech-enabled industry for several years, in a matter of months, the global pandemic has fast-tracked digital health care trends that have been primed and ready for greater investment and implementation. The increased investment in and use of technology-enabled care protocols like telehealth and remote patient monitoring during the crisis has accelerated the acceptance and adoption of digital solutions for both health care professionals and their patients. As a greater number of payers and providers adopt value-based payment arrangements and innovative data management and analytic solutions emerge, digital tools will enable the collection and analysis of robust patient data to inform population health management strategies and equip providers to creatively inform and transform their approach to care delivery.
In this episode, we share the audio from a recent webinar where we discuss the digital health landscape with two foremost experts, Dr. David Nace, Chief Medical Officer of Innovaccer, and Ed Marx, Chief Digital Officer of The HCI Group. Additionally, we offer the recent ACLC Intelligence Brief, Overview of the Digital Health Landscape. The brief offers a detailed review of the digital health landscape, analyzing major trends and recent merger and acquisition activity, and outlines expectations for the future. The intelligence brief, combined with this episode, will give you valuable insights to inform your own race to value!
https://www.accountablecarelc.org/publications/overview-digital-health-landscape
Only 25% of health is in the control of the healthcare system. So why does our country continue to pump the majority of its health care spending into a deficit-based health care model that focuses solely on the science of doing something to the individual? Aspirational Healthcare is a better answer, spending 75% on supporting the individual in the ownership and management of their own health. And employer-driven reform is the key that will unlock aspirational healthcare for millions nationwide.
Our guest this week is Darrell Moon, CEO of Orriant, a company that changes the dynamics of health care and gives employers control over the ever-increasing costs of the health care benefits they offer their employees. Join us as we discuss the Nuka System of Care in Alaska, employer-driven reform, and the principles of Aspirational Healthcare – all are important milestones on the race to value!
Episode Bookmarks:
1:45 What is an Aspirational Healthcare System?
2:50 Background on Darrell Moon, CEO of Orriant
3:20 Background on Nuka System of Care (the role model for Aspirational Healthcare)
4:30 The Aspirational Healthcare Conference (July 14-15, 2021)
5:20 Darrell talks about his recent discovery of Nuka System of Care and how it inspired him
6:00 Southcentral Foundation instituted a total system-wide transformation of care with Nuka
7:30 Referencing Dr. Doug Eby of Nuka and the requirements of an ideal health system
8:45 Training workers to be “partnering influencers” rather than just diagnosticians and treatment planners
9:40 The current healthcare system has an improperly skilled workforce (Aspirational Healthcare addresses this first!)
11:55 CQI drives us to meet the needs of the customer, but it doesn’t work in FFS
12:45 Business Leaders and the Federal Government are really the true customer in the American healthcare system (not the patient!)
14:00 Darrell talks about why employers are a transformational force to a more customer-centric health ecosystem
16:00 Employers need to create incentives in their healthcare purchasing model to empower change
17:00 Why would the system ever change on its own? Employers must take the lead!
18:00 Darrell explains an Aspirational Healthcare investment strategy for employers to follow
19:00 Creating a “massively powerful” primary care system
19:30 The importance of influencers in improving patient outcomes
20:30 Investing in Health Savings Accounts (HSAs) for employees to pay deductibles and copays
21:50 ‘Poor health’ costing employers $530B on top of the $880B they already spend in premium dollars!
23:30 Southcentral Foundation demanded “perfect healthcare” in creating Nuka twenty years ago (and it worked!)
24:30 Lessons learned from Haven’s failure being applied with Amazon Care and Walmart Health
24:50 The founding of employer-sponsored group health insurance in WWII
25:50 The leadership of Regina Herzlinger in creating Health Reimbursement Accounts
27:20 Darrell discusses what Amazon Care will look like when it completes its’ healthcare strategy!
28:30 Employers will move away from Employer-Sponsored Group Health Insurance in the next ten years!
30:00 Nuka’s relationship-based healthcare system is centered around “massively powerful primary care”
31:00 Building a Direct Primary Care practice based on a prescription model
32:45 Primary Care Quarterbacking to reduce medical errors associated with lack of specialty care coordination
33:30 Direct Primary Care is doing what Nuka did by creating a “massively powerful primary care” model.
35:30 Darrell discusses the impact of behavioral health integration on improving cost and clinical outcomes
37:30 Implementing strategies to address Complex Behavioral Change to improve population health
39:00 Creating relationships based on trust is key to helping patients
39:45 Balancing the amygdala (emotion) and prefrontal cortex (reasoning) func...
There is an immediate opportunity for value-minded medical practices and health systems in joining a Direct Contracting Entity (DCE) that is already established. Many of these DCEs (typically existing health care delivery organizations or newly-organized physician aggregators) are now seeking formal partnerships with providers in their area. These partnerships may facilitate an entry point for organizations who have not participated in prior CMMI models or those organizations more advanced in risk who wish to increase their value profile in a model that emphasizes beneficiary engagement and improved patient outcomes. If you have been approached to join a DCE, the ACLC wants to support you in the consideration of this opportunity.
To that end, we are pleased to share this bonus episode, with our guest Dr. Tom Davis. Dr. Davis is an expert in value-based care, a family physician, angel investor, founder of 6 companies, consultant, and speaker. In this episode, he helps simplify the decision process for the independent physician who wants to know whether they should consider participating in the GPDC model. Independent physicians now is an important time to consider your participation in value – whether you join the GPDC model or do something different, this episode will accelerate your move to value!
In addition to listening to this episode, make sure to read our blog post with additional details: https://www.accountablecarelc.org/publications/global-and-professional-direct-contracting-starter-checklist-prepare-dce-partnerships
Episode Bookmarks:
03:00 What are Direct Contracting Entities (DCEs) and how did they come about?
04:15 What types of DCEs are currently recognized by CMS and should I consider joining one?
06:45 What are the potential benefits to medical practices that are considering joining a DCE?
12:00 How is Value-Based Care innovation better addressed by DCEs than other payment models?
13:15 Is there a competitive disadvantage to not participating in a DCE?
14:30 How should an organization evaluate a prospective DCE suitor when approached to join one?
17:30 Why is joining a DCE such a rare and historic opportunity?
18:30 Parting comments and contact information for Dr. Tom Davis
Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region or community. In 2009, Congress attempted to modernize HIE processes by passing the HITECH Act, offering grants and incentives to states and municipalities for developing regional HIE initiatives. Although there has been some progress toward effective mechanisms for data exchange, in many regions of the country it is no easier to share medical information than it was over a decade ago. That is not the case in the State of Nebraska and neighboring states where CyncHealth has achieved health care transformation through data democratization and community betterment collaboration. They have done this by becoming more than a HIE; instead they have become a true “population health utility” by building the roads and the infrastructure for better workflows and better patient care (not just improved data exchange).
This week, we are pleased to welcome three important guests from CyncHealth, Dr. Jaime Bland, President and CEO , Dr. Larra Petersen-Lukenda, Vice President of Population Health, and Dr. Joy Doll, Vice President of Community and Academic Programs. Their vision for a ‘population health utility’ builds upon the ONC’s vision for interoperability through data democratization and cross-sector collaboration. In this episode, we interview these leaders to better understand how to leverage data to create the greater good in societal health outcomes. You will hear from them how health care transformation can be realized through community partnerships and data sharing across the continuum of care, collaborative research in population health, and an empowered “health data competent workforce” to meet clinical and social needs in a more holistic way.
Episode Bookmarks:
03:45The purpose of a ‘population health utility’ is to create better workflows and improved patient care, not just improved data exchange
04:45 Fewer than half of office-based physicians can exchange patient health information outside their organization electronically
05:30 The HIE market is projected to double from $1 billion in 2020 to $2 billion in only 5 years
06:00 Jaime discusses how CyncHealth’s 15-year journey to build a HIE infrastructure to support population health in Nebraska
07:20 Jaime and Larra’s vision for leveraging a HIE as the basis for a clinically integrated network/ACO
08:00 Improving upon the cumbersome query-based exchange model to deliver better patient outcomes in complex care scenarios
09:00 Jaime explains how they have reframed the HIE into a “population health utility”
09:40 Joy describes the application of the population health utility to address the Quadruple Aim and improve patient outcomes
10:25 Larra on reaching the ONC’s 10-year vision for interoperability can improve clinical decision support and patient engagement
11:55 Larra on how “The ability to influence the future of healthcare through data is an amazing responsibility to benefit the greater good of the community.”
12:30 Jaime on the Nebraska Prescription Drug Monitoring Program (PDMP) -- a stand-alone medication query platform integrated into the CyncHealth HIE
16:15 Larra on the benefits of the PDMP in improving completeness of the overall medical record, with impact on patient safety and care interventions
18:30 The Opioid Crisis and SUD (23.4 million have SUD causing 81,000 drug overdose deathsannually -- two-thirds of which are related to opioids)
20:00 Jaime on how CyncHealth has responded to the Support for Patients and Communities Actin order to address the Opioid Crisis
21:15 Larra emphasizes the importance of the Support Act as a way to leverage technology in response to the national opioid epidemic
24:30 Joy on the opportunities for health policy and public sector funding to address disparities in care
27:30 Jaime on how transforming an HIE into a “Population Health Utility...
We are discussing “Price Transparency and Free Market Healthcare” with Dr. Keith Smith, co-founder of Surgery Center of Oklahoma and Sean Kelley, Founder & Managing Partner of Texas Medical Management. Keith and Sean are the forefathers of price transparency as they have been providing upfront, transparent prices to patients for decades. This is one of our more controversial episodes to date, as we cover with brutal honesty, the systemically broken healthcare system that allows patient fleecing, price gouging, excessive profiteering, and limited competition to establish a market clearing price. This provocative interview will raise important concepts such as the needs of the buyer, the importance of price transparency, and why free market principles and bundled pricing for surgical procedures are necessary. Is there any difference between the healthcare industry and a Mexican drug cartel? Is the value-based care movement flawed? Should the government recuse itself from any conversation having to do with health value? Tune in to find out!
This is a special joint episode between Race to Value and Point Health, released alongside the ACLC Intelligence Brief entitled “Revealing Value? Hospital Price Transparency”. This brief can be downloaded here.
Episode Bookmarks:
02:00 Download the ACLC and Point Health Intelligence Brief entitled, “Revealing Value? Hospital Price Transparency”
02:30 Introduction to Keith Smith and Sean Kelley – the forefathers of price transparency
05:00 Dr. Smith shares the story of his founding of Surgery Center of Oklahoma – a free market ASC with fully transparent, bundled procedure pricing
06:00 The “rising terminator class of Administrators” and why Dr. Smith started seeing Medicare patients for free!
07:00 “We were accomplices to financial crimes that were devasting to patients.” (The fleecing of patients by profiteering hospitals)
09:00 Sean discusses the founding of Texas Medical Management (formerly Texas Free Market Surgery)
10:30 85% of all surgical dollars go to facilities! (Motivation to move cases out of the hospital that should be done in a surgery center)
12:00 “Really good doctors are not paid more than bad doctors. In fact, it is often the opposite.”
13:45 Sean reflects back on the early leadership and inspiration of Dr. Keith Smith in starting TMM
14:50 “The only reason I stayed in medicine is to be a part of a solution that brings doctors and patients back into relationship models that eliminate all the BS.”
15:30 Only 25% of all healthcare dollars spent actually go to people providing care!
17:00 “Changing the way that healthcare is purchased by employers and TPAs is the most critical part of the survival of free market providers.”
18:30 Medical Tourism and how patients are travelling from all over the country (and the world) for free market surgeries!
22:30 “The healthcare system is working as it is designed – it is a cartel; there is no mistaking that.”
24:30 Dr. Smith expresses his frustration with influencing peddling in health policy and how industry consolidation is driving up prices
26:20 Self-funded buyers are demanding transparent pricing and a stop to price gouging.
27:00 “The DC regulatory machine, brokers, and consultants needed a good thumping.”
29:00 Helping other surgery center disruptors with price transparency models to build critical mass across the country
33:00 The challenge of industry insiders and lobbyists to fight price transparency (“Washington is not the solution.”)
34:40 Sean discusses how a local employer challenged the “cartel” which led to Direct Primary Care and Free Market Surgeries
36:00 Referencing Rick Scott (former HCA CEO) on why hospitals are not going to fix the problem of high healthcare costs
37:30 Dr. Smith on why the new Hospital Price Transparency regulations won’t work…but it will change the narrative
39:30 Correcting the definition of price transparency so it i...
The movement to value-based care will necessitate a major paradigm shift in how physicians practice medicine. They can no longer be “cowboys” in the wild west of fragmented, uncoordinated care delivery where information technology is focused on fee-for-service. Instead of cowboys, we need “quarterbacks”, communicating with an interdisciplinary care team and facilitating hand offs across the care ecosystem. In this environment, information technology is like the offensive line, protecting the physician and creating the opening for a meaningful play.
Our guest this week is Dr. Matt Lambert, Chief Medical Officer of Curation Health, an advanced clinical decision support platform for value-based care that drives more accurate risk adjustment and improved quality program performance by curating relevant insights from disparate sources and delivering them in real time to clinicians and care teams. Author of two books, and with more than 20 years of experience as a clinician, CMIO, and change leader in value-based care, Matt’s insights will expand your vision of health value!
Episode Bookmarks:
4:00 Physician Workflow Optimization in the movement to Value-Based Care (Cowboys vs. Quarterbacks)
6:30 VBC is requiring providers to optimize workflow to support team-based care (the Quarterback role)
7:00 APIs will enable EHR systems to evolve over time to better support value-based care
7:30 Curating meaningful information (and minimizing noise) to providers at the point-of-care
8:00 Using AI to decrease cognitive load for providers
8:20 “Healthcare doesn’t have a data problem. It has a clinical workflow problem.”
9:00 Physician Burnout ("a public health crisis that urgently demands action")
10:30 How VBC is changing regulations and documentation standards for electronic health records
12:00 “The CMIO role is the bridge, it’s the translator between the clinical world and the technical world."
12:25 NLP models often overwhelm providers with data that is not meaningful
12:45 Reducing disruptions and hard stops in provider workflow with technology-enablement
13:00 Dr. Lambert discusses his own personal experience with physician burnout
14:45 Simplicity as the ultimate form of sophistication and the artful design of clinical documentation solutions
17:00 How healthcare technology companies come short when they don’t have strong clinical leadership
18:00 Expanding focus beyond point-of-care to clinical documentation integrity teams
18:30 HCC recapture for risk adjustment and how algorithms can help capture new HCCs
19:30 Using NLP to identify new diagnoses from discharge summaries
20:30 Dr. Lambert discusses a use case for HCC coding optimization with RAF lift to improve ACO performance
21:45 How HCC coding optimization can improve patient engagement and better address SDOH
24:20 Referencing Trenor Williams, MD and his work in SDOH and social risk intelligence
24:45 Social applications of the risk adjustment model
25:45 The impact of COVID-19 on the future of value-based care
26:00 Referencing his recent HIStalk article on subscription revenue models
26:15 Post-pandemic interest from providers in subscription models and VBC
27:00 Deferred care during the pandemic and how that will affect population health
27:50 Risk adjustment over FaceTime and over the telephone
28:30 The similarities between post-COVID healthcare in US and the National Insurance Act of 1911 in the UK
29:30 Post-viral syndrome and long-term sequelae related to COVID-19
33:00 Eric Neil (Chief Information Officer, UW Medicine): “There are no old and bold CIOs!”
33:45 Providers have the best technology at home but are averse to new HIT solutions in the ambulatory care setting
34:00 A design flaw of the EHR Meaningful Use program that encouraged only platform adoption
34:30 How the Pareto Principle applies to Health Information Technology and workflow automation
When Billy Beane decided to employ a recent Harvard graduate to use advanced statistical analysis to build a championship major league baseball team, he changed the game forever. While Beane’s famous early 2000s team never won a World Series, multiple 100-win seasons and a new record for the longest winning streak got the attention of teams across the MLB, all while on one of the league’s lowest payrolls. Most people know Beane’s story as it was popularized in the book—and later in the movie—Moneyball.
In healthcare, we are overdue for a “Moneyball” revolution. The shift towards value-based payment has made it clear that our system needs to do a better job generating outcomes that matter to patients — a positive health-care experience, improved health, and good quality of life. The machine learning techniques that were used to algorithmically determine a player’s value were light-years ahead of the archaic methods that had been used in baseball up to that point. Similarly, many of our conventions in delivering care come from an era when healthcare was delivered primarily by doctors and nurses with elite training whose success depended mostly on content expertise. A key component to value-based transformation in healthcare will be artificial intelligence. Without AI, medicine will never advance to a state where the totality of a patient’s data can be used to find predictive signals that will lead to enhanced treatment and population health interventions that improve outcomes.
Our guest this week is Andrew Eye, the founder and CEO of ClosedLoop.ai, the recently announced winner of the CMS Artificial Intelligence Health Outcomes Challenge. Listen and find out why Andrew and ClosedLoop are exemplars in the race to value!
Episide Bookmarks:
02:00 The Billy Beane story and how, in healthcare, we are overdue for a “Moneyball” revolution
03:00 A key component to value-based transformation in healthcare is artificial intelligence
04:00 Andrew Eye – a national leader in AI in Value-Based Care – and his company ClosedLoop.ai
06:45 Partnership with Dave DeCaprio following his work with the Human Genome Project
07:30 How Andrew’s daughter’s medical condition provided “WHY” inspiration to build a next-gen predictive analytics platform
09:20 How ClosedLoop.ai beat out the world’s leading technology and healthcare organizations to win the CMS AI Health Outcomes Challenge!
11:25 “Physician trust in AI is crucial. Algorithms never saved anybody’s life. We predict the future so that you can change it.”
12:50 Creating an open source, AI-based predictive model for predicting COVID-19 Vulnerability
13:00 Andrew discusses what it was like to submit the winning submission for the CMS AI Challenge without electricity in the Texas Snowpocalypse!
14:00 CMS’ focus on AI Explainability and how ClosedLoop was “born to win”
17:00 “Explainable AI” (XAI) versus “Black Box” machine learning algorithms
19:00 Early AI firms were reluctant to share “secret sauce” of proprietary algorithms and the impact on physician trust and external validation of bias
20:00 “We’re not building models. We are building a machine that builds models.”
20:20 “The idea that there is one algorithm that is best for every healthcare organization in the country is a total fallacy.”
21:00 “Explainability in AI is absolutely critical to helping care teams have more effective interventions in population health.”
22:30 Physician paranoia about “machines taking over” where there work will be eventually outsourced to algorithms and other artificial tools of clinical reasoning
23:45 The impact of AI on Radiology and how that scenario differs from other instances in medicine where AI is applied to population health
25:20 The opportunity to augment clinician pattern recognition with AI that goes far beyond manual chart review for surface insights
26:15 “There is going to be a point in time where patients choose a doctor ...
Sixty years ago, May 1961, President John F. Kennedy challenged the American nation in a speech to Congress, asking them to commit to “landing a man on the Moon and returning him safely to the Earth.” Eight years later, that bold goal was realized – in July 1969 Apollo 11 landed and returned safely with a crew. President Kennedy’s moonshot goal is an important reminder of courageous leadership that sets an inspiring goal that pushes us to think and achieve boldly. That is not unlike the 10-year vision of Ochsner Health to transform the health of Louisiana, taking it from 49th out of 50 in America’s Health Rankings to a ranking of 40 by 2030.
As a native Louisianan, Dr. David Carmouche is committed to transforming the health outcomes of his state. Dr. Carmouche serves as President of the Ochsner Health Network, the accountable care network of the massive Ochsner Health System. The health system is committed to a value-based strategy and its CIN has generated returns north of $100M in its value-based contract portfolio over the last few years. In this episode, Dr. Carmouche shares meaningful lessons from his value journey covering such topics as physician leadership in the value movement, partnerships with employers, community resilience, precision medicine and social determinants of health, and Ochsner's 40 by 30 vision to transform health in the state.
Episode Bookmarks:
04:00 Dr. Carmouche’s leadership purview (and reflections from his glory days on the gridiron???)
07:20 Dr. Carmouche speaks to the national pursuit to value-based payment and looming Medicare insolvency
09:10 The experimentation phase of value-based care and the next-level commitment to pursue the most viable APMs
10:10 Subsidizing government contracts (Medicare, Medicaid) with commercial payers to spot margin and why that is no longer tenable
12:00 Dr. Carmouche discusses the financial results of Ochsner’s value-based contract portfolio
13:00 Board-level and CEO commitment to value as a strategy for population health and long-term economic success
13:25 Investment in care capabilities and realignment of incentives within large employed physician group as keys to success
14:10 The ‘muscle memory’ of owning a health plan and how that created orientation to risk at Ochsner
14:40 The importance of leadership in driving success in value-based payment with improved outcomes in patient communities
15:45 The three verticals of Ochsner Health’s business: Care Delivery, Risk Operations and Insurance, and Digital Services
16:30 How Ochsner Health manages fee-for-service dependency in its legacy business model with its commitment to value
19:10 Building partnerships with insurance brokers and fully-insured employers to support appropriate steerage and drive cost savings
21:15 Creating economic alignment with self-funded employers and the challenges of creating meaning gainshare opportunities
22:50 Negotiating care management fees with self-funded employers as in interim step to full-risk
23:30 Dr. Carmouche discusses the network agreement they reached with Wal-Mart to provide high value care for employees across Louisiana.
26:45 “From Competition to Collaboration” – Dr. Carmouche’s contribution to a book that outlines the Health Ecosystem Leadership Model (HELM)
27:00 Dr. Carmouche reflects on the diverse experiences in his career that allowed him to learn about the different sectors of the healthcare ecosystem
28:15 “No one sector of the healthcare ecosystem can create significant value alone”
29:15 How an interaction with Dr. Paul Grundy inspired Dr. Carmouche to make the biggest impact possible in improving the health of Louisianans
31:00 Blending physician leadership with the business understanding of different sectors in the healthcare economy to drive value creation
34:00 How Ochsner worked to ameliorate the scourge of COVID-19 in New Orleans and lessons of community resilience from Hurric...
The difference between average people and achieving people is their perception of and response to failure. “Failing Forward” was a concept defined by John C. Maxwell several years ago, and that axiomatic truth could not be more readily apparent than in value-based care. Transforming healthcare to lower costs and improve patient outcomes is tough work. PERIOD. It requires many years of experimentation and “trial and error” innovation. The suffering index in the value movement can be immense, but the returns – in both financial success and personal/professional fulfillment – make it a purposeful endeavor.
Dr. Jesse James, the Chief Medical Officer for CHESS Health Solutions, is a leader in the value movement who believes in Failing Forward as a key to success in value-based care. In his role, he oversees quality and clinical services for a population health management company that supports more than 3,000 providers and 150,000 patients. Dr. James joins us this week to show us that as leaders in value, “We must be willing to fail forward. “It’s our scar tissue that makes us stronger.” Tune in this week to learn from one of the best! In this episode, Dr. James provides leadership and business insights that are profoundly helpful for physicians, executives, and entrepreneurs looking to win this Race to Value.
Episode Bookmarks:
04:20 Dr. James’ “defining moment” when he found his calling to practice medicine
06:00 The decision to begin a medical career at the bedside and then working at the system-level to transform healthcare
07:30 Dr. James’ early work in clinical quality and the influence and mentorship of Dr. Cary Sennett (“The Godfather of Quality Measurement”)
08:45 The permission to fail bestowed by a mentor has been a constant reminder to “Be Humble” in the practice of medical leadership
11:00 The legendary basketball coach John Wooden on how "Failure is not fatal, but failure to change might be."
12:25 “As a leader, you have be willing to fail forward. It’s our scar tissue that makes us stronger.”
12:45 The story of how CHESS was borne out of an innovative medical practice that embraced value before the payment environment would support it
14:30 Lessons learned from hardships in the Value Journey (transitioning from FFS to P4P to Gainshare to Full Downside Risk)
15:30 “You have to remove the stigma around failure. These are opportunities to learn and grow.”
15:40 The story of Sir William Osler and how the ideal physician should be equally to call out failures as much as successes
16:50 The influence of the Institute of Medicine report “To Err is Human” on the culture of safety in the practice of medicine
17:00 The need for a new culture change in medicine to learn from mistakes and failed experiments to advance population health and VBC
19:00 Medicare payment model innovation and how CHESS isgetting as close to premium dollar as possible by taking downside risk with MA and commercial insurers
20:00 CMS experimentation with global capitation and why providers should be thinking about the Direct Contracting model
23:30 The use of “innovation cells” to effectively disseminate learnings within partner organizations
25:00 Addressing transportation as a social determinant of health in rural areas
26:00 Partnering with Wake Forest Baptist Health to deploy a “hospital at home” model
27:15 Creating wrap-around services in the technology and clinical domains to meet with needs of clients with varying degrees of maturity
29:30 Dr. James describes the value-based care landscape in North Carolina and the impact of the Atrium Health--Wake Forest Baptist Health merger
33:10 Developing a leading Medical Management program with service hubs in Care Management, Pharmacy, Quality, and Risk Adjustment
33:40 Data Analytics and Predictive Modeling and how CHESS partnered with Wake Forest to develop a frailty index
34:35 Implementing a high utilizer conference to re...
Former President of South Africa, Nelson Mandela, made an important observation when he said, “There can be no keener revelation of a society’s soul than the way in which it treats its children.” Our children are wholly dependent upon us, their parents, teachers, and society for their education, their safety and their health. It is with this mindset that we proclaim, high-value pediatric care is critical for winning the race to value.
Our guests this week are Ginger Hines, Executive Director, Seattle Children’s Care Network and Dr. Sheryl Morelli, Medical Director for Seattle Children’s Care Network, and Clinical Professor of Pediatrics, University of Washington School of Medicine. Seattle Children’s Care Network (SCCN) is a pediatric clinically integrated network comprised of Seattle Children’s Hospital, 600 specialists in Children’s University Medical Group, and 20 primary care pediatric practices comprising more than 200 providers and 6 specialty clinics. Member practices in the CIN support the health of 50,000 pediatric lives in value-based contracts.
Episode Bookmarks:
03:20 Background on Seattle Children’s Care Network (SCCN) and Seattle Children’s Hospital
04:45 Pediatric value-based care being driven by employers and how SCCN formed direct-to-employer contracts
05:30 The movement to value-based care in Washington State’s Medicaid program
06:00 How SCCN engages with physicians to build trusting relationships and a shared vision
09:00 The long-term societal benefits to investing in children’s health
10:30 Children with high BMIs that become adults with diabetes, CHF, and depression
12:00 Parents missing work to take care of unhealthy children and how employers investing in children’s health care lead to productive employees
12:40 Leveraging data and analytics in the CIN and how vaccinations and well child visits are key to disease prevention
15:00 How pediatric value-based care is different than adult value-based care
15:30 Data integration within SCCN and how the HIT infrastructure is foundation to success in population health
17:20 The validation of data accuracy as a critical success factor to building trust and supporting evidence-based quality improvement
19:30 Operational efficiencies within the CIN as a more effective way to provide actionable insights to providers
21:00 Developing consistent pediatric quality metrics and standardizing care within the CIN
24:00 Benchmarking quality performance at both the regional and national level
25:00 Recognizing the opportunity in pediatric value-based care and how you have to look for cost savings and improvements in different areas
27:30 Establishing a secure intranet to provide resources and reports to providers in the CIN
29:30 Focusing on the full panel of patients in the presentation of data and how that leads to success in population health
30:00 Transitioning to telemedicine during the pandemic and how that will impact pediatric care delivery in the future
34:00 Financial results from value-based contracts by focusing on ED utilization, asthma management, well visit completion rates, transitions of care, and quality measures
36:00 Capitalizing on quality improvement projects to decrease exacerbations within asthmatic pediatric population
42:00 Expanding value-based contracts with payers, employers, and Medicaid to prepare for full capitation
44:00 Mental health of children nationally is more important than grades in school (mental health-related pediatric emergency department visits on the rise)
45:00 Integrating behavioral health within primary care and addressing social determinants of health through innovative partnerships
49:30 Food insecurity with children as a national problem (14 million children living with food insecurity, almost 6 times as many as in all of 2018)
50:00 How SCCN is looking to build a scalable, community-based approach to addressing SDOH and food insecurity
The all-too-common visualization of balancing between the two canoes of fee-for-service (FFS) and value-based care (VBC) is an appropriate illustration of the pressure that providers feel, but maintaining balance is clearly focused on staying upright, on survival. The challenge is that the FFS canoe has a motor, and the paddle for the VBC canoe is not enough to change direction – clearly the tools used to optimize reimbursement in the two worlds are oftentimes diametrically opposed. The mission behind VBC (lower cost, better outcomes, better care) has not been sufficient for many to overcome the momentum of the status quo, the requirement for margin that is the focus of FFS. This week’s episode features two leaders in the race to value who have vital insights focused on achieving margin in risk, giving provider leaders more clarity to make the best decisions for their organizations in positioning for the future.
François de Brantes serves as Senior Vice President of Commercial Business Development at Signify Health. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. He has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions. He is the foremost expert on designing and implementing episodes of care programs for employers, providers and health plans.
Joe Fifer is president and CEO of the Healthcare Financial Management Association. HFMA’s mission is to lead the financial management of health care. With more than 50,000 members, HFMA is the nation's leading membership organization of healthcare finance executives and leaders. Prior to assuming this position in 2012, Joe spent 11 years as vice president of hospital finance at Spectrum Health in Grand Rapids, Mich. He also spent time with McLaren Health Care Corporation, Ingham Regional Medical Center and Ernst & Young.
Episode Bookmarks:
02:00 Introduction to our Mission-Oriented Expert on Value-Based Care, François de Brantes (SVP, Signify Health)
02:20 Introduction to our Margin-Focused Healthcare Finance Executive, Joe Fifer (President & CEO, HFMA)
03:40 Healthcare organizations must position themselves for value-based payment without going bankrupt in the process!
05:00 The recently released report entitled, "The Future of Value-Based Payment: A Road Map to 2030”
07:00 François provides his perspective on the current state of value-based care and the current track record of CMS and CMMI payment models
11:30 Joe explains how excessive healthcare spending has forced the U.S. under-invested in infrastructure
13:00 Moving from payment model experimentation to a more focused set a models with the right incentives to move the industry forward
14:30 Performance Results of the Bundled Payments for Care Improvement (BPCI) initiative
16:00 How François and Joe initially met 10+ years ago while working on a bundled payment program
17:45 François explains how making better decisions in post-acute care when managing an episode of care can generate margin at the patient-level
21:00 Joe on why CFOs are leery of value-based payment because of the variation and uncertainty of the financial model, and how to create an attitudinal change
23:30 CMMI needs to develop a core set of APMs that show evidence in helping the delivery system make the right decisions around resource allocation to optimize their organizational structures.
25:00 Is there an organizational tipping point for value-based care based on the percentage of their revenue portfolio at risk?
26:00 François explains the “CFO’s Dilemma” (i.e. shifting a portion of FFS revenue to risk with increased associated margin per patient that can offset the decrease in the overall margin from the loss of incremental hospitalization revenue in FFS)
27:40 The “CFO’s Dilemma” is all about reaching a tipping point...
This month is National Military Appreciation Month and with this week’s episode we take opportunity to offer our solemn regard and deep gratitude to the brave men, women, and their families who have served our nation with selflessness, gallantry, and sacrifice in upholding our foremost ideals of liberty. We are grateful for their nobility, for their duty, and for their sacrifice and that they “loved country more than self” so that we may live in a nation that is free. We are grateful that our liberty and our pursuits of virtue, equity, and happiness continue to be protected by those who now serve. As we express our gratitude for all of those who have served and now serve to preserve our country, our security, and our liberty, we have invited a veterans advocate unlike any other.
Our guest this week is The Honorable David Shulkin, M.D., former U.S. Secretary of Veterans Affairs, and one of the most courageous leaders in the value movement that we have had on our podcast! As Secretary, Dr. Shulkin represented the 21 million American veterans and was responsible for the nation’s largest integrated health care system with over 1,200 sites of care, serving over 9 million Veterans. VA is also the nation’s largest provider of graduate medical education and major contributor of medical research and provides veterans with disability payments, education through the GI bill, home loans, and runs a national cemetery system.
Episode Bookmarks:
01:45 A Special Message from Race to Value regarding Military Appreciation Month
03:15 Brief Background on The Honorable David Shulkin, M.D., the former U.S. Secretary of Veterans Affairs
05:10 Examples showing that the VA System is an exemplar of innovation
06:30 Dr. Shulkin on how the VA is a leader in behavioral health integration, use of non-traditional therapies, and addressing social determinants of health
07:45 How the VA is entirely unconflicted with fee-for-service reimbursement and why we should learn from it as we build a more value-based delivery system in the private sector
08:45 The national scandal that rocked the VA and how Dr. Shulkin was called to serve by President Obama to address the crisis
11:30 As the newly appointed Undersecretary, Dr. Shulkin describes how he addressed access issues for urgent care in the VA system, while also improving delivery of same-day services and publishing wait times for all to see
16:00 Speaking out against the Trump Administration during his time as a cabinet member (e.g. Charlottesville violence, Agent Orange benefits, privatization of the VA system)
17:45 “It Shouldn't Be This Hard to Serve Your Country”: the dual meaning of Dr. Shulkin’s book title
19:30 Accepting the consequences of staying true to your principles which means even losing your job
23:10 Dr. Shulkin reflects on the government’s response to COVID-19 and how it felt to be on the sideline due to his firing by President Trump
24:30 Self-inflicted and avoidable failures in bio-surveillance, testing, and communication strategies and how we can overcome them in the Biden Administration
27:45 Dr. Shulkin explains the Whole Health Model of Care at the VA that includes self-care, peer counseling, and team-based interdisciplinary care
29:20 Results of the Whole Health Model, e.g. decreased opioid use, lower utilization, better patient outcomes
30:30 Dr. Shulkin’s awakening to the effectiveness of non-traditional therapies when he visited the VA Winter Sports Clinic with 400 veterans who were paralyzed or had spinal cord injuries, lost limbs and prostheses
33:30 Veteran Suicide as the top priority for the VA health system and how technology and behavioral health integration can improve care delivery
37:15 Dr. Shulkin speaks about the need for private citizens to enter into public service and how we can restore trust in our government.
40:00 Dr. Shulkin provides parting thoughts of gratitude for our military and their families in ...
Nurses have been rightly recognized as heroes during the pandemic – on top of their consistently tireless effort, providing sustained caring and empathy over long hours, nurses stepped up to do more, to meet their patients’ needs despite risk to themselves. For example, they innovated to find solutions that would allow families to stay connected despite the barriers of quarantine. Building on a tradition that has been evident since they first began, nurses have always innovated solutions to improve patient care and outcomes. Their humble service and willing advocacy for each of their patients have made them heroes.
This week is Nurses Week, and in honor of nurses everywhere, we are proud to welcome Bonnie Clipper, DNP, MA, MBA, CENP, FACHE as our guest. Bonnie is an expert in the nursing innovation space and was the first Vice President of Innovation for the American Nurses Association and created the innovation framework that is inspiring 4 million registered nurses to transform health through nurse-led innovation. She has published the Amazon international best-seller The Nurse’s Guide to Innovation, The Innovation Roadmap: A Guide for Nurse Leaders, and has published on the impact of AI and robots on nursing practice, as well as authored The Nurse Managers Guide to an Intergenerational Workforce. Bonnie’s insights into nursing are important and clearly articulate that, where a race to value is concerned, nurses are the ones innovating and delivering the solutions that will get us to the finish line!
Episode Bookmarks:
05:45 Nurses are more with patients and families than any other discipline
06:30 Nurses are in the best position to transform how care is delivered and how we view health
07:10 The scope of the nursing profession and how their problem-solving can drive cost-effective solutions
09:10 Where do nurses fit in this big picture?
10:00 Nurses in leadership and the 10th anniversary of the IOM’s landmark report, “The Future of Nursing: Leading Change, Advancing Health”
12:50 Interdisciplinary training of the current generation of nurses
13:40 Training nurses about the business of healthcare
14:30 The need for upgraded competencies in nursing (e.g. climate science, gun violence, AI and big data)
15:10 Virtual Reality as a crucial component of the future of nursing education
16:00 The pandemic as a catalyst for health equity, telehealth, and virtual care and how that will impact nursing education
17:45 The nursing workforce shortage and the trend of nurses leaving the bedside
19:00 Staffing ratios in nursing and how nursing can be amplified by Artificial Intelligence
21:30 The trend away from acute inpatient care and how nurses will provide care more home-based care in the future
22:10 “Nursing services should be paid for in relation to the value it brings in the care paradigm. It should not be built in the room rate like a commodity.”
23:00 Restructuring nurse compensation and how this will incentivize performance and promote retention
23:50 The agency-based nursing model and how nurses are finding this model more rewarding
25:00 Innovation in nursing and how that can be leveraged for human-centered design
27:30 Creating a culture of innovation for nursing to flourish and for patient outcomes to improve
28:30 Examples of nurse innovation on the frontlines during COVID-19
29:45 How younger nurses may lead the way in innovation and the “entreprenurse"
30:30 Teaching human-centered design in medical and nursing schools
31:00 The empathy and compassion of nurses and how the broken system can create moral injury
32:00 Eric reflects on a prior podcast interview with a patient and how it taught him the importance of culturally competent care
34:00 How to deliver culturally competent care with DEI coupled with artificial intelligence to reduce implicit bias
35:45 The accounting of the nurse labor structure as a challenge to provide patient-cente...
This week’s episode is the second part of our conversation with Dr. Robert Pearl. In his book, Uncaring: How the Culture of Medicine Kills Doctors & Patients, Dr. Pearl asserts that doctors are taught how to cure people, but they don’t always know how to care for them. There are many contributing factors, ranging from how doctors are trained, to increasing workloads and lack of resources, a widening disconnect between patients’ and doctors’ values and expectations, and increased risk and death due to the pandemic, all of which are intertwined with systemic and cultural issues. These are people who, with the highest ideals of caring for people, have entered a system rife with misaligned incentives that undermine and contradict their own hopes and expectations, and a culture that shapes them into being unable to care in the way they originally intended. The book examines the elements of physician culture that need to be corrected, the ones that should be preserved, and how to accomplish both.
Dr. Robert Pearl is the former CEO of The Permanente Medical Group (1999-2017), the nation’s largest medical group, and former president of The Mid-Atlantic Permanente Medical Group (2009-2017). In these roles, he led 10,000 physicians, 38,000 staff, and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members on the west and east coasts. He is the author of Washington Post bestseller “Mistreated: Why We think We’re Getting Good Healthcare—And Why We’re Usually Wrong,” and “Uncaring: How the Culture of Medicine Kills Doctors & Patients” which is scheduled to be published in spring 2021 (all proceeds from the book go to Doctors Without Borders). Dr. Pearl also hosts the popular podcasts Fixing Healthcare and Coronavirus: The Truth.
Episode Bookmarks:
00:30 The cultural hierarchy in medicine
01:00 Research on effects of concentrated primary and specialty care on life expectancy
03:00 Dr. Pearl explains how primary care was once on top of the cultural hierarchy before technology advancements
04:00 The need for Primary care to adjust to the current world (The Acceptance stage of the Kübler-Ross grief cycle)
05:30 Leading innovation in Primary Care and the success of ChenMed as a primary care model that can lower cost and improve outcomes
06:30 How the current fee-for-service model creates ineffective primary care delivery to ensure population health (e.g. lack of access and availability)
08:00 The use of telemedicine in the primary care setting to improve patient outcomes
09:15 The need for interdisciplinary, technology-enabled primary care teams and the integration of specialty services
10:00 How Kaiser Permanente leveraged telemedicine and other digital tools for clinical integration
11:30 PCP/SCP collaboration to determine evidence-based practices in a consistent, technologically-enabled, efficient way
12:00 Redefining primary care to elevate its value.
12:20 “Primary care shouldn’t just be the gatekeeper for referrals; they should be the facilitators of higher quality care by collaborating with specialists."
12:40 Inefficient, low-value referrals from primary care for consultations that could be prevented with better integration
14:00 Onsite primary care clinics for Apple employees that are improving collaboration with specialists
14:30 Consumerism and Patient Experience -- patients feel disrespected by long wait times, short visits, and poor communication.
17:00 “Culture, to some extent, allows you to avoid the harm you inflict and take privilege in what you desire. Some of that exists within the physician world.”
17:20 Physicians that refuse to value patients’ time as much as their own as seen by long wait times, limited access and availability, and limited consumer-driven technology
18:20 The culture of customer-focused technology and service, exemplified by Amazon, has changed patient expectations
18:50 Patients value empathy,
In a year of great need, during the pandemic, Americans saw and celebrated an army of physician heroes. In doing so, they overlooked an uncomfortable reality. Doctors are humans who share a culture that produces both remarkable successes and abysmal failures. As in Robert Louis Stevenson's gothic novella The Strange Case of Dr. Jekyll and Mr. Hyde, it is possible that one person -- or this case, one culture -- can be both a virtuous force and a destructive influence. Until now, the negative aspects of physician culture have remained largely invisible. But like a virus, it affects people even if they can't see it. Physician culture wields tremendous influence over the lives of patients, doctors, and the nation, regardless of whether people acknowledge (or are even aware of) its existence.
This week, we have as your guest Dr. Robert Pearl. He will be discussing his new book which tells the story of a profession that is both triumphant and dangerously flawed, filled with people who aspire to help others, yet who sometimes act coldly, callously, and indifferent. This book takes you inside the doctor's world, revealing unique insights about their training, their daily practices, and the culture they share. It is a book about people striving for perfection and about the impossibility of achieving it. It sheds light on the norms, rules, and expectations of doctors, and shows how culture shapes their thoughts and beliefs. It deciphers their evolving language, symbols, and codes. It highlights what brings doctors together and what isolates them from their colleagues and patients. Finally, this book examines the elements of physician culture that need to be corrected, the ones that should be preserved, and how to accomplish both. If we are to win this Race to Value, we must fully understand and reform physician culture so it can be more caring.
Episode Bookmarks:
2:00 “The Strange Case of Dr. Jekyll and Mr. Hyde” – Is it possible that one culture can be both a virtuous force and an equally destructive influence?
2:40 If we are to win this Race to Value, we must fully understand and reform physician culture so it can be more Caring.
3:00 Dr. Robert Pearl’s new book, “Uncaring : how physician culture kills doctors and patients.”
4:45 Physician culture tolerates low value care, inequitable outcomes, excessive profiteering, and perpetuation of institutional racism.
5:40 Despite the clear link between avoidable chronic disease and excessive COVID-19 deaths, physicians are not speaking out on this.
6:45 Dr. Robert Pearl defines what culture really is and how drives physicians to perform but also inflict harm
7:30 The “invisible” nature of physician culture
8:45 The heroism of physicians during COVID-19
10:00 Systemic issues and cultural issues go together – Why Mistreated and Uncaring are perfect companions in solving for healthcare.
10:45 Chronic diseases and the lack of accountability in physician culture
11:30 The focus on Prevention is not elevated in medicine, as illustrated by how we undervalue primary care
11:50 Research study showing that adding PCPs increases life expectancy in communities, while adding specialists does not have a comparable effect.
12:30 Primary care physicians are paid more in large multispecialty medical groups like Mayo Clinic, Kaiser Permanente, and Geisinger
12:50 Pre-Order information for “Uncaring” and all profits go to Doctors Without Borders/Médecins Sans Frontières (MSF)
14:00 How the “Art of Medicine” philosophy in physician culture prevents progress towards evidence-based medicine
15:30 Research showing that as much as one-third of physician services is low value care, offering little to no benefit for patients
16:30 The long lasting and pervasive effects of a physician culture that pre-dated scientific advancements
17:45 “It is not a question of how we maintain the esteem of the past, but how do we create the esteem of the future?”
It’s not a secret, the broken healthcare system is exquisitely tuned to react after patients get sick. For the most part, profits are made after we FAIL patients. And it hurts all of the caregivers who face the daily internal conflict of doing what is right for the patient or doing what is right for the business. But there are a few who are positioned differently. When the strategy and business are unconflicted they’re not worried about demand destruction and leakage but are instead focused on prevention and true care management.
It all begins with prioritizing and properly aligning primary care. A group of 100 adult primary care physicians can influence $1 billion in healthcare spend. This is the source of potential power and change in a value-based world, where health will improve for patients and their providers while costs are decreased. Aledade is such a place – by allowing providers to remain independent and unfettered by the constraints of fee for service, Aledade is blazing the path toward true health value.
Episode Bookmarks:
03:30 Comparison of Healthcare Spending ($6M per minute) to Niagara Falls (6M cubic feet per minute)
04:55 Aledade’s success in short lifespan of company (now at 800 practice partnerships with $360 million in healthcare cost savings)
06:05 The misalignment of incentives creating a perverse incentive for poor outcomes (e.g. profitability of treatments following a stroke)
06:45 Dr. Mostashari spending his career trying to find answers to the question, “How do we save the most lives?”
07:20 Adoption of electronic health records (“We succeeded in the battle, but we lost the war.”)
07:45 Provider workflow redesign and optimization (Regional Extension Centers)
08:25 “How can we create incentives so that private profit creates public good?"
09:30 “The Paradox of Primary Care Physician Leadership” (the influence of primary care on downstream healthcare spend)
11:30 Consolidation of primary care by Optum and private equity firms
12:00 The resiliency of independent primary care practices
12:30 “Independent practices can do what they believe is in the patients’ best interest, without worrying that they’re obligation to the patient conflicts with their obligation to the corporation.”
13:00 Data shows remarkably little change in hospital employment of PCPs, thereby showing resilience in the primary care market
15:00 Movements are led by effective storytelling and these stories can revitalize communities of people
17:00 Primary care heroes during COVID-19, and how society neglected them by failures in supply chains, testing, and vaccines
18:40 Aledade’s support of primary care practices during the pandemic
20:00 “It is remarkable what happens when you do the right thing.”
22:00 Dr. Mostashari’s terror in seeing early ER utilization data in knowing that a pandemic was coming (before the media was covering it)
23:00 Implementation of telehealth, finding PPE, and securing loans for practices in early stages of pandemic
23:25 “The idea of practices going out of business during the pandemic highlights the insanity of fee-for-service payment for primary care.”
24:00 The lessons of COVID-19: 1) Healthcare can change, 2) Primary care doesn’t have to be an in-person visit, 3) Capitation in primary care is preferrable to fee-for-service
25:40 “Primary care is about the relationship between a practice and patient -- it’s not about the 99213 visit.”
27:30 Dr. Mostashari addresses recent delays by CMMI in new APMs and what we should expect in future health policy
28:30 Scaling the models that work is the job of good health policy. (MSSP compared to CMMI programs)
29:00 The ACO Investment Model (AIM) program was successful and a model for future provider and patient incentive programs
30:30 CMMI delays should not be considered as a question to the direction of value-based models.
32:00 The progress of the ONC in standardizing health in...
Race to Value listeners -- April is National Minority Health Month, and this year, the HHS Office of Minority Health is focusing on the disproportionate impact the COVID-19 pandemic is having on racial and ethnic minority communities. This Bonus Episode is a compilation of viewpoints on health equity and racial disparities of care from some of our former guests in the past year. We hope you take the time to listen intently to their message.
Certainly over the last many year we have been exposed to the great inequities that have existed in our society for far too long. We have one major obligation we have to each other…that is to tell the truth. And the truth is, there are so many inequities in our society for minorities, including the manifestation of institutional racism within our nation’s health system. As leaders in value-based care, we have to be accountable to the endeavor that we are about. We endeavor to, in fact, ensure every patient receives the best treatment possible so they can live the life they are intended to live. That we endeavor to create the opportunity for health equity, and that is true regardless of race, ethnicity, gender, sexual orientation, or otherwise.
We hope you find meaning in this Bonus episode and gain awareness for how important health equity and social justice is to win this Race to Value.
Episode Bookmarks:
1:39 Daniel Chipping introduces National Minority Health Month and its’ focus on COVID-19 impact on minority communities
2:10 Dr. Eric Weaver delivers a special message on overcoming institutional racism in our nation’s healthcare system
3:29 Dr. Farzad Mostashari reflects on the murder of George Floyd and how it was a reckoning for social justice (and health equity)
6:33 Dr. Lerla Joseph discusses how she has devoted most of her life committed to health equity, how ACOs are a vehicle for change
12:30 David Smith provides a powerful social commentary on how pervasive systemic racism is in our society and his awakening as a white male
18:41 Christina Severin on the country’s reckoning, how her white privilege as conditioned her to be a racist, and how health centers can address inequities
23:10 Dr. Ernest Grant on the public health crisis of systemic racism, the disproportionate burden of disease related to SDOH, and how nurses can call for change
30:19 Dr. Stephen Klasko on how the zip code of communities ultimately determine health, and how the pandemic has raised awareness of inequities
31:46 Christina Severin on how the calling for racial justice, coupled with the pandemic, has created urgency to “bridge the digital divide”
33:36 Dr. Gordon Chen on the social injustice of different lifetime expectancy rates between white and minority communities
36:04 Shannon Brownlee on how Black Lives Matter has forced hospitals to focus on health equity
38:24 Dr. Mark Gwynne on how investment in data analytics can help ACOs identify opportunities in populations where there are disparate outcomes
39:11 Dr. Christopher Crow on how health equity in communities can be addressed through reforms in education, health, and business
40:27 Cheryl Lulias on building community-based coalitions to address health equity
42:10 Robert Sepucha on the disproportionate burden of kidney disease in minority populations
42:57 Dr. Edwin Estevez on the vulnerability of the Hispanic population on the Texas/Mexico border and how his ACO focuses on nutrition and health literacy
46:17 Mike Funk on how health plans can address disparities in minority communities
48:15 Dave Chase on the opportunity for social impact investment to creative cooperative structures in disadvantaged communities
48:53 Dr. Mark McClellan on health policy approaches to address health equity
49:30 Andrew Croshaw on how the Biden Administration will define value through health equity
Fixing the behavioral health crisis is an absolute imperative in the movement to value-based care. Currently, 1 out of 5 Americans (over 51 million) are living with a behavioral health condition, there are approximately 20 million individuals in the US with a substance use disorder, and 9 million people have had suicidal thoughts in the past year. The onset of a global pandemic has only exacerbated the behavioral health challenges in our country. The solution is the integration of behavioral health with primary care. Primary care is the “tip of the spear” as 70% of primary care appointments include problems with significant psychosocial issues, and less than half of those primary care patients receive any mental health treatment. Solving this crisis through integration, however, is simply not possible without digital health solutions that can facilitate coordination between behavioral and medical care. Innovation is our only gateway to value-based care at scale.
Mark Redlus, Chief Executive Officer of Tridiuum, is a venture-backed start-up executive with significant leadership experience in corporate management, M&A, strategy, and business development. His personal story aligns with the company’s transformational vision to advance behavioral-medical integration by delivering capabilities to identify those who need behavioral help, speed their access to care, and deliver a measurable impact on outcomes. Leveraging digital behavioral health solutions is key to winning this race to value.
Episode Bookmarks:
03:30 The inspiration of Apple and Steve Jobs on Tridiuum’s rebirth
04:30 “Digital intervention can make a difference in outcomes.”
05:40 Commercializing research to inform the development of new products in the behavioral health space
06:20 Challenging the status quo by designing digital behavioral health solutions with elegant design (Reference to Simon Sinek’s TedTalk)
06:50 The attempted suicide attempt of Mark’s daughter (Katherine) and how that informed his personal “Why” to improve behavioral health outcomes
08:20 Growing access problem for mental health services that has been exacerbated by COVID-19
08:50 The realization of the “inadequacy of care” in the immediate hours following Katherine’s attempt on her life
09:20 “We can do better about unlocking access to behavioral health services sooner. People searching months for someone to talk to is unacceptable.”
10:45 1 out of 5 Americans (over 51 million) are living with a behavioral health condition, including 20 million SUD and 9 million with suicidal thoughts
12:50 “Technology is not the holy grail, but it has a role to play in a fully integrated behavioral health experience.”
13:20 The difference between co-located, multidisciplinary models and true integrated models of care
15:20 Integration of psychiatry and psychological counseling into primary care practices
15:40 Telepsychiatry and telepsychology in response to COVID-19
16:35 “Primary care is the tip of the spear where the broadest of array of behavior health demand is occurring.”
17:00 Only 14% of ACOs even have a behavioral health component in their care model
17:30 Patients who have a chronic disease have a 3-4X higher frequency of behavioral health comorbidities
18:00 Patients with a chronic disease and behavioral health comorbidity cost as much as 50 percent more and are likely to be noncompliant
18:30 $26-48 billion could be saved through behavioral health integration, representing a 5-10 percent decrease in overall healthcare costs
19:20 Partnership with Fresenius in managing behavioral health for CKD and ESRD patients to lower total cost of care
21:15 Projected 60-80% reduction in total cost of care per patient when ESRD patients are treated for behavioral health comorbidities
22:00 “Value-based contracts are difficult to justify if you can’t drive behavioral health access for members and patients.”
Achieving health value demands the formation of a new social construct, one that puts aside self-interest and builds systems of care for the common good. One that prioritizes health and equity for all, including the underserved and most vulnerable among us. This effort requires stronger leaders and better leadership than ever before. Getting Medicaid right, transforming addiction and substance use disorder treatment, reframing behavioral health, and removing silos – these are a few of the efforts of this week’s guest as his work exemplifies the mission of achieving health as the seminal American institution to drive social connectedness and economic prosperity.
Our guest is David Smith, CEO and founder of Third Horizon Strategies (THS), a Chicago-based, boutique advisory firm focused on maximizing human potential through a better health system. David serves on the Health Care Council of Chicago, the Alliance for Addiction Payment Reform, the board of the Sinai Hospital System, the Founder’s Council of United States of Care and as a Senior Advisor at AVIA and a Project Executive for their Medicaid Transformation Project.
04:55 Facts on Medicaid: 75 million Americans covered (1 in 5 Americans), 50% of US births, $600B annual spend
05:40 Medicaid beneficiaries may even approach 100M in the next five years
06:00 Background on the Medicaid Transformation Project (MTP)
08:00 “The Medicaid program is the single most important endeavor in our country, PERIOD. And that’s not just in healthcare, I’m talking about in total.”
09:00 Health is required to serve in the function in the full human capacity.
09:45 The neglect of the Medicaid program over the years and why we need to get it right to improve health in underserved communities
10:18 “Getting Medicaid right improves health, and improving health creates economic development.”
10:30 Disparities in public health are drawn across racial lines
11:00 Transformation Factor #1: Evolution of payment models and realignment of incentives
11:45 Transformation Factor #2: An evidence-based approach to Care Model research and implementation
12:15 Transformation Factor #3: Leveraging technology innovation for underserving communities
12:40 Transformation Factor #4: Social impact investments to fuel innovation
13:00 Transformation Factor #5: Social determinants of health
13:30 Transformation Factor #6: Growth in Medicaid enrollment requiring scalable solutions
14:10 Lack of government boldness, states not moving fast enough, MCOs not eager to develop new payment models
14:40 Partnering with health systems in the MTP to look for disruptive solutions that with financial self-sustainability
16:40 Facts about Substance Use Disorder (SUD): 23.4 million Americans affected, 81,000 drug overdose deaths per year, 1 in 5 Medicaid beneficiaries, 46% of the total Medicaid spending
18:40 David shares how he has personally been impacted by drug overdose through the loss of his father, brother, and sister
21:25 The role of Big Pharma in creating the opioid problem and how Addiction (the “dopamine rush”) is the #1 most common human failing
23:00 How the system of care is setup to treat patients with SUD as “bad people”
23:35 “If we think our fee-for-service system is bad for our physical health, it is a dumpster fire for people who struggle with addiction.”
24:15 The total cost of care for a patient with high acuity SUD is $31-32k per year, and how that creates a $17k value gap.
25:20 “There is no “cure” for Substance Use Disorder; there is only reducing a person’s risk to a baseline.”
25:50 The Value Gap due to waste and inefficiency in the treatment of SUD that also results in poor outcomes in long-term recovery.
27:05 The Alliance for Addiction Payment Reform and its role in advocating for a new value-based payment model for long-term recovery of SUD
29:30 Partnering with commercial payers to develop APMs for Substance Use Diso...
When Thomas Edison created the electric light bulb, he didn’t stop with that one incredible invention. He took the next step and created the industry that would maximize the benefit of that light bulb, the infrastructure needed to make that light bulb become a permeating and permanent piece of society.
This is the type of vision needed for the health care system as a whole, and the type of vision that is occurring in Dallas Texas. Catalyst Health Network’s physicians are intent on the vision of “Primary Care for All”, serving communities that are mired in a systemic, multi-generational crisis—where one in three children in Dallas lives in poverty, the third-highest rate of child poverty in the nation.
This week’s guest, Dr. Christopher Crow, President of Catalyst Health Network, has connected and aligned a network of more than 1,000+ Primary Care Providers with nearly 1 million lives across North Texas, to build a better care model for patients that improves health and lowers cost. His work with Catalyst led them to be the first North Texas physician network to hold value-based contracts with the top four major carriers: Aetna, UnitedHealthcare, BCBSTX, and Cigna. To date, Catalyst has saved an impressive $100 million for the communities they serve. Dr. Crow and Catalyst are a bright example of leadership in the race to value!
Episode Bookmarks:
04:00 Thomas Edison’s signature invention of the light bulb was a little more than a parlor trick without a system of electric power generation and transmission
05:00 How Catalyst you’ve been able to imbue a full spectrum of innovation with its value attempts
06:00 The origin story of Dr. Crow and Catalyst Health Network
07:20 Systems thinking design and strategy as a leading force to payer collaboration
08:20 Dr. Crow’s A-Ha moment when seeing Catalyst’s performance data and how value design and PCMH really does lowers cost and utilization
09:30 How growing up in the small town of Hillsboro, Texas inspired Dr. Crow to help communities thrive
10:50 The three pillars to helping communities thrive are health, education, and business.
11:20 Building a healthcare system to deliver more value starts with team-based primary care.
12:45 f an independent primary care practice can thrive (not just survive), the data shows that the community will thrive as well.
13:30 Centralization of population health management with deep personalization
15:00 Leveraging trust of the physician-patient relationship by extending it to the entire care team at scale
15:35 The concept of relationship compounding in value-based care and how it leads to lower costs and better health
16:40 The income and public health disparities in Dallas, Texas and how life expectancy differs by 24 years between neighboring zip codes!
18:10 Dallas is a tale of two cities – affluence and poverty. What is Dr. Crow’s vision to help everyone in the community thrive?
19:30 Dr. Crow’s vision for “Primary Care For All” to improve longevity and prosperity
21:00 The impact of COVID-19 on building virtual care and telehealth capabilities within the practice
21:30 The importance of telehealth in addressing issues with Behavioral Health and “healthcare deserts”
23:00 Creating the Catalyst Community Foundation to provide access to affordable, quality care, starting with COVID-19 testing and vaccinations
25:15 “If you really want to create impact with high leverage, go upstream with primary care and social services”.
26:20 Building a business model for a self-sustaining, community-based foundation that will ultimately lead to Primary Care For All
27:30 Private Equity investment and provider consolidation – what does this mean for the future of primary care?
31:00 How Catalyst helps small primary care practices build the table stakes for value-based care from a technology and service standpoint
34:45 Catalyst receiving URAC’s full accreditation in Clinical Integratio...
Decades of poor outcomes in terms of cost, quality, and access have not created societal commitment to confronting the issue of low-value care in hospitals. Despite medical errors serving as the #3 cause of death, unpaid hospital bills leading as the #1 reason for personal bankruptcy in our country, vast disparities in care prevalent across racial and sociodemographic lines, and a general sense of pricing opaqueness, we have not yet seen a community-led movement towards hospital accountability for health equity, quality of care, and avoidance of low-value care. If hospitals are to equitably deliver the high-quality care that is essential to improving community health, the time is now. Assessing how well hospitals are serving all of their patients in their communities is a key first step in improving their quality of care. The Lown Institute, a think tank generating ideas for a just and caring system for health, has developed a tool to answer the question, “Are hospitals providing high-value care, achieving excellent patient outcomes, and meeting their obligation to advance health equity in their communities?” Today we are joined Vikas Saini & Shannon Brownlee of the Lown Institute to discuss The Lown Institute Hospitals Index, a novel way of evaluating and ranking hospitals in order to help them better serve their patients and communities and to hold them accountable to addressing social determinants of health. This unique hospital ranking system is breaking new ground as we move forward in the race to value.
Episode Bookmarks:
02:00 Despite decades of dreadful outcomes, society has yet to confront the issue of hospitals providing low-value care
04:30 The legacy of Dr. Bernard Lown, as a pioneering cardiologist, humanitarian, and early advocate of value-based care
08:20 Dr. Lown’s philosophy of value-based care and the subtle distinction between doing as little “to” patients, but doing as much as possible “for” them
11:15 A new hospital ranking tool is needed in value-based care -- one that factors in civic leadership and racial equity
12:50 The Lown institute Hospitals Index is the first ranking system that actually measures overuse and unnecessary care
13:20 Economic tradeoffs matter when you look at racial equity
14:05 In ranking hospitals, the value of the care is as important as clinical outcomes.
15:05 Good hospitals are vital to healthy communities, but how you define and measure “good” matters.
15:30 The Civic Leadership component of the Hospital Index which accounts for spending on charity care, pay equity, and racial inclusivity
19:00 Variation in social and civic leadership metrics with academic medical centers, particularly inclusivity and pay equity
20:20 How Black Lives Matter has forced hospitals to reexamine their culture and commitment to health equity
21:45 Neighboring hospitals with drastically different racial inclusivity scores and the impact of residential segregation
25:00 Segregated (“separate and unequal”) hospitals with disproportionate impacts in COVID outcomes for those in low-income communities
26:30 The way we have organized and funded the hospital sector will not meet population health needs for communities
27:30 The need for regional coordination, changes in payment mechanisms, and global budgeting for health care transformation.
29:00 The Big Business of Healthcare and why “Health care is too important to leave to the Healthcare sector.”
30:00 Having a hospital system based on cooperation in population health versus having individual healthcare businesses competing against each other for volume
31:00 The disappointing, yet predictable, inequitable distribution model for COVID-19 vaccines
36:00 Low-value care is a significant portion of waste; estimates of spending on low-value care range from $100 billion to $700 billion each year!
39:00 Vikas discusses how his clinical training with Dr.
Chronic kidney disease kills more people than breast or prostate cancer each year – it’s the 9th leading cause of death but you won’t see NFL players wearing socks and gloves to increase awareness. Thirty-seven million people in the U.S., or 15 percent of adults, are impacted by CKD, and around 90 percent of those with the disease don’t even know they have it! Treating kidney disease costs the Medicare program $130B and although patients with kidney failure account for only one percent of the Medicare population, they are responsible for over seven percent of all Medicare spending.
Over the last 40-50 years, kidney care has experienced significantly less transformation than other areas like diabetes, cardiology, cancer, and HIV/AIDS. We have been failing in kidney care for far too long, and instead of focusing just on dialysis, we need to realize that kidney disease is more than just ESRD, and there is way more to ESRD than just in-center dialysis. This historic stagnation in kidney care with a large population now in crisis is a hugely abundant opportunity for innovative companies like Cricket Health to come in and change the game.
In this week’s episode, we are joined by Bobby Sepucha, CEO of Cricket Health, a specialty care management company leading the way in the Value-based kidney care space. National Kidney Month is the right time to discuss how we can win this Race to Value with integrated nephrology and dialysis care for people with Chronic Kidney Disease and End Stage Renal Disease.
Episode Bookmarks:
02:00 37 million people in the U.S., or 15 percent of adults, are impacted by CKD, and around 90 percent of those with the disease don’t even know they have it!
02:15 Medicare pays well over $100 billion for people with all stages of renal disease, which was nearly 20 percent of all Medicare spending last year.
02:45 While just one percent of Medicare beneficiaries have kidney failure, kidney failure accounts for over seven percent of all Medicare spending!
05:35 The system is designed to fail patients with chronic kidney disease
07:45 How the 1972 Medicare enrollment eligibility provision for ESRD patients created an unintended consequence of earlier stage CKD patients getting neglected
08:09 President Trump’s Executive Order on Advancing American Kidney Health (July 2019)
08:35 Bobby recalls his work with CMS and Congress to bring the ESRD Seamless Care Organization (ESCO) alternative payment model into fruition
09:00 “Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited.”
09:30 40% annualized mortality rate for dialysis patients can only be addressed by upstream CKD intervention
09:40 The new Kidney Care Choices (KCC) and the ESRD Treatment Choices (ETC) payment models
11:50 “Only 12% of ESRD patients today in America dialyze at home – that lags other nations to such an alarming degree.”
12:15 “If you were going to design the worst imaginable healthcare delivery system for kidney patients, you’d come up with the one we have here in America. Costs are astronomical, outcomes are terrible, mortality rates are through the roof, everyone is dialyzing in a center instead of home…it just doesn’t make any sense.”
12:55 60-65% of ESRD patients “crash” into dialysis with an ER visit
14:00 Cricket’s model for upstream CKD intervention
15:00 “Getting patients to dialyze at home is a multifactorial problem.”
16:15 The overlap of nephrology and palliative care
18:00 Telehealth is the silver lining to the pandemic
18:30 A patient story about the success of transitioning to home-based dialysis
19:55 The appalling lack of kidney care innovation over the last 40-50 years
22:20 The obesity epidemic and exploding kidney care costs over the last few decades
23:00 Working with payers for a more holistic approach to value-based kidney care
23:45 Payer goals: 1) reduce CKD hospital utilizatio...
Last year, research at Johns Hopkins showed that healthcare consumes nearly half of all federal spending, which includes funding for Medicare, Medicaid, Social Security, military health benefits, health benefits for federal employees and their dependents, plus interest. Our federal government spends 48% of its money on health care and still healthcare devastates state budgets all across this country, with serious consequences in public health, education and other national priorities.
This week’s guest, Dave Chase, is the Creator, Co-Founder, and CEO of Health Rosetta. Health Rosetta is an ecosystem enabling public and private employers and unions to reduce their health benefits spending by 20% or more while improving the quality of care for plan members. Dave is also the author of Relocalizing Health: Relocalization is a strategy to build communities based on the local production of food, energy and goods. When applied to healthcare, a relocalization effort bring about systematic change – it could lead to strengthened local economies, improved population health, higher value in care delivery, and health equity. Dave expounds that health doesn’t start with a pill or in a hospital. It starts at home, with parents, with neighborhoods, with workplaces, and communities. Relocalization will be an important key for winning the race to value!
Episode Bookmarks:
04:05 Defining the Relocalizing Health strategy and why it needs to be applied to healthcare
05:45 How to create systems change at a grassroots level
06:25 Applying a systems change model that focuses on adaptable replication (not scalability)
07:15 The Nuka System of Care in Southcentral Alaska as an example of a successful effort to relocalize health care
07:25 Rosen Hotels as another example of creating a consumer-oriented redesign of health care
07:40 Learning from the Jönköping Health System in Sweden
08:35 “Transformation moves at the speed of trust, and trust is built on complete transparency.”
08:50 How the legal and economic underpinnings of health plans are ‘completely rotten’ and must be made transparent
09:15 Seeking transparency in the way health insurance brokers are paid
09:27 “There is no well-functioning healthcare system in the world not built on proper primary care.”
09:35 “Healthcare isn’t expensive -- only 27 cents of every healthcare dollar goes to clinicians who are the value creators. What’s expensive is profiteering, price gouging, administrative bloat, and fraud.”
10:00 Dave discusses the advancements of modern-day computing as an example of why we need to work on the fractals of healthcare (i.e. the piece parts)
11:05 Research from Marty Makary showing that the federal government spends 48% of its money on health care
12:55 A broken financing model for hospitals steals from public health, kids, education, social services, and public infrastructure
13:15 Economic Development 3.0: Playing the Health Card
13:35 How considering every hospitalization as a failure is a starting point for reform
14:30 The economic depression of the middle class due to wage stagnation, and how that was caused by healthcare costs
15:30 The Millennial Generation is the first generation in American history where life will not be better for their parents because healthcare is stealing their future
16:35 Referencing David Goldhill’s Catastrophic Care: Why Everything We Think We Know about Health Care
16:55 “I believe the Millennial Generation can be the greatest generation of this century.”
17:45 Massive student debt and how healthcare has driven up the costs of Higher Education
19:51 The national opioid epidemic crisis that is devasting communities. More than 760,000 people have died since 1999 from a drug overdose, and two out of three drug overdose deaths involve an opioid.
21:45 The opioid crisis isn’t an anomaly – it is our healthcare system. The key unwitting enabler is the employer.
Stephen Nuckolls grew up listening to his physician father talk about how healthcare could save money for Medicare if it was accountable for outcomes. It was with this intent that he built Coastal Carolina Health Care (CCHC) in 1998, a multi-specialty practice managing 36,000 patients with 60 providers across 16 sites of care in Eastern North Carolina. CCHC serves in both urban and rural communities, with a mission is to promote the health of its patients by providing high quality, compassionate, comprehensive, and personalized health care.
It’s no surprise that Stephen and his team formed one of the first 27 MSSP ACOs, Coastal Carolina Quality Care. Currently in the 8th year of the Medicare Shared Savings Program (ENHANCED Track), the ACO performs at the highest quality levels nationally and has saved consecutive years. The ACO exemplifies the vision of Stephen’s leadership, captured in the ACO’s slogan, “Tomorrow’s Health Care Delivered Today.”
Episode Bookmarks:
05:00 Stephen reflects on the influence of his physician father who championed value-based care early on
05:40 Setting up Coastal Carolina Health Care, PA (CCHC), a multi-specialty group practice, in 1998 to be accountable for cost and quality
06:00 Leveraging ancillary services and electronic health records to prepare for the future state of value-based care
06:45 The passage of the Affordable Care Act in 2010 as an opportunity for Stephen’s practice to demonstrate value
07:00 Stephen and his physicians head to Washington, D.C. to collaborate with CMS on the early design of the Medicare Shared Savings Program
07:20 The struggles of balancing FFS and VBC in the early years of Coastal Carolina Quality Care (CCQC) ACO
08:45 “It’s not the actual doctor services that are expensive. The real big costs are in hospitalizations.”
09:00 ACO Care Management dropped Hospital Admissions per 1000 by 22%
11:00 Engaging physicians in the early years of the ACO before Shared Savings performance
12:30 Mandatory transition to downside risk in the “Pathways to Success” MSSP final rule and how ACOs should evaluate potential for future success
13:30 Getting comfortable and fully understanding the ACO benchmarking methodology
13:50 “Ultimately we need to have risk in the game, but we need to recognize that different ACOs are in different periods in their transformation.”
14:00 How CCQC ACO is consistently ranked among the top performers nationally in quality measure performance, clinical outcomes, and Shared Savings returns
16:00 How having one practice in the ACO with one electronic health record supported quality outcomes
17:00 Selecting “true north” standardized quality measures that are managed consistently across the entire payer contract portfolio for all patients
17:20 Implementing a successful point-of-care quality measure reporting dashboard
18:00 Developing an equitable physician compensation/incentive structure as a key to success for driving quality
19:00 ACO concerns related to diminishing returns over time due to sustained performance in comparison to the benchmark
21:00 Advantages in specialist integration within the ACO due to multispecialty practice model
23:00 Capital investments required to build an ACO population health management infrastructure
26:00 Efficiencies gained by being a one-TIN/one practice ACO and how Advanced Payment ACO Model funds were used to build a Chronic Care Management program
27:00 Investments in automated dashboards for quality reporting to identify and manage gaps in care
28:00 Annual Wellness Visits (AWVs) as a source of funds for practice transformation in primary care
29:00 Reinvesting funds back into the ACO versus distribution to physicians
29:30 A recent investment in an “extended care” clinic (a higher acuity center with ER physicians, hospitalists, and nurses)
31:00 How the extended care clinic resulted in an ER visit per 1000 rate of 25 for self-i...
In this episode, reflect on the importance of Black History Month, an important time to recognize and honor the contributions and achievements of the millions of African Americans who have helped build our nation and enrich our culture. We also address racial disparities in care, which have become increasingly evident during the pandemic and vaccine distribution response. And we consider how value-based care can work to ensure true population health and parity in health outcomes for all.
This week we are honored to speak with Dr. Lerla Joseph, an African American physician, businesswoman, humanitarian, role model, mentor, and philanthropist. In 2012, she founded the Central Virginia Coalition of Healthcare Providers (CV-CHIP) one of the nation’s few minority-owned Accountable Care Organizations. Dr. Joseph not only leads a successful ACO, she has also led medical missionary trips to Haiti for the last 16 years. As a community leader, she has also served on boards for Richmond Community Hospital and the Bon Secours health system and was the 1st woman elected President to the Richmond Medical Society. This year she was a "Strong Men & Women in Virginia History" Honoree, a program that honors prominent African Americans past and present who have made noteworthy and admirable contributions to the commonwealth, the nation, and their profession. Dr. Joseph is a shining example that black history is around all of us.
Episode Bookmarks:
01:45 Black History Month is a time to contemplate the faith and sacrifice of every black ancestor.
03:00 “As leaders in value-based care, we endeavor to create the opportunity for health equity.”
03:30 Intro to Dr. Lerla Joseph, Founder and CEO of CVCHIP ACO (one of the few African American-led ACOs in the country)
05:30 “Of all the forms of inequality, injustice in health is the most shocking and inhumane” – Martin Luther King, Jr.
06:30 Outcomes research on racial disparities of care showing that inequities are built into the healthcare system.
07:45 A medical career devoted to bring about health equity to African Americans
08:20 "Having a health insurance card is not enough in terms of getting the proper care that African American need. Our populations needs physicians like them that understand their cultural background.”
09:20 The Accountable Care model as a vehicle for both access to care and health equity
10:50 How do we begin to have an open conversation as a society when it comes to recognizing systemic racism exists?
12:15 “Your health should not be determined by your zip code.”
14:15 Dr. Joseph speaks about her experience growing up with segregation and benefiting from affirmative action
16:05 An opportunity for America to overcome supremacy
16:55 Creating a movement for African Americans and White Americans to come together to have a conversation on race
18:20 Unwillingness of African Americans to take the COVID-19 vaccine due to past experiences that created distrust of health system
20:55 “As long as there are disparities in health care, the costs will remain high.”
21:20 Creating CVCHIP ACO with the recognition that African Americans were getting left behind in the value-based care movement
24:20 A recent study showing that life expectancy dropped sharply to its lowest level in 15 years, and even lower for Black Americans, during the first half of the coronavirus pandemic
25:35 The mission of CVCHIP to sustain the viability of the independent practice and how Dr. Joseph’s ACO helped practices during COVID-19
27:30 Implementing telehealth and ensuring patient access during the pandemic
29:00 The impact of COVID-19 on African American patients
30:00 Dr. Joseph’s medical missionary work in Haiti and her commitment to help others in the world
31:40 The most rewarding experience in her life and how she inspired others to serve
33:50 “Living in America, even with all of the disparities and inequities,
Our health care industry excels at rescue care – when a patient needs to be saved, our system has answers. However, we are not well suited to address the challenges associated with serious illness, death and dying. Evidence shows that palliative care and advanced care planning improve health value. These tools lead to better management of pain and symptoms and improve both the quality and length of life. The preferences of patients and their families and caregivers are better accounted for, and their satisfaction is much higher. Healthcare utilization is reduced and outcomes are improved. ACOs that have successfully implemented a palliative care program have demonstrated reductions in 30-day readmissions, avoidable hospital admissions, and ED visits. So why do only 10% of ACOs have palliative care as one of their foremost strategies?
Our guest this week is Stephen J. Bekanich, M.D., the co-founder and Chief Medical Officer of Iris Healthcare, a disease-specific advance care planning service. Prior to this he served as the CEO of Ascension Health’s Texas ACO (with 2,500 physicians and shared savings across government and commercial contracts), as well as the Chief Medical Officer of the health insurance joint venture between Cigna and Ascension Health. Before moving to Austin, he held the rank of Associate Professor of Medicine at the University of Miami Miller School of Medicine and the University of Utah’s Medical Center where he started and directed their palliative medicine programs.
Episode Bookmarks:
05:00 A journey in health value that is heartfelt and deeply personal, as it is associated with a personal tragedy
06:45 The loss of grandparents to serious illness and the call to change medical specialization to palliative care
07:21 “The era of antibiotics and airbags” – people no longer dying from infections and trauma like they did historically
08:10 Serious illnesses (COPD, Dementia, late stage malignancies, CHF, etc.) have become the new killer in an evolved society
08:31 Society is not prepared to deal with serious illness and the inevitability of death
10:30 “It is incumbent upon us to get people better prepared for what they will be facing. Almost 85% of us will face serious illness, yet healthcare literacy skills are so low. Something is clearly wrong.”
11:00 Research showing 70-80% of people with incurable cancer believing they will be cured is a failure of physicians to appropriately set expectations.
12:30 Stephen’s shares the personal story of his grandmother’s terminal illness and the difficulty of confronting death
14:00 Palliative care as a force for value and the appointment of a palliative care expert to lead CMMI (Brad Smith)
15:00 “Over the past five to ten years, a number of studies have repeatedly demonstrated how advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.” (Brad Smith)
16:00 Algorithms in population health incorrectly focus on last 6-12 months of life instead of providing a pathway to earlier intervention with Advanced Care Planning (ACP)
17:20 “In the last year of life, we are often delivering care that is unwanted, unnecessary, or nonbeneficial. That is not a good experience for patients and their loved ones.”
17:45 Patients with high symptom burden and in distress cannot focus in discussions about setting goals in care.
19:00 A calm environment prior to serious illness onset results in a better ACP conversation (better for patients).
19:30 Nonbeneficial care starts to occur in the last 12-15 months of life as a second reason to move interventions upstream (better for ACO bottom line)
20:20 Treatment plans should occur only after a patient is educated
22:35 “So much of palliative care is Advanced Care Planning.” (>70% of palliative care consults related to goals of care and ACP)
An industry inflection point is coming in the transition to value: federal and state governments are feeling an insurmountable level of pressure as public debt and spending increase, large employers are reeling from high healthcare costs, and provider organizations are being crushed by the current environment as they realize that FFS is perilous in the middle of a pandemic. Health system executives not leading with a strategy in health value are increasingly facing significant financial uncertainty. The coming industry shift to value is all but inevitable, however, pivoting successfully will require long-term strategic planning and investment in cultural alignment, technology and infrastructure, and partnerships.
When Travis Turner heard Dr. Don Berwick speak about the transformation to population health and value-based payments, he listened. Berwick had said the worst position to be in when transitioning from fee-for-service is static, stuck with a foot in each canoe – the change must be fast to achieve critical mass that enables modifying provider behavior. This became a priority for Travis, something that has been aggressively pursued and which has driven to his organization’s success.
This week, we speak with Travis Turner, SVP Chief Population Health Officer and COO of Mary Washington Medicare Advantage at Mary Washington Healthcare. Mary Washington Health Alliance is a physician-led, physician governed CIN – founded in 2013, the ACO has 437 participants that cover around 60,000 lives. During the 2017 MSSP performance year, the ACO achieved $11.9 million in savings. For the first three years it participated in the CMS Bundled Payment for Care Improvement program, it achieved $12.6 million in savings. The ACO now participates in the Next Generation ACO model and is active in the BPCI Track 2 for all 48 episodes of care.
Episode Bookmarks:
3:30 The inflection point in value-based care for employers, providers, and government
4:40 The value-based care journey of Mary Washington Health Alliance (MWHA) over the last 7 years
6:15 Transitioning from the upside-only MSSP to taking institutional risk in the NextGen ACO and BPCI programs
7:25 Entering downside risk by applying lessons learned from other value-based contracts
7:40 Reaching a critical mass in value to change the behavior of providers
8:00 Don Berwick’s influence on MWHA’s fast transition to value
10:00 “There has to be a bottom-up, top-down acceptance at every level for population health to succeed in a value-driven organization.”
10:30 Travis reflects on the slow uptake of value-based care in the national landscape and how learning environments will catalyze adoption
11:10 VBC is key to partnering with independent physicians
11:30 “Reaching critical mass in value is all about achieving the Triple Aim. That will overcome any perceived risks of demand destruction.”
12:15 The challenges of adapting to CMS changes to payment models
13:30 NEJM on care patterns in Medicare and the challenges of fragmented, uncoordinated care
14:30 “A true, clinically integrated network will be able to drive enterprise-level change with data.”
15:30 The challenges in siloed initiatives like Oncology Care Model and ESRD Treatment Choices Model in driving system change
16:00 Democratization of data with FHIR-based technologies and how that will improve population health analytics
16:45 Success in clinical integration means treating all patients the same (even those that are not attributed to value-based contracts)
19:15 Taking advantage of clinical integration by entering into single-signature commercial agreements
19:45 Stark and Anti-Kickback concerns associated with clinically integrated networks
20:15 The win-win-win advantages of employer and health system partnerships
20:45 Single negotiated rate advantages with clinical integration
22:25 How FFS can co-exist with VBC in reaching critical mass in value
The health care industry is experiencing a digital transformation that has been decades in the making. In this era of COVID-19 disruption and heightened consumer expectations for care delivery, the industry needs trusted leaders like Ed Marx. As one of the leading experts on artificial intelligence, machine learning, and other disruptive technology innovations in healthcare, Ed Marx is the trusted advisor that healthcare organizations seek for advice on successfully navigating this digital transformation journey. Our guest this week, Edward W. Marx, is Chief Digital Officer for Tech Mahindra Health and Life Sciences. As CDO, he oversees digital strategy and execution for providers, payors, pharma and bio-tech. Ed has had a phenomenal CIO career in leading the development and execution of digital strategies that have positioned his organizations for success and long-term relevance, including Cleveland Clinic, NYC Health & Hospital, Texas Health Resources, and more. Ed is a Fellow of the College of Healthcare Information Management Executives and Healthcare Information and Management Systems Society. He has won numerous awards, including HIMSS/CHIME 2013 CIO of the Year, and has been recognized by CIO and Computer World as one of the “Top 100 Leaders.” Becker’s named Marx as the 2015 “Top Healthcare IT Executive” and the 2016 “17 Most Influential People in Healthcare.” Edward also races for Team USA Duathlon, is an Ironman Triathlete, has climbed some of the tallest mountains in the world, and is a cancer survivor. In this episode, we speak with Ed about his most recent of 5 books, the new 2020 healthcare bestseller “Healthcare Digital Transformation: How Consumerism, Technology and Pandemic are Accelerating the Future.” Join us as we consider consumer-centric, data-driven care delivery -- enabled by technology innovation – as a blueprint for the digital transformation that will lead to success in this race to value! Episode Bookmarks:
01:45 Introduction to Ed Marx and his new book “Healthcare Digital Transformation: How Consumerism, Technology and Pandemic are Accelerating the Future”
04:30 Eric’s chance encounter with Ed at SXSW
05:20 “The unexamined life is not worth living.” (Ed’s passion to live life to the fullest)
06:00 Ed’s philosophy to “Risk Boldly and Often” during our short time on Earth
08:10 Experiencing the deaths of two young girls in Saint Petersburg, reflections on his own mortality, and finding inner peace with dying
09:30 Climbing Mount Kilimanjaro and creating a medical clinic in Tanzania
09:55 Fighting cancer and using his inner purpose (with the help of great clinicians) to heal
10:45 “When written in Chinese, the word crisis is composed of two characters -- one represents danger, and the other represents opportunity."
13:00 Ed reflects on the opportunity for healthcare digital transformation in the pandemic crisis
13:40 “We have to completely reengineer and reimagine the financial aspects of healthcare today and move swiftly into value-based care.”
15:20 How the velocity of change and disruption from new entrants and non-traditional players will impact current healthcare providers
17:00 The introduction of retail giants (CVS, Walgreens, Wal-Mart) into the healthcare arena and their “digital first” approach to patient engagement
17:30 The decline of virtual ambulatory care visits from the peak of COVID telehealth deployment and how that retreat is a bad signal for digital transformation
18:30 Payers reaping record profits during the pandemic; how payers will leverage capital reserves to aggregate providers and deliver care directly to patients
19:55 “Care is going to be directed more and more by new entrants (e.g. retail, pay-viders) which means that hospitals roles in their communities will be significantly diminished.”
20:45 The data explosion in healthcare and how there are 40X more bytes of healthcare data than there are stars in the observable un...
ACOs are increasingly moving into two-sided risk options with MSSP BASIC E and ENHANCED. The Direct Contracting model (with both Professional and Global options) introduces new opportunities and flexibilities that are not included in other CMMI models or through the MSSP. Prospective participants must act now to evaluate their model options in preparation for the 2022 performance year, with both MSSP and DC application cycles quickly approaching. CMS will soon reopen the MSSP for the 2022 performance year, and the application period for DC’s second and final cohort is also expected to open around in Spring 2021, according to CMMI’s latest timeline. Now is the time for organizations to evaluate options and make decisions. To aid in that analysis and decision-making, the ACLC and Lumeris partnered together to develop an intelligence brief (coming soon) that is also the focus of this podcast episode. The brief is designed to help provider organizations who are ready to take on significant levels of downside risk to judiciously evaluate the available options, consider the general opportunities and risk associated with the models, compare the methodological differences between MSSP BASIC Level E and MSSP ENHANCED with DC Professional and DC Global, and assess organizational fit. We share detailed comparisons across 7 key areas:
Participant Eligibility Beneficiary Attribution Financial Benchmarking Quality Performance Payment Models Financial Settlement Additional Benefits
Our guest this week is Rick Goddard, Senior Director of Market Strategy at Lumeris. Rick is a subject matter expert on value-based payment models and primarily serves as an enterprise strategist. Prior to joining Lumeris, Rick served as the Director of Clinical Innovation at Advocate Physician Partners / Advocate Health Care where led the Clinical Innovation Team. His in-depth operational and consulting experience makes him the perfect guest to help organizations considering their next step on this race to value! (Information coming from CMS is ongoing and any opinions are not necessarily those of Lumeris, the Accountable Care Learning Collaborative, or our research associate Leavitt Partners.) Access the transcript for this episode here.
Glossary of Acronyms:
MSSP – Medicare Shared Savings Program ACO – a contracted entity in the MSSP DC – Direct Contracting (new CMMI payment model) DCE – a contracted entity in the DC model APM – Alternative Payment Model MA – Medicare Advantage CMS – Centers for Medicare and Medicaid Services CMMI – Center for Medicare and Medicaid Innovation TIN – Tax ID# (ACO participants in the MSSP are contracted by TIN) NPI – National Provider ID # (DCE participants are contracted by the individual NPI)
Episode Bookmarks:
4:50 Rick Goddard explains his personal connection with mental health and how that informs his “Why”
6:00 Finding balance and lessons learned from training for the Ironman World Championship
7:00 “What excites me is that value is starting to get momentum in the environment, and that thaws out providers and forces them into the game.”
8:50 The accomplishments of the MSSP (growth, building a bridge to risk, and $2B in savings to date)
11:30 The early years of the Pioneer and MSSP ACO programs and what we learned as an industry
12:30 “The upside-only ACO opportunity didn’t have the teeth, nor did the program offer effective levers for us to succeed in managing the total cost of care.”
12:40 MSSP Challenges (e.g. beneficiary complaints and CCLF opt-outs, delays in data sharing, “black box” reconciliation)
14:00 “There weren’t enough managed care-like designs to assist MSSPs to progress in risk.”
14:40 CMS offering incentives for ACOs to accept risk (e.g. SNF 3-day rule, Telehealth waivers, an availability to work with a prospective attribution model)
15:00 “Up until the Next Generation ACO,
The American Dream is the hallowed ideology that any individual can advance his or her state of being through ambition and hard work. It defines the American psyche. Historian James Truslow Adams wrote, “The American Dream is that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement.”
In today’s episode we explore a Dream Plan in health care – one that is based on consumerism accountability for health outcomes. Janis Powers is so intent on improving health care that she’s designed a completely new payment system. Her Dream Plan is to eliminate health insurance, enabling individuals to redirect their financial resources into personal accounts that fund their lifetime health care needs. Her ideas are outlined in her Amazon Bestselling book Health Care: Meet the American Dream. Powers founded the company Longitudinal Health Care to bring the ideas from her book to reality.
Janis hosts her own podcast, The Powers Report, where you can learn more. She argues that the health care system needs a solution that must include affordability for consumers in addition to incentives that appropriately align behaviors, both for care provider as well as consumers
Episode Bookmarks:
1:43 “The American Dream is that dream of a land in which life should be better and richer and fuller for everyone, with opportunity for each according to ability or achievement.”
2:34 Janis Powers’ mission to eliminate health insurance and her Amazon Bestselling book Health Care: Meet the American Dream
4:30 Do bundled payments really improve outcomes?
6:42 “It’s our job not just to critique what people do. We must also come up with other solutions.”
7:13 Fixing Health Care by “starting from scratch” with a blue sky vision of decentralization and individualized consumerism
7:30 Why do we even need insurance since we have genetic information and predictive analytics?
7:55 “We don’t have health insurance…we have coverage. In designing it that way, we have created a one-size fits all system that creates tons of waste and administration.”
9:55 Disproportionate spending where the top 5% of most expensive patients spend 50% of the healthcare dollars, and the bottom 50% of the people spend 3% of the healthcare dollars!
10:45 The problems with government spending in healthcare (e.g. lack of consumerism, looming Medicare insolvency, rejection of single payer, low Medicaid reimbursement rates)
12:50 Rationing Care – Is this the only way to prevent Medicare insolvency?
13:10 Inappropriate treatment at the end-of-life and patient unwillingness to challenge doctors
14:05 “The goal of the government is to regulate – not manage --- health care.”
14:30 Should Medicare patients be allowed to opt-out the federal program and get the capitated rate directly from the government?
15:15 Should the government make Annual Wellness Visits mandatory?
15:55 Does the ACA requiring coverage for preexisting conditions cause a moral hazard?
16:42 Should the Medicaid program be partially funded by states since it poses standardization challenges by creating a different health system in every state?
17:44 9% of the enrollees in Medicaid are elderly (i.e. dual eligible) yet they spend 21% of the dollars. 14% of the enrollees in Medicaid are disabled yet they spend 40% of the dollars.
18:20 Should we separate Medicaid funding for low income families from duals and disabled since patient segment needs are so different?
19:00 Should we revoke the non-profit status for hospitals or restructure the assessment of community benefit so the contribution of economic value can be fully realized?
21:30 Are B2C digital health companies more appropriate than B2B digital health companies (e.g Teledoc, Livongo) in enabling a consumer-driven revolution in healthcare?
26:45 Establishing an individual lifetime healthcare account that leverages genetic ...
As we prepare for a new era in our government with President-Elect Biden’s administration and a Democratic-controlled Congress, we must be steadfast in our commitment to value-based care. Can soon-to-be President Biden capitalize on this historical moment of unrest to unite our country with a value-based care policy agenda? Is COVID-19 truly a silver-lining moment for the value movement? How will providers, payers, policy-makers, public health, and patients leverage increased regulatory flexibilities, technological innovations, and major cultural shifts to fast-track strategic priorities that support the triple aim? Our guest this week is Andrew Croshaw, Chief Executive Officer of Leavitt Partners. Andrew’s insights inspire and inform. Supported by leading-edge health care value economy research and intelligence from Leavitt Partners, this episode will provide you with the best policy analysis out there on this “Race to Value.” For additional information on the topics discussed in this episode, make sure to download the latest ACLC Intelligence Brief, The Future of Value-Based Care: 2021 and Beyond. Episode Bookmarks:
1:40 A nation’s sadness due to recent events that have unfolded in Washington, D.C., and hope for a peaceful transfer of power in our democratic republic
2:40 Value-Based Care in the new era of government with President Biden’s administration and a Democratic-controlled Congress
3:13 How the value movement will allow us to improve population health and remain competitive in a global marketplace
3:40 The moral and economic imperative to make value-based care work
4:34 Referencing the newly-released ACLC Intelligence Brief entitled, “The Future of Value-Based Care: 2021 and Beyond”
6:20 Andrew’s personal reflection on the recent violence at our nation’s Capitol and the need for human connection and civility
7:10 How lack of accountability and the divisiveness of social and mainstream media creates incivility and violence
8:40 Hope for a moment for renewal and a better tomorrow
8:53 How the recent Georgia runoff election, giving control of the Senate to Democrats, will enable additional pathways for President Biden’s health policy agenda
9:12 Progress independent of any bipartisanship with elements of the health policy agenda that will still require bipartisan support
10:00 Passage of legislation in the Senate with a budget maneuver called “reconciliation” that can allow legislators to pass certain bills with a bare majority of votes (not the typical 60 votes required)
10:27 “I am encouraged for a sense of bipartisanship based on us learning how precious and fragile we now realize stability in our country really is.”
11:50 COVID-19 emphasizing the need for significant payment and delivery transformation, showcasing the advantages of prospective, non-FFS-based alternative payment models
12:20 Leavitt Partners’ monitoring of public and private sector value-based contracts showing that “Value-based contracts continued in 2020 despite the pandemic.”
13:15 Increase private sector focus on value-based payment (e.g. bundles, specialty ACO models, traditional ACO contracts)
13:27 Medicare Advantage, as a segment of value-based care, showing significant growth and newly-emerging plans are working well for beneficiaries and sponsor
14:12 Large employer advocacy of value-based care and how their voice will continue to grow louder
14:52 Startups forming meaningful partnerships with employers in the value space and how that will be disruptive over time
16:05 The promise of high-touch, full-risk primary care organizations (like ChenMed) as an important driver of value transformation and an influencer of health policy reform
17:20 “One of the benefits of 2020 was that it did highlight the benefit of taking risk to primary care providers. (I am a little afraid, also, of what that signaled to payers.)”
17:30 Historical reluctance of payers delegating risk and how th...
ChenMed was created with a mission to provide care in such a way that it could alleviate suffering for those seniors in the poorest of communities, recognizing that full-risk primary care can truly be transformative in providing superior health outcomes. This strong sense of purpose is what guides the physicians at ChenMed and serves as a moral compass in caring for patients. It is born out of an idea that ChenMed is a ministry that allows those in the organization to glorify God by spreading more love and promoting better health to those they serve.
ChenMed is a family-owned, primary-care physician run organization that serves a challenging population: 75% have five or more chronic diseases, 70% are racial minorities, the average age of patients is 73 years old, 95% of patients within 300% of the Federal Poverty Level. But the success speaks volumes: patients use hospital emergency rooms at a rate 34% below the national average, have 50% fewer admissions than the average primary care practice, and have close to 30% lower cost. ChenMed’s scalable and successful approach has already reached 60 practices, and it is no wonder that they are poised to grow 4 times larger over the next 3 years.
Dr. Gordon Chen, CMO, along with his brother Christopher Chen, CEO, and other great leaders throughout the organization are proving that full-risk primary care is a solid and necessary foundation for winning the race to value!
Episode Bookmarks:
4:45 ChenMed named to Fortune Magazine’s “2020 Change the World List” for measurable social impact, business results, innovation, and corporate integration
5:30 Dr. Chen discusses the spiritual underpinnings of his family-run organization and the Chen family’s suffering during his father’s cancer misdiagnosis
10:13 The ChenMed ministry in glorifying God, spreading love, and promoting health in underserved communities that are suffering
11:20 A scalable approach that has resulted in 50% fewer hospitals admissions, a 75% reduction in ED visits, and 28% lower per-member costs
13:35 “The traditional, fee-for-service primary care model handcuffs PCPs to see more and more patient volume without being able to optimize outcomes.”
14:14 A Medicare Advantage full-risk business model allows ChenMed to see shrink the PCP panel size so they can focus on cultivating trusting relationships with deeper connectedness
15:50 How a full-risk model enables Primary Care Physician empowerment
16:55 The shift from a reactive approach (e.g. ER and preventable hospitalizations) to a more proactive, preventative model that supports health value
17:45 Having “Stockholm Syndrome” for a broken fee-for-service model that has held PCPs captive from practicing medicine in the way they thought they would when dreaming of becoming a doctor
18:05 COVID-19 as a tipping point for full-risk primary care models, struggling primary care, and PCP moral injury
20:40 Consistency of revenue within a capitated model
21:16 “Fee-for-service primary care is going to end. It is too challenging to make it work, and PCPs don’t like a purely transactional model that doesn’t value relationships.”
22:45 Dr. Chen discusses the fulfilling purpose of full-risk primary care and how it makes a deep impact in communities
24:55 Supporting high-risk patients through high touch telephonic “love calls” and telehealth
26:11 How ChenMed adjusted its care delivery model during the COVID pandemic (“flipping to 90% virtual in less than a week”)
29:05 Realizing the need for the ChenMed model is far greater than could have ever been imagined during a period of pandemic uncertainty and civil unrest
29:50 Finding the right balance between in-person and virtual visits during the COVID pandemic
30:34 “Telehealth is here to stay.”
31:05 Increased Net Promoter Scores when serving patients during the pandemic
31:30 Health inequities, racial disparities in care, and the plight of racial injustice in our soci...
In this episode, we interview Ken Terry, author of one of the best-researched books we’ve ever seen! The new book, Physician-Led Healthcare Reform: A New Approach to Medicare For All, explores why we must, and how we can, get doctors to change how they practice.
Most employed physicians and independent physicians alike feel powerless. Hospital-employed doctors feel like cogs in a machine, and community doctors are increasingly threatened by forces beyond their control. The biggest problems of physicians--both employed and independent--are a loss of professional autonomy, overwhelming administrative requirements, and the conflict between business and patient care imperatives.
This book, directed to physicians, healthcare administrators, health policy experts, politicians, and consumers, explains why the U.S. healthcare delivery system must be restructured to lower costs--and how to do it. Physician-led healthcare reform will give them back a large measure of control and pride in their work.
Ken Terry has been writing about health care for more than 25 years. He was a senior editor at Medical Economics, has contributed to numerous publications, including Medscape Medical News, Information Week, and FierceHealthIT, and has received several journalism awards, including the Neal Award from American Business Media. He's also authored the book RX for Health Care Reform. You can read more of Ken’s work, including articles and blogs at his website: https://physicianledreform.com.
Episode Bookmarks:
3:33 The progression of value-based care over the last decade (e.g. hospital VBP program, BPCI, the mandatory bundled payment program CCJR, CPC, MSSP)
6:20 Consolidation of the healthcare system and employment of doctors driving up costs
7:33 ACOs led by health systems are not as successful as physician-led ACOs in the MSSP
7:58 The first wave of managed care did little to move provider organizations towards taking financial risk (with the exception of Kaiser Permanente and a few others)
9:18 The push towards value-based purchasing in the Obama Administration (e.g. P4P, bundled payments) did not go far enough to change industry appetite towards risk
10:00 Advancement of medical technologies have been driving up healthcare costs (not lowering them)
10:42 “The evidence shows that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes at lower cost.” – Dr. David Nash
11:31 Research by Barbara Starfield showing that a higher ratio of PCPs to the population is associated with a lower mortality rate from all causes, heart disease and cancer
11:50 States where a higher percentage of physicians who were PCPs have higher quality of care and lower cost per beneficiary
13:00 The impact of medical school debt burden on the supply of primary care physicians and the relegation of PCPs to lower tier status in the medical community
13:51 How Advanced Practice Providers are filling the void to meet unmet primary care needs
14:32 Retail clinics and urgent care centers competing with PCPs
14:53 “The best way to reduce costs and improve outcomes in healthcare is to have larger groups of primary care doctors taking financial risk and competing on quality of care in local areas.”
15:20 Changes that would need to occur before we implement Medicare-For-All health reform (i.e. hospital payment parity, corporate practice of medicine restrictions)
16:10 Proposing federal requirements of hospitals divesting of their medical practices
16:35 Medicare-For-All option that would pay PCPs Medicare rates unless they join a larger primary care group and take financial risk for a larger upside opportunity
17:22 Primary care groups choosing high-value specialists to contract within their network
17:51 Placing primary care in charge of the healthcare system to build medical neighborhoods
Dr. Kevin Spencer, Medical Director, Texas at Agilon Health, is passionate about improving the health care delivery system. He believes that by enabling physician-led organizations with technology, proven processes, and human capital under global risk capitation models, we can transform care for patients and physicians alike. With a deep understanding of the local market, combined with extensive health care experience, Kevin Spencer, MD oversees the strategy, operations, and growth for the Connected Senior Care Advantage program, the unique Agilon Health risk-bearing entity (RBE) partnership model in the Austin, Texas market. As the former Managing Partner and CEO of Premier Family Physicians, the Austin-based physician network that joined Austin Regional Clinic in the Agilon Health RBE joint venture, Dr. Spencer takes his leadership and understanding of how to effectively partner with primary care physicians to build sustainable success in global risk capitation models in Medicare Advantage.
In this episode, Dr. Kevin Spencer shares important insights about the business of Medicare Advantage and how full-risk payment in primary care can lower costs and improve clinical outcomes within a senior population. This interview is not to be missed for anyone wanting to understand how to build value-based care success over time in a physician-led environment that embraces full-risk capitation within a market that is still heavily entrenched in fee-for-service. Dr. Spencer demonstrates a superior understanding of population health with a business acumen of Medicare Advantage that makes for a thought-provoking conversation on how MA may be the future of payment model reform. Given the success of global risk capitated models in the senior space, could Medicare Advantage-For-All be a viable health policy in the years to come?
Episode bookmarks:
4:38 Lessons learned in the early years of physician-led Accountable Care
9:08 “Health care is better delivered in a value environment. I believe that putting the premium dollar in the hands of the physicians that are taking care of patients will empower them to do the right thing, for the right reason, at the right cost.”
10:40 Choosing the right capital partner to form a Risk Bearing Entity
11:40 Agilon Health’s approach to physician partnership
12:50 Dr. Spencer referencing the excellent work done by other disrupters in the senior space (e.g. Oak Street, ChenMed, Iora)
18:00 “Medicare Advantage risk will only work if we deliver a much superior product to our seniors in America. The care they have been receiving up to now, in many cases, has been fragmented, disjointed, and not always aligned with their belief systems.”
18:55 Dr. Spencer discusses Connected Senior Care Advantage, the outward facing brand of his physician-led JV with Agilon Health
20:00 Medical management program investments (transitions of care, care management, home visits, and pharmacy programs)
21:00 Building patient trust so physicians can effectively quarterback care and how the pandemic has affected the patient-physician relationship
23:00 Medicare Advantage risk and its impact on physician burnout and physician/patient Net Promoter Scores
24:40 Marrying Risk Adjustment to Quality and the appropriate documentation needed to fuel the Population Health engine
25:20 Prospective chart reviews to improve coding documentation of disease burden
24:37 Annual Wellness Visits to improve coding documentation, screening effectiveness (mental health, fall risk), and care gap closure
28:00 The Economic Model of the Stars Rating in Medicare Advantage
30:00 Why the higher Stars-Rated MA plans actually cost less
31:20 Implementing a Playbook for Quality Improvement aimed at QM performance and improving patient experience/clinical outcomes
35:20 Capital Investment in Primary Care and how PCPs can maintain autonomy through interdependence with the right partners
Our nation has lost more than 300,000 people from COVID-19. It is the latest sign of a generational tragedy – one still unfolding in every corner of the country. As we head into the Christmas holiday, refusal to acknowledge the severity of the pandemic by acting irresponsibly will result in countless more deaths from the virus.
Our nation is at stake, and this week’s Race to Value guest, Dr. Brent Staton wants to share a personal message of love and hope for a brighter tomorrow. His featured podcast episode (recorded with Dr. Ty Webb) on how the Cumberland Center for Healthcare Innovation is “Building Economic Strength in Rural Communities” was released earlier this week. After recording that episode, he contracted COVID-19. We invited him back for a Bonus episode to share a message of God’s love in serving others by taking the pandemic seriously during this upcoming holiday season. Dr. Staton recorded this episode while hooked up to oxygen battling this terrible disease.
This pandemic is real. If Dr. Staton’s message saves just one life, his service to his community, and the world as a whole, will have been realized.
Episode Bookmarks:
0:00 Update on the COVID crisis and Dr. Staton’s personal battle with the illness
1:30 “As an American nation, we need to re-focus on unity and protecting one another”
2:30 Complications with COVID-19, Influenza B, and underlying asthma
2:50 Due to a flu vaccine shortage, Dr. Staton gave his own personal dose to a patient (and then ended up contracting the flu)
3:10 How Dr. Staton contracted COVID-19 from a patient during a 15-second interaction
4:30 Serving Others: Practicing medicine with a servant’s heart and Dr. Staton’s plea for his community to wear a mask as the ultimate gesture of servanthood and love for others
4:45 Health Inequities: Dr. Staton has access to care during COVID that all Americans should have.
6:20 Dr. Staton is in his late 40’s and was in excellent health prior to his COVID infection.
7:30 Post-COVID complications after recovery
7:50 Misinformation on COVID from the media and the Internet. “We can’t continue down a pathway of mistrust.”
9:15 Dr. Staton provides perspective on the unnecessary deaths he has seen due to COVID
9:50 Pandemic deniers, and the culture of fear and misunderstanding in our nation
11:00 The worst case scenario if people don’t begin taking the pandemic serious during the Christmas holidays
12:00 Appropriate mask wearing protocol
13:00 What a COVID infection really feels like (“a torture chamber”)
14:10 The truth about mask wearing and vaccine efficacy
15:10 “The disrespect for other human life” by those who refuse to wear masks
15:30 Trusting Dr. Fauci and public health officials, an update on the vaccine research, and misunderstanding of herd immunity
17:10 Using the God-given gift of a human brain and loving others as we get through the pandemic
18:20 Spiritual reflection on death and how we can preserve life by re-focusing on a pandemic plan, mask wearing, and social distancing
19:50 The end of the pandemic will take another year to reach and what Dr. Staton is seeing in the data from other countries
21:50 Treatment with monoclonal antibodies
23:20 The ultimate goal of CCHI is to serve patients in our community
24:00 World War II as a lesson for the unity needed in our nation to defeat COVID-19
27:10 Getting back to the basics (“wash your hands, social distance, love your neighbor, wear your mask, and take care of yourself appropriately”)
A guiding principle of Cumberland Center for Healthcare Innovation, CCHI, is that communities and the state benefit from healthier families, and it’s not just about cost savings or longer lives. Better health means a more productive workforce and greater opportunity for economic development. CCHI is focused on a structured approach to build economic strength in the community. And their approach is working – since being established in 2012, CCHI has saved CMS over $43 million and achieved a 98.48% quality score! In PY 2019 CCHI was one of the top performing ACOs in the nation, without any adjustment for benchmark.
In this episode, Dr. Brent Staton, CEO, and Dr. Ty Webb, CMO, share important insights into the challenges and successes of rural primary care. With a very lean team, they work with providers across more than 80% of Tennessee to provide personalized care at the practice-level. They truly fulfill their mission to demonstrate the value of rural independent primary care physicians in communities throughout Tennessee. Their model gives value-minded professionals nationwide an effective example for succeeding in the race to value.
Episode Bookmarks:
04:48 “Rural healthcare is personal” – having a deep personal awareness of each patient’s needs, values and preferences
06:58 Dr. Webb speaks about the challenge of getting physicians to practice medicine in rural areas
08:11 Dr. Staton on how the roots of family and growing up on a farm led him to a career in rural medicine
09:30 Dr. Staton on how hauling hay and stripping tobacco instilled the Rural American values of hard work in his life
10:50 The health and socioeconomic challenges in rural Tennessee and the opioid epidemic
12:22 “The depth of the challenges in rural health care is as deep as the sea.” (Staton)
12:40 The impact of the opioid epidemic, poverty, SDOH, and lack of health care resources in rural communities
14:05 High-touch approach to primary care and how ideas and best practices spread across various counties in the ACO
16:30 The mission of the ACO and how improving health will build economic strength in the community
17:20 “We saw that if we had healthier students, we could improve education. We saw that if we had a healthier workforce, we could improve productivity and attract new businesses and job opportunities to our communities.” (Staton)
18:30 “Rural communities grow and develop over time, in much the same way as a field or a meadow in the study of natural history and biology. The same pattern of strength, complexity, and diversity is there.” (Webb)
19:05 Education and Health care are important foundations for rural communities to grow, develop, and progress.” (Webb)
19:30 Hospital closures in rural communities
20:11 The economic contribution of physician practices and hospitals to rural communities
20:45 “Hanging on by a thread really isn’t enough – whether it is your health or your economic solvency as a family or company.” (Webb)
21:10 Practice stabilization through communication of best practices, standardized care delivery, and revenue stabilization
24:02 Dr. Staton on how a large physician-led ACO can collaborate with hospitals
25:17 “Acuity of care for a hospital is more important that ‘heads in beds’. Our goal is not to prevent a necessary hospitalization or preventing emergency care when it is needed. Our goal is to make sure that patients get appropriate care and early interventions that they need and deserve. (Staton)
29:00 The resiliency of CCHI’s primary care practices during COVID-19
31:12 Telehealth implementation and the benefits of telemedicine in rural communities
35:50 The lack of access to broadband internet access in rural communities and the need for additional infrastructure
37:37 CCHI’s COVID Task Force to prevent the spread of the virus
41:20 CCHI’s Shared Savings Success: $43 million in the Medicare ACO program (positive in corridor every year of ...
Join us in this episode as we speak with Dr. Mark McClellan, former CMS Administrator and former FDA Commissioner during SARS – his understanding of the COVID-19 pandemic and options for our national response is nearly unmatched. His unique insights into our health care system provide clarity around the new administration’s position on value-based care as well as offer understanding regarding what the presidential transition will mean for COVID-19 response efforts, including vaccine distribution.
Further, we highlight Dr. McClellans’s recent work on the Resiliency Framework with HCP LAN which presents a vision to create a health care system that is responsive and resilient to events like the current public health emergency and achieves better patient experience, outcomes, equity, quality, appropriateness, affordability and accessibility at a reduced total cost of care.
We have learned through the pandemic that we must upgrade our health care system – this is not the time to go back to health care the way it was before. Dr. McClellan’s work and insights are paramount for professionals in this race to value.
Episode Bookmarks
02:37 Dr. McClellan shares his thoughts about the ACLC and the role it plays to advance VBC in our country
03:35 Will the next two years will either be a period of gridlock or a time of historic legislative productivity?
04:14 Economic response and COVID-19 Recovery Plan are the two big legislative issues for the upcoming year
04:24 Evenly-divided Presidential election and the “reverse coattail” effect
04:36 Best case for the Democrats is a 50/50 Senate with moderate Democrats being “thoughtful” about big progressive agenda items
04:55 Bipartisan legislation is most likely outcome (most big legislation items - other than COVID recovery - are not going to happen)
05:14 Other key priorities: climate change, racial issues
05:25 Longshots: Lowering the eligibility age of Medicare or a big coverage expansion (unless Supreme Court ruling somehow takes action on ACA)
06:00 ACA guaranteed issue and community rating provisions
06:23 Potential bipartisan interest: transparency and surprise billing, drug pricing, and value-based care
06:45 “Value-Based Care approaches are a bipartisan issue, but it may not continue quite in the same way.”
07:11 How the Biden Administration approach to VBC may be different
08:15 Health Care Payment Learning & Action Network trying to align public and private efforts on reform
09:15 “We can now see the light at the end of the tunnel. Vaccines are moving into more advanced development and availability”
09:26 “What we learned throughout the pandemic is that we really need to upgrade our health care system. This is why the work of the ACLC is particularly relevant now.”
10:00 Disruptions in our health care system due to massive reductions in revenue associated with shelter-in-place provisions.
11:30 “The farther away you were from fee-for-service, the more robust and resilient your care response was to the pandemic.”
11:56 Provider success stories in COVID: Advanced Integrated Care Systems (Intermountain, Geisinger) and Primary Care groups centered around capitation (Iora Health, Oak Street)
12:51 Hospital utilization returning back to pre-COVID levels
14:26 Advanced multidisciplinary primary care teams now including more virtual care and behavioral health integration
15:11 Shift to home dialysis for kidney disease and home drug infusion for cancer care
15:53 Social determinants of health enabled by capitation
16:26 Integrated approach to patient management for patients dealing with social isolation and depression consequences
16:45 Elimination of low-value care (the 30% of services that offer limited to no value in health outcomes)
17:05 NEJM Catalyst Article - Building a Better Health Care System Post-COVID-19: Steps for Reducing Low-Value and Wasteful Care
Dr. Elizabeth Teisberg is a leading figure in the value-based health care strategy movement and is the executive director of the Value Institute for Health and Care as well as a Professor at the Dell Medical School at the University of Texas at Austin. With her deep background in strategy and innovation, and with special attention to the health care sector, she collaborates closely with Michael Porter, renowned authority on competitive strategy. Together they co-authored “Redefining Health Care: Creating Value-Based Competition on Results” (Harvard Business Review Press, 2006), which received the American College of Healthcare Executives’ 2007 James A. Hamilton book of the year award. Teisberg’s forthcoming book, “Capability, Comfort and Calm: Designing Health Care Services for Excellence and Empathy” is co-authored with Scott Wallace, who also recently joined the Dell Medical School faculty.
While her definition of value in health care, “the measured improvement in a patient’s health outcomes for the cost of achieving that improvement,” has largely been adopted by the industry, the VBHC movement continues to move at a glacial pace in juxtaposition with the moral and economic imperative to make it happen. We struggle with how to operationalize it as we often conflate value-based health care with operational programs that focus on cost reduction, quality improvement, or patient satisfaction. Those efforts – while important – are not the same as value, which focuses primarily on improving patient health outcomes. We are not pursuing more treatment, we are pursuing more health and more caring.
Value Institute For Health and Care Website
Value Institute For Health and Care Annual Report 2020
Episode Bookmarks:
03:05 Dr. Eric Weaver shares with Dr. Teisberg how “Redefining Health Care” impacted his life and career
05:08 Revisiting Value-Based Health Care In the 15 years since Dr. Teisberg wrote Redefining Health Care (Current State of the VBHC movement)
07:07 Dr. Teisberg explains the difference between “healthcare” (one word) versus “health care” (two words)
07:59 Patients want to choose better health which doesn’t mean they always want more “healthcare”
08:41 The purpose of health care is to improve the health outcomes for the people we serve (instead of just measuring profits)
09:25 Dr. Teisberg shares her perspective on why the diffusion of innovation in value-based health care delivery takes so long
09:50 Strategy, Culture, and Measurement must be woven together for the transformation to occur (“braid of change”)
11:05 How the pandemic will accelerate the Value Based Health Care movement (COVID as an inflection point)
14:25 Improving health outcomes through clinically integrated care (Integrated Practice Units)
15:51 Identifying gaps to inform the development of human-centered solutions that can be delivered through IPUs
17:52 Dr. Teisberg shares an example of a new IPU at Dell Med (The Texas Center for Pediatric and Congenital Heart Disease)
20:00 Patient-Reported Outcomes as a core component of IPUs
21:50 “When we talk about value, we mean value for patients” (not to enable health plans)
22:48 Collaborating with Scott Wallace in working with patients to understand the outcomes that matter to them
23:33 Person-centered measurement through Capability, Comfort, Calm
27:05 “Health care is drowning in measures… And what needs to be reported externally is a relatively small set of important outcomes. Outcomes that matter to patients and families.”
31:43 The Musculoskeletal Institute at Dell Med and UT Health Austin as a success story in condition-based, bundled payment innovation
34:43 Alignment of the interdisciplinary team within condition-based, bundled payment models
35:30 “Payment change doesn’t need to precede change in care delivery”.
37:30 VBHC Lessons Learned from Other Countries (New Zealand Ministry of Health, King’s Health Partners, Santeon,
It was Thanksgiving 2016 and Sugandan (Su) Barathy was a normal college student in Texas, with finals and graduation in the weeks ahead. His future was bright with a comfortable job already secured, but a car accident changed his life. Though seriously injured, the medical professionals sent him home twice as a result of negligent care. Consequently, Su experienced avoidable complications and needless pain - but the blatant errors and deficiencies of the health care system are distant followers to the foremost lessons of Su’s healing journey. During a nearly month-long ordeal in the ICU, Su experienced mental and spiritual pain and suffering, as well as loneliness and neglect. Only kindness, love, and gratitude brought him from the brink of complete despair to a place of joy.
As health care professionals we each have an obligation to develop a holistic, patient-centered mindset that goes beyond repairing a broken body. We must practice healing the broken spirit. True healing power comes from kindness, love, and gratitude. These are the healers of the soul.
"At times, our own light goes out and is rekindled by a spark from another person. Each of us has to think with deep gratitude of those things that have lighted the flame within us." - Albert Schweitzer
“When we are no longer able to change a situation, we are challenged to change ourselves.”― Viktor E. Frankl
"Gratitude turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity...it makes sense of our past, brings peace for today, and creates a vision for tomorrow." -- Melody Beattie "Thankfulness is the beginning of gratitude. Gratitude is the completion of thankfulness. Thankfulness may consist merely of words. Gratitude is shown in acts." Henri Frederic Amiel Episode bookmarks:
1:47 Introduction to the episode – A Message of Love and Healing for this Season of Thanksgiving
3:04 The Car Accident that happened one day before Thanksgiving and a Health System that Failed
4:55 “I don’t feel like I was acknowledged.”
6:00 Nurses shopping online for Black Friday deals when leaving the ER with an untreated ruptured spleen and broken ribs
6:45 Ten days of immense pain and suffering after leaving the ER with negligent care
7:10 Su goes to the student clinic and sent to the ER…on his own accord, without an ambulance
8:05 The “horrific walk” to the ER after ten days of suffering with pneumonia, pulmonary edema, ruptured spleen, and broken ribs
9:00 The ER doctor is shocked that Su was able to walk to the hospital in his condition without being transported by an ambulance
9:20 Emergency surgery!
10:00 The poorly designed environment of care is not conducive to Su’s healing post-surgery
11:11 “I felt like the care that was given to me was transactional and check-the-box medicine”
12:05 “My body was being taken care of, but there was no one to listen to me and care for my needs beyond the physical level.”
13:05 “A very dark place where no one was listening to me”
13:20 “It was me alone in this battle to heal rather than a team that can help me heal through this.”
13:40 All alone in the hospital and finding out his grandmother just died
14:20 The care team was detached from Su’s emotional wellbeing and is not at all patient-centered
15:20 The power of human relationships and its effect on healing of the soul
16:00 “Without emotional support, you are broken.”
16:30 “The extra ounce of courage from within” that comes from the expressed love of others
18:00 Pain recognition as part of the healing
19:00 Culturally relevant care from one nurse that prevented an opioid addiction
23:00 “Feeling the pain made me feel alive again, gave me the courage to fight, and gave me the connection to the present to truly heal.”
24:15 The darkest nights of the soul in the ICU
25:00 “At times our own light goes out and is rekindled by a spark from an...
Welcome back for part 2! This episode further explores Klasko’s vision of health assurance, an industry that focuses on consumer’s health, and that is enabled through innovative partnerships between health care and technology organizations. Patient’s expectations are shifting toward a system of care that is empathetic, communicative, creative, and responsive – those providers, policy-makers, payers, and other partners who align with these principles will be the winners in the race to value!
Dr. Stephen Klasko is the President and CEO of Thomas Jefferson University and Jefferson Health. His newest book, co-authored with venture-capitalist Hemant Teneja, is a manifesto that advocates for bringing consumerism, affordability, and rational economic behavior to the healthcare sector. UnHealthcare: A Manifesto for Health Assurance is a declaration to usher in a new age of digital and mobile consumerism in the healthcare industry, and introduces the concept of “health assurance” – a gamechanger that would force a redesign of the system. His vision is for a consumer-centric, data-driven, cloud-based healthcare system designed to help us stay well: we would need as little “sick care” as possible.
Episode bookmarks:
03:18 The FHIR Interoperability Standard and Blue Button are “necessary but not sufficient” to bring about widespread consumerism and democratization of health data
03:30 Consumers will eventually wake up when they “no longer feel like patients”
04:00 Consumers have way too much respect for the healthcare system because they are too forgiving when it fails
04:40 Patients always assume their doctor is the best, and doctors can take advantage of this by not being patient-centered
04:54 Dr. Klasko shares a personal story of a friend who always chooses the best service option in every transaction, but then naively chooses to have his heart surgery wherever the PCP tells him
06:10 Dr. Klasko shares an anecdote on how patients will not often heed the advice of a second opinion because of fear that their primary physician will judge them
06:40 How the younger generation will be more demanding as a health care consumer and how the younger physicians are embracing thus
08:05 Data interoperability is an issue where health policymakers have been “asleep at the wheel”
08:15 The World Economic Forum tells Dr. Klasko, “There were two industries that escaped the consumer revolution – banking and healthcare. Now you are alone."
09:20 Dr. Klasko describes how nonsensical telehealth medical licensure restrictions are
09:45 Data and interoperability are unnecessarily limited by ridiculous and overly strict laws, including HIPAA.
09:59 “Data needs to be interoperable. It is just absolutely crazy that we have to get most of the data we need from insurance companies.”
10:21 “My view of the future is that the patient owns their own health data.”
10:30 Getting permission from doctors to share their own data is straight out of the 1970s
11:20 “Interoperability challenges between different EHR systems is another absurd reality.”
11:25 Commure is an example of an SSO, FHIR-layer, health assurance company which “overcomes the tyranny of the traditional EMR”
12:13 “Health assurance will require consumers demanding it, open interoperability standards, enlightened health policy, and entrepreneurs working with the healthcare system in a way they haven’t before.”
13:20 Moral injury and suicide rates among doctors due to a monolithic, rigid and impersonal system of care
14:14 “Med schools choose doctors based on science GPA, MCATs, and organic chemistry grades…and then we wonder why doctors aren’t more empathetic, communicative, and creative.”
14:45 Med Schools are based on an antiquated 1970’s model that emphasizes memorization in an era before digital computing, iPhones, and AI
14:55 “When you select doctors on self-awareness, empathy, communication skills, and cultural competence,
Dr. Stephen Klasko is the President and CEO of Thomas Jefferson University and Jefferson Health. His newest book, co-authored with venture-capitalist Hemant Teneja, is a manifesto that advocates for bringing consumerism, affordability, and rational economic behavior to the healthcare sector.UnHealthcare: A Manifesto for Health Assurance is a declaration to usher in a new age of digital of mobile consumerism in the healthcare industry and introduces the concept of “health assurance” – a gamechanger that would force a redesign of the system. His vision is for a consumer-centric, data-driven, cloud-based healthcare system designed to help us stay well: we would need as little “sick care” as possible.
This episode explores the principles behind the manifesto and health assurance. Built on open technology standards, empathetic user design, and responsible AI, the vision for health assurance will only be realized through creative partnership between professionals in traditional healthcare and technology companies. As these two worlds of healthcare and technology innovation merge, we can transform our fragmented, expensive, and inequitable healthcare system into one of improved health and decreased cost. Join us as we explore the role of health assurance in the race to value!
Bookmarks:
05:37 “Health care has not only escaped the consumer revolution --we’ve lost touch with what patients really need.”
06:12 Dr. Klasko discusses what he learned from Steve Jobs and how he “changed the world” in 3 years
08:00 Jefferson Health and the “new math” of innovation and strategic partnerships
08:55 Partnership with Silicon Valley entrepreneur Hemant Teneja
09:12 “Mass production and economies of scale is giving way to mass personalization at scale”
09:36 Livongo and how it “treats people with diabetes, not as patients, but as people who that want to thrive without diabetes getting in the way”.
10:00 “Costly sick care will give way to affordable, personalized, and preemptive care with genomic sensors and AI-based digital therapies. That will be the true revolution in healthcare.”
10:40 Health Assurance as an emerging movement towards consumer-centric, data-driven healthcare
11:12 How the Presidential election cycle only seemed to focus on how we pay for the expensive, fragmented, and inequitable system – not how we fundamentally disrupt and transform it
13:12 Dr. Klasko tells the story of the future pandemic of October 2030 and how Health Assurance stopped it in its tracks
15:25 The “Amazon moment” of healthcare and how it redefines competition (future competitors are those who can bring health to home)
16:03 Dr. Klasko discusses JeffConnect (the telemedicine platform used by Jefferson Health)
16:37 Current business models for providers, insurance companies, and pharma are dead!
17:37 The 4th Industrial Revolution of AI and its impact on the future of care delivery
18:43 The use of wearables in cardiology care
19:53 Moving away from the current sick care model and making the health system easier
20:25 “The secret sauce at Jefferson Health is that getting to people while they are people, and not patients.”
21:24 Consumer segmentation needed for patient-centeredness
22:32 The real revolution will take place when patients reach the “mad as hell, not going to take it anymore” moment
25:58 The consumer mistrust in FAANG (Facebook, Amazon, Apple, Netflix and Google) to manage personal health data
26:23 Dr. Klasko provides his take on Haven Healthcare (the JV between Amazon, Berkshire Hathaway and JPMorgan Chase)
27:07 Healthcare disruption by startups should not be about moving fast and breaking things
27:40 Jefferson is moving entire digital innovation and consumer experience team to General Catalyst, a multi-billion dollar venture capital firm
28:25 “The future for the traditional healthcare ecosystem is going to be creative and strategic partnerships.”
North Carolina seems like an unlikely laboratory for value-based care. It refused to expand Medicaid coverage under the Affordable Care Act and ranks in the bottom third among states in measures of overall health. North Carolinians are experiencing stagnant or worsening population mortality rates and substantial health disparities, with 15% percent of residents living below the poverty line, and over one million (10% - 9th highest in the US) North Carolinians uninsured. Health care costs are rising, crowding out other state budgetary priorities and limiting wage increases. But the state has embarked on one of the country’s most ambitious efforts to transform how health care is defined and paid for. Accountable Care Learning Collaborative co-founder Dr. Mark McClellan, CMS Administrator during the George W. Bush administration, has publicly stated the “No state is moving as far and as fast as North Carolina.” UNC Health is leading that charge. Mark Gwynne, DO, is the President and Executive Medical Director of UNC Health Alliance (statewide CIN) and UNC Senior Alliance (NextGen ACO): his leadership, results, and vision for the future provide Race to Value listeners a rich viewpoint for value. The physician-led CIN unites independent and employed providers in a program that drives collaboration and communication across the health care continuum to improve quality of care, control health care costs, and work in partnership to provide coordinated care Their recent performance has reduced the cost of care for 140,000 Blue Cross NC members, earned $17.5 million in quality and shared savings payments, and achieved a 100% quality score. The NextGen ACO is one of only a few academic organizations participating in the highest-risk alternative payment model and ranks #1 nationally for quality. Bookmarks:
3:55 The state of Value-Based Care transformation in North Carolina in juxtaposition with the state’s health outcome challenges
4:49 “North Carolina: The New Frontier For Health Care Transformation” (Dr. Mark McClellan: “No state is moving as far as fast as North Carolina.”)
7:03 “We’ve created a pretty good substrate for our payer partners across market segments where we are really starting to see the scale that we need to catalyze this kind of work.”
7:28 The tipping point for value-based care transformation of 35-40% needed to capitalize on investments and leverage the altruism of providers
8:00 The key to value-based success in NC is based on Partnership (e.g. partnering with forward-thinking payers)
8:35 UNC Health Alliance and its recent outstanding performance of $17.5M in shared savings and 100% quality score in the Blue Premier program
11:13 Dr. Gwynne discusses how Blue Cross NC is approaching its collaboration with his CIN and what the national payer community can learn about partnership with providers to transform care delivery
12:01 Transparency in calculating benchmarks and MLR and making quality targets achievable
13:54 Investing in a robust infrastructure around clinical quality improvement and establishing improvement collaboratives among primary care practices
14:23 Pivoting an internal infrastructure to focus on outcomes with appropriate patient outreach, provider education, facilitating improvement efforts in practices, and making EMR adjustments to support the work
16:25 The economic effects of COVID-19 on the PCP community and the Blue Cross NC “Accelerate to Value” stabilization program
21:17 Dr. Gwynne discusses how primary care practices should be looking at capitation in the years to come
23:15 Dr. Gwynne shares his perspective in balancing shared savings distribution to providers with capital re-investment (UNC Health Alliance distributes 80% of Shared Savings to its providers across all contracts)
23:47 Making key investments in data analytics, systems to support health equity, intensive case management services, point-of-care interventions,
The concept of “accountable care in the safety net” was introduced in a Dartmouth Study published by the Commonwealth Fund back in 2013. In that study, there were 4 critical success factors outlined for a coalition-based Medicaid ACO: 1) aligned leadership through a shared vision, 2) strong governance, 3) a unified strategy for using data, and 4) a sophisticated care coordination infrastructure. MHN ACO has exhibited excellence in all four of those areas.
Since 2009, Medical Home Network has served as a beacon for healthcare transformation and collaboration. Established as a formal provider collaborative working to improve healthcare delivery and access for individuals most in need, today MHN leverages a suite of innovative technologies, healthcare expertise, and a passion for improving the provider and patient experience to create practice-based programming that integrates Chicago’s delivery system, transforms on the ground delivery and achieves real results.
Cheryl Lulias launched and serves as CEO of the 1st Medicaid ACO in Illinois. The MHN ACO is provider owned and governed by leaders from 12 health care organizations, representing nine federally qualified health centers and three hospital systems. In an ever-changing healthcare landscape, MHN ACO has established itself as a beacon high value, high impact integrated delivery system in the safety net ensuring patients receive better care where and when they need it.
Bookmarks:
4:01 “History of Accountable Care in the Safety Net” (Reference to Commonwealth study on FQHC coalitions forming ACOs)
5:38 Cheryl shares the history of Medical Home Network and its journey in health value
7:42 Creating a standardized, whole-person model of care centered within a digitally connected, clinically integrated delivery system
8:35 Cheryl discusses MHN ACO’s results ($50 million in savings, 24% reduction in inpatient hospital days, 25% reduction in readmissions, 8% reduction in ED visits)
9:51 FQHC resiliency during the COVID-19 pandemic crisis and scaling up of telehealth and virtual care
13:46 Adjusting MHN’s AI-powered risk stratification model to identify community members at high-risk for hospitalizations from a COVID infection
16:15 The devastating impact of COVID and the scourge of violent crime, drug overdoses, and suicides impacting Cook County
17:40 Establishing ADT connectivity and real-time alerting with 30 hospitals through MHN Connect Health Information Network
18:21 Data liquidity, supercharged AI predictive models, and the creation of a 360o patient view by integrating data from claims, pharmacy, and health risk assessments
21:04 How prediction of “rising risk” informs MHN’s whole approach to care management
26:10 Cheryl explains MHN’s collaborative care program that utilizes a decentralized, team-based approach where interdisciplinary care teams are embedded at the practice level
28:26 Cheryl shares a patient success story
31:17 Cheryl counters the skepticism of artificial intelligence by sharing the results of her collaboration with Closed Loop AI
35:22 MHN’s commitment to advance health equity and reduce disparities of care through the Racial Equity Rapid Response Team
36:41 The impact of systemic racism and threat it poses on the health of our communities
43:03 Holistic integration of primary care and behavioral health at Medical Home Network
45:43 Cheryl’s strategy in forming a Board that decoupled ownership and governance and created a balance of power between the health centers and the hospitals
49:37 MHN’s commitment to workforce development for care coordinators and community outreach workers
51:23 The challenges associated with provider and care team burnout in developing the workforce
53:48 MHN’s launch of a MoreCare, a Medicare Advantage Special Needs Plan in partnership with Cook County Health
57:09 Cheryl describes the future of medicine and what we need to do to fix a broken healthc...
Today’s episode follows Austin Regional Clinic (ARC), a large multi-specialty medical group that serves over 500,000 patients in Austin, Texas. Founded in 1980 as an HMO, ARC is coming full-circle on their journey in value-based care as they now serve more than half of their population in value-based contracts.
Tyler Willson, VP of Population Health and Clinical Quality talks with us about the tipping point for value, ARC’s strategy during and post-COVID, as well as partnerships with payers. We also explore Austin’s unique market where corporate giants like Apple, Tesla, Amazon, and IBM are turning the area into a hub for innovation, which offers a unique opportunity for ARC. Find out what will happen with Medicare Advantage plans in the market, how analytics and automation are enhancing care, and how an important partner is making it all possible for ARC to be a leader in the race to value.
Bookmarks:
4:01 Reaching the financial tipping point in health value
5:24 Austin Regional Clinic’s value-based care journey
8:28 Tyler describes ARC’s current population health infrastructure
9:08 The shift of payment environment towards full- and delegated-risk models
10:25 Sourcing capital and investments to build infrastructure
10:45 JV with Agilon Health (a PE-backed company that supports ARC in taking fully delegated, capitated risk in Medicare Advantage)
11:35 Evaluating the landscape to determine strategic planning horizon, scope, and scale for VBC portfolio
12:00 How the increased level of involuntary risk will necessitate strategic investments in enhanced care models
12:35 Lessons from COVID-19 in determining the “true” risk in ARC’s revenue portfolio
13:40 Shared Savings are critical lifelines in the COVID era
14:40 Austin, TX as an emerging national innovation hub
16:04 “so much of an organization's capacity for innovation comes from what it believes”
17:00 Competition for workforce talent in Austin
17:30 How to design and implement patient satisfaction surveys to collect meaningful data
18:53 Austin as an “innovate or die” type market
19:35 An outline of poor public health measures in the state of Texas
21:04 ARC’s commitment to patient access as a bedrock principle
24:05 ARC’s holding true to its value proposition during the pandemic crisis
25:11 Ensuring patient access to telehealth
26:00 Creating a patient-centered care medical home by focusing on patient access
27:10 An overview of ARC’s quality measure performance
29:00 ARC’s focus on automation, predictive analytics, and extensive outreach to ensure successful closure of care gaps
33:45 The use of ML and NLP in algorithms to drive automation in burden of illness documentation
36:22 Predictive analytics as the “unicorn of our industry”
38:00 Development of a Medicare Advantage strategy in partnership with Agilon
41:30 Incubating the types of infrastructure to test innovation viability for managing full-risk MA
42:31 The importance of an investment partner in ARC’s expansion of its full-risk MA portfolio
43:00 Market growth of Medicare Advantage being driven by consumer price sensitivity
45:00 Capturing accurate documentation in the burden of illness to the highest level of specificity
46:30 Advocating for CMS to include audio-only visits as a means to document and revalidate HCC codes
49:30 An overview of ARC’s participation in Medicare ACO program with Ascension Seton
50:58 Evaluation of the Direct Contracting ACO model
53:50 Employer-physician collaboration to deliver quality care
There are over 1,300 Federally Qualified Health Centers (FQHCs) in our country providing a healthcare lifeline for more than 28 million Americans living in underserved areas of the country. The vast majority of these are living with significant health concerns and are extremely vulnerable to economic fluctuations. Community Care Cooperative, C3, epitomizes what the research shows, that despite the inherent challenges of serving as a safety net, FQHCs perform better in caring for the Medicaid population.
C3 is Massachusetts’ largest ACO taking on full global risk, and the only state ACO that is governed exclusively by FQHCs. Under the guidance of Christina Severin, the organization has been raising the bar in ramping up and utilizing telemedicine, integrating and prioritizing behavioral health, identifying and rooting out racism, and fighting for health equity and social justice.
Christina has been in CEO roles in Boston-area health care organizations for 20-plus years, at Codman Square Health Center in Dorchester, at the Medicaid managed care organization called Network Health, and at Beth Israel Deaconess Hospital’s new ACO. Her passion and effectiveness are evidenced in this riveting episode – get ready to be elevated to another level on your race to value!
Bookmarks:
3:37 The transformation of MassHealth, the state’s Medicaid program
4:15 18 FQHCs coming together to form their own physician-led ACO
7:47 Research from the American Journal of Public Health showing that FQHCs have better outcomes and lower costs
8:00 Research from the American Journal of Preventative Medicine showing that FQHCs have better performance on select quality measures
9:00 Christina discusses how FQHCs have lower medical loss ratios than their counterparts
10:00 The “incredible paradox” of the US healthcare system
10:55 The unique cultural characteristics of FQHCs
11:55 “Necessity is the mother of invention” and the magic of Federally Qualified Health Centers
12:45 Deciding to take two-sided risk for total cost of care when undercapitalized
15:45 How the largest FQHC-based ACO in the country developed operational programs for early success in downside risk
17:45 Setting up an effective governance structure as a key to success
21:22 Leading and managing the COVID-19 pandemic in the state of Massachusetts
22:50 Bridging the “digital divide” by providing patients with laptops and broadband access to support telehealth visits during the pandemic
24:00 Working with the community to raise $5M to scale up telehealth capacity, training, and infrastructure
25:20 The early collaborative success of the Massachusetts FQHC Telehealth Consortium
27:01 The murder of George Floyd and the calling for racial justice as a driving force
29:38 Advancing alternative telehealth modalities as a way to ensure health equity and access to care
32:00 Health centers are on the vanguard of developing the most effective models of care that includes behavioral health services
34:24 Delivering behavioral health services during the pandemic
35:55 The impact of the pandemic on mental health (depression, loneliness, isolation, and trauma)
36:45 Higher prevalence of COVID-19 illness with low-income workers and communities of color
40:20 Recognition of institutionalized racism and how white supremacy been the key driver of adversity for African Americans
42:00 What C3 is doing to support and advance diversity, equity, and racial justice
44:00 A 30-year difference in life expectancy between white and black communities in the Boston area
45:10 The difference between health-related social needs and Social Determinants of Health
46:50 The MassHealth ACO flexible spending program that provides cash assistance to individuals with complex needs and are experiencing impediments with food nutrition and housing
49:54 Referencing Health Affairs article, “Value-Based Health Care Must Value Black Lives” that ...
In this virtual panel discussion, Dr. Ernest Grant (President of the American Nurses Association), Dr. Jan Jones-Schenk (Senior Vice President – College of Health Professions, WGU), and Jason Thompson (Vice President - Diversity, Equity and Inclusion, WGU) will discuss how we must eliminate barriers to equity in access and learning in order to reduce racial disparities in care.
Progress in advancing diversity in the US health care workforce has been slow. This is evidenced by the low numbers of people from historically underrepresented populations joining the health professions workforce, ongoing reports of bias and discrimination in health professions learning environments, and a continuing dearth of proven and replicable best practices to advance diversity. Many of our health professions schools and clinical practice sites are taking some action on diversity and the more contemporary concepts of equity and inclusion, but without making the necessary commitment to comprehensive, system-wide approaches that create meaningful culture change. As a result, addressing harmful bias and eliminating discrimination remain critical challenges to achieving excellence in health care and health professions education.
Within the registered nurse (RN) workforce, according to the National Council of State Boards of Nursing (NCSBN), 81% are White/Caucasian (vs 60% of the US population), while 19% of nurses are from underrepresented racial/ethnic populations. The Accountable Care Learning Collaborative believes that nursing programs must address bias and reduce discrimination in health professions learning environments because, in not doing so, racial disparities in care will persist. In our Accountable Care Atlas, we identified a specific competency to “understand the unique cultural characteristics of the population served to implement changes in the organization to provide high-value care”. This cultural competency failure is reinforced by research that shows that care.
If you would like to watch a video recording of this webinar, you can do so here.
Bookmarks:
1:40 ACLC Leadership takes a stance on institutional racism and how BLM movement is a public health issue
4:00 Introduction to panelists: Dr. Ernest Grant, Dr. Jan Jones-Schenk, and Jason Thompson
4:50 Reference to population health research that shows us that the American health care system is not immune to institutional racial discrimination
8:05 Jason Thompson on how we can engage in a societal conversation to foster a better understanding about the presence of racism
8:26 “I can’t make you racist in 45-minutes…and I can’t undo it in 45-minutes. It takes multiple conversations and constant engagement.”
9:51 “There has never been any period in American history where the health of blacks was equal to that of whites. Disparity is built into the system.”
10:19 “Advancing health equity will require a justice-oriented framework that identifies structural racism’s manifestation in medical care.”
10:50 Reference to Don Berwick’s recent article, “The Moral Determinants of Health“
12:05 Dr. Ernest Grant on how our country can reorient value-based care and public health policies around racial and health justice
13:30 Dr. Ernest Grant on how the nursing profession can mobilize around the issue of institutional racism and health inequity
13:50 Dr. Ernest Grant references his testimony to the House Ways and Means Committee on the disparate impact of COVID-19 in the African American community
14:37 “As nurses we have the responsibility to use our voice to call for change. Our code of ethics obligates us as nurses to be allies and to speak up against racism, discrimination, and injustice.”
16:00 Dr. Jones-Schenk speaks to how we need to “go upstream to the source” to address seek solutions in reforming society
17:05 “As a profession, we make a promise to society that we will address the health needs of society.
Most people know that 3M as a massive industrial conglomerate, a Fortune 500 company with 60,000 products that include Post-It notes, Scotch tape, sandpaper, hanging hooks, band-aids and more. A lesser-known division, but the one that is paramount to our focus on value-based care, is their Health Information Systems division: a $1billion+ dollar enterprise built over the last 35 years and focused on healthcare data aggregation and analysis.
3M’s Health Information Systems business works with more than 8,000 healthcare organizations worldwide, including 250,000 physicians, health plans, and 80% of US hospitals, as well as local and national governments in the US and 25 other countries. They deliver software and services across the continuum of care and combine clinical documentation systems and risk assessment methodologies to capture, analyze, and advance patient information in value-based care.
Dan McMaster is our guest for this episode. He is the Director of Strategy and Business Development for 3M Health Information Systems. Dan’s leadership and vision have served 3M for over 16 years – his in-depth knowledge of the organization reveals a compelling origin story and unfolds a future of innovation that ensures 3M will be a winner the race to value.
http://www.3mhis.com/
http://www.3mhiscer.com/
https://www.3mhisinsideangle.com/podcast/
5:46 The need for analytics and business intelligence in the transition from volume to value
6:12 Potentially Preventable Readmissions (PPR) – identifying acute care hospital readmissions to improve the quality of care
6:37 Clinical Risk Groups (CRG) – “a FICO score for your health”
7:27 Providing key population measures to health plans all over the country and CMS for improving health outcomes
8:26 Using AI to surface real-time insights when completing the medical record
11:00 3M’s journey in health information technology from when the healthcare company first started 35 years ago
13:40 Clinical and Economic Research at 3M HIS and the development of DRGs related to Rich Averill’s health-related research at Yale University
15:10 Collaboration with payers to develop capitation models
15:30 3M’s and M*Modal launch of AI and natural language understanding CDI tool for real-time alerts at the point-of-care
17:00 The story of the challenging new product development of the Post-It note and how this experience shaped the current culture of innovation at 3M
20:23 Developing innovation for HCC coding for Medicare Advantage risk adjustment
22:08 Partnership with payers, providers, government, and EHR companies is key for innovative solutions in healthcare
26:18 How to sift through all of the noise, buzzwords, and rhetoric when evaluating new and emerging technologies
26:53 The potential for AI and NLP to enhance the capabilities of providers in order to improve health outcomes
29:27 AI can reduce the intense documentation burden that contributes to physician depression, anxiety, and suicidality
31:40 Innovation with Medicare Advantage and how advancement in health informatics systems for this population can be leveraged for the bigger whole
37:10 Dan speaks to 3M’s involvement in the ACLC and how Michael Leavitt has led with the need for collaboration in value-based care
39:30 Leveraging technology appropriately can free up time for physicians so they can better address patient care needs
41:48 The need for an “Infinite Game” mindset in healthcare innovation
The importance of Humana’s consumer focus, care in the home, technology, and other strategic imperatives related to value-based care have been amplified by the novel coronavirus (COVID-19) pandemic. As COVID-19 presses onward, this week Race to Value presents an industry perspective from Mike Funk, Vice President for the Office of Health Affairs and Advocacy. Mike Funk believes that the transition to value-based care is inevitable. In his role with Humana, he leads the organization’s commitment to ensure that Humana providers are well equipped for the transition to value, especially during these unprecedented times. From stabilizing physician practices, increasing access to care, creating a high-touch primary care model, improving interoperability, and more, Humana has been a leader in the race to value. In this episode Mike reveals Humana’s efforts in value, including outlining impressive partnerships with the DaVinci project, OATS, Epic, Oak Street Health, Iora Health, Kindred Health, and the University of Houston, to name a few.
Mike Funk is responsible for thought leadership at Humana in transforming the industry to value-based care, as well as serving as the voice of the provider, infusing clinical thinking and leadership across the enterprise. His prior experience includes; executive positions in hospital administration, physician practice management, managed care, insurance products, and health and wellness services. Mike most recently spent the last several years in the Provider Development Center of Excellence, where he focused on developing value-based programs, and assisting physicians with the tools, capabilities, and best practices for transitioning from fee for service to value. Mike is a fellow of the American College of Healthcare Executives and a Certified Medical Practice Executive.
References for more information:
https://www.humana.com/provider/news/value-based-care
http://valuebasedcare.humana.com/
Bookmarks:
5:45 “Unprecedented times call for unprecedented actions”
6:24 Primary focus of Humana during the pandemic has been to improve access to healthcare services
6:45 Pandemic was the catalyst for jumpstarting and mainstreaming telehealth
8:01 5-10 years of technology adoption progress happening in 2-3 months
8:30 The “genie is out of the bottle” when it comes to telehealth
9:10 Limitations with technology and telehealth access in rural areas
9:30 Older Adults Technology Services (OATS) investment by Humana Foundation to launch national digital engagement consortium for older adults
10:11 Recognition by CMS of increased need for telehealth
10:20 Mike shares a story of a practice leveraging telehealth visits in an innovative way
12:40 Lack of interoperability held back the healthcare system in navigating the pandemic crisis
13:20 Need for interoperability COVID-19 test results
13:50 Humana’s participation in the HL7 Da Vinci Project to support increased data sharing by leveraging the FHIR Standard
14:20 Humana’s work with EMR companies to advance interoperability (Epic, eCW, AthenaHealth)
17:00 Humana’s goal to ensure stabilization of physician practices
18:00 Risk-based payment models providing stability in cash flow
21:00 Humana has evolved its value-based product portfolio to include specialty bundles (e.g. joint replacement, spine, maternity care)
21:10 Humana’s omni-channel approach to create a value-based care ecosystem that is “personalized, proactive, and predictive”
21:40 Increased demand in home care services and Humana’s recent investments in Kindred and Heal
22:00 Humana’s partnership with high-touch primary care practices (e.g. Iora, Oak Street) and their own practice (Partners in Primary Care)
22:20 Moving from a health insurance company to a health company with elements of insurance
23:45 Humana’s Bold Goal initiative and other strategies to address social determinants of health and support whole-person care
Many industry insiders believe that health system-led ACOs are inherently disadvantaged to demonstrate value-based care in an environment where most revenue is still generated in fee-for-service. In moving to value, hospitals must contend with demand destruction on their fee-for-service lines of business as they reduce admissions, emergency department visits, and procedures. Physician-led ACOs, they argue, simply do not have this dichotomy; therefore, they have a clearer pathway to financial benefits from reducing hospital costs outside of the physician practice. This premise often appears correct as we often see “low-revenue” ACOs, typically led by physicians who mostly provide outpatient services, have better results than “high-revenue” ACOs, generally led by hospitals that provide both inpatient and outpatient services.
Lisa M. Trumble, President and Chief Executive Officer at Southern New England Healthcare Organization (SOHO Health) respectfully disagrees. She believes that “Clinical Integration is the Answer” in this race to value, and she has the results to prove it! As one of the leading CIN executives in the country, Lisa Trumble has shown how clinical integration can enhance communication between providers and improve on the outcomes and excessive costs that are commonly seen in an uncoordinated care delivery model.
This week’s episode features Lisa M. Trumble, the President and CEO of SOHO Health, a new ACO and CIN that is a partnership between Saint Francis Healthcare Partners and Trinity Health of New England. With 30 years of experience in health care leadership, Lisa shares powerful insights on clinical integration and challenges healthcare executives to “buckle up” on this race to value.
Bookmarks:
3:45 Lisa comments on what it was like to start a new job as CEO right when the pandemic started!
6:30 Leading change during an important inflection point in the industry as it shifts towards value
6:45 The fragility of the FFS model during the throes of a pandemic
7:08 Lisa reflects on prior work in value-based transformation in Massachusetts and how that state differs from Connecticut in its commitment to health value
7:42 SOHO Health and Trinity Health of New England are committed to (and invested in) this transition to value-based care
8:15 Remaining on a FFS chassis is not sustainable. Negotiating increases in FFS will not be tolerated in the future. (“Buckle up and look out!”)
8:45 Direct-to-Employer contracting
9:03 Partnering with physicians and creating JVs for Centers of Excellence and Bundled Payments
10:50 Hospitals needing to evaluate core business and how to reduce infrastructure cost to create a “survive-able” margin
11:09 Reducing utilization for unnecessary services and preventing leakage within a CIN
12:00 Despite reductions in inpatient services in VBC models, utilization is still growing in ambulatory surgery
12:20 Developing a bundled payment model with physicians in ASCs where financial incentives are aligned
12:50 Employers will no longer tolerate paying for surgeries that cost twice as much when performed in an inpatient setting
13:15 Value-based care is a difficult situation for health systems. At the same time you are losing business, you also have to transform and make key investments.
13:25 “If you don’t commit to value-based care, you will slowly work your way out of the market and be uncompetitive. The market will find a way to figure it out with others.”
15:15 PHOs, IPAs, ACOs, and CINs all are struggling to figure out the best way pursue clinical integration
16:00 The beauty of a design of a Clinically Integrated Network is that it isn’t limiting you to only one area of care delivery -- “Clinical Integration is the answer to how to perform well in a value-based environment.”
17:30 Multidisciplinary collaboration is important to providing the appropriate level of care
19:25 Lisa explains how SOHO is approaching colla...
MaineHealth Accountable Care Organization (MHACO) serves a uniquely heterogeneous population that is spread across coastal, rural, and urban communities with multiple different cultural components. And they serve the oldest population of all states in the Union! The organization’s ED utilization in its early years was historically around 775 visits per thousand – a significantly high number when compared to other ACOs in the country which were well below 700. At the same time, the ACO was about 10% lower than other ACOs in providing primary care services. Find out how MaineHealth was able to implement a Value Oversight Committee, leverage technology, improve processes, and engage their workforce to achieve nearly $20 million dollars in savings in its first year of contracting with CMS in the Medicare Shared Savings Plan.
In this episode we speak with Jennifer Moore, MBA is the president of MHACO, whose membership includes 10 acute care hospitals and over 1,600 private practice and employed physicians, and manages numerous commercial ACO value-based contracts. These ACO contracts cover approximately 230,000 Medicare and commercial lives. Jen has significant expertise in value-based contracting, ambulatory quality measurement and performance, data analytics, and provider relations activities. Jen is a board member of the National Association of Accountable Care Organizations (NAACOS) and serves as chair of the NAACOS governance committee.
Listen to MHACO’s BACON podcast: https://mainehealth.org/mainehealth-accountable-care-organization/provider-resources/bacon-podcast
Bookmarks:
4:24 Introducing an extreme ED Utilization scenario and how the ACO initiated an historic turnaround!
5:57 Jen discusses how critical the Value Oversight Committee (VOC) is pivotal to the success of the ACO
6:48 Diagnosing a Patient Access issue in the ACO with key metrics (ED visits/K and PCP visits/K)
7:30 “Houston, we have a problem” (the ACO was higher than the market in 16 of 17 contracts!)
8:00 Performing a root cause analysis of high ED utilizers
8:41 Loneliness is a major driver of ED use
9:05 Getting stakeholder buy-in for the ED Problem: showing physicians there was actually a failure in the care model by using data
9:44 Finding actionable data and knowing what steps to take to solve a problem
11:28 The importance of flexibility in ACO operations: solving challenges at the local level in each of MHACO’s regions
12:12 Leveraging population health management data, SMEs, and Value Oversight Committee to develop a focused operational tactics
12:30 Selecting tactics for the ED Playbook: 1) Patient Education campaign and 2) Actionable Care Planning
12:50 Implementing the “Where to Go for Care” Patient Education Campaign
14:44 Implementing ED Actionable Care Planning
16:45 Risk Stratification and Predictive Modeling (Johns Hopkins ACG)
19:30 ED Propensity Scoring (Urgent Risk, Impactability, Frequent ED Utilizers, Recent ED Utilizers)
20:00 Capturing Social Determinants of Health Data
21:15 Transitioning from a Centralized to an Embedded Care Management Model
23:50 The “a-ha moment” during the pandemic: the need for more primary care capitation
24:10 Telehealth deployment during COVID-19
26:50 The importance of Clinical Documentation as a driver of ACO contract performance
28:45 Engaging specialists in clinical documentation
30:35 MHACO’s “heat map” report for Top 10 ACO quality measures
33:30 MHACO’s practice incentive report for other ACO quality measures
34:00 Payer collaboration
36:00 Joint venture between MaineHealth and Anthem Blue Cross and Blue Shield
36:35 Forming a Provider Advisory Council to make recommendations to payers
39:35 The leadership domains that are most relevant and impactful for ACOs
42:00 Designing a compensation formula for distribution of P4P and Shared Savings to physicians
Primary care is especially compromised in the ongoing pandemic crisis. PCPs are uniquely vulnerable to the deleterious economic effects of COVID-19, since most of their revenue still comes from in-person visits which have plummeted since March amid widespread stay-at-home orders and fears about in-office virus transmission. The pain has been particularly acute for PCPs who are not backed financially by health systems, private equity or other entities. Roughly half of U.S. doctors still own their own practices, and those independents were already operating on razor-thin margins after years of reimbursement cuts, unfavorable payment structures, and expensive EHR and tech implementations. Add a pandemic to the mix, and it's a recipe for disaster.
We are pleased to welcome Dr. Jed Constantz as our guest this week. As a primary care finance and delivery reform strategy consultant, he has worked with payers, employers, and providers, all the way from independent primary care physicians to large health systems. Over his 30 plus years in healthcare, he has developed tools and resources for primary care providers and employers seeking to reduce costs, drive greater efficiency and quality outcomes, and thereby create a “featured-and-favored” network in their regions and community. This process includes a deep focus on the selection of the right community of primary care physicians and specialists, a thorough audit of existing patient and population data, commitment to accountable care standards, and improved compensation for the physician. Jed comes with wisdom and critical counsel for sustaining PCPs as the foundation of our health care system.
Bookmarks:
5:50 The lack of a payment strategy for primary care prevents trusting relationships.
6:50 COVID-19 has provided a deeper understanding of why primary care needs to be purchased differently.
8:00 Payment reform will allow primary care to live up to the expectations of true patient-centered care and population health.
10:30 Primary Care must retain the agency to care for patients when underlying financial arrangements and equity positions change.
11:30 Terms and conditions of primary care business arrangements must allow physicians to continue to have a high level of accountability to the patient.
14:30 Primary care physicians must pursue business models that allow them to practice independent clinical decision-making.
16:00 The VillageMD and Walgreens partnership is a perfect example of a corporate model that retains primary care independence.
16:45 Blue Cross North Carolina as an example of how to calculate the future value of primary care so money in health care can be spent more intelligently.
21:55 Innovation must be focused on meeting the needs of the patients, and F2F encounters are not as important as we once thought.
22:40 Dr. Constantz explains how the FFS economic model makes it impossible to spend quality time with patients.
23:17 The innovation of telemedicine is a great example of how primary care was able to make a pivot towards improved population health during COVID-19.
24:00 The Primary Care Innovators Network (PCIN) and its contribution to innovating care delivery through payment reform.
24:42 The Triple Aim as a foundation for patient activation to improve health outcomes (Dr. Constantz cites the research of Judith Hibbard.)
25:08 Payment reform in primary care gives you the opportunity to imagine a different relationship between the primary care team and the patient.
26:50 The disruption of the employer-sponsored health insurance marketplace
27:52 Rosen Hotels as an example of what employers can do to take charge of healthcare costs and funnel savings back into the community.
31:15 Dr. Constantz shares his perspective on how self-funded employers are planning their health benefits strategy for 2021.
33:54 Partnership between The National Alliance of Healthcare Purchaser Coalitions (National Alliance) an...
Quality in health care has been a hot topic for over 20 years, ever since the landmark report, To Err is Human, which declared that up to 100,000 people die each year from preventable medical errors. Since that time, the industry has increased its efforts to incorporate quality principles from Lean, Six Sigma and other models, but only one organization has raised a quality standard for health care organizations and their workforce. The National Association of Healthcare Quality (NAHQ) is leading the quality revolution with its framework of essential qualities for the health care professional.
Join the conversation as we speak with Stephanie Mercado, CEO of NAHQ. Stephanie is a leader in healthcare association management, advancing healthcare professions, and workforce development. Since joining NAHQ in December 2013, NAHQ membership has increased by more than 70%. Stephanie has raised NAHQ’s prominence and value in the healthcare quality space, with the introduction of industry elevating initiatives such as the award-winning HQ Essential Competencies and the National Healthcare Quality Summit. In partnership with NAHQ’s Board of Directors, and an outstanding staff and volunteer team, Stephanie led the development of the profession’s first-ever Comprehensive Competency Framework, and the profession’s first-ever Workforce Study, offering critical insights to workforce development opportunities for healthcare quality and safety professionals.
In addition to her work with NAHQ, she currently serves on the Institute for Healthcare Improvement’s National Steering Committee for Patient Safety, the Association Forum Healthcare Collaborative Steering Committee, and is a board member of the Commission on Accreditation for Healthcare Management Education (CAHME), and more. In 2018, Stephanie was selected as a recipient of the Outstanding Nonprofit Leader Award from .orgCommunity. We are grateful for Stephanie’s leadership in the race to value!
Bookmarks:
6:00 Workforce Empowerment and Culture Alignment to support Quality Improvement6:55 Healthcare Quality Competencies needed to improve patient safety and health outcomes
8:45 The acceleration of Value-Based Care and the recognition of codependent relationships across the care continuum
9:45 A coordinated and competent workforce is a ‘must have’ to thrive in health value
10:15 Breaking down the barriers to coordinate care across the continuum
12:00 The NAHQ Healthcare Quality Competency Framework
12:55 The juxtaposition of Quality Training and Medical Training
14:00 Setting a standard to serve as a roadmap for the industry
14:40 Governor Leavitt providing thought leadership in the creation of national standards
15:00 NAHQ’s support of individual contributors
15:45 NAHQ’s partnerships with healthcare organizations to find opportunities for improvement
16:15 Healthcare leaders sometimes don’t know who is doing the work of quality in their organization
17:00 NAHQ’s partnerships with academic organizations to hardwire competencies into curriculum
18:05 WGU as a leading national example of hardwiring quality competencies into nursing education
22:35 Leveraging the synergies between health value and quality in partnership with the ACLC
25:30 The Quality competencies that are underperforming the lowest are ones that are underpinnings to Health Value
29:00 Data that shows a correlation between quality training and a higher level of work performance
32:20 Stephanie speaks about the administrative burden of quality measures and the need for standardization
33:10 Looking at other industries with similar challenges in alignment and harmonization of standards, e.g. the history of railroads
35:56 How healthcare can have its own “intercontinental connectedness” with outcome measures, systems, and competencies
38:46 How consumer focus on service reliability and customer service can align with clinical performance and process imp...
Palliative care, and the role it plays in health value, is difficult for many people to understand because it runs so contra to the linear algorithm that is allopathic medicine. Curative care – played out in the form of surgeries, procedures, therapies, and various other medical interventions – is focused on doing something TO the patient. This becomes problematic when the patient has a terminal illness - eventually the illness will win. Nature always wins. Palliative care shifts the caregiver’s paradigm from one of asking, “How can I help prevent death?” to the more appropriate question, “How do you want to live?”
When caregivers ask the right question, treatment activities naturally move away from an escalation of clinical interventions that can shorten life and worsen quality of life, and move toward supportive medicine and therapy in the form of symptom-controlling medication, rehabilitation, and counseling that focuses on a patient’s quality of life, symptoms, and emotional wellbeing. – things they do FOR the patient. That’s not to say that curative treatments aren’t appropriate or indicated – palliative care works in partnership with other specialists – but the palliative care provider plays an important role in truly helping the patient understand the nature of the disease, the treatment options, and the patient’s physical ability to respond to the treatments. Inevitably, patients choose less treatment: costs decrease while quality of life increases.
In this episode we speak with Dr. Tim Ihrig, Chief Medical Officer at Crossroads Hospice and Palliative Care. Dr. Ihrig is a nationally recognized thought leader in palliative care, with 1.5 million hits on his Ted Talk “What We Can Do To Die Well” and author of the important book, Palliative Care and Symptom Management. His work in multiple organizations has proven that effective palliative care aligns with the objectives of the Triple-Aim – it is a key organizational and individual competency required to make value-based care a reality.
5:50 Dr. Ihrig explaining his early involvement in the ACLC and his journey in health value
8:00 Reverse engineering the individualized care of a patient into programs, training, policy, and reimbursement
10:45 The linear algorithmic model of treatment that leads to an escalation of clinical interventions
11:05 The need to reform medical education so that death is not always viewed as a failure of the physician
12:30 Asking the question, ‘how do I want to live?’ shifts the narrative to loving, learning, and growing through every breath
13:00 Informed Consent as one of the core tenets of true palliative care
14:10 Physicians must ask the question: what is sacred to you as an individual? That doesn’t change over time, cancer or not.
14:45 Understanding the appropriateness of treatment against the backdrop of where somebody’s at on their physiologic journey
14:53 True palliative care going beyond the limits of allopathic reductionism and looking at the whole human being
16:04 Aligning therapies with the clinical reality of where patients are physiologically and what their goals of care are
16:45 Palliative care needs a concise, unified definition of what it is to overcome current misperceptions
18:31 The present medical paradigm sets up fighting to beat Mother Nature, which means we all fail.
19:56 The inflection period - the moment in our health journey when our bodies no longer have the capacity to recover or restore
22:50 Using the inflection period as a tool to prevent iatrogenic causality which potentiates decline secondary to physiologic stress.
23:45 The diminishing ROI of medical interventions at the inflection period
24:18 Dr. Ihrig describes a personal example of iatrogenic causality that brought about death
25:07 Patients becoming victims when we don’t understand the reality of death and the limitations of medicine
In health care, we excel in addressing problems in the human body that are fixable. However, with regard to the two main un-fixables in life -- aging and dying--- we often inflict therapies on patients that shorten lives or increase suffering before death. These heroic measures result in wasteful costs in the healthcare system: of $700 billion a year spent in Medicare, it's estimated that about one-quarter of that spending goes to the 5% of Medicare beneficiaries who are in their final year of life, without knowing which of those dollars are actually adding value to the patient.
While many healthcare organizations are struggling to develop risk-based population health management strategies, geriatric care models, focused on high-risk, high-need patients, can be valuable resources for healthcare organizations hoping to improve care and reduce costs.
In this episode, Carrie Coumbs, an expert in geriatric care models, shares valuable insights in caring for seniors, covering topics of senior housing, rehabilitation, home health, home-based care, hospice care, re-hospitalization avoidance, home care collaboration, as well as Alzheimer’s and Dementia care. Carrie is an exemplar in building a legacy of care for seniors.
5:07 How Carrie found her calling to care for seniors by hearing their life stories 8:38 An administrator telling a nurse that there is not enough time for a patient that is running out of time 11:45 The importance of communication and empathic listening in the healing journey 13:00 Honoring the preferences and values of a patient defines health care quality 17:30 The importance of educating our youth on “real” life expectancy 19:13 Incorporating assisted living, independent living, and memory care into the medical school curriculum 21:33 Learning from other countries how to educate our society about aging 28:24 The influence of Dr. Bill Thomas on geriatric medicine and eldercare 27:15 Providing home care to a patient makes someone whole again, just like providing a prosthetic to an amputee 29:02 A patient that fell one mile short of receiving palliative care support due to a benefit coverage limitation 29:28 Current hospital landscape prevent physicians from being a part of their community (referencing Charles Martin) 33:21 How ACOs can improve transitions of care from hospital to PAC 35:25 Just achieving ACO Shared Savings is not the true measure of success 39:00 Senior housing and assisted living 41:40 An example of a senior housing community-saving Medicare nearly $4M (Juniper Communities’ Connect4Life) 46:40 The ever-increasing shift to ambulatory care and newly-emerging home-based care models 48:00 The growth of telemedicine and remote patient monitoring 49:23 The growth of community medicine, senior housing, and in-home care support 52:37 Ideas about getting seniors to embrace technology as a way to improve health and wellbeing 57:34 Vision for a coordinated care network (CCN) model (referencing ACLC whitepaper) 1:02:36 It’s not OK for seniors to accept being invisible. Society needs to change. We can learn from seniors, and they should walk proud. 1:06:04 The importance of the ACLC in expanding the conversation on aging
How does an organization have a banner year in 2019, start 2020 with additional momentum, and then continue to grow despite COVID-19 making them change their whole approach? Because they have something the market needs, because they are able to adapt, because they care about solving their customer’s needs – and the list goes on.
Earlier this year, Innovaccer released survey results showing that more than 45 percent of healthcare executives understand value-based care; however, most of those are still in the pilot phase of their value-based performance or risk-based transition. About 30% said all patient data is not in one place, and many organizations are not using artificial intelligence. The inadequate progress towards true democratization of data and widespread interoperability confirms we have much to do as an industry in creating a more workable approach to health value. Innovaccer is leading an important movement towards data activation and the creation of a unified, longitudinal patient record, including in part, their InCare solution: an artificial Intelligence-enabled care management platform that automates workflows and creates point-of-care alerts.
In this podcast episode, we are speaking with Dr. David Nace, Chief Medical Officer for Innovaccer. His experience as a family physician, an executive in the insurance industry, an advisor on a government task force, a chair for the Primary Care Collaborative, and a host of other experiences make Dr. Nace a perfect guest to help health care professionals understand better approaches to data. In the race to make value work, Dr. Nace and Innovaccer are showing the industry how to care as one.
05:27 Fee-for-service as the “wild west” of healthcare motivating his journey in value
09:40 Data activation required to effectively manage a patient population
12:27 The effect of the pandemic as a contributor to even more innovation
16:30 Education and workforce development needed for value-based care transformation
19:05 Transcending the vendor-customer relationship by forging collaborative partnerships
23:05 ACLC as a vehicle to expand learning through industry collaboration
26:21 Leveraging large employers to drive patient-centered, primary care empowerment
28:10 PCMH principles as building blocks of whole-person care
30:45 The birth of the ACOs as an outgrowth of the PCMH movement
36:18 Using machine learning and AI to provide insights and create efficiencies
37:24 Overcoming inertia and using COVID-19 as a source of technological innovation
40:22 The three stages of AI: real-time data insights, insight-driven action, and automation
43:55 Unified patient records allow for automated chart reviews and AI-driven clinician workflows
47:05 How the pandemic will allow us to overcome inertia in health value
49:06 Medicare Advantage as a potential scenario for payment reform
51:25 SDOH and how to understand the true drivers of patient health outcomes
54:23 Zipcodes and credit scores are the two most important data points to understand vulnerability
The Rio Grande Valley, located in the southernmost tip of Texas along the US-Mexico border, has become a new epicenter for COVID-19 over the last month. Death rates are also over five times higher than the rest of Texas because more than 60-percent of residents are diabetic or prediabetic and more than 90-percent of the population is Latino. To compound the situation, the Valley was also impacted by the landfall of Hurricane Hanna on July 25th creating mass flooding, infrastructure stress, and home displacement in the local community.
The Valley needs our prayers and support. In this bonus episode to the Race to Value podcast, Edwin Estevez provides an update on how the RGV community is dealing with this current public health crisis. If interested in helping out the Rio Grande Valley community, please contact Edwin at eestevez@rgvacollc.com. Resources to community benefits organizations provide relief to the Valley are also listed below.
http://www.foodbankrgv.com/
https://www.redcross.org/local/texas/central-and-south-texas/volunteer.html
https://www.salvationarmytexas.org/mcallen/
Physician groups are becoming the dominant type of new entrant into the ACO space and have been most successful in achieving savings to date. Many in our industry think that physician-led ACOs are at a disadvantage in comparison to hospital-led ACOs because they lack the capital and the administrative firepower to spin up a population health infrastructure. RGV ACO, one of the leading Accountable Care Organizations in the country, has proven that physician leadership is actually the key ingredient to success in health value.
Located in the southernmost tip of Texas along the US-Mexico border in the Rio Grande Valley, RGV ACO has achieved its success with some of the most insurmountable odds imaginable. In the Rio Grande Valley, more than a third of families live in poverty. Nearly half of the residents have no health insurance, and obesity, diabetes, and heart disease are widespread. This region, made infamous by Dr. Atul Gawande over a decade ago in the New Yorker article “The Cost Conundrum” was once the most expensive healthcare market in the country. In response to the problems of its local community, RGV ACO was formed and took the charge to lead a revolution in health value. Their success story shows that something truly magical can happen when physician leadership, innovation, and aligned incentives converge in a way to solve important problems in our health care system.
In this podcast episode, we are speaking with Edwin Estevez, the Chief Executive Officer of RGV ACO. Edwin is a remarkable leader in our health care industry and will share his journey in health value. Anyone interested in how leadership can transform the care outcomes in a community should listen to the story of RGV ACO. We are in a race to make health value work in our country, and RGV ACO is a true success story of how to beat the odds and transform the lives of many.
06:45 Creating a competency-based framework for value-based care 07:40 Implementation of the ACLC Accountable Care Atlas
10:00 The Success of Physician-Led ACOs
13:00 When “something magical happens in value-based care”
15:20 Community engagement with high-risk populations
18:10 Tapping into the altruism inherent in the practice of medicine
19:30 Creating “interdependence” for independent physicians
22:14 Capital requirements for startup ACOs
25:15 Creative thinking and capital support from payers
28:17 Incentivizing for physician leadership and process transformation
32:40 Overcoming the “The Cost Conundrum” by refusing to fail
35:00 Engaging the community in a culturally appropriate way
36:00 Home Health Partnerships
38:42 Addressing Racial Disparities in Care and Health Equity
43:00 Developing a Patient-Centered Diabetes Care Playbook
48:55 Partnering with local grocery stores to improve population health
54:00 Edwin shares his passion for health care and education
58:00 Workforce Development for independent practices within an ACO
1:02 Next-level risk contracts and multi-payer strategies
1:07 Direct Contracting must be “physician-led” to be successful