Clinical Integration – The Race to Value Podcast™: Recent Episodes
Institute for Advancing Health Value
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.
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.”
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 ...
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, ...
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 ...
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.
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.
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.
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.
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.
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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, ...
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 ...