Physician Leadership – The Race to Value Podcast™: Recent Episodes
Institute for Advancing Health Value
Innovation and partnership are the twin engines that propel us into a new era of healthcare. The fusion of cutting-edge technology and clinical innovation, empowered by collaborative relationships, can revolutionize primary care. This cohesion of innovation and partnership makes primary care more accessible, effective, and patient-centered than ever before. There is no better example of primary care modernization than Central Ohio Primary Care (COPC), the largest physician-owned primary care group in the United States with over 480 physicians and 83 locations in central Ohio. Rooted in a long history of clinical excellence and a commitment to the highest ethical standards, COPC is building a new holistic model for primary care that gives physicians time to build relationships with their patients and one another. Through ACO REACH, full-risk delegated capitated Medicare Advantage Plans, and direct-to-employer value-based arrangements, they are able to engage their entire team in the innovation of their primary care model. Furthermore, through partnerships they are able to share risk and build a pathway to sustainability in the provision of value-based care for decades to come.
Joining us on the Race to Value this week is Donald Deep, M.D., the CEO of Central Ohio Primary Care. In this episode, we discuss the modernization of primary care that is underway at COPC – including technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up. We explore the successes of their Extensive Care Center and Comprehensive Home and Palliative Care programs. There is also in-depth discussion on low value care, the importance of payer partnerships, direct-to-employer strategies for commercial populations, accessing capital partnerships in full-risk MA, and collaborative leadership for success in VBC.
This episode is sponsored by Agilon Health, a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program.
Episode bookmarks:
01:30 Introduction to Donald Deep, M.D., the CEO of Central Ohio Primary Care (the largest physician-owned primary care group in the U.S.)
02:45 Referencing prior episode featuring Dr. Bill Wulf (“The Value Game”: Achieving Success with Capitated Risk and Patient-Centered Primary Care)
03:00 This week’s episode is brought to you by Agilon Health
04:30 COPC has directing 2,200 employees across 90 locations covering six counties and has been on a value journey since 2010.
05:30 The modernization of primary care at COPC.
06:30 Patient care coordination that includes technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up.
07:30 “We are responsible for the care of our patient population, even outside of the exam room.”
07:45 Empowering PCPs to spend more time with patients and engage patients and families in the care process.
08:00 Addressing prevention and SDOH requires a modernized primary care model.
08:45 Extensive Care Center (ECC): A Novel Approach to Reducing Emergency Department Visits and Observation Unit Utilization
10:00 The Extensive Care Center at COPC returns 95% of patients to the home (ER Avoidance) and prevents 2-3 hospital admissions each week.
11:00 Scaling the ECC model in co-location with Same Day Centers at COPC to provide immediate access for emergent primary care needs.
12:00 Addressing chronic disease in the extensive care center avoids unnecessary ER visits and hospitalizations.
13:30 Payer recognition of the ECC model, with high levels of patient satisfaction.
14:45 The Comprehensive Home and Palliative Care (CHPC) program at COPC provides primary and palliative care in the home setting.
15:30 Palliative care in ACOs have demonstrated reductions in 30-day readmissions, avoidable hospital admissions, and ED visits.
15:45 Advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.
16:30 The difference between palliative care and hospice.
17:30 Dr. Deep reflects on his experience as a hospitalist that repeatedly saw patients readmitted to the hospital due to poor symptom management.
18:00 “Palliative care is invaluable in primary care, and we must take it into the patient’s home. Poor symptom management leads to unnecessary ER visits and inpatient stays.”
20:00 The composition of the interdisciplinary team that provides comprehensive home and palliative care services.
21:30 Spending on low-value care range from $100 billion to $700 billion each year.
23:30 Identifying waste in the provision of primary care and defining clinical pathways that define value.
24:30 Patient advocacy for services provided outside of the practice in the promotion of high value care.
25:00 Demanding risk-adjusted outcomes for specialists seeing COPC patients. Providing RFPs to specialists to ensure accountability to expectations for high value care.
25:30 How PCP-led global capitation and compensation redesign incentivizes high value care.
27:00 Referencing a recent Morgan Health study that shows extreme variations in clinical quality for employer-sponsored health plans (e.g. statin medication adherence for CAD).
27:45 COPC’s partnership with JP Morgan Chase to provide onsite health clinics, health coaching, behavioral health services, and after-hours access to care.
28:30 Dr. Deep explains COPC’s advanced primary care model that is provided on a direct-to-employer basis.
29:30 Direct-to-employer care that is convenient, longitudinal, preventative, and consistent.
30:00 How partnering with Vera Whole Health expanded behavioral health services at COPC.
30:30 Providing an advanced primary care access point to large employers as a critical success strategy for VBC.
33:00 Dr. Deep discusses how the ECC model has allowed them to forge more collaborative partnerships with payers.
34:00 “Shifting of financial risk to prepayment (instead of Shared Savings) allows us to engage our entire team in the innovation of our care model.”
35:00 Assessing data to identify high-risk patients. Developing win-win payer-provider partnerships.
36:30 The history of COPC’s partnership with Agilon Health.
37:30 The COPC-Agilon partnership with COPE Health Solutions that led to the development of a primary care Advanced Practice Provider (APP) Fellowship Program.
39:00 The exciting potential of a new value-based care fellowship for APPs.
40:00 “The old way of delivering care where a physician does everything is not sustainable. Team-based care will ensure that we are sustainable decades into the future.”
41:30 How the partnership with Agilon Health enabled value-based care transformation at COPC.
42:30 Finding a VBC enablement partner that truly believes in partnership (beyond just the provision of capital).
43:30 Parting thoughts from Dr. Deep on the importance of collaboration in value transformation.
45:00 “Leaders in healthcare must ensure that both their organization and the community they serve is strong. Doing that through trusted partnerships will make a lasting impact.”
The plasticity of primary care, in the new value-based era, embodies remarkable adaptability, innovation, and responsiveness to evolving community health needs. As our understanding of health and well-being expands, primary care stands as the first line of defense, ready to transform and customize its services to address the unique challenges faced by diverse populations. This flexibility allows primary care providers to pivot swiftly, whether it’s in responding to public health crises, addressing disparities in healthcare access, or integrating innovative technologies into daily practice. In embracing this plasticity, primary care not only becomes a cornerstone of community health but also a powerful catalyst for positive change, driving us closer to the goal of a healthier, more equitable society.
In this week’s episode of the Race to Value, we are joined by R. Shawn Martin, Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians. The AAFP is the medical specialty organization representing 129,600 family physicians and medical students nationwide. Shawn Martin works with the AAFP Board of Directors on the mission, strategy and vision for the AAFP and provides representation to other organizations, including medical, public, and private sectors. He is nationally recognized for his thoughtful leadership on a range of healthcare and workforce issues. While his career portfolio has focused on numerous health care and public-policy issues, he is best known for his extensive work on the development and implementation of primary care delivery and payment models.
In this episode, we discuss such things as payment reforms in primary care, the industry impact of primary care consolidation, physician-led ACOs, the new Making Care Primary (MCP) payment model and the need for multipayer collaboration, health equity, rural healthcare transformation, physician workforce challenges, and the future implications of AI on the medical profession. With leadership from Shawn and his constituents throughout the primary care ecosystem, we are well-positioned for transformation in the race to value!
Episode bookmarks:
01:30 The plasticity of primary care and how it can evolve to meet community health needs in the new value era.
02:30 Introduction to R. Shawn Martin, the Executive Vice President and Chief Executive Officer for the American Academy of Family Physicians.
04:45 People who have access to advanced primary care tend to have better health, receive timelier diagnoses, and get more prompt treatment when it is needed.
05:30 The U.S. spends only 5-7% of its healthcare dollars on primary care — less than half of the 14% average in Western European countries.
06:00 AAFP Advocacy Priorities: Fighting for Family Medicine!
07:00 Shawn discusses the need for additional investment in primary care at a national level.
08:30 The misalignment of fee-for-service in the primary care setting.
09:00 “Appropriate investment in primary care, coupled with a prospective payment model, will transform both patient experience and care team performance.”
09:45 PCP Infrastructure Investments + Rapid Transition to Value-Based Care = Primary Care Transformation
10:45 Vertical integration of primary care can lead to higher prices and costs, including insurance premiums, without improving care quality or patient outcomes.
11:30 Site-of-service payment differentials create uneven playing field between independent practices and hospital-owned primary care.
12:00 Shawn’s congressional testimony to the Senate Finance Committee on the “Consolidation and Corporate Ownership in Health Care”
13:00 The Medicare program created siloed benefits between hospitals and physicians, and these design flaws created incongruencies in system economics and patient health outcomes.
14:30 The inability of independent physician practices to survive on the regulatory framework of the modern healthcare system.
15:30 Community-based primary care innovation empowered by partnerships.
16:30 The explosion of IPAs and clinically integrated networks and how these models are applied to population health management.
17:00 Data sharing and interoperability empowering chronic care management and transitional care pathways.
17:30 The trend of provider consolidation within “payvider” platforms offered by major payers (e.g. Optum, Centerwell).
17:45 Wall Street interest in primary care that led to additional capital infusion in the absence of public payer support.
18:30 “Private equity investment has created a necessary lifeline of capital for primary care to survive the onramp of value-based care.”
19:00 “It is difficult to focus on primary care transformation when you are seeing 30-35 patients a day, 6 days a week, for 48-49 weeks out of the year.”
19:30 How investments in primary care created the physician mindshare needed to transform their practices.
20:45 On average, physician-led ACOs produce almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACOs.
22:45 Shawn discusses how the autonomy of physician-led ACOs leads to them having better Shared Savings results than their hospital counterparts.
23:00 “The empowerment of PCPs with the autonomy to be patient-centered at the point-of-care has shown what is possible with value-based care.”
24:00 “The challenging occupancy-dependent model of hospitals is not insurmountable if you create collaborative, community-based physician networks.”
24:45 Overcoming the toxicity of fee-for-service in primary care.
25:00 “Primary care is built upon the foundation of a trusting, longitudinal relationship between a patient, their caregivers, and the primary care team.”
25:45 Leveraging virtual care and telemedicine to enhance relationships in the primary care setting.
26:00 “The combination of primary care autonomy with risk-based payment models will help us overcome the toxicity of fee-for-service.”
26:30 The new state-based multi-payer model from CMMI, “Making Care Primary” (MCP), supporting primary care practices in the transition to prospective value-based payment.
27:00 Recent AAFP Press Release: “Primary Care-focused APM Checks AAFP Advocacy Boxes”
27:30 Shawn discusses how the multipayer MCP model construct (Medicare/Medicaid) will serve to eventually bring value to primary care at scale.
29:30 The rationale behind making MCP a 10-year transformation project (instead of a 3-4 year evaluation cycle).
30:00 The imperative for CMMI to transition providers to more sophisticated payment models with downside risk over time.
31:00 Referencing Shawn’s recent article: “How Moneyball can teach us to invest in primary care”
32:00 A recent AAFP member survey that indicated while 85% of surveyed physicians believe social needs are directly related to poor health, 80% are not confident in their ability to address their patients’ social needs.
33:00 Inspiration from Michael Lewis regarding the applicability of Moneyball in healthcare transformation.
34:00 “The single best investment to improve health equity in our system is primary care. It is a main street discipline of care in our communities that is not confined to a building.”
34:30 The plasticity of primary care to meet community health needs and why equity must start with empowered, community-based PCPs.
35:00 The AAFP formed the Center for Diversity and Health Equity to address social determinants of health with The EveryONE Project.
35:30 “You cannot even begin to change the trajectory of health inequities in our health system without primary care.”
36:00 Meeting the workforce goals having access to primary care in every community.
37:00 Mortality rates are 23% higher for people living in rural communities than those who live in urban communities.
38:00 “The movement to prospective, capitated payment models is nowhere more important than in rural communities.”
38:45 How trusting relationships and localized interventions drive patient engagement in rural communities.
39:00 Shawn shares the lessons learned from his father who was a primary care physician in a rural area.
40:00 The relationship between the physician workforce and critical access hospitals and the opportunity to reinvent the rural healthcare ecosystem.
41:30 Physicians have higher levels of satisfaction when practicing in a value-based environment.
42:30 U.S. health is threatened by a primary care workforce shortage, and the country will need up to 48,000 more primary care physicians by 2034.
43:00 Shawn shares his perspective on the physician workforce and the how the AAFP is working to ensure that we have an adequate physician workforce in the decades to come.
45:00 The “infatuation of specialization” that favors procedural intensity.
46:30 The multi-faceted roles of primary care are not fully understood in medical schools.
47:30 How specialty economics contribute to the shortage of primary care.
49:00 The transformative potential of AI in family medicine.
49:45 AAFP recently adopted a policy on the “Ethical Application of Artificial Intelligence in Family Medicine.”
50:30 The need for transparency in the development and implementation of AI in healthcare.
51:30 How AI can be used to reduce administrative burden in primary care practices (e.g. documentation, prior authorizations, utilization management, chart reviews)
52:00 Using AI to decompress the knowledge management of specialization in medicine in order to support more comprehensive primary care.
53:00 The future of AI-enabled, comprehensive primary care.
53:00 Empowering patients with AI through lifestyle-based knowledge transfer and improvement of health literacy.
55:45 Parting thoughts of optimism on the future of primary care and how the value movement will drive us to improved population health.
58:00 The presence of primary care increases life expectancy.
59:00 Stay connected with Shawn on social media and find out more about the work of the AAFP.
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.”
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.
The Quadruple Aim of physician satisfaction is such an important aspect of value-based care. In the predominant world of fee-for-service reimbursement, physicians are struggling and burned out. Consequently, over half of all doctors won’t even recommend medicine as a career. This negative shift in wellbeing is important to understand because the attitudes and feelings of doctors bear directly on the way they treat patients. A recent Harvard report calls physician burnout “a public health crisis that urgently demands action.” Some physicians are even going as far as to say the profession is dealing with moral injury because the word “burnout” is insulting and insufficient in describing the pain they feel when the fee-for-service system prevents doctors from doing what’s right, thereby forcing them to inflict harm on patients – where physicians themselves experience a form of injury.
The business of fee-for-service medicine continues to get in the way of physicians healing patients. It breaks the spirit and the heart of our physician workforce, and it is imperative that physicians become empowered to lead a system transformation. Value-based care will be a losing effort if we do now cultivate physician wellbeing in the value journey.
In this podcast, you will hear from three physician thought leaders about the plight of physician burnout and its impact in advancing the aims of the value-based care movement. Most importantly, you will learn the tools necessary to transform organizational culture to ameliorate this important workforce challenge.
Speakers:
– Dike Drummond, M.D., CEO, Physician Coach & Speaker, TheHappyMD.com
– Moshe Cohn, M.D., Associate and Advisor, Moral Injury of Healthcare
– Amadeo Cabral, M.D., President, Turning Point Healthcare Consultants
Sponsored by: VBCExhibitHall.com (VBCEH)
Episode Bookmarks:
01:30 The differentiation between physician burnout and moral injury.
02:15 “Physicians need to heal in order to provide their best care for patients.”
03:00 Moral injury is a symptom of something larger – our broken health care system.
04:00 Introduction to Drs. Drummond, Cohn, and Cabral
05:45 Physician burnout and moral injury is a leadership failure.
06:30 Dr. Drummond provides context for why the physician workforce is suffering.
07:30 “The business of fee-for-service medicine gets in the way of physicians healing patients. It breaks our spirit and breaks our heart.”
07:45 “Burnout is a symptom of overwhelm in a physician that cares about what they do, when their purest expression of healer, helper, and light worker is blocked.”
08:15 Burnout is a physician impairment when it comes to ensuring quality and patient satisfaction.
08:45 Dr. Cohn explains the concept of why “language really matters” in communicating the public health crisis of physician burnout.
10:00 How physician moral injury is related to a clinical diagnosis of PTSD.
11:00 The leadership need for healthcare executives to address the repeated moral injury of their physician workforce.
12:30 How physician burnout differs from burnout we observe in other facets of the non-healthcare workforce.
13:15 The repeated barriers imposed by a system that prevents physicians in getting patients what they need to get better.
14:00 Dr. Cabral explains how the “slow boiling” public health emergency of physician burnout differs from more explosive public health emergencies like COVID-19.
15:00 Referencing confirmatory research (e.g. New York Times, Advisory Board) on the incongruence between the business of medicine and relationship-based care.
15:30 “Healthcare is not a broken “business” model — it is a broken “health care” model. It is imperative that physicians are at the table to lead a transformation.”
16:00 How do we get the incentives of business and medicine to merge into a congruent state?
17:30 The “canary in the coalmine” – physician suicides are signaling that something is wrong with the overall healthcare system.
18:00 An interesting dialogue about how Don Berwick posed an expansion to the Quadruple Aim as an apology for the Triple Aim.
19:00 Dr. Cabral on how true Value-Based Care (a wellness model) is a solution for physician wellbeing which can sometimes differ from the business model of VBC.
20:30 Dr. Cohn discusses the need a better definition for “Value” and why the Triple Aim does a disservice to the industry when the overall cost model is broken.
22:30 “As a physician, the only thing we really care about is patient outcomes. However, our outcomes are now mostly centered on checking boxes.”
24:20 Dr. Drummond reflects on the need for physicians to carve out a more rewarding practice in the reality of their business model.
24:45 Does capitation actually produce a healthier physician workplace with better patient outcomes?
26:30 The need for non-physician administrators to respect the healing encounter. (How many leaders regularly shadow their doctors?)
28:30 Dr. Cohn reflects on how investment levels prioritize societal importance (in relation to pediatrician compensation, mental health, education)
29:30 Dr. Cabral on how other countries are able to better align the incentives of their health care systems.
30:30 The physician burden of meeting end-of-life treatment expectations with heroic interventions that are costly (profitable) and result in poor quality of life.
31:45 The “classically American” problem of patients seeking low value care at end of life. (How does this factor into value-based care?)
32:45 “Eighty-percent of the hospital beds in our country are unnecessary if we granted our society the ability to determine what is a reasonable and unreasonable investment in quality of life.”
33:00 Dr. Cohn compares the current healthcare delivery system to a “fast food” model influenced by big money and advertising.
34:00 Advancements in technology and innovation in healthcare does not mean that we can fix everything that is wrong with patients.
36:15 Dr. Cabral discusses how patient satisfaction scores are being weaponized against providers.
37:30 The need for quality measures to translate into quality outcomes. (The misalignment leads to “check the box” medicine and weaponization against physicians.)
39:30 Dr. Cohn tells the painful story of a pediatric patient with a terminal brain bleed that led him to the realization of how administrators value documentation over human emotion.
41:30 Dr. Drummond explains how patient satisfaction should never be 100% (unless you are a criminal!)
42:00 “A true value journey requires a culture of provider support and a proactive burnout prevention strategy.”
42:30 The need for a super-majority value-based revenue tipping point in a contracting portfolio to bring about true cultural change.
43:45 Dr. Cabral on how the $4T American healthcare system spends 30% on administration (compared to 9-10% in other countries).
44:15 Healthcare Job Growth since 1970’s: 200% for providers and 3500% for non-clinical providers!
46:00 Drs. Cabral and Cohn speak about the monolithic structure of medical education that is over 100 years old and why that is a barrier to team-based care.
48:30 Dr. Drummond on how there are no leadership classes in medical school or residency (leadership is instead learned once practicing in a broken industry).
50:00 Dr. Drummond references Team Care Medicine, Dr. Jim Jerzak, and Dr. Corey Lyon as leading exemplars in team-based care models.
51:00 Dr. Cabral on how physicians “crossing the schism” into leadership often imposes unrealistic meeting expectations (unless the practice of medicine is completely abandoned).
52:45 Dr. Cohn on how healthcare leaders takes physicians for granted (referencing “The Daily Exploitation of Medical Staff” by Danielle Ofri)
54:00 Dr. Drummond – Should I go the extra mile for a patient if the organization gets in my way and it is unhealthy for me and my family?
55:30 Parting thoughts from our guests on implementing strategies to cultivate physician wellness.
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