Workforce – The Race to Value Podcast™: Recent Episodes
Institute for Advancing Health Value
A new era in value-based care is emerging where employers are no longer sleeping giants willing to tolerate a broken fee-for-service healthcare system. ‘Poor health’ costs employers $575B in lost productivity on top of the $880B they already spend in premium dollars annually. Employers (and their employees) continued to get fleeced by unsustainable double-digit premium increases every year, with hospitals using that excess spend in commercial insurance to their subsidize losses on the public pay side. The paradigm shift to value-based purchasing is underway in employer-based health insurance; however, it will not achieve the aims of population health unless a similar transformation occurs in workforce wellbeing. Joining us this week in the Race to Value is Dr. Richard Safeer, the Chief Medical Director of Employee Health and Well-being at Johns Hopkins Medicine, where he leads the Healthy at Hopkins employee health and well-being strategy. Dr. Safeer is a highly influential thought leader on building a culture of health and is the author of the groundbreaking new book, “A Cure for the Common Company: A Well-Being Prescription for a Hopper, Healthier, and More Resilient Workforce.” In this interview you will hear from one of the leading experts on employee health in our country about what it takes to cultivate a healthy workforce.Episode Bookmarks:01:30 Introduction to Richard Safeer, M.D. and “A Cure for the Common Company”04:45 Developing a holistic view where we look at individuals as both patients and employees.05:15 “Until we integrate a strategy that includes the workplace, we are not likely to optimize population health.”06:00 The economic and cultural imperatives for workforce well-being.06:30 A key factor in achieving health goals is the support of people you are closest to at home and at work.07:45 Connecting the spectrum of employee health from well-being to chronic disease.08:30 Why have attempts at corporate wellness failed so often in the past?09:30 “Our health and well-being are greatly influenced by the relationships we have in the workplace.”10:00 Most employers do not fully leverage the social sciences to optimize the support of their workforce.10:45 Innovative self-funded health insurance as a requisite component of a corporate wellness strategy.12:30 How a company benefits from a healthy workforce.13:45 Innovations to create access to high quality primary care and lifestyle medicine (e.g. Direct Primary Care and onsite clinics).17:00 Employers must fully leverage all resources (e.g. data from health insurers, EAPs, collaboration with local health systems).18:30 The 6 Building Blocks of a Wellbeing Culture.20:45 Making it easier for employees to make healthy choices.21:30 The influence of social climate in the workplace.22:30 The plight of healthcare workforce burnout and moral injury.23:45 We need supportive work environments to produce good health (not paternalism).25:00 “Employers who demonstrate genuine care and back it up with genuine resources to support health and well-being will be the ones to attract and retain talent.”25:30 Resiliency does not rest solely on the individual!26:00 Employees cannot maintain mental health if their work doesn’t align with education and skill set.27:00 Social connections to team and trust in management improves resiliency.29:00 70-80% of employees are willing to take a pay cut to get a job that better supports their mental health (see UKG study)30:00 Balancing the need for social connection with remote work.31:30 Referencing the new book, “Culture Shock: An Unstoppable Force is Changing How We Work and Live.”32:00 One-size fits all decisions about onsite work doesn’t make sense for all employees.33:30 Cisco Systems as an exemplar of a workplace culture for health and well-being.36:00 The role of technology in health is superseded in importance by the workplace, home, and community settings.37:00 How technology can be leveraged to foster community, communication, tracking, and data collection.38:00 The over-reliance of biometrics.39:00 Lifestyle Medicine as a foundation to a culture of wellness.40:00 How LM at Johns Hopkins has been successful in improving employee health.43:00 New Year’s Resolutions – advice from Dr. Safeer how to achieve success by using the workplace.45:30 Connect with Dr. Safeer and learn more about his thought leadership.
Crossing the Value-Based Healthcare Rubicon isn’t just a journey, it’s a revolution in care, where the currency is quality, and the compass is compassion. This transformation is both an economic ...
This week is National Nurses Week, and it is a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world. As workers who perform the most essential healthcare tasks, nurses serve as the first point of contact for most patients…and they save lives and restore health in the process. Yet, nursing is often a thankless profession that is underappreciated and experiences high levels of burnout and moral injury. There are a multitude of factors related to societal attitudes towards the nursing profession, and many of them result in a lack of recognition and support, inadequate compensation, limited opportunities for career advancement, and ultimately a lack of respect and appreciation for the work they do. We must begin to think about how to better position the profession to take a leading role in healthcare innovation. Nurses must become more empowered as we transition to a future of value-based care.
This week on the podcast, we are honored to be interviewing Rebecca Love. She is an experienced nurse executive, the first nurse featured on Ted.com, and part of the first nurse panel at South by Southwest. Rebecca is a regular contributor on the Forbes Business Council, and has been featured in BBC, Fortune, Becker’s, Forbes, Chief Healthcare Executive Magazine and ABC news. Rebecca, was the first Director of Nurse Innovation & Entrepreneurship in the United States at Northeastern School of Nursing – the founding initiative in the Country designed to empower nurses as innovators and entrepreneurs, where she founded the Nurse Hackathon, the movement has led to transformational change in the Nursing Profession. In early 2019, Rebecca, along with a group of leading nurses in the world, founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders, a non-profit that quickly attained recognition by the United Nations as an Affiliate Member to the UN. Rebecca is a world renowned Nurse Entrepreneur and currently serves as the Chief Clinical Officer of IntelyCare.
Click here to learn moreEpisode Bookmarks:
01:30 National Nurses Week – a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world.
02:00 We must better position the nursing profession to take a leading role in healthcare innovation. Nurses must become more empowered as we transition to a future of value-based care.
02:30 Introduction to Rebecca Love – a nationally-recognized nurse executive and entrepreneur, the first nurse featured on TED.com, and part of the first nurse panel at SXSW.
03:00 Rebecca founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders and currently serves as the Chief Clinical Officer of IntelyCare.
04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:30 How do we better position the nursing profession in the value-based care movement?
06:30 “There is going to be no healthcare in the future without nurses leading value-based care.”
07:00 How tracking VBC outcomes by Provider NPI # is a challenge since nurses do not have assigned NPI #’s.
07:45 Nursing costs were rolled into room rates in the 1930’s with the establishment of modern-day insurance models. This occurred due to a male physician-dominated environment.
08:30 Nurses are the only clinical professional in the healthcare environment without a NPI for billing or tracking outcomes!
08:45 “Value-based care cannot fully be amplified or adopted until we address the lack of a NPI number with nurses.”
09:30 The infuriating pay inequity between executives and nurses. (Nonprofit hospital CEOs make on average 10X the rate of nurses!)
10:00 Should we align compensation to both executives and clinicians tied to patient outcomes?
10:45 North Carolina’s seven largest hospital systems reaped billions of dollars in profit from COVID Relief Funding but couldn’t afford to pay nurses! (Read more hereand here)
12:00 CEO pay doubled over five years in North Carolina, but nursing pay there only increased 12-14% over the last decade!
13:00 The national increase in nurses pay over the last decade was 1.6% per year(less than the increase in cost of living).
13:45 The UK Nurses Strike – the largest labor protest in the history of the nursing profession.
14:00 How the cost allocation methodology for nursing will cause continued exacerbation of the nursing working shortage in the U.S.
14:45 “We have to find a way to unpack nursing overhead from the room rate to make sure our healthcare system stays operational and can support our communities.”
15:30 Inspiration from President John F. Kennedy about recognizing the opportunity in a crisis.
16:00 There is a shortage of 450,000 nurses in the US today, and it is projected that over 1 million registered nurses in the U.S. will leave the workforce by 2030.
16:45 70% of new nursing graduates have left the bedside since last year!
18:00 Rebecca speaks about the compassion and empathy of nurses and how they are suffering due to burnout and moral injury.
19:30 How the healthcare industry treats nurses like an “endless commodity” and does little to address their burnout.
20:00 What if we invested only a quarter of what we spend in healthcare technology on nurses?
20:30 “Nurses have been degraded and relegated to the lowest rung of healthcare delivery today. If we want VBC to be successful, we must stabilize the nursing workforce.”
21:00 “Value-based care will certainly not survive without the nursing workforce at the heart and the center.”
22:00 93% of nurses are experiencing staffing shortages in their hospitals, which is a significant increase from 59% in a 2020 survey.
23:00 Last year over 90,000 qualified nursing applicants to nursing school were turned away due to lack of space!
24:00 We have more nurses today than any other time in American history, but we have a critical shortage because they are unwilling to work in the current healthcare environment.
24:30 The highly controversial RaDonda Vaught Homicide Case where a nurse was found criminally negligent for a self-reported medical error.
26:00 1 in 3 bedside nurses have left the profession since the RaDonda Vaught case!
26:30 Nurses and CNAs being criminally prosecuted for errors in long-term care delivery when not a single owner is held responsible for the unsafe care environment!
27:00 Rebecca speaks about the role of Higher Education in building bridge pathways and ensuring diversity to support the nursing workforce shortage.
30:30 Workforce challenges are now the #1 issue on the mind of hospital CEOs (ACHE Survey)
31:00 Hospitals have turned to travel nurses to ease staffing shortages during the pandemic, contract labor expenses have risen more than 250% over the past three years!
31:30 Annual burnout-related turnover costs are $9 billion for nurses!
32:30 Rebecca speaks about the need to enable more nurses to serve in senior leadership roles and as governing fiduciaries on hospitals boards to redesign care delivery.
33:30 “Innovation is opposite of the definition of insanity.”
34:00 How hackathons can be utilized in the empowerment of a nurse-led innovation movement.
35:30 Investing in technology to improve nurse staffing (e.g. improving float pool and per diem services).
35:45 80% of women nurses do not return full-time after they have a baby! (Could tech solutions provide staffing flexibility to empower nurses to continue working?)
37:00 “Reverse pitch events” – honing frontline innovation to address adverse events in the healthcare setting.
37:45 Applying the UI/UX methodology to the healthcare end user in order to improve care delivery at scale.
40:30 The lack of nursing input when health systems role out new technologies (and how these tech decisions often end up creating more work and administrative complexity).
42:30 The importance of the Chief Nurse Health Informatics Officer.
43:45 The role technology can play in Patient Safety.
46:00 The work of Healing Politics in getting nurses more involved in the political arena to reshape healthcare.
47:00 The lack of business education in nursing programs.
48:00 The need for more nurses holding political positions and why more nursing input is needed in health policy. (Betty Rambur is currently the only nurse on MedPAC.)
49:00 Nurse-led innovation happens when nurses are trying to save lives!
50:00 How the COVID-19 pandemic depended on nurse-led innovation.
51:30 “Why are we not trusting in nurses now – to hear them and trust them – so we can build the system needed to sustain workforce, sustain healthcare, and sustain our communities?”
52:00 How Florence Nightingale forever fundamentally changed the future of science, history, and medicine with the establishment of the nursing profession.
54:30 Rebecca discusses how attending a healthcare hackathon changed her life and led to a career path in nursing innovation!
60:00 What the hackathon taught Rebecca about the importance of the nurses voice and how they can save healthcare.
62:30 Parting thoughts from Rebecca and the life lesson learned from surviving a shipwreck at sea. (Bet on yourself and believe you can overcome adversity!)
64:00 “Were there none who were discontented with what they have, the world would never reach anything better.” – Florence Nightingale
65:00 2030: Florence Nightingale’s prediction of a future nursing renaissance.
Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward.
This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare’s Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence.
In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey. He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He’s responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care.
Episode Bookmarks:
01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare’s Path Forward”
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability
05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory
06:00 Optimism for healthcare because how bad things really are!
07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change.
08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.”
09:00 “Healthcare is not working for anyone. That is where real change can happen and what makes me optimistic.”
09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters.
11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once?
12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient. There are many other things that have to happen.”
12:30 Michael Porter’s Value Chain and the importance of clarity and differentiation in the creation of value.
13:30 “Payment reform is just one activity of healthcare reform. We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.”
15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture.
16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change.
17:30 No one can do everything! If leaders focus on only three things, they will be successful in strategy execution.
18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain
18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson
20:30 3 Functions of Managers: Create Social Capital, Bring High Reliability Principles to Life, Eliminate Waste of all Types
21:30 “Social capital is more important than financial capital in the times in which we live.”
22:00 Applying High Reliability to all the dimensions (including patient experience) and refusing to tolerate failure in matters of trust.
23:45 “Culture of No Waste” – includes both time and resources
24:30 3 Functions of Frontline Caregivers: Create a Culture of Respect, Be Full Participants on Great Teams, View Job as Shaping the Memories of Patients and Families
25:30 The healthcare workforce often feels that they are part of a organization that does not respect them.
26:30 “Treating people with respect should be treated in the same way that the industry tackled hand hygiene to improve patient safety.”
27:45 Referencing the TED Talk from Daniel Kahneman: “The Riddle of Experience vs. Memory”
29:00 Frontline caregivers are like Steven Spielberg, i.e. they are the producers and directors of the patient memories.
32:00 “We live in a time where trust is under attack in society. You can’t take trust for granted in healthcare.”
33:00 Trust goes beyond the clinician encounter – it encompasses the whole episode of care, including the web presence of the provider before the visit.
35:30 The importance of 5-Star Ratings online in building trust.
36:30 “Patients are unnerved from friction, chaos, and any indication that they may not be safe. The pandemic has really heightened their fears.”
38:00 Dr. Lee discusses how Press Ganey has begun surveying patients on their perceptions of patient safety.
39:45 High-reliability and the Anna Karenina Principle (“Happy families are all alike; every unhappy family is unhappy in their own way.”)
41:45 In 2021, the Press Ganey Employee Engagement Indicator declined in every single job category!
43:00 Dr. Lee discusses how building trust with workers coincides with the actions taken to build trust with patients.
44:30 Personal Pride: Pride in the organization, Pride in what you do for the organization, Pride in what your team does.
45:30 Personal Alignment: Aligning with the cultural beliefs of employees and the need for inclusion. (Lack of DEI creates a 4X greater risk of employee turnover.)
46:00 Personal Resilience: Activation (employee motivation) and Decompression (ability of employees to forget about work when at home).
47:30 Activation is increasing in healthcare, but decompression continues to go down!
50:00 Dr. Lee explains how the pandemic and social unrest has created a deeper understanding of human suffering and how systems create harm.
50:30 Understanding Patient Safety beyond Physical Harm by also considering Emotional Harm (e.g. not feeling safe or financial distress due to healthcare)
51:30 The nuance of perception in Patient Safety (an example of how patients didn’t feel safe when a change when a hospital starting using odorless disinfectant).
53:00 Lack of respect as a safety issue.
53:00 The murder of George Floyd prompting an examination of the impact of inequality throughout society.
54:00 Diversity, Equity, and Inclusion in healthcare as a form of social capital and the pursuit of zero inequity.
55:00 The importance of DEI in health equity is now understood at a deeper level by healthcare leaders following the murder of George Floyd.
56:00 “Zero Inequity should be our goal just like Zero Harm is our patient safety goal.”
56:45 The data from safety net hospitals showing continued challenges in assessing pain with African American patients.
58:00 How organizational mistreatment of patients creates mistreatment of workers (and why lack of patient-centeredness is main reason for employee turnover).
61:00 Dr. Lee touts the virtues of healthcare and why it is such a great industry to work in.
62:00 New Skills for the Era Ahead: Strategy (Porter’s Value Chain), Social Capital (Teamwork, Leadership), Growth Mindset (read Grit: The Power of Passion and Perseverance!)
64:00 The potential to do great work in medicine and making a difference in the lives of others.
64:30 “This is the best time to be going into healthcare. You can really make a difference in a noble field.”
65:00 How to reach out to Dr. Lee and learn more about his work in healthcare transformation.
The healthcare industry is facing immense financial pressure. Staffing shortages, skyrocketing labor costs, continuing supply chain disruptions, inflation, rising interest rates, and volatile markets are pressuring both revenue and expenses for provider organizations. These economic challenges, however, are an opportunity to catalyze value-based care. The promise of value in health can lift up communities through improved clinical outcomes, reduced disparities, financial rewards associated with population health, and emerging opportunities for upskilling the workforce. Now is the time to prioritize value-based care as a key strategic priority for long-term success and sustainability. There are few other health systems in the country that have demonstrated more of a longstanding commitment to transformation than Ochsner Health through its population health enterprise.
A leader in innovative healthcare delivery, Ochsner Health Network (OHN) is the accountable care network of the massive Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana (and one of the largest health systems in the Southeastern region of the US). Ochsner has 47 hospitals and more than 370 health and urgent care centers across Louisiana, Mississippi, Alabama, and the Gulf South. Ochsner Health Network – the value-based care arm of the health system –has 277 affiliated physician practices with nearly 3,500+ physicians spanning 625 locations. They are responsible for managing 406,000 lives across six risk-based, accountable care contracts in their value-based care portfolio. Through its collaborative efforts, OHN is making a difference for the nearly 1 million patients throughout Gulf South communities each year.
In this week’s episode of the Race to Value, we are engaging two incredible leaders from Ochsner Health Network (OHN). As Chief Executive Officer for OHN, Eric Gallagher is responsible for directing network and population health strategy and operations, including oversight of value-based performance management operations, population health services and care management programs, post-acute and home care strategies, value-based analytics, and OHN network development and administration. Joining him is Dr. Sidney “Beau” Raymond, the Chief Medical Officer for OHN who is board-certified by the American Board of Internal Medicine and has been on staff at Ochsner since 2016 and practicing medicine since 2000. These two leaders discuss what it takes to transform a health system in the “race to value” and how to ultimately improve the health for an entire state in the process!
Episode Bookmarks:
01:30 Ochsner Health Network (OHN) is the value-based care arm of the Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana.
02:30 Through its collaborative efforts with patients, communities and employers, OHN is caring for nearly 1 million patients in Gulf South communities.
04:00 Introduction to Eric Gallagher (CEO, OHN) and Dr. Sidney “Beau”Raymond (Chief Medical Officer, OHN)
05:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!
06:00 A recent Kaufman Hall report on the mounting pressures facing providers (e.g. staffing shortages, labor costs, supply chain disruptions, inflation, rising interest rates, volatile markets).
07:30 Eric Gallagher discusses the critical challenges of staffing shortages and the skyrocketing cost of labor.
08:30 “Staffing shortages and rising costs of labor is a critical challenge. It serves as a catalyzing environment for value-based care.”
09:30 Investments in value-based infrastructure has forged collaborative relationships within the entire system.
11:00 Dr. Raymond on how post-pandemic workforce pressures have impacted primary care access and care delivery innovation.
13:00 The number of Americans ages 65 and older is expected to more than double over the next 40 years.
14:00 Approximately 10,000 Americans are aging into Medicare each day.
15:00 The Ochsner value journey in caring for seniors — from global capitation risk in Medicare Advantage to the Ochsner Accountable Care Network (OACN) ACO.
15:30 OCN/OACN have saved CMS over $100 million in the last 5 years! (recent press release on OACN Shared Savings Results)
16:30 Ochsner Health Plan – the only Medicare Advantage plan sponsored by and fully integrated with Ochsner Health.
17:30 Oschsner 65 Plus – a new initiative consisting of freestanding, PCP value-focused clinics delivering high touch, team-based primary care for seniors.
20:00 In the last three years, OACN MSSP ACO has doubled in size to 63,000 attributed beneficiaries.
21:30 How Ochsner has improved quality results performance in the ACO and is scaling it through continued growth.
23:00 The importance of value-focused leadership in building infrastructure and culture to drive performance outcomes.
23:45 “You can’t undervalue the importance of having the talent, leadership-buy-in, and investment to drive value-based outcomes.”
26:00 How senior-level engagement and alignment creates an environment for care delivery innovation.
27:45 The elevation of value-based care to one of four pillars of success for Ochsner Health.
28:00 Hardwiring VBC success into the compensation model for both system executives and physicians in the Ochsner Health enterprise.
28:30 How primary care engagement has led to next-level partnerships with specialists in the network.
30:00 How compensation plans and bonus incentives have driven provider engagement in value-based performance.
33:00 Ochsner’s partnership with Walmart to provide integrated, coordinated, high value care for employees across Louisiana.
34:30 The importance of employer-provider partnerships in improving the health and wellness of a workforce.
35:30 Sharing of financial-risk with self-funded employer-sponsored health plans.
37:00 Negotiating PMPM prospective payment with employers for a care management team model that improves clinical outcomes.
40:00 How Ochsner has been very intentional in building a population health data infrastructure to support its partner physicians.
41:00 Using claims groupers and population-based analytics to evaluate the totality of care spend for specific patient populations.
41:45 Collaborating with partner hospitals and community physicians to democratize population health data analytics at the point-of-care.
43:00 “HIT infrastructure capability and democratization of data at the point-of-care are the dual challenges in reaching greater depths of analytical precision.”
43:45 Ochsner’s patient population: 14-percent have diabetes and 40-percent have hypertension.
44:00 Improving outcomes for patients through enrollment in the Ochsner Digital Medicine program.
46:30 The use of algorithms for personalized care interventions to better engage chronically ill patients.
47:00 Overcoming physician concerns that the use of digital medicine is competitive to in-person E&M encounters.
47:30 The digital medicine program has improved outcomes (e.g. screenings, care gap closures, patient engagement) without diminishing office-based RVUs.
48:30 Piloting digital medicine for Medicaid populations and how that has increased care access and engagement.
50:00 Digital Health as a core component of Ochsner Health’s strategy (along with value-based payment).
51:00 The role of innovationOchsner (iO) as an important think tank and lab for digital health innovation.
52:00 Piloting the Ochsner Connected Stability Fall Prevention digital health program for MA members who are the highest risk of falls.
56:30 How the Ochsner population health enterprise delivers integrated behavioral health in the primary care setting.
58:00 Virtual behavioral health integration as the next big opportunity for care delivery innovation.
59:00 The Office of Professional Well-Being at Ochsner that has been established to improve the well-being of the workforce.
60:00 The growing concern of burnout and moral injury with physicians, APPs, and other clinicians.
61:30 A conscious effort to minimize inbox messaging for providers as a way to eliminate administrative burdens that contribute to provider burnout.
62:30 Integration of pharmacists in primary care setting to help manage prescription refills.
63:30 Team-based care (e.g. social workers, nurses, care coordinators, dieticians, patient engagement specialists) as an opportunity to improve overall workforce outcomes.
66:30 Partnering with Higher Education for interprofessional upskilling opportunities (e.g. Delgado Community College partnership in training nurses and CHWs).
69:00 The Healthy State by 2030 initiative as a catalyst to improve health equity in marginalized and underserved communities in Louisiana.
71:00 Community partnerships that recognize the impact of education as an opportunity equalizer.
74:00 Parting comments on the importance of health equity as a societal priority that is a shared responsibility in communities.
The 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.
Equitable and accessible care must ensure appropriate and optimal use of medications since nearly 70 percent of clinician visits involve drug therapies. However, each year there are an estimated 275,000 deaths and $528.4 billion wasted in the US due to suboptimal medication use through inaccurate prescribing, medication errors, adverse drug reactions, skipped doses, or treatment failures.
Given that most therapeutic options for the treatment of illness involve pharmaceutical interventions, we must find a way to maximize medication benefits and mitigate harm. That promise for a more patient-centered approach to optimize medication use can be found through Comprehensive Medication Management (CMM). The GTMRx Institute defines CMM as: “The standard of care that ensures each patient’s medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.”
Joining us this week on Race to Value are three amazing thought leaders who recently wrote a Health Affairs article on how CMM should be integrated within value-based care delivery:
- Katie Capps, is co-founder, executive director and board member of the Washington-based Get the Medications Right Institute (GTMRx) and founder and president of Health2 Resources, a national health care project management and consulting firm practicing in the Washington area for nearly 23 years. At GTMRx, Capps collaborates with fellow board members to develop and execute the Institute’s strategy, bringing together critical stakeholders to focus on appropriate use of medications and gene therapies.
- Michael Barr, MD, MBA, MACP, FRCP – Dr. Michael Barr is a mission-driven physician executive with 35+ years of clinical and leadership experience is founder and president of MEDIS, a health care consulting company which provides customized, client-driven services and support for health care organizations and the dedicated professionals who deliver care to people. In addition, he is the executive physician advisor at GTMRx.
- M. Shawn McFarland, Pharm.D., FCCP, BCACP — Dr. McFarland is the National Program Manager VA Clinical Pharmacy at Veterans Health Administration in Washington D.C. In the past, Dr. McFarland was responsible for the direction of clinical pharmacy services within the Tennessee Valley Health Care System.
In this episode, we discuss the role of CMM in value-based care, the importance of interprofessional collaboration, CMM implementation strategies, CMM use cases, HIT infrastructure requirements, pharmacoequity, and value-based payment reforms needed for CMM adoption growth and sustainability.
Episode Bookmarks:
01:30 Nearly 70 percent of clinician visits involve drug therapies; however, there are an estimated 275,000 deaths and $528.4 billion wasted due to suboptimal medication use.
04:00 Introduction to Dr. Michael Barr, M. Shawn McFarland, Pharm D., and Katie Capps (and their recent Health Article on CMM and VBC)
07:00 Katie defines Comprehensive Medication Management (CMM).
07:45 Dr. Barr further explains that CMM helps provide “better care for people” and the work GTMRx Institute is doing to bring much-needed attention to it.
09:00 Katie outlines the multitude of problems in care delivery associated with the inappropriate use of medications (e.g. polypharmacy issues, adverse events, high costs)
10:00 The important role of a clinical pharmacist working in close collaboration with physicians.
10:30 Shawn discusses the success of CMM in the Veterans Affairs system.
13:45 Shawn describes the confusion about the role of the pharmacist and how CMM can expand the profession.
15:00 The role of the pharmacist in interprofessional, team-based care and how CMM relates to winning teams in football.
16:45 “When we integrate a pharmacist on a care team to provide CMM, we provide the utmost benefit to patients and can win together by improving outcomes.”
17:30 CMM services have an estimated 12:1 return on investment when used for patients with chronic conditions. (Referencing Fairview Case Study)
18:45 Dr. Barr describes his prior experiences with team-based care with a clinical pharmacist.
20:00 Katie describes how a winning strategy for interprofessional, team-based care is to appropriately define roles.
21:45 USC School of Pharmacy study that shows 87% of patients receiving CMM reached their blood pressure targets within 45-days.
22:45 “Adding a clinical pharmacist to the interprofessional team makes sense from a clinical and economic perspective – and it is a more humane way to manage medication needs.”
25:30 Shawn outlines the three components of successful CMM implementation.
25:45 #1 Success Strategy: “Philosophy of Practice”
26:30 #2 Success Strategy: “Fidelity to the Practice Management components CMM”
28:00 CMM Practice Management Assessment Tool
28:40 #3 Success Strategy: “Well-Defined Patient Care Process”
30:30 Katie references the multitude of free CMM resources that are available through GTMRx (GTMRx Resource Page on Value-Based Care)
31:20 The confusion between CMM and MTM
32:00 Dr. Barr discusses the importance of trust in interprofessional, team-based care delivery and the need to make CMM broadly available.
33:00 Katie describes how trust brings about success in performance measurement and accountability.
35:00 Shawn provides an example of how the VA incorporates patient experience into the delivery of CMM services.
37:00 How the VA enhanced patient access – creating an additional 3 weeks of provider availability – by implementing CMM.
38:30 “CMM occurs over the journey of healthcare – not just in the 30-minute patient appointment.”
40:30 The extensive studies that show how pharmacist integration improves clinical outcomes.
41:00 How CMM decreases provider burnout and improves patient satisfaction.
42:45 Dr. Barr explains how clinical pharmacist integration can impact on CAHPs scores, HEDIS measure performance, and overall Medicare Advantage Stars Ratings.
44:15 Katie references the GTMRx Library of CMM Use Cases and further explains how Fairview Health received 12:1 ROI on CMM and lowered overall healthcare costs by 31.5%
46:00 The HealthPartners CMM Use Case showing 3.5 ROI with $1,268 PMPM healthcare cost reduction.
49:00 The Four Formative Pillars: Top Health IT Capabilities that will Improve Comprehensive Medication Management
49:30 Dr. Barr speaks to how CMM success is at the mercy of a sophisticated data infrastructure.
52:20 How important is Artificial Intelligence in CMM?
53:00 Katie on the importance of liberating actionable data at the point-of-care.
54:00 Identifying all drug therapy problems (not just those related to one medical condition).
54:45 Creating a care plan, that includes medication management, in collaboration with patients.
55:30 Shawn provides an example of how the VA creates automated dashboards for recommending patients to CMM.
58:00 Recent JACCP issue on pharmacoequity and how equitable medication use is paramount to eliminating health disparities.
59:00 Dr. Barr discusses the intersection of health equity and Comprehensive Medication Management.
60:30 The origin of the term “pharmacoequity” by Dr. Utibe Essien as a policy prescription for reducing health disparities.
61:00 Shawn discusses the integration of health equity within the VA system.
65:00 Katie on why a common definition for CMM is important for value-based payment policy reforms.
66:00 Shawn provides an in-depth explanation comparing CMM vs. MTM (Patient-focused process vs. medication-focused activity)
68:20 The Medicare Modernization Act was an early attempt to promote CMM, but it fell short.
69:00 Katie on why value-based payment needs to evolve to a point where care teams are directly reimbursed for CMM services.
70:20 “Value-based payment models are optimal for the provision and sustainability of CMM.”
72:00 Measuring the value of CMM with attributable patient outcomes measures and clinical information provided at the point-of-care.
72:30 Integrating pharmacogenomics into the CMM process to improve clinical decisionmaking.
74:00 Will the new vision for Medicare to advance accountable care and health equity by 2030 catalyze policy changes to support patient-centered CMM programs?
75:30 Focusing only on drug costs does not support access and appropriateness in medication use.
The need for physician leaders has never been greater. As the healthcare industry continues to undergo significant change, there is a clear opportunity for physicians with extensive administrative experience to ...
As we look around to see what is enduring in our society, it is the work that was accomplished through loving relationships and mutual understanding. The power of love-driven leadership ...
While there have been meaningful improvements in healthcare delivery over the last decade, they have not catalyzed the transformation necessary to advance health value and equity. The promulgation of health ...
This week we are talking about how value-based care transformation is related to the “Hero’s Journey” monomyth that was initially described by Joseph Campbell, an intellectual known for his work ...
This week is Nurses Week – a time for all of us to reflect on the contributions that nurses make to our society. During this important time of observance for ...
This week we are honored to have as our guest, the legendary John W. Bluford III. Mr. Bluford is a nationally known healthcare innovator who has been recognized by Modern ...
This week we have the great honor of hosting one of the most respected American political leaders over the last few decades, a visionary who ushered in a new era ...
Healthcare worker burnout has reached crisis proportions, and we must find real solutions to address the intense psychological suffering of our workforce. The seemingly endless intensity of work, the mounting ...
Health care is the largest employment sector in the US, and women account for 75-percent of the workforce. Gender equity in medical leadership is of paramount importance in value-based care ...
This week on Race to Value, we are excited to celebrate Pharmacy Week – it is a time to recognize the invaluable contributions pharmacists and technicians make to patient care ...
In this week’s episode, we spotlight the recently released Future of Nursing report, “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.” The report is a landmark consensus ...
Nurses have been rightly recognized as heroes during the pandemic – on top of their consistently tireless effort, providing sustained caring and empathy over long hours, nurses stepped up to ...
This week’s episode is the second part of our conversation with Dr. Robert Pearl. In his book, Uncaring: How the Culture of Medicine Kills Doctors & Patients, Dr. Pearl asserts ...
In a year of great need, during the pandemic, Americans saw and celebrated an army of physician heroes. In doing so, they overlooked an uncomfortable reality. Doctors are humans who ...
In this virtual panel discussion, Dr. Ernest Grant (President of the American Nurses Association), Dr. Jan Jones-Schenk (Senior Vice President – College of Health Professions, WGU), and Jason Thompson (Vice ...