Health Policy – The Race to Value Podcast™: Recent Episodes
Institute for Advancing Health Value
We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing. Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs.Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health. She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models.Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value. And make sure to tune in to Mara’s special announcement about Health Care Value Week at the end of the interview so you don’t miss out on important educational events occurring January 29th thru February 2nd.Episode Bookmarks:01:30 The need for accountable care policies that create better health outcomes and patient experiences.02:00 Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH03:00 Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event).06:00 How A4H is translating thought leadership to action in the advocacy arena.06:30 Accountable care as the solution to fragmented, uncoordinated care.07:00 Political turnover in D.C. has made VBC a “new” health policy solution.07:30 Educating the Hill comes down to conveying enthusiasm for health care transformation.08:00 Accountable for Health Members are shaping the national conversation for payment and delivery system reform.09:00 The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH).11:30 If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism?12:00 The need to overcome misunderstandings about what ACOs are trying to achieve.13:00 Providing education to dispel the myth that ACOs can actually limit services.14:00 How uninformed policy decisions could potentially create a catastrophic blow to the value movement.14:45 “Accountable care is integral to care delivery system reform.”15:45 Confusion with the term “value-based care” and why it will fail unless people understand the truest aims of the movement.17:00 The need for effective storytelling to advance care delivery transformation.18:00 Prioritizing care experience over cost reforms (delivery innovation will address costs!)20:00 The topline takeaways from CMS model evaluations and whether or not programs should be expanded.21:00 What do most people think when they hear the word “value”? (the need to reframe the conversation with more precise language)22:00 The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement.24:00 Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking).25:30 How strong relationships between MA plans and provider networks (underpinned by capitation) drive value.26:30 Understanding provider compensation in MA value-based payment and the synergies between managing MSSP and MA populations.27:00 Rethinking supplemental benefits in Traditional Medicare.28:00 An overview of the Medicare Access and CHIP Reauthorization Act (MACRA).30:30 The “cliff effect” of the Advanced APM Bonus reductions (and why that threatens the value movement).31:30 “We need strong incentives to continue this work in accountable care transformation. The Advanced APM Bonus has built important momentum.”32:30 The MIPS program maximum bonus is at 9% — in what world would the Advance APM incentive make sense at only 0.5%?33:00 Why are providers in the last year earning full bonuses in MIPS when 2-3% has been the historical average?33:30 An overview of The Value in Health Care Act of 2023 and consideration of a full-risk ACO option in the MSSP.35:45 The need for a long-term vision for MACRA (i.e. MACRA 2.0).38:45 The integration of specialists in accountable care models.39:30 Leveraging the physician fee schedule as a glide path for specialist adoption. Providing data to ACOs to better engage specialists.41:00 The responsibility of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to advance specialty-specific APMs.41:45 The move to mandatory payment models to catalyze healthcare cost savings goals for CMMI.45:00 How are Medicare-value based efforts aligning with Medicaid transformation?47:00 Health Care Value Week is a week of action from January 29th to February 2nd, providing broad-based education on VBC.48:30 The Virtual Value-Based Payment Summit is open to everyone (free registration) and the speaker lineup is incredible!49:30 A4H’s Health Care Value Week Conference in D.C.on Feb. 1st to celebrate the progress of VBC in improving people’s lives!51:00 Learn more about A4H and sign up for their newsletter at accountableforhealth.org.
With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy. By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union. While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country!
On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington’s internal game. He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care. Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health’s first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health.
Episode Bookmarks:
01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending.
02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers.
02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies.
05:30 The glacial pace of the value-based care movement. Is there truly bipartisan consensus on the aims of health value?
07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”)
08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”)
09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.”
10:00 Explosive growth of the Medicare Advantage program.
11:00 Consumer-centric innovation and higher quality of care in MA plans.
11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”)
13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service” to those leery of privatization.
13:30 The incredible popularity of MA and the research showing it has superior outcomes.
14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years.
15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions).
16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell).
17:00 The importance of Patient-Reported Outcome Measures since process measures alone don’t achieve patient-centeredness.
19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.”
20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.”
21:00 If we are incentivized to keep patients healthy and out of the hospital, we will naturally do screenings. (Measuring number of screenings not as important as the outcome itself!)
21:30 NQF guidance on Risk Adjusting Social Risk Factors in quality measurement in order to pay for outcomes.
22:30 “Infusing SDOH, risk adjustment, and quality metrics into everything we do will shift the system to move towards outcomes.”
23:30 The role of CMMI in payment model innovation and the need for the continuation of the advanced APM bonus.
24:30 “True transformation cannot happen unless you have providers willing to take on full risk. Right now, there is not a full-risk track inside MSSP.”
25:00 The “courage of conviction” in knowing you can make people healthy.
25:30 The lack of value-based care training in medical schools and GME.
26:00 Capital requirements for full-risk.
27:00 Lack of clarity in VBC policy will perpetuate a multi-tiered system (e.g. specialists paid on FFS, primary care pushed more to capitation).
27:30 Full-risk is the only way forward to incentivize the entire system! (Everything else is just half measures.)
28:00 How the medical establishment and generational divides in medicine are holding back the value movement.
30:00 Internal, professional government affairs expertise as an essential corporate positioning and sales function.
31:00 Positioning your views front and center to a government audience through internal advocacy.
32:00 Creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation.
33:30 Speaking to policymakers and elected officials is different than speaking to investors.
35:00 Figuring out the right model for advocacy (a hired gun lobbyist vs. an embedded government affairs function).
36:30 Leveraging the lobbying power of unified voice in a trade association (versus in-house government affairs that emphasizes the uniqueness of a company’s individualized and specific interests.)
38:00 Trade associations as the place where policy gets settled before it is advocated to elected officials.
39:00 Strategies for effective in-house government affairs collaboration with professional associations.
41:30 The need to teach incoming doctors about the benefits of value-based care to prepare them for success.
42:30 It is also important to teach medical students about the importance of advocacy and the effect of health policy on their career.
44:30 Medical school funding should be tied to solving a specific problem (e.g. integrating behavioral health into primary care).
45:00 “If we want to get to VBC and outcomes delivery, we have to start teaching advocacy and policy in medical schools to effectuate the future.”
47:00 Examples of effective advocacy (e.g. addressing the pediatric uninsured, the Chronic Care Act, direct billing of LSWs within Medicare, expansion of mental health workforce)
49:30 Private sector innovation in addressing health disparities in underserved communities (e.g. Oak Street Health).
50:30 “Forming a more perfect union” – always working towards perfection while knowing it will never be perfect.
51:30 How to follow and connect with Andrew!
Everyone needs access to quality, affordable health careregardless of health status, social need or income. To reach this paradigm shift, healthcare leaders must evangelize within industry and communities they serve. There is a better path forward for American health care – one that is people-centered and transformational; however, to get there we must unite the power of one at the intersection of people, policy, and politics. By listening to people’s needs, jointly developing policy solutions, and partnering with others, we can ensure our health care system works for everyone.
This week on the Race to Value, we bring to you Natalie Davis and Dr. Venice Haynes at the United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. It brings together stakeholders from various backgrounds, including healthcare experts, patients, policymakers, and advocates, to develop and implement practical, bipartisan solutions to improve the healthcare system in the United States. By fostering dialogue and collaboration, conducting research, and advocating for policies that enhance access, lower costs, and improve healthcare outcomes, the organization finds common ground and works across party lines and ideological divides to address the healthcare challenges facing the nation.
As CEO and Co-Founder of the United States of Care, Natalie Davis is on a mission to reshape and implement American health care policies that improves the lives of all people. Dr. Venice Haynes, the Director of Research & Community Engagement for United States of Care, is a social and behavioral scientist focused on an overarching research agenda to address social determinants of health and health disparities in underserved populations using qualitative and community-based participatory approaches. In this episode we talk about the tenets of patient-first care (a.k.a. value-based care) including affordability, dependability, personalization, and understandability. We also have an in-depth conversation on the power of storytelling in health care transformation and the imperative to overcome structural barriers in the creation of health equity.
Episode Bookmarks:
01:30 United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans.
02:00 Introduction to Natalie Davis, Chief Executive Officer and Co-Founder.
02:45 Introduction to Venice Haynes, PhD, Director of Research & Community Engagement.
05:00 Natalie shares her personal story that led her towards an entrepreneurial career path in health care policy transformation.
07:30 Mentorship from Andy Slavitt and his advice to get out of Washington, D.C. to make an impact on health policy.
08:30 Venice discusses how her science and public health background inspired her to lead people-centered health care change.
11:45 Inspiration from Camara Phyllis Jones, a physician, epidemiologist, and anti-racism activist who specializes in the effects of racism and social inequalities on health.
14:30 When offered an alternative, by a 4:1 margin, people favor a model that compensates providers for improving overall health, delivering superior care, and coordinating patient care.
15:30 What it means for United States of Care to be at the intersection of people, policy, and politics in health care transformation.
16:00 Research and listening to people as a way to overcome tribalism and build an agenda of reform for the whole country!
16:45 The 4 goals and 12 solutions of United States of Care to meet the needs of people across demographics and can drive collection action to build a better health care system.
18:30 “The 4 goals of United States of Care – Affordability, Dependability, Personalization, and Understandability – comprehensively cannot be done in a fee-for-service model.”
19:00 The need to bring new health policy leaders into the value-based care movement (at the risk of the movement stalling out altogether for lack of emerging leadership).
20:00 Reframing the value-based care movement to the specific vocalized needs of constituents in the general public (instead of just payment models, quality measures, etc.)
21:00 “There is a resounding drumbeat in our community-focused value-based research — people want more whole-person care.”
22:30 Selectively using the right language when engaging communities (“using a new approach” instead of “reforming the system”).
23:00 Communities are overwhelmingly expressing their anger about the greed of the American healthcare system.
24:00 “When engaging our communities, language matters so very much. We must find the commonality in language to resonate with people.”
25:30 The storytelling project, “Voices of Real Life”, as a vehicle to galvanize healthcare experts, patients, policymakers, and advocates around a human-centered focus.
26:00 Movements are led by effective storytelling and these stories can revitalize communities of people. (Is a social movement like civil rights or gay marriage any different than the movement for value-based care?)
27:30 The fear that people have in making large scale changes to American healthcare.
30:00 The importance of everyone feeling like they are a part of the change that is needed. (Reframing health care failures from “individual” to “systemic.”)
31:00 Venice shares personal stories from her work with community focus groups and how people often feel alone when it comes to navigating health care challenges.
32:45 An example of poor maternal health care – a patient driving an hour for a prenatal checkup only to find that her doctor was not at that clinic on that day.
33:00 People often make life altering decisions over health care (e.g. marrying someone they don’t love, taking a second mortgage on their own).
34:00 People that are “satisfied” with their health care do not really exist! (They are just “satisfied” because they are one of the lucky ones with health insurance and access to care.)
37:00 Health Care Affordability and USofCare Poll showing 42% of voters have foregone health insurance in the past, and 41% of those under 30 have opted not to seek medical treatment in the last year.
38:00 Driving a multi-state approach to expanding coverage through public option.
39:00 “Affordability is always the #1 issue that comes up in our community conversations, regardless of the entry point where people enter the health care system.”
39:45 The breaking point of health care costs (e.g. federal deficits, employer cost shifting) and the levers that can be utilized to reign in costs through a public option.
40:30 The “hidden fees” passed on to patients by hospitals.
41:00 The different levers of change at the state level, and how they can impact change at the federal level.
41:30 The equity component to reforming health care costs at both an individual and societal level. (Check out the USofCare Health Equity Report)
42:00 Enhancing primary care access will lower overall health care costs in our country in the long-term.
43:00 Dependable healthcare coverage is an anchor in the storms of life, providing individuals and families the peace of mind that their health and well-being will be safeguarded in times of need.
43:45 More than 9 million people have been disenrolled by Medicaid redeterminationsresumed several months ago.
44:45 Common stories of people fearing lack of health care dependability (e.g. contractors, employees in the gig economy, pregnant women worried about repercussions from employers).
47:45 The challenge of health policies being written by people without the lived experiences of those directly impacted.
48:00 “Policy is nothing if not implemented well.”
49:00 The Texas Court Case (Braidwood v. Becerra) — may cause nearly half of Americans (more than 151 million people ) the loss of access to free preventive services!
49:45 How the United States of Care is fighting to preserve the rights of Americans to retain their access to free preventive primary care. (See USofCare Preventive Services Resource Hub)
52:00 Personalized care to support to caregivers, improve mental health coverage, enhance maternal and newborn care, make care more convenient, and ensure that people can equitably access care virtually.
53:30 “We cannot reimagine health care with a one-size-fits-all approach.”
54:00 The work in Colorado to build a public option and culturally responsive networks.
55:30 How do we ensure that access to virtual care doesn’t exacerbate health inequities?
58:30 For people to get behind value-based care, we must relate to them at a personal level.
59:45 Speaking in terms of “quality over quantity” when personalizing the message of value-based care to patients.
60:00 Why “Value-Based Care” is such a poor choice of wording and causes confusion with patients.
62:00 A much-needed wave of patient consumerism is needed; however, the complexity of the system stifles innovation and creates a lack of understanding.
64:00 Natalie provides perspective on the need for community feedback on people-centered change in health care.
65:00 “We need to change the way we do change in health care. This is not working!”
65:30 Can health care be as consumer-friendly as Uber or Chick-fil-A?
67:00 The importance of asking the right questions and engaging stakeholders before implementing a new technology innovation.
68:00 Creating trust in the system through co-creation and rightsizing of change management.
70:00 The amazing opportunity in engaging patient communities!
73:00 Support the work of United States of Care and follow Natalie on LinkedIn– “Be a part of the narrative change to follow the more systemic change that is necessary.”
Peering into the horizon of healthcare, we unveil the vanguard of value-based care research and innovation, where data-driven insights and daring ideas converge to shape a healthier tomorrow. In the ...
In the universe of value-based care transformation, there has been one disease that represents a metaphorical black hole, where the gravitational pull of fee-for-service is so strong that nothing can escape. These patients experience the fullest depths of pain and despair, and this chasm is so deep and wide that there is only darkness. You may have guessed it, but we are talking about chronic kidney disease, a condition that impacts 37 million people in the U.S. The suffering of those inflicted with CKD is so immense, yet the Medicare reimbursement system is designed to fail this patient population. In fee-for-service medicine, we wait until patients succumb to end-stage kidney disease, where they crash and burn and need costly dialysis to stay alive for a little while longer. Because of this flawed reimbursement model, Medicare pays over $125 billion for people with all stages of renal disease, which is around 20% of all Medicare spending! Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited. We must “give life” to this patient population in the Race to Value!
The giving of life and that is what DaVita Kidney Care is doing. In fact, the name DaVita is an adaptation of the Italian phrase for giving life. In value-based care, DaVita works with healthcare payers and providers to develop and implement care delivery models that focus on improving outcomes and reducing costs for CKD patients. And I am excited to share with our listeners, that our guest this week is Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita. Dr. Weinstein works across numerous lanes helping bridge the intersection of IT, clinical nephrology, and healthcare policy. He is focused on delivering IT tools that take advantage of DaVita’s clinical data and help nephrologist and DaVita teammates deliver the best care possible. A kidney doctor from Maryland, Dr. Weinstein is passionate about slowing the progression of chronic kidney disease in patients. This was such an outstanding conversation with one of the true innovators in technology and clinical care!
Episode Bookmarks:
01:30 The importance of crossing the chasm of chronic kidney disease, a condition that impacts 37 million people in the U.S.
02:30 Introduction to Dr. Adam Weinstein, the Chief Medical Information Officer for DaVita Kidney Care.
03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
05:30 Dr. Weinstein shares how his lived experiences and positive mindset have shaped his work as a nephrologist, healthcare executive, and technology innovator.
06:45 Treating kidney disease costs Medicare $130B – although CKD patients are 1% of the population, they account for over 7% of all Medicare spending!
08:30 An overview of the DaVita Integrated Kidney Care (IKC) program and how it produces solid results through data enablement and relationship building.
10:30 Integrated Kidney Care accomplished through people working in collaboration, predictive modeling, and population health management.
11:30 Facility versus At-Home Dialysis and the empowerment of patients through education and health literacy.
12:30 An overview of DaVita’s participation in value-based care payment models focused on CKD and ESKD.
14:30 Dr. Weinstein on how to bring scale to value-based payment innovation in kidney care.
16:00 The need for specialist and care team coordination that goes well beyond the office visit.
17:00 Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models and how they provide financial and philosophical alignment for integrated care.
18:00 The challenges of including broader specialties and building an advanced data infrastructure in value-based kidney care.
19:00 The “clinical nebulous” that requires a longer runway for value-based payment model innovation to deliver improved patient outcomes.
22:00 The Relative Value Scale Update Committee (RUC) and how it provides recommendations for setting payment amounts for different physician services.
23:30 The challenges of valuing the technical aspects of physician services that reward procedural intensity versus cognitive services that require critical thinking.
24:00 The tension that a Relative Value Unit system provides in a healthcare system evolving to value-based care.
27:00 Black Americans are 3.5X more likely than White Americans to experience kidney failure. (Black Americans are also less likely to do home dialysis or get a kidney transplant.)
28:00 “Value-based care arrangements are one step toward solving health inequities.”
29:00 The need for a culturally sensitive and contextual understanding of health determinants to address disparities in care.
32:30 “The single most important trust building issue in healthcare is the assurance that we have a caring workforce.”
33:00 How DaVita ensures that its facilities are equipped with motivated, engaged, and culturally competent care teams.
34:30 Addressing clinician burnout through the provision of robust talent pipelines.
36:00 The need to focus on early CKD detection so interventions can happen earlier to slow the progression of disease.
37:00 How lab tests to screen kidney function are not always the best diagnostic indicator for early detection of CKD.
38:30 The role of nephrologists in assuring an effective care regimen.
39:00 The use of Artificial Intelligence to help predict the progression of CKD to ESKD or the likelihood of a hospitalization.
41:00 How risk models that predict future likelihood of dialysis can drive crucial conversations with patients.
42:00 The need for clinical experts to interpret AI predictions in a way that can drive meaningful patient interventions.
43:00 Innovation Results at DaVita (e.g. survival rates for dialysis patients, cost improvement in dialysis, increase in home dialysis, lower hospitalizations).
44:30 Dr. Weinstein discusses DaVita’s innovative approach to data and how it informs an enhanced understanding of value-based care as a clinician.
46:30 The development of a CKD-specific EHR system to drive value-based care at a practice level.
47:30 How data integration and HIEs can bring about improved care delivery with independent providers on disparate EHR systems.
47:45 “Chronically ill patients are similar to projects that need their own personalized Gantt Chart to drive care delivery with enhanced outcomes.”
48:45 The importance of patient- and population-level data at the point-of-care, alongside performance benchmarking tools.
51:00 A brief update on Mozarc Medical – the new venture between DaVita and Medtronic established to develop new kidney care technologies and at-home treatments.
52:45 DaVita Venture Group (DVG) invests in companies that are aligned with DaVita’s mission of improving the quality of life for patients with kidney disease.
54:30 Impacting the kidney space at scale through capital investment in innovation.
56:30 Achieving success in value-based kidney care through people, process, and tools.
58:00 Aligning clinicians for the future of value-based care.
For all of you leaders out there on a value-based care journey, it is not lost on any of you that health value has become synonymous with health equity. We are at an inflection point in our society in the recognition that everyone needs a fair and just opportunity to attain their highest level of health. Achieving this will require ongoing societal efforts to address injustice, overcoming socioeconomic barriers to health, and eliminating preventable health disparities. But we cannot do that as a healthcare industry without the proliferation and scale of payment models that align incentives so we can realize true change for the better. On the Race to Value this week, you will hear from one of the foremost leaders on the national scene who is shaping the landscape for accountable care delivery that can advances health equity.
Dr. Dora Hughes is someone who has taken this charge to lead in service to the underserved so that we may realize the dream of a more equitable and healthy society. She is the chief medical officer at the CMS Innovation Center at the Centers for Medicare & Medicaid Services (otherwise known as CMMI). She leads the Center’s work on health equity, provides clinical leadership and input on models, serves as the Innovation Center’s primary liaison with medical and clinical stakeholders, and provides leadership to the Innovation Center’s clinician community. In addition, Dr. Hughes is part of the CMS Innovation Center’s Senior Leadership Team, helping to provide enterprise-level leadership and strategic direction to the Center. In this interview, we discuss the elevated national consciousness to advance health equity, how ACOs and other risk bearing entities can succeed with a health equity strategy, and the work being done by the Innovation Center to redesign alternative payment models for equity. We spend considerable time discussing ACO REACH and value-based Medicaid transformation as well. This is certainly a conversation you should listen to as you plan for success in your Race to Value!
Episode Bookmarks:
01:30 Health Value has become synonymous with Health Equity — everyone needs a fair and just opportunity to attain their highest level of health.
02:30 Introduction to Dora Hughes, M.D., M.P.H., the chief medical officer at the CMS Innovation Center (CMMI)
04:30 If you control for all variables that may contribute to health disparities, African Americans still get the worst quality of healthcare of any demographic in the country.
05:30 The first pillar of CMS’ Strategy Plan is Health Equity
06:30 Cara James, Ph.D., president and CEO of Grantmakers in Health: “I’m someone who’s working on equity before it became cool to work on equity.”
07:00 Referencing the seminal findings of the Heckler Report in the 1980s that investigated racial and ethnic disparities in the United States.
08:00 Momentum has been building towards addressing health inequities, despite the historical lack of national prioritization.
08:30 “It really took the pandemic and police brutality to blast the issues of health inequities into the national consciousness.”
09:00 Disparities go beyond COVID (e.g. black disparities in maternal health, colorectal cancer, kidney disease)
09:45 “Executive pay is now being tied to reduction in disparities. You wouldn’t have heard that 10 years ago or even perhaps five years ago.”
10:00 Referencing CCSQ Deputy Jean Moody-Williams: “For those of us engaged in health equity, this is our moment, but it is only a moment.”
10:30 Actions Needed: collecting and analyzing demographic and health data, knowing patients individually and at the population level, identifying disparities, implementing evidence-based interventions.
11:45 “It takes vibrancy, resiliency, and an indomitable spirit to tackle disparities and scale progress at a national level.”
13:00 CMMI’s work to address Social Determinants of Health (SDOH), e.g. ACOs, Accountable Health Communities (AHC) Model
14:30 80% of what contributes to health reflects non-medical or social determinants of health (e.g. healthy eating, stable housing, educational economic opportunity, jobs)
15:00 “To maximize our patients health, we as providers have to think about our role both inside and outside the health system.”
15:45 The revolutionary nature of the AHC model in fostering healthcare and community partnerships to plan SDOH interventions.
16:30 Results from the AHC Model showing a 9% reduction in emergency department use among participants.
17:00 “Our understanding of healthcare has evolved. We are not going to be able to achieve our health goals without addressing health related social needs.”
17:30 The flaw of Medicare FFS that does not allow providers to code for SDOH interventions.
18:00 The flexibility of MA benefit design and capitated payments in advanced Medicare APMs supports hiring of social workers and CHWs.
18:45 Dr. Hughes responds to criticism from providers that SDOH interventions are “out of my lane” when it comes to health care delivery.
19:30 The need for health policies to address food deserts, lack of affordable housing, weak transportation infrastructure, etc. at the community level.
20:00 Dr. Hughes describes how CMS and other agencies are working to support culturally-competent and linguistically-appropriate care.
20:45 Resources: “A Physician’s Practical Guide to Implementing Culturally Competent Care” (CMS), “Think Cultural Health” (OMH), and “Multicultural Health Care” (NCQA)
22:00 Is implicit bias within current payment models contributing to health inequities?
24:00 Referencing Dr. Hughes’ and Melissa Majerol’s recent blog in Health Affairs: “CMS Innovation Center Tackles Implicit Bias”
25:00 How the estimated glomerular filtration rate (eGFR) leads to erroneous results and findings of kidney disease in African Americans.
26:00 Another example of how a heart disease risk calculator may incorporate racial bias into diagnosis of disease.
27:30 Identifying potential sources of bias before the launch of new payment models.
29:30 The longstanding history of bipartisan support for the movement to VBC and accountable care.
30:00 The 2021 performance year marks the fifth consecutive year that the MSSP has generated net positive savings to CMS. (See recent Race to Value podcast and Institute Brief)
31:30 Dr. Hughes responds to concerns about the reduced growth and participation in the Medicare ACO program and how this challenge is addressed in the CMMI Strategy Refresh.
33:00 Addressing health equity and ACO growth through external partnerships like the Health Care Payment Learning & Action Network (LAN) and provider site visits.
35:00 Developing a CMS-wide vision for Accountable Care expansion (Referencing recent NEJM Article on “Expanding Accountable Care’s Reach among Medicare Beneficiaries”)
35:45 The ACO program is a chassis for testing innovation center models in achieving 2030 accountable care goals.
36:00 CMS has proposed scaling successful features of the ACO Investment Model (AIM)and will leverage ACO REACH more broadly in years to come.
37:30 The ACO REACH program unlike other APMs to date, has made health equity a bedrock of payment model design.
39:30 Dr. Hughes on healthcare complexity, PCP and specialist fragmentation, and the challenges of reforming the system to better care for underserved communities.
41:00 MSSP ACOs and ACO REACH models are helping providers coordinate care and improve health outcomes for Medicare beneficiaries.
42:30 How the ACO REACH model provides flexibility to healthcare providers in how they deliver and they coordinate care (e.g. telehealth, diabetes preventive care, dental care, pharmacy integration)
44:30 “ACO REACH is forging new ways to address the health inequities underserved communities experience.”
44:45 Health Equity Action Planning and Health Equity Benchmark Adjustments under ACO REACH.
46:00 Dr. Hughes addresses concerns expressed by critics of the ACO REACH model.
50:30 Dr. Hughes provides perspective on CMS’s newly refined eligibility criteria and design characteristics for ACO REACH and why it matters to advance health equity.
55:45 Dr. Hughes discusses the work that CMS is doing to advance accountable care to Medicaid beneficiaries and how they are engaging with safety-net providers.
62:00 Parting thoughts from Dr. Hughes on how CMMI is engaging beneficiaries and caregivers in conceptualizing, designing, and testing payment models.
The Health Care Payment Learning & Action Network (HCP LAN or LAN) is an active group of public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate our care system’s adoption of alternative payment models (APMs). The LAN mobilizes payers, providers, purchasers, patients, product manufacturers, policymakers, and others in a shared mission to lower care costs, improve patient experiences and outcomes, reduce the barriers to APM participation, and promote shared accountability.
Last month the LAN held their 2022 Summit, and this year’s event featured appearances by CMS and CMS Innovation Center leadership, the release of the 2022 APM Measurement Effort results, a discussion on the HEAT’s Social Risk Adjustment Guidance for APMs, and the announcement of the LAN’s 2030 APM Adoption Goals for Medicare, Medicaid, and commercial plans. Joining us this week in the Race to Value are LAN Executive Forum Co-Chairs, Dr. Judy Zerzan-Thul and Dr. Mark McClellan. They discuss the overall goal of the LAN and the LAN Summit is to collaborate and act on strategies that will accelerate the transition to innovative, patient-centered payment models by focusing on equity, access to high-quality and affordable care, engagement of patients, and reduced provider burden.
HCP-LAN Fall 2022 Summit: Summary
Visit the Institute for Advancing Health Value’s website.
- Download their recently released Intelligence Brief summarizing the 2022 LAN Summit.
Visit the LAN’s website:
- Learn more about 2020 & 2021 APM Measurement Efforts
- Consult the HEAT’s APM Design Guidance – Advancing Health Equity Through APMs
Episode Bookmarks:
01:30 The purpose of the Health Care Payment Learning & Action Network (HCP LAN)
03:00 Introduction to Dr. Mark McClellan and Dr. Judy Zerzan-Thul
05:45 Dr. Mark McClellan speaks to the impact of the pandemic on value-based health reforms
06:45 “Payment flexibilities are one of the unsung heroes in the pandemic when it comes to value transformation.”
07:15 How capitation enabled some to navigate the pandemic favorably, while others struggled with FFS revenue disruption, team-based care, and telehealth deployment.
08:45 CMS payment flexibilities will soon go away so prepare for continued focus on patient-longitudinal well-being and outcomes tracking.
09:45 The especially challenging times of high inflation and workforce resilience and how value transformation is a strategy for sustainability.
12:00 Dr. Zerzan-Thul speaks about the Accountable Care Commitment Curve and how that can guide organizations to advancements in Health Equity.
13:30 The LAN’s Health Equity Advisory Team (HEAT) and its recommendations for developing a Health Equity action plan.
14:30 Measuring equity outcomes through an enhanced data infrastructure and community partnerships.
15:45 Dr. McClellan speaks to how Social Risk Adjustment (SRA) can advance health equity through APMs (starting with ACO REACH)
17:30 The challenges of implicit biases in individual measures of social risk.
18:15 “Risk factors like food insecurity and transportation will eventually get more built in to our approach to health care.”
19:00 The additional considerations of community engagement, peer transformation, and other payment incentives to advance health equity.
20:30 The recent release of the APM Measurement Effort (survey data compiled the HCP LAN).
21:30 Dr. McClellan discusses the current status of 2022 APM adoption (see interactive graphic showing that nearly 20% of payments flowing through Category 3B-4 models.)
24:30 Dr. Zerzan-Thul comments on trajectory of APM adoption and current status of Medicaid transformation in population-based payment.
27:00 Dr. McClellan discusses the Accountable Care Commitment Curve more at length.
29:00 “You can’t get to a critical mass of value transformation in the U.S. healthcare system without multistakeholder alignment.”
30:00 Dr. Zerzan-Thul speaks to what state agencies like the Washington State Health Care Authority can do to move healthcare organizations along the Commitment Curve.
31:00 Examples of legislative tools in Washington State that are advancing value-based payment and collaboration.
33:00 Data and transparency – how do we measure progress in health equity and value transformation?
34:30 Dr. Zerzan-Thul speaks about the work LAN is doing with State Transformation Collaboratives (STCs) (see Summit video on State Transformation)
35:00 Primary care transformation and multi-payer alignment as the starting points to transform healthcare at the state-level.
36:00 The impact of the economic downturn and Medicaid transformation in states moving to value.
37:00 Dr. McClellan on the importance of state leaders (e.g. policymakers, employers) to reform healthcare.
38:30 The STC pilot states (Arkansas, Colorado, California, North Carolina) are working closely with CMS in reaching their value-based care goals.
39:30 Key directional alignment between CMS and states will reshape health policy at the federal level.
41:45 Dr. Zerzan-Thul discusses the importance of FQHCs as “safety net” providers and how they can transition to APMs.
42:45 Oregon, Colorado, and Washington are leading states in FQHC adoption of APMs.
43:30 Dr. McClellan on how Medicaid payment shifts in Washington State are bringing more affordable and accountable care to patients.
46:00 Dr. McClellan discusses the strategic importance of multi-payer alignment in the national movement to value-based care.
49:00 Reducing care variation and supporting more efficient processes in delivering care across disparate populations.
50:00 Dr. Zerzan-Thul on how multi-payer alignment of quality measures can lead state-level value transformation efforts.
51:00 “We are asking payers to align on paying primary care at a Level 4 level, and we have commitments from payers to do that.”
52:00 Data aggregation and exchange at the state-level.
52:30 Certifying advanced primary care at a centralized level as a means to direct payment transformation.
53:15 Engaging health plans in various states to adopt and scale APMs in the transition away from FFS.
55:00 How the LAN, in partnership with states, are engaging purchasers in the commercial market.
56:30 Dr. McClellan on how to get patients to understand “accountable care” or “value-based care” by delivering on our goals.
58:00 “Value-based care is not a privatization plot of Traditional Medicare.”
59:00 Paying for “health” can help with the reduction of chronic diseases.
59:30 The political pressures of disrupting the status quo in healthcare.
60:00 The importance of effective storytelling in value-based care success as a way to inform legislators.
61:30 Dr. Zerzan-Thul on how the U.S. is 4% of the world’s population but spends half of the $8T global spend on healthcare services.
62:30 How do we measure whether people are getting person-centered care? (We need patient-reported outcomes in addition to CAHPs.)
65:00 Dr. McClellan on the imbalances of healthcare worker supply and demand.
63:30 Capital investments in value-based care are going towards digital transformation and upskilling of the workforce.
65:30 “The biggest challenge in the movement to value-based care is the workforce.”
67:30 Dr. Zerzan-Thul speaks about the challenging demands of managing the workforce pipeline for behavioral health professionals.
68:00 The importance of team-based care (everyone) in guiding us to the health care that we want.
69:20 APMs and the work of the LAN is key to building a better workforce and improving health care!
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