Health Equity – The Race to Value Podcast™: Recent Episodes
Institute for Advancing Health Value
The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.” As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It’s essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities.
In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet.
This week we are interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health. Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare’s Most Influential Clinical Executives as well as Modern Healthcare’s Most Influential People in Healthcare.
Episode Bookmarks:
01:30 The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.”
02:00 Climate change burden falls disproportionately on historically marginalized populations.
02:30 The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector.
03:00 Introduction to Vivian Lee, M.D.
04:30 One in four deaths can be attributed to preventable environmental causes…and climate change is exacerbating these risks.
06:00 Climate change resilience as a lens for value-based transformation.
06:45 The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere.
07:00 What are health care leaders going to do about this? (The need to manage the crisis through an empowered workforce.)
08:30 Exposed vulnerabilities in our supply chain as a complication to address climate-related crises.
09:00 The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!)
10:00 How do we decarbonize healthcare in order to “do no harm”?
11:45 Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors).
12:30 The strong business case for health care organizations to reduce their carbon footprint.
13:00 Tax credits offered by the Inflation Reduction Act to decarbonize hospitals.
14:30 “Renewable energy actually costs less than fossil fuel energy.”
14:45 The Inflation Reduction Act will cover about 30% of the capital needed to invest in a renewable energy system. (Add another 10% each for serving underserved regions and buying American made!)
15:00 ROI in the tens of millions for health systems going green! (“doing good and doing well”)
16:00 Non-productive energy use (e.g. ~60% of energy consumed by MRI and CTs occur when offices are closed on evenings and weekends!)
17:00 Putting high intensity imaging machines in idle mode would reduce the carbon footprint at a level equivalent to the NHS!
18:45 Kaiser Permanente became carbon neutral. (Referencing Kathy Gerwig article co-written with Dr. Lee – “Decarbonizing Healthcare“)
19:30 Boston Medical Center reduced carbon emissions by more than 90%.
20:00 Resources: Kathy Gerwig’s book, “Greening Health Care: How Hospitals Can Heal the Planet”, the AHRQ Climate Change Primer, and Health Care Without Harm, Medical Society Consortium on Climate & Health
22:00 “There are so many opportunities for aligning with the decarbonization effort that are completely synergistic with value-based care.”
22:45 “Primary care has a much lower carbon footprint than high intensity tertiary or quaternary care.”
23:20 How can we utilize telehealth and telenursing to reduce patient and clinician transportation needs?
24:30 Referencing the influence of Don Berwick in medical waste elimination. (see article “Eliminating Waste in U.S. Health Care“)
25:30 “Eliminating health care waste will do good for the planet, do good for the communities, and actually make ourselves financially healthier as well…all in the spirit of bringing more value to our health care system.“
26:45 The AMA is encouraging physicians to assist in educating patients and the public on sustainable practices and to serve as role models in providing environmental sustainability (see AMA Code of Medical Ethics Opinion on Climate Change)
28:00 Dr. Lee discusses the role of clinicians to advocate for eco-friendly practices in patient communities.
30:00 An example of how a pediatrician conducts climate change counseling (see Dr. Andrew Lewandowski’s study)
34:00 The tech-based application of AI, data, and analytics to combat climate change through value-based care delivery.
35:45 Using a health meter to advise patients on how best to deal with extreme heat and bad air advisories.
37:00 Lowering the health care carbon footprint through supply chain optimization.
39:00 The need for more engineering and technical innovation to support innovation in climate resilience.
39:30 The White House and HHS launched the Health Sector Climate Pledge to cut greenhouse gas emissions by 50% by 2030 and net zero by 2050.
40:00 “Solving the climate crisis is the greatest and most complex challenge that Homo sapiens have ever faced. The main solution, however, is so simple even a child can understand it. We have to stop our emissions of greenhouse gases. And we either do that or we don’t.” — Greta Thunberg
41:00 Parting thoughts from Dr. Lee on value-based care and climate change resilience. (“It doesn’t matter what political party or what socioeconomic class you are. We can’t escape this issue of climate change. We are all on this planet together.”)
Many factors impact our health beyond genetics and aging. Collectively, these are called social determinants of health and include factors such as education, housing, income, occupation, hunger, language, literacy, where we live, and access to affordable healthcare services. However, there is a gap in the current list of social determinants of health, and that is the influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes. It is critical to consider “information” as another social determinant of health since it can be used to drive positive patient health outcomes. How we deliver it, where we deliver it, and who delivers it is crucial to value-based health care transformation and patient-centeredness.
So, how do we harness this idea that information can change health outcomes? To answer this question, we have invited Debbie Welle-Powell back to the Race to Value! As a 30-year healthcare executive veteran, value-based care thought leader, and educator, she is committed to the empowerment of change management principles to drive population health at the intersection of patient engagement and information sharing. In this episode, we discuss what is needed to empower the patient and clinician, technology-enablement and value-based payment to fine tune the delivery system, and the information ecosystem needed to drive healthy outcomes.
As a companion to this podcast, make sure to read Debbie’s new article on this topic. It is available for download on the Race to Value webpage for this episode!
Information as a Social Determinant of HealthEpisode Bookmarks:
01:30 Introduction to Debbie Welle-Powell, a healthcare executive veteran whose work focuses on delivering affordable and accessible high quality care.
02:45 Reference previous R2V episode – “Climbing the Mountain: Reaching New Heights for a Transformative Future”)
03:00 Read the companion article to this interview on the Race to Value episode website!
03:45 Debbie provides a brief update on her professional work in value-based care (and her mountain climbing adventures!)
05:30 The influence of “information” or an “information ecosystem” on patients’ behavior, engagement, and health outcomes.
06:30 Should we consider information as another Social Determinant of Health (like transportation, education, housing, and food security)?
07:30 “Information only really matters if it helps patients change behaviors. The delivery of information is crucial to empowering health outcomes.”
08:30 “The American healthcare system is not as patient-centric as it claims to be because of a failure to provide empowering information.”
09:00 The roles of clinicians and patients to improve health literacy.
10:00 Patient noncompliance – Ex: 20-30% do not pick up prescriptions, 30-40% do not follow-through on referrals.
10:45 The challenges of interpreting and addressing SDOH challenges to avoid unnecessary utilization.
12:00 The importance of the patient-provider relationship. (Eric shares insights from his healthcare trip to Cuba.)
14:30 Technology enablement and health system evolution to better address patient information needs.
15:00 Improving patient engagement through the online user journey (i.e. the digital front door).
15:45 Debbie shares a personal example from her cancer journey where the care team failed to provide adequate information.
17:00 Half of patients seeking receive misleading information when independently searching online sources.
17:30 The opportunity for clinicians to provide trusted and reliable online educational resources.
18:00 The hyper-saturation of online content (e.g. 500 hours of content uploaded to YouTube per minute!)
18:30 How the value-based care movement provides incentives for improving patient engagement.
19:30 The use of Generative AI in the clinical setting to help patients better navigate their care journey.
20:45 Merging the science of medicine with the art of information – how to best engage patients during a formidable time of distress.
22:30 Realigning healthcare investments into patient engagement information systems, AI-based tools, and team-based care delivery.
23:30 The need for change management tools at the system-level to improve patient engagement.
24:00 Transforming clinical practice using the Prosci ADKAR change management model.
25:45 Creating a patient advisory council to guide health systems in the optimal curation of patient information.
26:30 Addressing chronic disease through online resources, team-based care delivery innovation, and value-based payment.
27:00 The importance of neuroplasticity (rewiring of the brain’s neural pathways) to reinforce new habit formation.
28:00 Mountain climbing as a metaphor for behavior change in chronically ill populations (i.e. dealing with pain, incremental progress).
28:45 The overwhelming challenges of addressing SDOH in underserved communities.
30:00 Differing perspectives on the role of the individual in health accountability.
31:00 Merging system-level patient-centered engagement with individual-level accountability.
32:00 Deploying information tools to empower health and improve SDOH screenings.
32:45 Rethinking medicine to live better longer (referencing new book, “Outlive: The Science and Art of Longevity” by Dr. Peter Attia).
34:00 “Poor health literacy is a public health problem.” (9 in 10 adults exhibit poor health literacy when under extreme stress.)
34:30 Population health resources should be written at a 5th grade level to ensure they are readable, actionable, and trustworthy.
35:00 Improving Health Literacy Could Prevent Nearly 1 Million Hospital Visits and Save Over $25 Billion Per Year. (see UnitedHealth study)
35:30 The importance of primary care in empowering patient education.
36:30 A recent court ruling threatens access to critical preventative care for more than 150 million people! (see USofCare Preventive Services Resource Hub)
38:00 The importance of Patient Advisory Councils in care delivery design (e.g. telehealth, AWV campaigns, patient portal design, refill strategies)
38:45 CBO Partnerships as an opportunity to “learn, course correct, and transform.”
39:00 The flawed structure and lack of funding for a Public Health system that improves health equity and fosters patient trust.
41:00 The intergenerational impact of health information in improving health, supporting families, building social cohesion, and ensuring economic competitiveness.
42:00 What is the role of government in creating a healthy, well-educated population? How can CMS improve beneficiary engagement?
42:30 Prioritizing multipayer alignment, administrative simplification, and health equity accountability to promote value-based care.
43:30 The 21st Century Cures Act is a health policy focused on information sharing and care coordination.
44:00 Creating accountability in underserved communities through workforce competency and alignment of payments.
45:00 “You can’t talk about quality unless you talk about equity.”
46:45 ADKAR is an acronym for the five outcomes of successful change management: “Awareness, Desire, Knowledge, Ability, and Reinforcement”.
47:00 Debbie discusses the systemwide application of ADKAR as a powerful tool for change management at an individual level.
48:00 How did the ADKAR change management model improve care delivery at Essentia Health?
49:45 Applying change management principles to achieve patient-centricity.
50:45 The promise of precision medicine (at the individual level) as a compliment to community health (at the group level).
52:30 Developing a roadmap to make wellness and prevention a priority (versus sick care and chronic disease management).
53:30 Parting thoughts from Debbie on actions that can be taken today to improve patient communications.
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.”
Fourteen years ago, surgeon, writer, and public health researcher, Atul Gawande wrote his landmark article, The Cost Conundrum, about the healthcare challenges of the Rio Grande Valley (RGV) of South Texas. Gawande showcased the challenges that health systems confront when dealing with public and private insurers and the paradox between high-cost treatment options and low-quality outcomes. His careful assessment of McAllen, Texas, a small city on the border, found that it had the most expensive healthcare system in the nation. This “cost conundrum” in the Rio Grande Valley inspired President Obama to pass the Affordable Care Act and begin a national movement to value-based care. Now that ACOs have reached a critical mass in the Rio Grande Valley we must now ask ourselves “to what degree can value-based care accelerate health equity?”
Value-based care is the seed from which health equity transformation can bloom, nurturing a system that values every life, cultivates well-being, and harvests a future where health disparities are but a distant memory. Health equity transformation in underserved regions (like the RGV) is not just a matter of providing medical care; it’s a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity. Equity transformation is currently underway in the Rio Grande Valley, one of the most underserved regions in the entire United States. The RGV – a 50-mile stretch of towns that span the border of Texas and Mexico – is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country. Issues like poverty and lack of access to healthcare burden the Valley. These factors are the leading cause of health problems like diabetes, obesity, and cervical cancer.
Our guest this week is Dr. Edwin Estevez, a nationally-recognized value-based care leader and champion for health equity in the RGV. His vision is to activate the local health ecosystem to expand access and promote inclusivity through the power of co-opetition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem.
If you want to be a part of the health equity transformation in the Rio Grande Valley, register today for Accelerator2023 on October 17th! (Attendees can attend in-person in Mission, Texas or virtually). More information at www.equity-accelerator.org
Additional Resources:
WGU Aims to Transform Rio Grande Valley’s Healthcare
A Vision of Pioneering Co-opetition for Health Equity
Episode Bookmarks:
01:20 The landmark article, “The Cost Conundrum” about the healthcare cost crisis and how it inspired a national movement to value-based care.
01:45 Obama’s Favorite New Yorker Article led to the passage of the Affordable Care Act and the development of ACOs.
02:00 Edwin Estevez returns to the Race to Value! (Episode #1 with Edwin)
02:30 The underserved region of the Rio Grande Valley (RGV) as a focal point to create a replicable convening model of equity-based co-opetition.
04:30 Advancing health equity through a community-based ecosystem – Eric and Edwin discuss their upcoming collaboration in the RGV.
05:45 “Value-based care is a platform to shape policy, redirect programs, and understand services better through the lens of health equity.”
06:00 Edwin’s prior VBC success with RGV ACO, one of the earliest (and most successful) physician-led MSSP ACOs in the country.
06:30 Edwin discusses AltaCair, a new population health enablement company borne out of the desire to optimize efficiencies and maximize care management.
08:45 The RGV is a bilingual, border region is home to 1.4 million people (almost twice the population of El Paso), nearly 90% Hispanic, and has some of the poorest counties in the country.
09:00 According to the RGV Health Connect Organization, the region’s median household income is $46,016, compared to $71,347 median household income state-wide in Texas.
09:30 The RGV has 24.7% of families living below poverty level, nearly triple the percentage for the nation. The Rio Grande Regional Hospital states that an estimated 76,000 people in the region have diabetes.
10:00 Edwin provides his perspective on the economic development and demographic growth in the RGV (and how it has not contributed to a rising tide for underserved communities).
11:00 The opportunity for whole-person care and community collaboration to address social determinants of health.
11:45 Despite value-based interventions to reduce avoidable ED visits in the RGV, SDOH challenges still contribute to overutilization of healthcare services.
12:00 The opportunity for Community Benefit Organizations (CBOs) to create a “collective impact model.”
13:30 Dr. Gawande’s careful assessment of McAllen, Texas, a small city on the border, that found that it had the most expensive healthcare system in the nation.
14:00 According to the U.S. Census Bureau, 9.8% of people under the age of 65 do not have health insurance nationwide, but the percentages in the RGV are much higher at around 30%!
15:30 How a broken system of big business fee-for-service healthcare emphasizes profiteering at the expense of community health outcomes.
16:30 “The economics of value-based care galvanized our healthcare community in the RGV following the wake of Gawande’s The Cost Conundrum.”
17:00 The continued challenges of accessing primary care in the RGV (wait times may be up to 2 hours).
17:30 Various community ACOs (e.g. RGV ACO, RGV Health Alliance, South Texas Clinical Partners ACO) have triggered an elevation of consciousness to drive accountability.
18:30 “A mindfulness of engagement to see the whole-person” (focusing on prevention and AWVs)
18:45 RGV-based hospital systems are now focusing on value-based care (e.g. direct admissions)
19:30 Finding opportunities to disrupt the local ecosystem to improve equity (whole-person care responsiveness and focus on social influencers that drive health).
20:00 The critical shortage of PCPs, nurses, and other healthcare professionals and the opportunity to create equity in the access and attainment of education for underserved learners.
21:00 A recent survey of healthcare CEOs by ACHE shows the #1 challenge is workforce — eclipsing even financial challenges which held the top spot for 16 years in a row up until last year!
22:00 Edwin discusses the Higher Education landscape of the RGV (WGU Texas, UT RGV, STC) that are actively engaged to address staffing shortages and workforce development needs.
23:00 How the pandemic created a perfect storm to transform the educational landscape in the RGV for health professions.
23:30 The presence of educational institutions change the relationship of labor to community-based health challenges in a given region.
24:00 “Access to care is at the pinnacle of problems related to equity and opportunity for people of the Rio Grande Valley.”
24:30 “It is astronomically crazy that folks in our market can find it easier to access basis care in the ER than see a primary care physician!”
25:00 A renewed focus on the development of additional primary care access points in the RGV.
25:30 “We must think of access to primary care and labor shortages as a matter of equity. Collaboration can better coalesce around the opportunities to better meet these needs.”
26:30 A Vision of Pioneering Co-opetition for Health Equity — a partnership between theInstitute for Advancing Health Value at the Leavitt School of Health and AltaCair.
26:45 “Co-opetition is a transformation strategy that combines elements of both cooperation and competition. It involves competing organizations in the same market, working together on something that is mutually beneficial while simultaneously competing in other areas. Coopetition in healthcare is the catalyst for transformative change, where the pursuit of collective well-being transcends individual interests, and collaboration becomes the cornerstone of a healthier local ecosystem.”
27:30 Accelerator2023, will be held in Mission, Texas on October 17th, bringing together competing health system and ACO leaders, CBOs, Higher Education, entrepreneurs, civic and other community leaders.
28:00 Collaboration with Aneesh Chopra and Sister Norma Pimentel to advance value for health equity in the Rio Grande Valley.
29:30 “We want to advance equity through community-based focused conversations. Transformation in health equity in the RGV will result from co-opetition.”
31:00 Edwin discusses how a researched-backed convening event can foster impactful strategies that drive high-level tactical execution in the advancement of equity.
32:00 To what degree has health value accelerated health equity?
33:00 The activation of an ecosystem for better health.
34:00 Creating replicable models for health equity co-opetition across the country.
34:30 “Health equity transformation in underserved regions is not just a matter of providing medical care; it’s a testament to our commitment to justice, compassion, and the recognition that the well-being of every individual, regardless of their circumstances, is a reflection of our shared humanity.”
35:00 “It is impossible to continue on a trendline where your zip code is a better determinant of health than your genetic code.”
36:00 Activating entrepreneurship for social justice and health equity through community collaboration.
37:00 Parting thoughts from Edwin on our upcoming event to transform health equity in the Rio Grande Valley.
38:30 Register for in-person or virtual attendance to Accelerator2023!
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Dr. Stephen Klasko is a transformative leader and advocate for a revolution in our systems of health care and higher education. He has been a university president, a dean, a CEO, and an obstetrician, and now pursues his vision for the creative reconstruction of American healthcare by bridging traditional academic centers with entrepreneurs and innovators. His passion is using technology to eliminate health disparities and offers everyone the promise of health assurance. Dr. Klasko is also a lifelong DJ who believes that the message in the music can give us the courage to tackle a broken, fragmented, unfriendly, expensive, and inequitable healthcare system.
In this episode, Dr. Klasko merges with his alter ego “Stevie K the DJ” to discuss his new book, “Feeling Alright: How the Message in the Music can Save Healthcare” published by ACHE. Feelin’ Alright leverages the emotional power of song lyrics to inspire healthcare executives to envision and build a more accessible, high-quality, and equitable healthcare system. Using music as a metaphor, Dr. Klasko encourages us to examine what is problematic in the existing healthcare model and to take tangible steps toward a more consumer-centered healthcare experience.
Infused with the passion inherent in music, this interview motivate healthcare leaders to take the lead in building a better healthcare system!
Episode Bookmarks:
01:20 DJ Eric “The Dream” Weaver introduces Dr. Stephen Klasko (aka Stevie K the DJ)!
03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:30 Using the power of music to inspire a more optimistic world.
05:30 Dr. Klasko discusses his prior career as a DJ and how getting fired started him on the path to medicine.
06:30 Using music at Jefferson to inspire his others to find hope in overcoming the pandemic, financial tsunami, and systemic racism.
07:00 “Choice of Colors” by Curtis Mayfield and the Impressions (healing during the George Floyd protests)
07:45 “Courage to Change” by Sia become a theme song for frontline workers and their heroic response to the COVID-19 pandemic.
10:00 Health care delivery during the pandemic was a war and how music helped to see a brighter day.
10:45 “We have to stop saying we are the best healthcare system in the world.”
11:00 “Medicine’s Dilemmas: Infinite Needs Versus Finite Resources” and the “Iron Triangle” of Healthcare
11:30 The performance of stocks as evidence for flawed thinking around healthcare disruption.
12:30 Kaiser Permanente and Geisinger come together to launch Risant Health and expand access to value-based care.
13:00 Payer-Provider Alignment in Medicare Advantage
13:45 Cityblock Health leveraging capital investment to build a Community Health Worker model for population health.
14:30 Taking population health, social determinants, predictive analytics, and health equity to the mainstream of healthcare.
14:45 “Keep the Customer Satisfied” by Simon & Garfunkel as inspiration for health assurance to rebuild trust and equity in a broken system.
17:00 In healthcare, do we really view the people as the customer?
18:00 The healthcare system is setup to enrich the people in control.
18:30 “The concept behind health assurance is that costly sick care will give away to affordable, personalized, and preemptive care, partly through genomic sensors and AI-based digital therapies.”
19:00 The future of Jefferson as a health system without a location.
20:00 Livongo and Jefferson Health — a strong, sustainable partnership between technology and providers to remake medicine.
21:00 Poor consumer segmentation in American healthcare (viewing patients monolithically).
22:45 Radical change needed! (collaboration, concentration on health disparities, creativity, and portfolio diversification)
24:00 Dr. Klasko’s prediction for the future market landscape of health systems and hospitals.
25:00 “Mr. Roboto” by Styx bemoans the plight of ‘modern man’ oppressed by technology and is a cautionary tale for the use of tech-enabled healthcare.
27:30 The interface between technology and humans (“When offline meets online, what happens to the human in the middle?”)
27:45 Elon Musk and Generative AI
28:00 The importance of recognizing change in society when selecting and training medical students.
29:00 How do we create humans that are more human than robots, instead of more robotic than robots?
29:45 Retraining doctors and faculty who “joined a cult” when entering medicine.
30:00 The lies to providers that technology would make their life easier.
31:30 Building a relational bridge between healthcare leaders and generative AI.
32:00 Failure of IBM Watson vs. Success of Aidoc (why it is important to augment – not replace human intelligence).
33:00 “I am Changing” by Jennifer Hudson from the movie Dreamgirls – a theme song for American healthcare delivery in the 2020s.
35:30 “Hospital CEOs need to think like Target and Walmart trying to compete with Amazon.”
37:45 Why hospital billboard ads and commercials make no sense!
38:30 The new marketing in healthcare is all about consumerism (helping patient navigate, offering convenience, inspiring loyalty).
39:45 “We need to demonstrate value by giving consumers a single point of contact to create a seamless experience across the continuum.”
40:00 The Amazon acquisition of OneMedical is emblematic of a failed primary care model that lacks consumerism.
41:00 The inevitable failure of Chief Marketing and Growth Officers that are aging white men.
41:45 Examples of innovation: Strongline (staff safety) and Guild (upskilling the workforce)
43:00 Dr. Austin Chang and his incredible work as a Chief Medical Social Media Officer at Jefferson.
44:00 Overcoming the “poor me” mentality (embracing payer-provider alignment, lower costs, consumerism,Jand portfolio diversification).
44:30 “For the Love of Money” by The O’Jays speaks to the destructive impact that a singular focus on money and profit can have on individuals and society at large.
44:30 The Maryland All-Payer Model – mandated global budgets for hospitals achieved great success.
46:30 Dr. Klasko discusses the concept of a single payer by state model.
47:45 Fear and greed caused by the flow of money into politics.
48:30 Direct patient marketing of expensive, specialty drugs.
49:00 Spending 4X more for obstetrical care than other countries (with far worse outcomes).
50:00 The dilemma of expecting a system to change when salaries depend on it not changing.
51:00 Our healthcare system does absolutely great! (for plaintiff’s lawyers, specialists, pharma and insurance industries, EMR companies, PBMs, and patients with unlimited resources who have the best insurance)
52:00 The unconscionable deaths of people during the pandemic who died at home when telehealth companies made record profits.
53:00 The need for companies to fail.
54:00 “Born This Way” by Lady Gaga as an anthem for self-acceptance and celebrating diversity.
55:30 Dr. Klasko on how zip code and living conditions mean more to life expectancy than one’s genetic code.
56:30 Dr. David Nash and his landmark population health research on Social Determinants of Health.
57:00 “In a practical world, a health system CEO is incentivized to keep their population as healthy as possible.”
57:30 The radical shifts that took place at Jefferson Health to improve health equity.
60:00 Solving for food deserts through bar coding and drone delivery.
61:00 The challenge of focusing on SDOH interventions when fee-for-service revenue declines.
62:00 “The Myth of Trust” by Billy Bragg as a somber reminder that people have lost trust in institutions.
63:00 Lack of trust in the healthcare system (citing the failure of GPS technology to improve health)
64:30 Distrust with genomics testing and the privacy of data.
65:30 Patients being able to monetize their own data when participating in clinical studies.
66:30 Nurses who feel that CEOs do not care about them.
67:00 Reinstating healthcare as a public good with servant leadership at the helm.
68:00 “Don’t Stop Believin’” by Journey
69:00 The future of 3D printing, RPM, and digital medicine in serving humankind alongside compassionate providers
70:00 Dr. Klasko describes a future scenario in 2033 where technology could prevent a global pandemic.
73:00 Optimism for the future of health assurance with currently available technologies.
74:00 “Will it Go Round in Circles” by Billy Preston as reminder that we do not want to reform healthcare 360 degrees!
In value-based care, we have both an economic and a moral imperative. What’s at stake is so much more than saving our healthcare system. It is about ensuring the continued prosperity of our nation to ensure that we leave it better for future generations. The best indicator of whether our country is on the right path is the assurance that healthy mothers can give birth to healthy children. And those children, in turn, must be assured of good care and a sound education that will enable them to face the challenges of a changing world. If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.
This week on the Race to Value, you are going to hear from a value-based care leader who is boldly moving beyond with a call to action to serve our nation’s youth. Karen Wilding, the Chief Value Officer at Nemours, is on a passionate pursuit of the Quadruple Aim, and her health system is redefining children’s health in our country. Nemours Children’s Health is truly “leaning in” to the promise of population health by transforming the very definition of what it means for children to be healthy. And their value journey reflects a bold vision to create the healthiest generations of children that will take us beyond medicine by ultimately impacting the world. If you are looking for an example of inspirational leadership in value-based care, look no further than Karen Wilding and the Nemours Children’s Health System!
Episode Bookmarks:
01:30 “If we could have but one generation of properly born, educated, and healthy children, many of the insurmountable problems in our country would vanish in our lifetimes.”
02:30 Introduction to Karen Wilding, the Chief Value Officer at Nemours Children’s Health
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
05:45 Karen describes the whole-person care orientation at Nemours and how the mission of “Well Beyond Medicine” guides their value-based care journey.
06:45 Social Determinants of Health (SDOH) screening in underserved populations to expand care network and create community partnerships.
07:45 Driving “macro-system impact” as an anchor institution (e.g. best practice clinical research, cross-sector partnerships, health equity investments)
08:30 Health Equity opportunities in pediatric whole-person care (e.g. teen birth rates, preventative care access, infant mortality rates…and even household income).
09:00 “Well Beyond Medicine is a commitment to not just care for the medical aspects of children – we also care for the larger health ecosystem to create whole-child health and healthier generations.”
11:45 “Payment transformation is foundational to being able to create sustainability in value-based care.”
12:30 Karen explains how the fee-for-service infrastructure does not align incentives for healthy outcomes (e.g. asthma exacerbations with children in Delaware).
13:30 “Investing in children’s health is the single most important thing we can do as a society.” (balancing present-day economics vs. future economics).
14:45 Partnering with payers to pursue health equity transformation and the importance of community-based investments.
16:45 Nemours has been utilizing Community Health Workers to conduct SDOH screenings and individualized interventions through a culturally competent care model.
17:45 Karen explains how the interdisciplinary care team at Nemours works together to capture, assess, and address SDOH barriers.
18:45 The importance of enterprise-level buy-in when launching a SDOH population health strategy.
20:30 Overcoming fears and concerns of families in sharing personal information about their social barriers.
21:00 The creation of a national toolkit on whole-child population health and how Nemours is collaborating with policy stakeholders at the federal level.
23:30 “We want to be where children live, learn, play, and grow. In order to address health in communities, you need partnerships.”
24:00 The role of virtual care and home health in a community-based ecosystem.
25:00 Karen describes how Nemours provides physical and behavioral health services in partnership with elementary schools.
26:00 Working with CBOs and faith-based organizations to address SDOH barriers in communities.
27:00 Partnering with government agencies (e.g. juvenile justice, CPS) to elevate the health of vulnerable children.
28:30 The focus of Nemours leadership in technology innovation to develop the system’s EHR infrastructure and digital, consumer-centric strategy.
30:45 Karen discusses the importance of technology enablement to drive population health through an omni-channel patient experience.
32:00 EHR optimization to drive clinical decision support at the point-of-care.
32:30 Leveraging analytics to bridge the clinical and claims data experience.
33:00 How the MSSP empowered healthcare organizations through the provision of claims data. (Medicaid data in children’s health is not the same.)
34:00 The need for national data standards to have consistency with all payers in the country.
35:45 1 of 6 children between the ages of 6 and 17 has a treatable mental health disorder, yet only around half ever receive treatment.
36:45 The pandemic created an increase in childhood Emergency Department utilization (25% increase in children 5-11, 30% increase in adolescents 12-17).
37:00 40% of children are living with anxiety and 45% are living with behavioral health disorders.
37:45 How Nemours is handling the pediatric behavioral health crisis through clinical integration, telepsychiatry, and digital mental health tools.
38:45 Behavioral health diagnoses is 17% more prevalent in a Medicaid population.
40:00 Referencing Daniel Dawes (“The Political Determinants of Health”): We would save over $300 billion per year if we were to eliminate American racial health disparities in our healthcare system.
40:30 Black children are 3X more likely to die in infancy than white children, 7X more likely to die from asthma attacks, and more than 3X more likely to die after elective outpatient surgery than white children.
41:00 Disparities in household income based on race and how that contributes to teen birth rates and health inequities.
42:00 Nemours commitment to equity through program development to ensure education and access.
43:00 The Chief Health Equity Officer role supports health equity transformation, community partnerships, and workflow process changes.
45:00 How payment disparities and demographical attributes between Medicaid and commercially-insured pediatric populations may contribute to health disparities (ex: asthma).
45:45 Designing a whole-person care model to ensure every child is given optimal treatment regardless of their health insurance status.
47:00 Integrated behavioral health in the primary care setting needed to make timely interventions.
49:30 Parting thoughts on the meaningful and impactful work of value-based care transformation and how that provides the passion for service-oriented leadership.
Patients who are high utilizers, also known as multi-visit patients (MVPs) or frequent flyers, whether found in the ED, inpatient units or other departments, drive up readmission rates and tie up resources. Often, clinicians and administrators hold out little hope that they can end the multi-visit cycles of these patients. Yet, by looking at a patient’s multiple visits as a symptom of a deeper problem, and then identifying and rectifying that underlying problem, clinicians can end a patient’s cycle of care utilization.
On this podcast, a leading expert in high-utilizer care discusses her MVP Method which has been used by rural hospitals, community hospitals, safety net hospitals, and academic medical centers across the country. Dr. Amy Boutwell, President of Collaborative Healthcare Strategies, is a nationally recognized thought leader in the field of reducing readmissions and improving care for highest risk and multi-visit patients. She is the developer of the STAAR, ASPIRE, ASPIRE+ and MVP methods to reduce avoidable acute-care utilization and deliver whole-person care across settings and over time.
The general principles and actions of the MVP Method can revolutionize care, break the cycle of utilization and change the life of your patients. The Institute for Advancing Health Value has released an Intelligence Brief and Case Study to accompany this special podcast episode.
- Download the Open Access Intelligence Brief: “Building An Effective Care Pathway for Multi-Visit Patients: The MVP Method” (Available to Everyone!)
Building An Effective Care Pathway for Multi-Visit Patients: The MVP Method
- Download the Members-Only Case Study Brief: “Transforming Care MVPs at a Safety-Net Health System” (Available to Institute Members – Join the Institute for free if you work for a Provider Organization!)
Episode Bookmarks:
01:30 High utilizers, also known as multi-visit patients (MVPs) or frequent flyers, whether found in the ED, inpatient units or other departments, drive up readmission rates and tie up resources.
02:00 Can high utilization by MVPs be impacted by addressing symptoms of a deeper problem?
02:30 Introduction to Dr. Amy Boutwell and the MVP Method to improve care for High Utilizers.
03:15 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:45 Referencing the Dr. Atul Gawande article called “The Hot Spotters” which showed how a health system experienced a 40% reduction in super-utilizer reduction.
07:00 The risk of conflating the terms of “high risk,” “high utilizer,” “high cost,” and “complex”.
07:45 Busting the myth that multi-visit patients are un-impactable.
08:30 “We must walk away from the dogma that it is not worth serving high utilizers. The industry must reengineer its thinking around that to advance health equity.”
09:00 Dr. Boutwell references the work of the Camden Coalition and how “Hot Spotters” did not confirm the myth of un-impactability.
10:30 The Hospital Readmissions Reduction Program (HRRP) aims to minimize the number of avoidable hospital readmissions by incentivizing hospitals to improve post-discharge planning.
11:30 Dr. Boutwell discusses the challenges of HRPP as a health policy and why hospitals have still yet to evolve in care delivery transformation.
12:30 Readmissions programs often are treated as a pilot instead of as a strategy for transformation.
13:30 Dr. Boutwell’s work in partnering with health systems to develop a population health playbook to lower hospital readmissions.
14:30 The challenge of focusing on just one chronic condition in a readmission reduction strategy (e.g. heart failure).
15:45 “Multi-visit patients account for over half of all readmissions at every single hospital in the United States.”
16:45 “We have to go beyond payer-specific or disease-specific paradigms to find higher leverage population segments to impact.”
18:00 The MVP Method was designed for scale and is used by rural hospitals, community hospitals, safety net hospitals, and academic medical centers across the country.
19:00 Dr. Boutwell provides a thorough explanation of the MVP Method and how it supports hospitals in achieving delivery system redesign.
22:30 Multi-visit patients are typically determined to be ~7% of all patients, yet account for 20% of hospital admissions, 50% of readmissions, and 10% of ED visits.
24:30 Physicians identify the cause of a symptom to accurately diagnose a patient. (This is the same paradigm one should apply to a MVP with a symptom of recurrent overutilization!)
26:00 The root cause approach is at the core of the MVP Method.
26:45 Harris Health article (“A New Way to Support Frequent Emergency Department Visitors”) about how they achieved a 15% reduction in ED visits across all MVPs (with Ben Taub reducing theirs by 77%!).
28:00 The success that Harris Health has had in implementing your MVP Method for addressing frequent ED utilizers. (Join the Institute and download the members-only Harris Health Case Study!)
35:00 New York State Medicaid is the largest sponsor of the MVP program so far and is focusing on hospital and community partnerships in care delivery redesign as part of its DSRIP strategy.
37:00 A personal story about a multi-visit patient dealing with housing instability.
38:45 Human-centered pathways and systems are a crucial determinant of success with the MVP Method.
39:00 How the New York State Medicaid system built equity value-based population health through cross-continuum team-based care on the frontlines.
42:00 The need for accountable teams to ensure definitive and timely linkages to MVP root cause solutions.
43:00 A personal story about successful care team engagement with a complex multi-visit patient.
48:00 ASPIRE Framework to Reduce Hospital Readmissions
50:00 The importance of understanding patient data before implementing a readmissions reduction strategy.
51:00 How analyzing data led to health systems learning for the first time that alcohol abuse was the main cause of hospital readmissions.
53:00 A great example of how a hospital developed a collaborative team-based interdisciplinary approach to readmissions reduction.
55:00 Nationally, 56% (or roughly 67 million ED visits) are potentially avoidable. The average cost of an ED visit is $580 more than the cost of a comparable office visit.
57:00 The importance of advanced primary care access and the need to address the fear and uncertainty that patients experience regarding their condition.
60:00 Emergency rooms do not adequately address fear and uncertainty (an opportunity for person-centeredness).
62:00 How the state of Maryland dramatically decreased overutilization once financial incentives were realigned (from worst place to above the national average!)
65:00 “Value-based is the way we must practice medicine with regard to whole-person care.”
65:30 Parting thoughts from Dr. Boutwell on the importance of value-based care in the practice of medicine.
Three perfect storms in recent years – the health storm produced by the COVID-19 pandemic; the economic storm that resulted from its disruptions; and the social storm that followed the murder of George Floyd which sparked fresh outrage at longstanding inequities – have sharpened and added important nuances of what health care really means. The goal of health care has always been to reduce suffering, but we must now prioritize transformation in leadership now more than ever. Building trust, eliminating inequities, and ensuring high reliability are of the highest magnitude of importance as we blaze a new path forward.
This week, on the Race to Value, we are joined by Thomas H. Lee, M.D., the author of the new book “Healthcare’s Path Forward” to discuss how the healthcare industry is being transformed by deeper knowledge of what suffering means for patients, their families, and healthcare providers themselves. Since healthcare is not working for anyone, Dr. Lee provides wisdom and insights of optimism for where true change can happen in creating new standards for excellence.
In addition to being a bestselling author and expert on healthcare transformation, Dr. Lee is the Chief Medical Officer of Press Ganey. He brings more than three decades of experience in healthcare performance improvement as a practicing physician, leader in provider organizations, researcher, and health policy expert. He’s responsible for developing clinical and operational strategies to help providers across the nation measure and improve the patient experience, with an overarching goal of reducing the suffering of patients as they undergo care and improve the value of their care.
Episode Bookmarks:
01:30 Introduction to Thomas H. Lee. M.D. and his new book “Healthcare’s Path Forward”
03:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:00 The six elements of organizational culture that lead to transformation – Excellence, Trust, Respect, Inclusion, Resilience, Reliability
05:00 John Nash (“A Beautiful Mind”) and Non-Cooperative Game Theory
06:00 Optimism for healthcare because how bad things really are!
07:00 Nash Equilibrium states are commonplace in healthcare – it creates inertia and stifles change.
08:30 “Equilibrium states break down when the pain of the status quo exceeds the fear of the unknown for multiple parties.”
09:00 “Healthcare is not working for anyone. That is where real change can happen and what makes me optimistic.”
09:45 The destabilizing trends of supply chain disruption, social unrest, political divisiveness, consumerism, demographic shifts, workforce drain, and environmental disasters.
11:30 Responding to social justice, climate change, and the need to redesign healthcare – is it too much for us to tackle all at once?
12:00 “Changing the way healthcare is paid for – in absence of other reforms – is grossly inefficient. There are many other things that have to happen.”
12:30 Michael Porter’s Value Chain and the importance of clarity and differentiation in the creation of value.
13:30 “Payment reform is just one activity of healthcare reform. We also need trust in the workforce and with patients, an understanding of what safety means, and a response to consumerism.”
15:00 In times of turmoil, healthcare organizations need more than a performance culture; they need a learning culture.
16:30 The most important part of transformational leadership is division of responsibilities and areas of key focus to enact organizational change.
17:30 No one can do everything! If leaders focus on only three things, they will be successful in strategy execution.
18:30 3 Functions of Governing Boards and Executives: Articulate the Core Values, Develop Strategy, Understand the Value Chain
18:45 “An organization is the lengthened shadow of its leaders.” – Ralph Waldo Emerson
20:30 3 Functions of Managers: Create Social Capital, Bring High Reliability Principles to Life, Eliminate Waste of all Types
21:30 “Social capital is more important than financial capital in the times in which we live.”
22:00 Applying High Reliability to all the dimensions (including patient experience) and refusing to tolerate failure in matters of trust.
23:45 “Culture of No Waste” – includes both time and resources
24:30 3 Functions of Frontline Caregivers: Create a Culture of Respect, Be Full Participants on Great Teams, View Job as Shaping the Memories of Patients and Families
25:30 The healthcare workforce often feels that they are part of a organization that does not respect them.
26:30 “Treating people with respect should be treated in the same way that the industry tackled hand hygiene to improve patient safety.”
27:45 Referencing the TED Talk from Daniel Kahneman: “The Riddle of Experience vs. Memory”
29:00 Frontline caregivers are like Steven Spielberg, i.e. they are the producers and directors of the patient memories.
32:00 “We live in a time where trust is under attack in society. You can’t take trust for granted in healthcare.”
33:00 Trust goes beyond the clinician encounter – it encompasses the whole episode of care, including the web presence of the provider before the visit.
35:30 The importance of 5-Star Ratings online in building trust.
36:30 “Patients are unnerved from friction, chaos, and any indication that they may not be safe. The pandemic has really heightened their fears.”
38:00 Dr. Lee discusses how Press Ganey has begun surveying patients on their perceptions of patient safety.
39:45 High-reliability and the Anna Karenina Principle (“Happy families are all alike; every unhappy family is unhappy in their own way.”)
41:45 In 2021, the Press Ganey Employee Engagement Indicator declined in every single job category!
43:00 Dr. Lee discusses how building trust with workers coincides with the actions taken to build trust with patients.
44:30 Personal Pride: Pride in the organization, Pride in what you do for the organization, Pride in what your team does.
45:30 Personal Alignment: Aligning with the cultural beliefs of employees and the need for inclusion. (Lack of DEI creates a 4X greater risk of employee turnover.)
46:00 Personal Resilience: Activation (employee motivation) and Decompression (ability of employees to forget about work when at home).
47:30 Activation is increasing in healthcare, but decompression continues to go down!
50:00 Dr. Lee explains how the pandemic and social unrest has created a deeper understanding of human suffering and how systems create harm.
50:30 Understanding Patient Safety beyond Physical Harm by also considering Emotional Harm (e.g. not feeling safe or financial distress due to healthcare)
51:30 The nuance of perception in Patient Safety (an example of how patients didn’t feel safe when a change when a hospital starting using odorless disinfectant).
53:00 Lack of respect as a safety issue.
53:00 The murder of George Floyd prompting an examination of the impact of inequality throughout society.
54:00 Diversity, Equity, and Inclusion in healthcare as a form of social capital and the pursuit of zero inequity.
55:00 The importance of DEI in health equity is now understood at a deeper level by healthcare leaders following the murder of George Floyd.
56:00 “Zero Inequity should be our goal just like Zero Harm is our patient safety goal.”
56:45 The data from safety net hospitals showing continued challenges in assessing pain with African American patients.
58:00 How organizational mistreatment of patients creates mistreatment of workers (and why lack of patient-centeredness is main reason for employee turnover).
61:00 Dr. Lee touts the virtues of healthcare and why it is such a great industry to work in.
62:00 New Skills for the Era Ahead: Strategy (Porter’s Value Chain), Social Capital (Teamwork, Leadership), Growth Mindset (read Grit: The Power of Passion and Perseverance!)
64:00 The potential to do great work in medicine and making a difference in the lives of others.
64:30 “This is the best time to be going into healthcare. You can really make a difference in a noble field.”
65:00 How to reach out to Dr. Lee and learn more about his work in healthcare transformation.
It is Black Maternal Health Week, and this week’s episode provides context and value-based solutioning on how to address the alarming rise of maternal mortality in the U.S. We have horrifically poor maternal health outcomes in the African American population of our country, and it is directly attributable to a flawed design of our healthcare system juxtaposed with the presence of longstanding and systemic institutional racism. If there ever was an opportunity for improving health equity through value-based care, it is with this moral imperative to ensure the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival. On this week’s podcast, you are going to hear from one of the leading voices in health equity, reproductive justice, and value-based maternal health.
Our guest is Dr. Neel Shah, the Chief Medical Officer of Maven Clinic, the world’s largest virtual clinic for family health care. He is also a visiting scientist at Harvard Medical School where he previously served as a professor of obstetrics, gynecology and reproductive biology. Dr. Shah has been recognized with the Franklin Delano Roosevelt Humanitarian of the Year Award from the March of Dimes for his impact on maternal health in the United States. He is featured in the films Aftershock, which won the Special Jury Prize for Impact at the 2022 Sundance Film Festival, and The Color of Care from the Smithsonian Channel and Executive Producer Oprah Winfrey. As a physician-scientist, Dr. Shah has written landmark academic papers on maternal health and health care policy, and contributed to four books, including as senior author of Understanding Value-Based Healthcare. He is listed among the “40 smartest people in health care” by the Becker’s Hospital Review, and he currently serves on the advisory board of the National Institutes of Health, Office of Women’s Health Research.
In this podcast, we discuss a special documentary that Dr. Shah contributed to called “Aftershock”. This inspiring film on black maternal health equity turns pain into power and should be watched by all who strive to make a positive change in American healthcare. Join us on April 12th, for a screening of the Aftershock documentary and a discussion with other attendees.
This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system.
Bookmarks:
01:30 Black Maternal Health Week and the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival.
02:15 Introduction to Dr. Neel Shah, one of the leading voices in health equity, reproductive justice, and value-based maternal health.
03:30 AFTERSHOCK, is an original documentary on black maternal health equity. (Watch Trailer and attend special free virtual screening on April 12th).
04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:15 This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system.
05:30 Since 1970, we have seen a 500% increase in C-Section procedures over vaginal deliveries, with the rate of C-sections among black birthing persons being much higher than the general population.
06:00 C-sections bring in an average of $10k per procedure, compared to an average reimbursement of $4,500 for a vaginal delivery.
07:30 “Childbirth is the most utilized healthcare service in the United States of America and accounts for 25% of all hospitalizations.”
08:30 The opportunity to extract more “value” in the maternal health system.
08:45 “In childbirth, we predominantly have a “too much too soon” problem. One in three receive a major surgery to give birth, and one in ten babies go to ICU.”
09:00 Profit margin of 50% per case has normalized C-sections, despite the overwhelming adverse outcomes and contra-indications for most C-sections performed.
09:30 How the surgical apparatus for childbirth creates flawed financial incentives.
09:45 The institutionalization of both birth and death in the American healthcare system.
10:30 Pregnancies are the easiest episodes of care to define and that lends itself readily to bundled payments.
11:00 The need to pay less for C-sections and the need to pay more for vaginal deliveries.
11:30 The maternal mortality rate for black women is 43 per 100,000 which shows that they have a pregnancy-related death risk that is 3-4X greater than that of white women.
12:45 “The wellbeing of Moms is a bellwether for society in general. Every injustice in society shows up in maternal health and maternal health outcomes.”
13:30 The high degree of racial inequity across outcomes, which include death, morbidity, undertreated illness, economic disempowerment, and social isolation.
14:00 The data shows that anti-black racism contributes to the most severe forms of health inequities.
14:30 How public health data has conflated race and racism in interpreting evidence-based practices in medicine.
15:30 The flawed maternal health outcomes calculator that erroneously downgrades patients for being black as a physiologic indicator.
16:15 “Redlining in healthcare” – how historical racism in urban planning decisions creates social barriers and leads to systemic health inequities.
16:45 The 1921 Tulsa Race Massacre as an example of how the legacy of racism contributed to the worst maternal health outcomes in the country (still persisting to this day).
17:45 Black moms often aren’t dying of the medical condition like what is stated on their death certificate…what they are really dying of is failure of communication.
18:30 Disparities in health literacy can have serious consequences for the health outcomes of Black individuals.
19:45 Joint Commission: 80-90% of sentinel events (near misses, deaths) are due to failures of communication and teamwork.
20:00 Communication and teamwork are the ultimate artisanal crafts in medicine, but medical schools traditionally do not teach this.
21:00 Childbirth is the ultimate team sport, but “the team” only forms for the first time upon the onset of delivery.
22:00 Dr. Shah discusses how a communication whiteboard in the maternal health setting can improve both teamwork and patient outcomes.
23:30 The importance of collaboration in an interdisciplinary care team.
24:00 The longstanding racism in the medical establishment that leads to multigenerational distrust of the health system.
25:00 “The existential challenge for the healthcare system in 2023 is trustworthiness. The job is not for patients to be more trusting of us; we need to be more trustworthy.”
26:00 How the legacy of the institution of slavery commoditized the reproductive potential of people and contributed to anti-black racism.
26:45 The insidious nature of adequately responding to pain reported by African American patients in the healthcare setting.
27:00 Racism in healthcare is systemically embedded and irrespective of status or income. (Examples include Serena Williams, Beyonce, Meghan Markle.)
27:15 How racism is embedded in medical textbooks.
27:45 Horrendous racist medical experiments (e.g. Tuskegee Experiment, Henrietta Lacks, “welfare queens”)
28:00 The three criteria of trustworthiness: Competence, Affirm Dignity for People’s Lived Experience, Reliability.
28:30 The competency of reliability is what we furthest from in the healthcare system.
30:00 J. Marian Sims, the father of gynecology, developed the C-section procedure so slaves could avoid fistulas from vaginal births to produce more slave labor.
31:00 Despite the longstanding track record of racism in maternal health, journalists didn’t really start telling the telling the story of back women dying in childbirth until 2018.
32:30 Injustices in society comprise gender inequity, racial inequity, geographic inequity, and generational inequity.
32:45 The pervasiveness of generational inequity in our politics, e.g. MAGA, Build Back Better.
33:00 “Hope, opportunity, and progress in our country are eroding in our country. There is empirical evidence that this is true. We see it in policing, educational attainment, and maternal health.”
33:30 The danger of leaving African Americans behind in the pursuit of generational equity.
33:45 The most convincing evidence that racism still exists in America in 2023 (comparing risk of wealthiest black woman to poorest white woman).
34:00 Dr. Shah speaks about his personal experiences traveling across the country to better understand maternal health inequities.
35:00 How George Floyd and BLM movement changed awareness for the presence of racism in healthcare.
35:30 Maternal mortality is the lagging indicator and recent increases are discouraging (despite that leading indicators are strong).
36:00 Avoidance of preventable deaths are an improving leading indicator.
36:30 Maven Clinic is the world’s largest virtual clinic for family health care that offers continuous holistic care for fertility and family building.
39:00 Loretta Ross as an inspiration for optimism in reproductive justice (“making sure the chain doesn’t break at your link”)
40:00 Dr. Shah provides an overview of the Maven Clinic and how it “thinks differently” in providing a model for health.
41:00 Providing a model for care, support, and access by meeting people where they are.
42:30 Earning trust through the provision of virtual, cultural-affirming care.
43:45 Developing economies of scale through technology.
44:00 “Social determinants of health need a hyper-local response, especially when it comes to material needs like food and housing.”
44:30 How Maven Clinic employs a short-form digital SDOH screening tool that reduces barriers to identifying addressing social needs.
45:00 Defining loneliness and why community partnerships are so important in the birthing process.
45:45 “The birth equity movement is in a similar place that the HIV/AIDS movement was in the late 1980’s. There are a proliferations of CBOs galvanizing on behalf of their community.”
47:30 Identity shift from academic physician to technology executive and CMO (WSJ: “Obstetrician Neel Shah Joined the Telehealth Revolution”)
49:30 How COVID-19 caused an awakening within Dr. Shah to make a more outsized impact on maternal health equity at a national level.
50:45 Building a Car Instead of a “Faster Horse” – seizing the disruptive opportunity for innovation in maternal health.
51:30 “Correctly deployed science gives you confidence in what you think you are observing is true. It then allows you to create products that can fit into markets and drive scale.”
54:30 Parting thoughts of inspiration from Dr. Shah’s experience as a contributor to the Aftershock documentary.
56:00 “Historically, the healthcare system has treated people’s experience as a secondary luxury after you made them safe. We got it backwards – the way you make people safe is by attending to their lived experience.”
This week we have the honor of being joined by a world-renowned family physician and health equity expert, with deep experience in value-based care transformation, technology and innovation, and health disparities improvement. You are going to hear from the one and only Dr. Nwando Olayiwola, a leader in this Race to Value who is committed to ensuring that everyone has access to fair, high quality and equitable health and health care, no matter their background. To achieve this, she has committed her career to health system reform, practice transformation, primary care redesign and leveraging technology and other innovations to mitigate health disparities.
Dr. Olayiwola is Nigerian American physician, professor, author, speaker, consultant, and health equity leader. She was named the American Telemedicine Associate’s Woman of the Year in 2019, she was named one of the most influential minority executives in healthcare by Fierce Healthcare in 2021. Dr. O is a tireless advocate for healthcare of underserved populations, women and girls, and community and social determinants of health and innovations in technology, and the intersection of social justice and healthcare. As the inaugural Chief Health Equity Officer and senior VP of Humana, a role that she started in 2021, and she’s responsible for setting equity agenda and strategy for Humana.
In this episode, you will learn about the enablement of an equitable healthcare ecosystem through actionable data, performance measurement and quality improvement, health equity innovation, and relationship-based care.
Episode Bookmarks:
01:30 Introduction to Dr. J. Nwando Olayiwola, a Nigerian American physician, professor, author, speaker, consultant, and health equity leader.
02:30 Dr. O is the inaugural Chief Health Equity Officer and senior VP of Humana.
04:00 Personal background and formative experiences that has led Dr. O towards a career path in healthcare equity transformation.
05:30 The Health Equity Journey at Humana. (“Making Health Equity Part of the Value of Value-Based Care”)
06:45 Humana became a pioneer of health justice and health equity in rebuilding and uniting Louisville after the murder of Breonna Taylor.
07:00 Humana’s Bold Goal Population Health Initiative to enable an equitable healthcare ecosystem.
07:45 “We need to innovate constantly in the way that we deliver and finance healthcare. It must fit within the lives of people’s own lived experience.”
08:00 Optimism for the evolution of our healthcare ecosystem to better prioritize health equity.
09:00 “We must do everything we can to eliminate barriers to healthcare that are unnecessary, that are avoidable, and that are unjust.”
09:45 Imagining a world where healthcare is more than just having an insurance card – it actually becomes an equitable ecosystem of liberation and authenticity.
10:30 Dr. O provides specifics on the various types of health disparities that we encounter in our country and how those impact minoritized and marginalized populations.
12:00 Dr. O’s TED Talk: “Combating Racism and Place-ism in Medicine”
13:00 How is Humana positioning itself as a catalyst for equity innovation by leveraging it health plan and provider assets collectively?
15:00 How the Health Equity movement mirrors the path of the Health Quality movement following the “To Err is Human” report.
16:30 Referencing landmark National Academy of Medicine paper: “An Equity Agenda for the Field of Health Care Quality Improvement”
17:00 Measuring health equity on dashboards measuring organizational performance.
18:00 “We must get the right data to validate we are providing culturally affirming, culturally sensitive, and culturally humble care to people we’re caring for.”
18:00 Referencing NEJM Catalyst article on how Humana developed a health disparities impact measure: “Building the Foundation for Reducing Disparities in Medicare Advantage”
19:30 The need for committed leadership to support health equity work.
20:45 The importance of equity-focused executive hiring practices and actionable SDOH data capture.
22:00 Preventive care measures as a component of a health equity action plan.
22:45 Social Barriers preventing Equitable Care: Financial Strain, Food Insecurity, Housing Instability, Loneliness, Lack of Transportation.
23:00 Positive correlation between social risk and high medical loss ratio.
24:00 Building a more relationship-based delivery model of care that engenders trust between patients and providers.
25:30 The importance of continuous learning in health equity through performance measurement, testing, and validation.
26:30 Building partnerships with Community Benefit Organizations (CBOs) across the country.
27:00 Leveraging insights from acquired data intelligence on underserved communities to improve patient health literacy and economic empowerment.
29:00 “Our vision is that every person will have a fair, just, and dignified opportunity to reach their full health potential.”
30:45 Inspiration from Oprah Winfrey: “I firmly believe that none of us in this world have made it until the least among us have made it.”
31:45 How structural racism limits the positive impact of education as an ultimate opportunity equalizer.
32:30 Learning from Serena Williams’ challenge in accessing equitable health care.
34:00 Working at the “speed of trust” to overcome generational traumas from racism and inequities in healthcare.
35:30 “Trust is earned – it is not given.”
The message from state and federal regulators, healthcare leaders, and our society-at-large is being heard loud and clear: Health equity is a moral imperative.
A cultural zeitgeist for health equity has been awakened in the collective consciousness of all ethnicities in the context of COVID-19 health disparities and the ongoing fight for civil rights and social justice. The economic imperative for equity is also too big to ignore, given that inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed. The future of equitable health is important to the future of our country, and we must address this moral imperative with business solutions.
Joining us this week in the Race to Value is Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator. Dr. Bhatt is the Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), Dr. Bhatt directs the research, insights, and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. He is a prominent thought leader around the issues of health equity, health care transformation, public health, and innovation.
Do you want to learn more about how we can create a catalytic engine for equitable health? Tune in to this podcast to learn from one of the nation’s leading minds on how to advance health equity through business solutions. In this episode, we discuss collaboration with life sciences and health care industry to advance health equity, digital transformation, ACO REACH, and climate-related strategies.
Episode Bookmarks:
01:30 Introduction to Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator.
03:00 Subscribe to the Race to Value weekly newsletter and leave us a review and rating on Apple podcasts!
04:30 The three root causes of health equity: 1) socioeconomic, gender, racism and other biases, 2) disparate circumstances in the drivers of health, and 3) inadequately designed healthcare systems.
06:15 Creating a catalytic engine for the future of equitable health and why the Deloitte Center for Health Solutions and The Deloitte Health Equity Institute (DHEI) are so critical to the health of this country.
06:30 “There is a workforce imperative, a market imperative, and a moral imperative for health equity. We must address the moral imperative through business solutions.”
07:00 Deloitte Report: “Inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed.”
07:30 Collaboration with life sciences and health care industry to advance health equity, digital transformation, and climate-related strategies.
08:30 Engaging key decision makers and global leaders in health equity through Deloitte’s involvement in the World Economic Forum.
09:00 Activating Boards and C-Suite leaders in health equity and implementing place-based change through community outreach and population health interventions.
09:40 Health equity innovation through an accelerator that supports minority-led non-profit organizations and social entrepreneurs.
10:00 Addressing access to maternity care deserts that contribute to inequities throughcollaboration with the March of Dimes.
10:45 A recent research report conducted by the Deloitte’s Health Equity Institute and other partners entitled, “Collection of Race and Ethnicity Data for Use by Health Plans to Advance Health Equity.”
11:45 “Continuing to analyze the delivery of care and examine patient outcomes across demographics, including race and ethnicity but also sexual orientation, gender identities, and language is critical to administering more equitable and inclusive care, and building trust with communities across America.”
12:45 “Building and sustaining trust is critical to improve the availability of high quality race and ethnicity data to advance the journey of health equity.”
13:30 The importance of proximity and lived experience, community partnerships, transparency, and assurance of patient privacy in the collection of race and ethnicity data.
14:30 Federal agencies are advancing more inclusive standards for self-reported, voluntary identification of race and ethnicity data.
14:45 “Health Equity by Design” through interoperability standards developed by the Office of the National Coordinator (ONC).
15:30 “Transparency, trust, and partnership can improve the collection and use of race and ethnicity data. If we want better results, we have to create better systems.”
16:30 Medical Home Network (MHN) – a FQHC that is one of the nation’s foremost clinically integrated and digitally connected delivery networks to improve the health of Medicaid beneficiaries in safety net communities in the Greater Chicago area.
17:45 Chicago is a city facing immense challenge in health equity. In the last decade, life expectancy has fallen for everyone except for non-Hispanic white Chicagoans.
18:30 ACO REACH explicitly identifies Equity – not just Value – as a central goal. Have other payment models perpetuated racism and structural inequities?
19:30 REACH ACOs now being required to develop a Health Equity Plan.
20:00 Dr. Bhatt speaks to the MHN FQHC model and how it contributes to improved community health outcomes.
21:00 Health Risk Assessments (HRAs) that drive the advanced application of AI and predictive analytics for targeting population health interventions in underserved communities.
21:45 Individuals with unstable housing have a life expectancy that is 27-years less than others with a stable housing situation.
22:30 “Industry collaboration is an ecosystem. The alliances we make support trust, collaboration in alternative care sites, and reduce friction to care access.”
23:00 The importance of the “Digital Front Door” and Virtual Care Delivery Transformation in value-based care.
24:00 How SCAN Health Plan educed disparities in medication adherence for cholesterol medications by 35%.
26:30 The ACO REACH payment model and a data-driven strategy will be key to designing a more equitable model for care delivery.
27:30 Translating key learnings in equity improvement through rapid cycle evaluation and improvement in action.
28:00 An example of a SDOH intervention to find improved housing for someone dealing with allergen exposure.
29:00 Seizing the moment for industry to galvanize around the advancement of health equity.
30:00 The seminal IOM Report, Unequal Treatment, that determined Black and Hispanic Americans typically receive lower quality of care—across a range of diseases—when compared to white Americans.
31:00 Referencing the recent actuarial analysis from Deloitte entitled, “Breaking the Cost Curve”
32:00 Dr. Bhatt explains why our country can no longer afford to endure systemic health inequities.
32:30 COVID-19 awakened a national consciousness for health equity.
33:00 How nonprofits, CBOs, governments, and the private sector can collaborate to overcome the challenges of the past, heal the present, and build a more resilient healthcare system for the future.
33:30 Gender equity and how placed-based change can help to identify, understand, and address social issues.
34:00 Diversity, Equity, and Inclusion (DEI) in the workforce as a key lens and driver of health equity.
34:45 Creating an ecosystem for equity through community partnerships and collaboration.
37:30 How digital tools (e.g. SMS texting, virtual care, remote patient monitoring, VR) can empower healthcare consumerism.
38:45 Creating digital literacy and improved access to broadband connectivity in underserved communities.
40:30 Designing clinical workflows and implementing training programs to avoid provider burden.
41:00 The impact of life sciences and research & development to improve diversity in clinical trials and address issues with pricing and affordability.
41:30 Referencing the 2022 Deloitte Global Life Sciences Outlook focused on health equity innovation in the life sciences sector.
42:00 Dr. Bhatt speaks about the need to improve diversity in clinical trials.
43:30 Establishing relationships with community leaders in black colleges and minority-serving institutions.
45:00 Dr. Bhatt discusses the future of Public Health and how it will overcome extreme challenges such as a decades-long backlog of funding needs and a global pandemic.
48:00 The complex relationship between climate change and health equity (climate change is now the “greatest threat” to global public health)
49:30 Dr. Bhatt on how climate change exacerbates health inequities and increases the total cost of care.
51:00 “Climate change stands out as a key force multiplier that amplifies the effects of health inequities in an exponential, non-linear way.”
53:00 Parting thoughts from Dr. Bhatt on rebuilding trust between minoritized communities and the health care sector.
Did you know that an estimated 80 million Americans currently lack access to dental care? As oral health is essential to the overall health and well-being of an individual, the high volume of those without access can have potentially devastating health consequences such as an increased risk of developing cardiovascular disease, respiratory disease, diabetes, and adverse pregnancy outcomes. Oral health can also influence eating habits and sleep patterns, which in turn can adversely impact both physical and mental health. And tragically, research shows that poor oral health is more common among individuals with lower income and educational attainment. And in value-based care, the growing number of emergency department visits for conditions related to poor oral health clearly shows the relationship between oral health and physical health. (There are approximately 1.8 million hospital ED visits annually for non-traumatic dental conditions which cost $3.4 billion to treat!)
We need to establish a more integrated, accessible, and equitable oral health landscape in our country. In this special episode, you will hear from a leader in the field of oral health who is working to reduce disparities in access to and quality of care. Kaz Rafia is the Chief Health Equity Officer for the CareQuest Institute for Oral Health — a leading national nonprofit focused on creating a more accessible, equitable, and integrated oral health system. At CareQuest, he leads strategic initiatives to advance access to integrated oral health care for ethnically and socially diverse communities. He is someone definitely leading us in this Race to Value!
If you like what you hear, you can also access a companion blog to this episode entitled, “Why Oral Health is Critical in a Value-Based System” brought to you by the Institute for Advancing Health Value and the CareQuest Institute for Oral Health!
Episode Bookmarks:
01:30 An estimated 80 million Americans currently lack access to dental care.
01:45 Lack of dental care can lead to devastating health consequences and an increased risk of developing chronic disease.
02:30 Introduction to Kaz Rafia and the CareQuest Institute for Oral Health
03:30 Companion blog to this episode: “Why Oral Health is Critical in a Value-Based System”
04:30 The link between oral health and community health.
06:30 Kaz speaks about the work that CareQuest is doing in building alliances to create a more accessible, equitable, and integrated oral health system.
07:00 “The inability of a person to receive oral health care is a clear threat to their overall health far beyond the mouth.”
07:30 Chronic periodontitis results in a higher risk of developing Alzheimer’s disease.
07:45 Oral care is a key intervention for reducing the risk of aspiration pneumonia.
08:00 The link between poor oral health and adverse birth outcomes.
08:30 CareQuest has developed MORE Care to integrate oral health capabilities into a person-centered primary care model.
09:30 Community Oral Health Transformation (COrHT) initiative and framework for safety net dental clinics to transform oral health care delivery.
11:00 Health disparities data showing that oral health varies across racial and socioeconomic lines.
12:00 Drivers for lack of access to dental care include geographic isolation, lack of transportation, and poverty.
13:00 How poor Medicaid reimbursement and “provider clustering” due to compensation economics contributes to oral health disparities.
14:00 Black adults are 68% more likely than white adults to have unmet dental care needs.
14:30 Dental coverage gaps contributing to oral health disparities in rural communities.
15:30 Alabama is now the only state currently lacking adult dental care benefits in Medicaid.
16:00 “The work done to evangelize value-based care models in dental care are reducing barriers to access nationally.”
17:30 World Health Organization recognition of dental care as a fundamental human right and their landmark global strategy on oral health.
18:30 Kaz discusses the importance of value-based care in oral health and how we define it.
19:00 Examples from Sweden and other countries on how to provide universal access to dental care.
19:45 The use of dental therapists to expand access to dental care and the recent legislative win for dental therapists to practice in Oregon.
22:00 The importance of clinical integration and how the “100 Million Mouths” campaign is integrating oral health into primary care.
23:30 Complications associated with lack of oral health, e.g. high blood pressure, diabetes, Alzheimer’s, poor pregnancy outcomes, behavioral health issues.
24:00 Research showing that medical-dental integration can enhance closure of medical care gaps.
24:30 Value-based opportunities to lower costs and improve clinical outcomes, e.g. checking Hemoglobin A1cs at dental appointments for diabetic patients.
25:30 Kaz discusses how the 100 Million Mouths campaign is integrating dental health into medical school curriculum.
26:45 There are 1.8 million hospital ED visits for non-traumatic dental conditions (NTDCs), which cost $3.4 billion to treat.
28:00 Kaz discusses the financial impact of non-traumatic dental conditions and how trends in ED utilization for NTDCs relate to social determinants of health.
29:00 Out-of-pocket expenditures are 40% of overall dental care spending and how this contributes to lack of optimal oral health outcomes.
30:30 “Accrued interest” that occurs when delays in front-end dental care treatment and prevention results in costly ED visits.
31:00 NTDC-related ED visits costs 3X what a regular dental visit would cost.
31:45 90% of NTDC-related visits are only given treatment for pain and then referred back to the dentist!
33:00 The mouth horror scene in Cast Away and how that relates to the millions of people facing access challenges to dental care!
33:30 6 million adults lost their dental insurance during the COVID-19 pandemic!
35:00 Kaz discusses the impact of the pandemic on dental care delivery and the potential for telehealth innovation in the long-term.
37:00 Teledentistry as a successful modality for triaging care needs to avoid unnecessary ED visits.
38:00 Investments to scale a value-based care infrastructure for oral health.
40:00 Kaz discusses the recent progress being made by CMS to include dental benefits coverage in the Medicare program.
42:00 “Oral health care is, in fact, health care.” – Kaz explains why preventive dental care coverage makes sense in value-based care transformation!
44:00 Anti-Racism in Dental Public Health: A Call to Action and the recent CareQuest collaboration to expand research in this area.
45:00 “Racism is a public health epidemic, and having difficult conversations is a key ingredient to change.”
46:30 “Being anti-racist is not a zero-sum game that takes away from anyone else. It is about the betterment of our society.”
49:00 Investing in Health Equity Innovation – how CareQuest Innovation Partners through a new initiative called SMILE Health will scale early-stage startups.
50:00 How do we effectively invest in health equity in a sustainable and meaningful way?
54:00 A recent CareQuest Institute survey revealed that more than half (51%) of oral health providers surveyed had never heard of APMs in dentistry.
55:30 Kaz on the importance of understanding the past to envision a more optimistic future for value-based care.
57:30 “The misnomer of dental insurance is that it seems more like a luxury than an absolute need and human right to ensure population health.”
59:00 nspiration from Michael Leavitt in the building of alliances to impact health inequities and low value care.
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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