Technology and Innovation – 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.”)
The future of health will be shaped by consumer expectations for a mobile-centric experience with personalized insights and care services. Information is determinant of health, where people already search for health information on Google hundreds of millions of times a day. Additionally people view YouTube videos about health conditions 100 billion times globally in a year. As consumers seek information ubiquity in their online experience, health information will also become more personalized through wearables and other mobile devices.
Our future in health will also be enabled by AI. Artificial Intelligence has the potential to transform the health of people on a planetary scale akin to the discovery of penicillin. If developed boldly and responsibly, AI will be a powerful for health equity on a global scale. It will also bring the joy back to practicing medicine by reducing cognitive burden and giving providers more time to spend with patient.
In this week’s episode, we explore health tech consumerism and AI enablement with Dr. Karen DeSalvo, Chief Health Officer at Google. Dr. DeSalvo is an internist and health leader working at the intersection of medicine, public health, and information technology. She has dedicated her career to improving health outcomes for all with a focus on solutions that address all the determinants of health. Dr. DeSalvo continues to be a powerful voice and advocate for eliminating inequities and improving the public’s health. Under her watch, Google has optimized search and YouTube to better answer common health questions, updated its consumer health wearables to function more like medical devices and built artificial intelligence products to meet industry demands.
This episode covers various topics in the realm of healthcare technology innovation from consumerism, Generative AI and LLMs, health equity by design, and various initiatives underway at Google to connect and bring meaning to health information. In the interview, we also discuss the role of technology in mitigating the health impacts of climate change and addressing the epidemic of loneliness and isolation at a global level.
Episode Bookmarks:
01:30 Introduction to Karen DeSalvo, Chief Health Officer at Google.
03:30 How Google understands “information as a determinant of health.”
05:00 “We see heavy consumer orientation to the way we see our opportunity to improve the health of everyone everywhere.”
05:30 The evolution of healthcare businesses to meet people in an increasingly virtual world with ever-changing consumer expectations.
06:00 Informing health empowerment through high quality information and personalized insights.
06:30 Personal reflections from clinical practice when the flow of information was not enabled by technology automation.
07:30 Modern-day tools for patient education and personal health tracking and measurement.
08:00 The optimization of Google search results to convey trust in the provision of health information.
08:30 “The conveyance of information through trusted messengers is an important way we address information as a determinant of health.”
09:00 Patients showing up with more knowledge and power – a priority goal for Google Health.
09:30 How AI can improve health for everyone everywhere. (Karen’s recent blog on the future of AI as a transformational path forward in population health.)
10:00 Leveraging AI at Google Health to advance medical research, improve accuracy and efficiency of diagnostic processes, and improve health information quality.
11:00 A future world were everyone has access to the best quality care on their phone (e.g. AI-enabled health agents combined with the human care team).
12:00 Developing health technology for the entire world. (“A billion people on the planet don’t have access to primary care.”)
12:15 AI can address workforce challenges by reducing cognitive load to address burnout and filling capability and capacity gaps.
12:45 Using large language models in high risk health scenarios (e.g. suicide-related searches, AFib detection on watch products).
13:45 How ChatGPT elevated the interest in front-facing, consumer-focused large language models.
14:15 Search generative experience and the development of Bard (a conversational AI tool by Google).
14:45 Enhancing the Fitbit experience with generative AI and large language models (seearticle)
15:00 Med-PaLM harnesses the power of Google’s LLMs in the medical domain to accelerate scientific advancement.
16:00 “Do no harm” as the ultimate guiding philosophy in AI innovation.
16:30 Human oversight needed to mitigate the risk of AI hallucinations.
18:30 Google use cases for generative AI in clinical care — from helping radiologists to detect breast cancer, to supporting diabetic retinopathy screening.
19:00 Using AI to enhance radiology clinician workflows in mammogram screening.
20:00 Using AI to identify multi-drug resistant tuberculosis in Sub-Saharan Africa.
21:00 Developing an AI model that can perform many tasks at once (e.g. medical record summary, presenting research evidence and recommended clinical pathways)
22:30 Reduction of algorithmic bias to improve health equity and quality of care.
22:30 “The next generation of AI models are going to bring joy back to medicine. They will reduce cognitive burden and give providers more time to spend with patients.”
26:45 Reduction of implicit bias and the “health equity by design” approach at Google.
28:00 Solving for global health inequities observed with the 4M’s (i.e. metabolic disease, malignancy, maternal health, and mental health).
29:00 Developing cloud partnerships and research collaborations for population health in action.
30:00 Ensuring effective deployment of tools and technology for everyone everywhere.
30:45 Diversity, equity, and inclusion of Google Health’s teams.
31:45 Challenges and risk in the early stages of AI foundation models.
33:00 Additional background on Med-PaLM as a medically-tuned, domain specific large language model.
35:00 Use cases for Med-PaLM in care delivery, payer, and life sciences environments.
36:00 Multimodal application of Med-PaLM with wide-ranging capabilities to enhance clinician workflows.
36:45 “Large language models have many capabilities. Constraining them to do the appropriate thing is such an important priority.”
38:30 There is no one-size-fits-all approach to LLMs – it depends on the preferred use case (e.g. writing contracts, customer chatbots, distilling research insights, pop health enablement).
40:00 Climate change is the biggest threat to global public health.
41:00 “Health is more than health care.” (The impact of social determinants and the physical environment on health and wellbeing).
42:00 Applying data and analytics during the pandemic to improve health equity.
43:00 Novel signals from Google searches on symptoms — identifying trends to inform public health priorities.
44:00 The need for timely, granular, and actionable data in the public health setting.
44:30 AI predictions for future climate risks associated with health, fire, and floods.
45:00 Notifying patients with pulmonary disease of air quality risks in real-time.
46:00 The impact of social isolation on public health due to its association with a range of negative physical, mental, and emotional outcomes.
46:45 The health impact of loneliness is so far-reaching that one study compares it to smoking up to 15 cigarettes a day!
47:45 Dr. DeSalvo’s important work on the WHO Commission on Social Connection to better address the global loneliness challenge.
49:00 Using technology to address loneliness and isolation (e.g. AI and robotics to augment human support for seniors).
50:00 The detrimental impact of social media on the youth – striking a balance between screen time and human interaction.
51:30 Parting thoughts from Dr. DeSalvo pm the importance of health for all and value for all.
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.
A revolution is imminent in American healthcare, and “the revolution will not be televised” for passive observation. Value-based care transformation, like any other important movement, requires the active participation of all leaders on the frontlines. However, for these leaders to make the right decisions, they need to embrace innovation in order to realize the fullest potential of generative AI and predictive analytics. Through the reengineering of care delivery, we can achieve a more personalized, proactive, and efficient outcomes-based model that can ultimately transform population health.
As we navigate this transformative journey, data will play a pivotal role in reshaping the landscape of care delivery. And no one knows this better than Nassib Chamoun, Founder President & CEO of Health Data Analytics Institute (HDAI), our guest this week on Race to Value. In this episode, you will hear from a leader and primary inventor of a broad-based population health data analytics platform, enabling healthcare providers to make informed decisions based on real-time information. Tune in to an informative conversation covering such topics as data aggregation, predictive analytics, digital twinning, network management, generative AI in clinical care, and future advancements in technology-enabled value-based care.
Episode Bookmarks:
01:30 The Imminent “Big Data” Revolution in Value-Based Care
02:00 Introduction to Nassib Chamoun of Health Data Analytics Institute
03:00 As a teenager living in Beirut, Nassib experienced the horror of a civil war.
04:00 The inventor of Bispectral Index monitoring – a technology standard in operating rooms around the world.
05:00 Nassib discusses the pivotal moments in his life that shaped a passion for data analytics in healthcare.
07:00 80% of health information in EHRs is unstructured and entirely unusable unless converted to discrete data.
07:45 CMS provided HDAI a highly coveted Innovator’s License that allows the company access to data on 100 million Medicare beneficiaries.
09:00 How Big Data drives powerful AI algorithms and predictive models in healthcare.
10:00 “If you can’t measure something, you can’t improve it.”
11:00 Understanding the intersection between cost, outcomes, and utilization.
11:30 Making data actionable in order to effectuate change in care delivery.
11:45 Data overload can actually lead to clinical inefficiencies if it isn’t curated appropriately.
12:30 The artful curation of data to drive operational improvements at point-of-care.
14:00 The limitations of claims data in making timely clinical decisions and treatment interventions.
15:00 Interpretation of unstructured EHR data to extract potential new conditions and HCC coding opportunities.
16:00 The importance of clinical judgement in augmenting AI-based recommendations in value-based care.
17:00 Combining behavioral, psychosocial, and biometric data with the existing sciences of epidemiology and clinical medicine.
18:00 Generalized clinical use cases of AI at the point-of-care to improve costs, outcomes, and utilization.
19:00 “To be successful in value-based care, you must operationalize two separate goals: Prevention and Avoidance of Complications.”
20:30 “The goal of AI is to very simply do what a clinician does, but do it repeatedly and do it continuously for every patient in their cohort.”
21:00 How staffing limitations and an aging populations necessitates a more optimal use of technology in VBC.
22:00 In 2032, U.S. healthcare spending will reach $8 trillion (ahead of the economy of Japan) making it the third largest economy in the world!
22:45 Leveraging predictive models to drive more effective care coordination and interdisciplinary team-based care.
24:30 Patient engagement as one of the more challenging aspects of value-based care.
26:30 The integration of predictive analytics and digital twinning for individualized patient care.
28:45 Using multiple predictors to serve every component of the care team.
29:30 How the use of RAF scores to normalize utilization creates noise within a dataset.
30:30 Using digital twin matching for improved predictive modeling of patient outcomes.
32:30 Aggregation from the patient level as an opportunity to reduce predictive variance.
34:00 Benchmarking against clinical exemplars in population health management.
35:00 Empowering the care team through AI and predictive analytics to drive clinical interventions.
36:30 How Houston Methodist Coordinated Care leveraged the HDAI analytics platform to enable care teams.
38:30 Using AI as a core capability in a health system (for both FFS and value-based care).
40:00 Leveraging AI to make appropriate care management resource allocation decisions at the network level.
41:00 Using analytics to better understand post-discharge outcomes and mortality.
42:30 Early interventions driven by predictive analytics have reduced both hospital mortalities and readmissions.
44:00 AI insights to drive network management decisions in building a clinically integrated network.
45:00 With the explosion of ChatGPT, we are seeing Generative AI emerge as a technology offering transformative opportunities across society.
47:00 “A lot of the big tech companies have jumped into healthcare without the appreciation of what’s involved here.”
48:00 “There are three components of trustworthy AI in healthcare: Transparency, Explainability, and Reduction of Bias.”
49:00 Transparency
50:00 Explainability
51:30 Bias
52:30 Overcoming implicit bias in algorithms to reduce disparities in care.
53:30 The complexity of Generative AI algorithms.
54:00 HDAI’s approach to generative AI in the creation of transparent, explainable, and bias-free models.
56:30 Connecting the source code in generative AI to the recommendations made to clinicians.
58:30 Will we eventually see AI models enriched with crime data, geospatial analytics, food availability data, climate change impacts, consumer purchasing data, and biometrics?
60:00 The potential harm of applying negative use cases of AI to restrict care.
61:30 Arthur C. Clarke: “Any sufficiently advanced technology is indistinguishable from magic.”
61:45 The 4th Industrial Revolution of technology in healthcare.
63:00 EHR data has been largely underutilized until the recent tidal wave of AI.
64:00 Creating synergies within care teams on the basis of synthesized information and AI recommendations.
64:45 The application of AI in the future of health genomics.
65:30 Parting thoughts of optimism for the future of AI-enabled value-based care transformation.
Data interchange and interoperability are the keystones of a united ecosystem for value-based care, where information flows seamlessly, connecting patients, providers, and payers to drive better outcomes, lower costs, and improved patient experience. Overcoming siloed information is the key to breaking down the barriers that fragment care delivery, and in doing so, we unlock the potential for a healthier future for all. While health data interoperability has arguably become an industry buzzword over the past decade, the concept’s importance for digital health transformation cannot be understated. The benefits of optimal interoperability in healthcare includes improved care coordination for patients and reduced administrative burden for healthcare payers and providers. Interoperability also supports public health surveillance and population health initiatives that are so critical to value-based care transformation.
In this podcast episode, you will hear from two executives on a mission to unlock greater value in American healthcare by aggregating, normalizing, and unifying data. Venkat Kavarthapu and Dr. Summerpal Kahlon are the Chief Executive Officer and Chief Medical Officer for Edifecs, a Best in KLAS interoperability platform that serves as the foundation for the solutions that eliminate stakeholder friction to overcome healthcare’s biggest challenges. We discuss how interoperability will accelerate value-based payment adoption and help providers obtain more complete and accurate care funding for alternative payment models. We cover such topics as the future of AI, the potential for automated prior authorization, how ACO REACH will drive population health management, and the collaboration that is enabled by technology.
Episode Bookmarks:
01:30 Introduction to Venkat Kavarthapu and Dr. Summerpal Kahlon and their company Edifecs that provides a leading interoperability platform.
04:00 Industry struggles to implement interoperability requirements of the CMS Interoperability and Patient Access Final Rule.
04:30 The benefits of interoperability and how it serves as a foundation for value-based care.
05:30 Venkat discusses how value-based care is the only path forward in creating a sustainable healthcare system.
06:30 The need for data to improve patient experience and quality of care.
07:00 “True value-based care can only be accelerated if information is available to all entities in all three dimensions – clinical, administrative, and financial.”
08:00 Exchanging information across organizations and between systems without friction, while ensuring privacy and security.
09:00 How data siloes create healthcare dysfunction.
10:00 Extreme data siloing increases data management costs (25-30% of total cost spent to ensure data accuracy).
10:30 Payer-provider collaboration supports value-based care but is still limited by interoperability adoption.
12:00 “Driving interoperability is not a burden on the industry, but a true competitive advantage for the industry.”
12:30 How interoperability reduces administrative burden and the cost of human capital.
13:45 “An interoperability framework can drive a meaningful dialogue, and communication is key to driving good patient outcomes.”
14:30 Summer describes how an overly-fragmented healthcare system that still relies on fax machines contributes to data inaccuracy.
16:00 Emphasizing data accuracy within an interoperability framework ensures patient safety.
16:30 How Natural Language Processing and AI can provide context and improve communication at the point-of-care.
19:00 CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule
20:00 The need for fully automated Prior Authorization (PA) enabled by EDI processing, FHIR-based APIs, AI/ML, and NLP.
21:45 Electronic PA will foster payer-provider collaboration and drive clinical decision support.
23:30 PA transactions are only automated 30% of the time at present (compared to 90% or more for claims eligibility, enrollment payment, etc.)
24:30 The value of PA automation in alleviating physician workflow burden.
26:00 Implementing an electronic Prior Authorization system will enhance clinical decision support (without adversely impacting UM metrics).
27:45 Correcting physician perspectives on value-based technology adoption following bad prior experiences in EHR adoption.
29:00 Venkat discusses the challenges facing providers as they look to adopt technology to drive value-based care performance.
31:00 Physicians can only succeed in value-based care when empowered by information at the point-of-care.
33:00 “Providers need systems and technology to participate in the value-based care revolution.”
34:45 Summer provides a physician perspective about the friction posed by documentation in EHRs.
36:00 Structured data vs. Unstructured data
36:45 The potential for Natural Language Processing in extracting information from EHR notes to tell a story.
37:30 “As we transition to value and look to enhance communication through technology, NLP is going to be front and center.”
38:00 ACO REACH as inflection point for the value movement.
40:00 The transfer of financial risk to ACOs and Risk-Bearing Entities.
42:00 The need for real-time data exchange from payers to providers.
43:00 Making it easier for technology to integrate into the value-based care ecosystem.
45:00 Applying lessons learned in the development of new alternative payment models.
46:00 The evolution towards full risk prospective payment/capitation and disease-specific models.
47:30 Developing a Population Health Management platform that accommodates both existing and new payment models.
49:30 The explosion of ChatGPT and the potential for Generative AI to drive healthcare transformation.
51:00 Venkat shares his optimistic perspective on the future of AI in transforming care delivery.
53:00 “By leveraging interoperability, AI and workflow optimization, the industry has a potential to lower costs and save Medicare from insolvency.”
54:45 AI works best when it runs behind the scenes and is invisible to the end user.
56:00 AI has a role to play in eliminating the noise from extremely large, disparate datasets.
58:00 Summer discusses a successful use case for effective AI and NLP in the risk adjustment environment.
60:30 Leveraging AI to mitigate inconsistencies with human-based coding (upwards of 15% observed variance between two coders).
65:00 4 characteristics of Industry transformation: 1) Existential Threat to current model, 2) Regulatory Environment favorable to transformation, 3) Technology advancement, 4) Consumerism
66:00 Why you should be optimistic about the future of value-based care!
Innovation and partnership are the twin engines that propel us into a new era of healthcare. The fusion of cutting-edge technology and clinical innovation, empowered by collaborative relationships, can revolutionize primary care. This cohesion of innovation and partnership makes primary care more accessible, effective, and patient-centered than ever before. There is no better example of primary care modernization than Central Ohio Primary Care (COPC), the largest physician-owned primary care group in the United States with over 480 physicians and 83 locations in central Ohio. Rooted in a long history of clinical excellence and a commitment to the highest ethical standards, COPC is building a new holistic model for primary care that gives physicians time to build relationships with their patients and one another. Through ACO REACH, full-risk delegated capitated Medicare Advantage Plans, and direct-to-employer value-based arrangements, they are able to engage their entire team in the innovation of their primary care model. Furthermore, through partnerships they are able to share risk and build a pathway to sustainability in the provision of value-based care for decades to come.
Joining us on the Race to Value this week is Donald Deep, M.D., the CEO of Central Ohio Primary Care. In this episode, we discuss the modernization of primary care that is underway at COPC – including technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up. We explore the successes of their Extensive Care Center and Comprehensive Home and Palliative Care programs. There is also in-depth discussion on low value care, the importance of payer partnerships, direct-to-employer strategies for commercial populations, accessing capital partnerships in full-risk MA, and collaborative leadership for success in VBC.
This episode is sponsored by Agilon Health, a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program.
Episode bookmarks:
01:30 Introduction to Donald Deep, M.D., the CEO of Central Ohio Primary Care (the largest physician-owned primary care group in the U.S.)
02:45 Referencing prior episode featuring Dr. Bill Wulf (“The Value Game”: Achieving Success with Capitated Risk and Patient-Centered Primary Care)
03:00 This week’s episode is brought to you by Agilon Health
04:30 COPC has directing 2,200 employees across 90 locations covering six counties and has been on a value journey since 2010.
05:30 The modernization of primary care at COPC.
06:30 Patient care coordination that includes technology-enabled care efficiency, 24/7 access, care management, and post-discharge follow-up.
07:30 “We are responsible for the care of our patient population, even outside of the exam room.”
07:45 Empowering PCPs to spend more time with patients and engage patients and families in the care process.
08:00 Addressing prevention and SDOH requires a modernized primary care model.
08:45 Extensive Care Center (ECC): A Novel Approach to Reducing Emergency Department Visits and Observation Unit Utilization
10:00 The Extensive Care Center at COPC returns 95% of patients to the home (ER Avoidance) and prevents 2-3 hospital admissions each week.
11:00 Scaling the ECC model in co-location with Same Day Centers at COPC to provide immediate access for emergent primary care needs.
12:00 Addressing chronic disease in the extensive care center avoids unnecessary ER visits and hospitalizations.
13:30 Payer recognition of the ECC model, with high levels of patient satisfaction.
14:45 The Comprehensive Home and Palliative Care (CHPC) program at COPC provides primary and palliative care in the home setting.
15:30 Palliative care in ACOs have demonstrated reductions in 30-day readmissions, avoidable hospital admissions, and ED visits.
15:45 Advanced illness programs can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%.
16:30 The difference between palliative care and hospice.
17:30 Dr. Deep reflects on his experience as a hospitalist that repeatedly saw patients readmitted to the hospital due to poor symptom management.
18:00 “Palliative care is invaluable in primary care, and we must take it into the patient’s home. Poor symptom management leads to unnecessary ER visits and inpatient stays.”
20:00 The composition of the interdisciplinary team that provides comprehensive home and palliative care services.
21:30 Spending on low-value care range from $100 billion to $700 billion each year.
23:30 Identifying waste in the provision of primary care and defining clinical pathways that define value.
24:30 Patient advocacy for services provided outside of the practice in the promotion of high value care.
25:00 Demanding risk-adjusted outcomes for specialists seeing COPC patients. Providing RFPs to specialists to ensure accountability to expectations for high value care.
25:30 How PCP-led global capitation and compensation redesign incentivizes high value care.
27:00 Referencing a recent Morgan Health study that shows extreme variations in clinical quality for employer-sponsored health plans (e.g. statin medication adherence for CAD).
27:45 COPC’s partnership with JP Morgan Chase to provide onsite health clinics, health coaching, behavioral health services, and after-hours access to care.
28:30 Dr. Deep explains COPC’s advanced primary care model that is provided on a direct-to-employer basis.
29:30 Direct-to-employer care that is convenient, longitudinal, preventative, and consistent.
30:00 How partnering with Vera Whole Health expanded behavioral health services at COPC.
30:30 Providing an advanced primary care access point to large employers as a critical success strategy for VBC.
33:00 Dr. Deep discusses how the ECC model has allowed them to forge more collaborative partnerships with payers.
34:00 “Shifting of financial risk to prepayment (instead of Shared Savings) allows us to engage our entire team in the innovation of our care model.”
35:00 Assessing data to identify high-risk patients. Developing win-win payer-provider partnerships.
36:30 The history of COPC’s partnership with Agilon Health.
37:30 The COPC-Agilon partnership with COPE Health Solutions that led to the development of a primary care Advanced Practice Provider (APP) Fellowship Program.
39:00 The exciting potential of a new value-based care fellowship for APPs.
40:00 “The old way of delivering care where a physician does everything is not sustainable. Team-based care will ensure that we are sustainable decades into the future.”
41:30 How the partnership with Agilon Health enabled value-based care transformation at COPC.
42:30 Finding a VBC enablement partner that truly believes in partnership (beyond just the provision of capital).
43:30 Parting thoughts from Dr. Deep on the importance of collaboration in value transformation.
45:00 “Leaders in healthcare must ensure that both their organization and the community they serve is strong. Doing that through trusted partnerships will make a lasting impact.”
Democratizing access to value in healthcare through primary care enablement is the compass guiding us toward a future where health is a universal right, not a privilege, and where the promise of value-based care is accessible to all. It represents a fundamental shift in our approach to healthcare delivery. By prioritizing primary care and leveraging technology, we can extend the reach of healthcare services, making them more affordable and accessible to diverse populations. This approach emphasizes preventive care, early intervention, and patient education, reducing the burden on emergency rooms and hospital admissions. Ultimately, primary care enablement has the potential to transform the healthcare landscape, promoting healthier communities and improving the overall well-being of individuals while also making healthcare a more equitable and sustainable system for everyone.
Joining us this week on the Race to Value is Michael Kopko, the CEO of Pearl Health – a company that is on a mission to democratize access to value in healthcare. More than 800 primary care providers across the country partnered with Pearl to align payments with patient health and leverage emerging data and technology to achieve better outcomes more efficiently. And earlier this year, they closed on a $75M Series B funding round to bring even more capability to the health value economy, by empowering providers to transition to a more proactive care model, enabling them with a technology solution that surfaces urgent cases before they become emergent, and rewarding them for outcomes aligned with value. This is a company that you need to know about, and it is my pleasure to have Mike on the podcast this week to discuss the challenges facing our industry and how Pearl Health is accelerating the development of innovative solutions that place providers at the center of healthcare delivery and cost management.
Episode Bookmarks:
01:30 Introduction to Michael Kopko and Pearl Health — a company that is on a mission to democratize access to value in healthcare.
03:30 After more than a decade of value-based care efforts, the U.S. still pays about twice as much for healthcare than any other country, despite underperforming in quality and outcomes.
04:00 How do we reach a critical mass with ACOs and other APMs to save the Medicare Trust Fund from insolvency by catalyzing care delivery transformation?
05:45 There is reason for optimism for healthcare in the long-term, e.g. R&D in the health sector, the steady march to value since Michael Porter coined the term in 2006.
07:00 The increasing adoption of Medicare APMs and value-based Medicare Advantage (see HCP-LAN APM Measurement Effort).
07:30 “The underlying infrastructure and operating system for healthcare is positioned well for value.”
07:45 More work needs to be done, e.g. Medicare negotiations with pharma companies to lower drug costs, further realignment of incentives.
08:00 Medicare cost growth has abated. (See recent NYT article: “A Huge Threat to the U.S. Budget Has Receded. And No One is Sure Why.”)
08:30 The need to balance ACO Shared Savings performance over time with the democratization of data to improve population health outcomes.
09:00 “We are starting to get the highways and freeways established for data interoperability to be very proactive in creating health value.”
09:30 “Our healthcare system has so much money that with the right capability sets and incentives, we will solve any problem as long as we have the will to do so.”
10:00 Pearl has seen 10X year-over-year growth, expanding from 10 to 29 states, since its founding in November 2020.
11:00 Technology enablement requires the harmonization of the platform with the wisdom of experienced healthcare professionals.
12:30 Michael shares key learnings in his healthcare leadership journey and how that led to the founding of Pearl Health.
14:45 The realization that the missing piece of value transformation was the enablement of PCPs to visualize and understand how to better care for patients.
15:00 “VBC is no longer a gamble when the right physicians are plugged into the right enablement partners.”
15:45 The renaissance of primary care due to value-based care and business intelligence (and how that is addressing historically high levels of PCP burnout).
16:30 Predictive analytics in primary care (e.g. future diagnosis codes, ER admissions, missed medication moments).
17:30 Aggregation of data to power an Urgency Score, which prioritizes patients in need of outreach and creates holistic, longitudinal visibility.
18:30 The overburden of primary care (e.g. it would take 21.7 hours/day for a PCP to accomplish everything that he or she is expected to do to for patient care and maintaining a business.)
20:00 The assembly line of FFS compared to the “New World of Value” and how innovation can reduce administrivia and create cost effectiveness.
22:00 Using automation to streamline patient outreach efforts.
22:30 The delayed absorption of technology into healthcare as compared to other business sectors.
23:00 “The future of automation and AI in healthcare is just beginning, and that is a reason for optimism.”
23:30 Does the MIPS program really add to population health? (JAMA article: Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System)
23:45 How ACO REACH reduces the administrative burden of MIPS. (Reach for Simplicity: How ACO REACH Makes Quality Measurement Easy)
24:30 Since FFS favors procedural intensity over cognitive care, population health suffers. And the mental health of primary care physicians suffers too.
27:00 The crucible moment for PCPs to become elite practitioners in our healthcare system!
27:30 Getting “above the visit” by combining tools and technology to succeed in VBC.
28:00 A renewal of entrepreneurship and a willingness to change your business model.
28:30 An elite segment of the PCP landscape (5-10%) with business performance that surpasses FFS, along with impacts made in community health.
29:00 Solow Growth Model – the application of technology, labor, and capital to support long-run economic growth.
29:30 The enablement sector in value-based care is not feeling the pain of capital constraints.
30:00 “People are adopting and considering value-based models more rapidly than I’ve ever seen in a decade of working with and building networks in healthcare.”
31:00 The average PCP generally earns relatively little but influences ~$10M in downstream healthcare costs.
31:30 PCPs taking fully capitated risk must get specialists contracted into VBC arrangements and that requires overcoming friction due to oligopolistic market dynamics.
33:00 Recent Atul Gawande article in The New Yorker about the Costa Rica healthcare system (improved population health and longer life expectancy through primary care enablement).
33:30 The regression equation for healthcare – advanced primary care with optimal specialty management would address 60-80% of medical costs!
34:00 The changing business model for specialists due to advancements in VBC.
35:00 The tipping of the fulcrum – alignment of primary and specialty care is progressing due to data interoperability.
36:00 Democratization of access to value due to changes in enablement and economics.
37:00 Will advanced hospital systems have a role to play in the future of value?
38:00 Innovators and disrupters will be at the leading edge in VBC because they will be more nimble, agile, and unconflicted.
39:30 15% of the insurance premium dollar goes to administration and profit. (The shift of risk to providers will lower that admin cost to 4-5% or less!)
40:00 Upstarts can create real economic value. (Just look at how AWS disrupted intensive server requirements for businesses.)
40:30 VBC enablement can be as revolutionary as cloud-based computing!
41:00 Michael’s advice to entrepreneurs: “Focus on creating value in a thesis of change.”
41:30 Other opportunities for disruption, e.g. Drug delivery and development, AI and automation, data interoperability.
42:00 Creating an escape velocity through TAM (Total Addressable Market) and Team.
43:00 ACO REACH is a gamechanger for value because it presents an opportunity for PCPs to increase and stabilize revenue with prospective payment.
44:30 Keys to success in models like ACO REACH: reducing the cost of access and improving intelligence capabilities.
45:30 “ACO REACH is a cheaper, faster path to an alignment shift.”
46:30 “Healthcare doesn’t have a data problem. The real test now is what data matters and when does it matter. How do you synthesize and distill information at the POC in a salient way that is actionable.”
47:00 Developing an urgency score, promoting the patients that are most at-risk, and surfacing interventions through a suggestion engine.
48:45 The trend towards PCPs selling their practices to larger enterprises like hospitals and PE-backed physician aggregators.
49:30 The benefit of working within a larger primary care practice (more capabilities, risk protection, negotiation leverage).
50:00 Autonomy and independence of PCPs and how that can happen in a corporatized model.
51:00 Clinical integration – “Hospitals are a key ingredient in VBC when properly applied.”
52:00 Finding a business model that is aligned morally and ethically to what one wants to contribute to the world.
53:00 “The new practice of the future will be less capital intensive with these new value-based models becoming more proliferated.”
53:30 “Culture is what everyone says it is at that moment in time. It’s an evolving organism.” (A Values-Based Culture: Principles at Pearl)
54:00 Creating a company with a strong value compass.
55:00 Transparency and Interoperability.
56:00 Recognition that you get what you pay for. (FFS rewards chronic disease. We need to realign incentives to reward health.)
57:00 Technology, Automation, and Artificial Intelligence.
58:30 The value of health equity in value-based care transformation.
59:00 How ACO REACH finally put an emphasis on the importance of equity in the value movement.
59:30 “Start where the patient is, not where the business model begins.”
60:30 Multidisciplinary care to enhance the health of communities and how capital markets are the great unlock.
61:30 “The model of providing agency to the stakeholders generating high costs is a backwards model. We need a more proactive, sentient system.”
63:00 Parting thoughts on transforming a complex system.
In the ever-evolving landscape of healthcare technology, humility is the compass that guides successful change management. It reminds us that the journey towards seamless adoption of health information technology is a collaborative one, where the wisdom of many outweighs the knowledge of one. The humility to acknowledge one’s limitations fosters an environment where collaboration and learning thrive. In the context of clinical informatics, allyship and teamwork are indispensable. Effective clinical informatics demands a diverse skill set, often spanning healthcare providers, IT specialists, and administrative personnel. Allyship within this multidisciplinary team is essential, and applied clinical informatics can be the linchpin in the transition to value-based care. Through successful HIT implementation, leaders can illuminate the path to better outcomes, reduced costs, and patient-centered excellence. A new era for Clinical Informatics is upon us and will empower healthcare with data-driven insights, AI capabilities, virtual care at scale, and precision medicine to ensure that quality triumphs over quantity in our pursuit of healthier communities.
On the Race to Value this week, we are joined by Brittany Partridge, a national thought leader on health data management and informatics. Brittany is passionate about implementing technology that impacts clinical workflow in a positive way and increases patients’ access to care. Join us for an informative discussion on Clinical Informatics, the importance of allyship to mitigate medical technology risk, the impact of Generative AI and virtual care on health system transformation, and change management best practices to lead your organization to successful healthcare innovation.
Episode Bookmarks:
01:30 Introduction to Brittany Partridge, an industry leader in Virtual Care Technical Architecture and Informatics Implementations.
03:00 Recent book collaboration with Ed Marx – “Voices of Innovation: Fulfilling the Promise of Information Technology in Healthcare”
04:30 The sub-disciplines of Health Informatics (e.g. Nursing, Pharmacy, Public Health, Biomedical, Medical, and Clinical Informatics).
06:00 AMIA: Why Informatics? – “Informatics is the overarching field of study that pulls all these subdomains into one discipline focused on improving health and healthcare.”
06:30 Applied Clinical Informatics – the frontline of healthcare innovation with direct clinician interaction.
07:00 Early experiences in e-prescribing implementations that led to other care delivery innovations such as virtual care and remote patient monitoring.
08:00 The intersection of Clinical Informatics and VBC (ensuring tech usability to optimize care workflows for clinical quality improvement).
09:00 Best Practice Advisories (BPAs) – pop-up alerts to empower clinicians to make the best informed decisions at the point-of-care.
09:45 Leveraging technology innovations to improve patient access and affordability.
11:30 The importance of shadowing and workflow analysis as a catalyst for innovation.
13:00 How shadowing is incorporated into user validation, user design, and Lean (“Go to the Gemba”)
14:00 Simply asking clinicians to describe a workflow is insufficient in understanding the entire process.
15:00 “Get a robust current state workflow before you implement any innovation project because you need to know what you’re going to be replacing.”
15:45 How virtual interactions with providers can complement provider shadowing in an embedded CI model.
16:30 Non-judgement in applied clinical informatics is required to build trust.
17:30 “The most important part of rolling out any technology project is clinician trust. They need to know that you have their best interests at heart.”
19:45 Allyship is key to reducing medical technology risk because the inclusion of diverse perspectives yields the greatest rewards.
21:30 “Fail fast and iterate” and “Perfect being the enemy of good” philosophies don’t work in healthcare technology adoption because human lives are impacted.
22:30 Leaders should not surround themselves with “Yes People” – you need allies with a different focus or strength to help you fully understand the risks.
23:30 Finding allies with certain traits and behaviors such as listening, empathy, communication and transparency.
24:30 Medical technology risk increases when trust is lacking and people try to hide things.
25:30 The future impact of Generative AI in the field of clinical informatics. (With the explosion of ChatGPT, how can Generative AI provide transformative opportunities in healthcare?)
27:45 The difference between Generative and Predictive AI.
28:30 The need for clinician trust with Generative AI models in healthcare.
29:00 How Clinical Informaticists can create transparency with Generative AI models to support adoption at the point-of-care.
30:00 “The biggest opportunity for Generative AI in medicine is the reduction of physician administrative burden so they have more time to meaningfully interact with their patients.”
31:00 How UC San Diego Health is piloting Generative AI to support more efficient Provider Inbox messaging to patients.
32:00 The application of Generative AI in ambient listening during the provider-patient encounter and how that will improve information capture and care experience.
33:00 Additional uses of AI in the clinical setting (e.g. medical imaging analysis, diagnostic decision support, diagnostic accuracy).
34:00 The development of a framework and standards to enable trust with AI models.
35:00 The success story of how UC San Diego Health rapidly scaled their telehealth program during the height of the pandemic (i.e. 1,200 visits a day — a 1000% increase).
37:00 Teamwork during a time of crisis.
39:00 Agile governance to ensure rapid decision-making.
40:00 Training and tip sheets to enhance communication during technology adoption.
41:30 Current telehealth utilization at UC San Diego Health post-pandemic.
44:00 Humility as a foundation for communication and collaboration in medicine.
45:00 Why the foundational premise of humility is antithetical to how medicine has been structured in our country (e.g. Flexner Report).
47:30 The challenges of ego in attaching self-worth to what you produce, what you know, and how you earn.
48:45 “Humility and vulnerability in health tech requires you to look at what you’re creating to see if it this making a positive impact in the lives of an end user.”
49:30 “Radical curiosity” as a key to humility in healthcare innovation.
51:00 Knowing what you don’t know. Seeking first to understand prior to being understood. (how this drive success health tech adoption)
52:45 “Having an open mind and getting radically curious will make health technology have a better impact.”
53:30 Lessons learned from the “Meaningful Use” adoption of Electronic Health Records.
55:30 Using The Kotter 8-Step Process for Leading Change to guide effective Change Management.
57:45 Generating short-term wins with the use of AI.
60:00 Follow Brittany on Twitter and LinkedIn for more thought leadership on clinical informatics, AI, and virtual care!
In this week’s episode, we embark on a journey into the realm of transforming rheumatology care with tech-driven value-based care. Autoimmune conditions affect millions of people worldwide, causing chronic inflammation, ...
Since diabetes is one of the few chronic conditions that can be very effectively managed by an individual, why are there so many people with poorly managed diabetes? Despite conventional ...
In the universe of value-based care transformation, there has been one disease that represents a metaphorical black hole, where the gravitational pull of fee-for-service is so strong that nothing can ...
Data enablement has the power to transform American Healthcare. It can foster trust between patients and clinicians and make healthcare more accessible, affordable and equitable. This future of an open and connected health ecosystem may seem elusive, but it’s not out of reach. Technology will not hold us back — instead our biggest challenge will be creating a value-based model of care where new innovations can thrive. This week we our joined by Dr. David Feinberg, the Chairman of Oracle Health. Dr. Feinberg is committed to advancing thought leadership and strategy related to unleashing the healing power of data through an open and connected healthcare ecosystem. Previously Dr. Feinberg served as president and CEO of Cerner, now Oracle Health, where he led teams delivering tools and technology to improve the patient and caregiver experience. He has also served as the VP of Google Health, and he served as the President and CEO of Geisinger where he led a complex turnaround and guided Geisinger’s transition to value-based care. Episode Bookmarks:01:30 Introduction to Dr. David Feinberg, Chairman of Oracle Health.02:45 The massive generation of data by humankind in the modern day (projected to be 175 Zettabytes by 2025).03:45 Approximately 80% of healthcare data today is unstructured.04:30 People are dying unnecessarily and suffering poor outcomes despite the amount of data generated by the healthcare system.05:30 “Healthcare fundamentally is people caring for people. Data is secondary; the primary aspect of healthcare is trust.”06:30 Making Electronic Health Records usable is of paramount importance (PCPs Need 27 Hours a Day to Do Their Best Work!)07:00 Digitizing the medical record has made clinical workflows humanly impossible and compromises trust.07:30 The vision for an open and connected health data ecosystem.08:45 The Meaningful Use program did nothing for EHR usability (an example of the Gartner Hype Cycle).10:00 Dr. Feinberg’s clinical and executive leadership background provided a great lesson in technology adoption.11:00 Can there be a high level of technology adoption in healthcare like Google dominates the non-healthcare marketplace?12:30 We have solved for interoperability, but healthcare lacks a level of usability to allow a true longitudinal health record.14:00 Motivating doctors for high performance ultimately comes down to the data scorecard.15:00 Knowing the game (volume vs. value) and the promise of data enablement in value-based care.16:00 The 21st Century Cures Act and the path forward in interoperability.17:00 Can scalable FHIR-based interoperability and Open APIs eventually reach critical mass in the U.S. to improve population health?19:45 Dr. Feinberg describes the two points of failure by technology companies trying to disrupt the healthcare ecosystem.20:30 How Oracle Cerner is designing an intelligent, cloud-enabled platform to change healthcare for the better.22:00 An example of disruption with Internet Banking and how application of those principles could change the healthcare system.23:45 Digitization of medical records was a requisite first step.24:00 Integration and normalization of disparate data sets provides an opportunity to create data intelligence.25:00 How Larry Ellison’s impatience for healthcare disruption clashes with the realities of the industry.26:30 Recognizing the “life and death” aspects of healthcare transformation.27:00 Making incremental progress with a digitized medical record…and then COVID happens to accelerate value-based care!29:00 Workforce burnout and EHR usability – “Simplicity is the ultimate art of sophistication.”30:00 “Value-based care is ultimately the best way to address the root cause of burnout in the workforce.”30:45 The need for UX in the design of EHR applications to optimize physician workflow.31:30 Results in usability redesign — ex: 19% reduction in nursing time at the terminal, 8M less clicks at one health system.31:45 “The future of EHRs has to be where everything is voice-enabled. Physicians and nurses should be freed from the terminal.”32:30 An example of how sophisticated AI can be used to generate EHR documentation in a regular primary care visit.33:30 Nurses spend half their time at the terminal. (Voice-enabled EHR documentation could double the nursing workforce!)34:30 The game changing nature of voice-enablement. This innovation is in our lifetime!36:00 The historical opportunity to address health inequities.37:00 The Oracle Cerner Learning Health Network — unlocking the power of data to improve health equity.38:00 Using clinical trials to build a foundational infrastructure for equity.39:00 The use of advanced AI and clinical trials to improve diagnostic capabilities and clinical outcomes.41:00 The movement to precision-based care to personalize treatment (ex: genomics, wearables)42:00 Geisinger’s population-based precision health model and how it drives patient-specific care pathways.43:00 Making data understandable and culturally sensitive for patients in order to improve adherence.44:00 Parting thoughts — the importance of making healthcare understandable, accessible, and affordable.46:00 Why sharing of best practices is so important for the future of our industry. The time is now!
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!
This week is National Nurses Week, and it is a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world. As workers who perform the most essential healthcare tasks, nurses serve as the first point of contact for most patients…and they save lives and restore health in the process. Yet, nursing is often a thankless profession that is underappreciated and experiences high levels of burnout and moral injury. There are a multitude of factors related to societal attitudes towards the nursing profession, and many of them result in a lack of recognition and support, inadequate compensation, limited opportunities for career advancement, and ultimately a lack of respect and appreciation for the work they do. We must begin to think about how to better position the profession to take a leading role in healthcare innovation. Nurses must become more empowered as we transition to a future of value-based care.
This week on the podcast, we are honored to be interviewing Rebecca Love. She is an experienced nurse executive, the first nurse featured on Ted.com, and part of the first nurse panel at South by Southwest. Rebecca is a regular contributor on the Forbes Business Council, and has been featured in BBC, Fortune, Becker’s, Forbes, Chief Healthcare Executive Magazine and ABC news. Rebecca, was the first Director of Nurse Innovation & Entrepreneurship in the United States at Northeastern School of Nursing – the founding initiative in the Country designed to empower nurses as innovators and entrepreneurs, where she founded the Nurse Hackathon, the movement has led to transformational change in the Nursing Profession. In early 2019, Rebecca, along with a group of leading nurses in the world, founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders, a non-profit that quickly attained recognition by the United Nations as an Affiliate Member to the UN. Rebecca is a world renowned Nurse Entrepreneur and currently serves as the Chief Clinical Officer of IntelyCare.
Click here to learn moreEpisode Bookmarks:
01:30 National Nurses Week – a time to honor the contributions and sacrifices of nurses who perform some of the most difficult and heartbreaking tasks in the medical world.
02:00 We must better position the nursing profession to take a leading role in healthcare innovation. Nurses must become more empowered as we transition to a future of value-based care.
02:30 Introduction to Rebecca Love – a nationally-recognized nurse executive and entrepreneur, the first nurse featured on TED.com, and part of the first nurse panel at SXSW.
03:00 Rebecca founded and is President Emeritus of SONSIEL: The Society of Nurse Scientists, Innovators, Entrepreneurs & Leaders and currently serves as the Chief Clinical Officer of IntelyCare.
04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts.
04:30 How do we better position the nursing profession in the value-based care movement?
06:30 “There is going to be no healthcare in the future without nurses leading value-based care.”
07:00 How tracking VBC outcomes by Provider NPI # is a challenge since nurses do not have assigned NPI #’s.
07:45 Nursing costs were rolled into room rates in the 1930’s with the establishment of modern-day insurance models. This occurred due to a male physician-dominated environment.
08:30 Nurses are the only clinical professional in the healthcare environment without a NPI for billing or tracking outcomes!
08:45 “Value-based care cannot fully be amplified or adopted until we address the lack of a NPI number with nurses.”
09:30 The infuriating pay inequity between executives and nurses. (Nonprofit hospital CEOs make on average 10X the rate of nurses!)
10:00 Should we align compensation to both executives and clinicians tied to patient outcomes?
10:45 North Carolina’s seven largest hospital systems reaped billions of dollars in profit from COVID Relief Funding but couldn’t afford to pay nurses! (Read more hereand here)
12:00 CEO pay doubled over five years in North Carolina, but nursing pay there only increased 12-14% over the last decade!
13:00 The national increase in nurses pay over the last decade was 1.6% per year(less than the increase in cost of living).
13:45 The UK Nurses Strike – the largest labor protest in the history of the nursing profession.
14:00 How the cost allocation methodology for nursing will cause continued exacerbation of the nursing working shortage in the U.S.
14:45 “We have to find a way to unpack nursing overhead from the room rate to make sure our healthcare system stays operational and can support our communities.”
15:30 Inspiration from President John F. Kennedy about recognizing the opportunity in a crisis.
16:00 There is a shortage of 450,000 nurses in the US today, and it is projected that over 1 million registered nurses in the U.S. will leave the workforce by 2030.
16:45 70% of new nursing graduates have left the bedside since last year!
18:00 Rebecca speaks about the compassion and empathy of nurses and how they are suffering due to burnout and moral injury.
19:30 How the healthcare industry treats nurses like an “endless commodity” and does little to address their burnout.
20:00 What if we invested only a quarter of what we spend in healthcare technology on nurses?
20:30 “Nurses have been degraded and relegated to the lowest rung of healthcare delivery today. If we want VBC to be successful, we must stabilize the nursing workforce.”
21:00 “Value-based care will certainly not survive without the nursing workforce at the heart and the center.”
22:00 93% of nurses are experiencing staffing shortages in their hospitals, which is a significant increase from 59% in a 2020 survey.
23:00 Last year over 90,000 qualified nursing applicants to nursing school were turned away due to lack of space!
24:00 We have more nurses today than any other time in American history, but we have a critical shortage because they are unwilling to work in the current healthcare environment.
24:30 The highly controversial RaDonda Vaught Homicide Case where a nurse was found criminally negligent for a self-reported medical error.
26:00 1 in 3 bedside nurses have left the profession since the RaDonda Vaught case!
26:30 Nurses and CNAs being criminally prosecuted for errors in long-term care delivery when not a single owner is held responsible for the unsafe care environment!
27:00 Rebecca speaks about the role of Higher Education in building bridge pathways and ensuring diversity to support the nursing workforce shortage.
30:30 Workforce challenges are now the #1 issue on the mind of hospital CEOs (ACHE Survey)
31:00 Hospitals have turned to travel nurses to ease staffing shortages during the pandemic, contract labor expenses have risen more than 250% over the past three years!
31:30 Annual burnout-related turnover costs are $9 billion for nurses!
32:30 Rebecca speaks about the need to enable more nurses to serve in senior leadership roles and as governing fiduciaries on hospitals boards to redesign care delivery.
33:30 “Innovation is opposite of the definition of insanity.”
34:00 How hackathons can be utilized in the empowerment of a nurse-led innovation movement.
35:30 Investing in technology to improve nurse staffing (e.g. improving float pool and per diem services).
35:45 80% of women nurses do not return full-time after they have a baby! (Could tech solutions provide staffing flexibility to empower nurses to continue working?)
37:00 “Reverse pitch events” – honing frontline innovation to address adverse events in the healthcare setting.
37:45 Applying the UI/UX methodology to the healthcare end user in order to improve care delivery at scale.
40:30 The lack of nursing input when health systems role out new technologies (and how these tech decisions often end up creating more work and administrative complexity).
42:30 The importance of the Chief Nurse Health Informatics Officer.
43:45 The role technology can play in Patient Safety.
46:00 The work of Healing Politics in getting nurses more involved in the political arena to reshape healthcare.
47:00 The lack of business education in nursing programs.
48:00 The need for more nurses holding political positions and why more nursing input is needed in health policy. (Betty Rambur is currently the only nurse on MedPAC.)
49:00 Nurse-led innovation happens when nurses are trying to save lives!
50:00 How the COVID-19 pandemic depended on nurse-led innovation.
51:30 “Why are we not trusting in nurses now – to hear them and trust them – so we can build the system needed to sustain workforce, sustain healthcare, and sustain our communities?”
52:00 How Florence Nightingale forever fundamentally changed the future of science, history, and medicine with the establishment of the nursing profession.
54:30 Rebecca discusses how attending a healthcare hackathon changed her life and led to a career path in nursing innovation!
60:00 What the hackathon taught Rebecca about the importance of the nurses voice and how they can save healthcare.
62:30 Parting thoughts from Rebecca and the life lesson learned from surviving a shipwreck at sea. (Bet on yourself and believe you can overcome adversity!)
64:00 “Were there none who were discontented with what they have, the world would never reach anything better.” – Florence Nightingale
65:00 2030: Florence Nightingale’s prediction of a future nursing renaissance.
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.”
The healthcare industry is facing immense financial pressure. Staffing shortages, skyrocketing labor costs, continuing supply chain disruptions, inflation, rising interest rates, and volatile markets are pressuring both revenue and expenses for provider organizations. These economic challenges, however, are an opportunity to catalyze value-based care. The promise of value in health can lift up communities through improved clinical outcomes, reduced disparities, financial rewards associated with population health, and emerging opportunities for upskilling the workforce. Now is the time to prioritize value-based care as a key strategic priority for long-term success and sustainability. There are few other health systems in the country that have demonstrated more of a longstanding commitment to transformation than Ochsner Health through its population health enterprise.
A leader in innovative healthcare delivery, Ochsner Health Network (OHN) is the accountable care network of the massive Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana (and one of the largest health systems in the Southeastern region of the US). Ochsner has 47 hospitals and more than 370 health and urgent care centers across Louisiana, Mississippi, Alabama, and the Gulf South. Ochsner Health Network – the value-based care arm of the health system –has 277 affiliated physician practices with nearly 3,500+ physicians spanning 625 locations. They are responsible for managing 406,000 lives across six risk-based, accountable care contracts in their value-based care portfolio. Through its collaborative efforts, OHN is making a difference for the nearly 1 million patients throughout Gulf South communities each year.
In this week’s episode of the Race to Value, we are engaging two incredible leaders from Ochsner Health Network (OHN). As Chief Executive Officer for OHN, Eric Gallagher is responsible for directing network and population health strategy and operations, including oversight of value-based performance management operations, population health services and care management programs, post-acute and home care strategies, value-based analytics, and OHN network development and administration. Joining him is Dr. Sidney “Beau” Raymond, the Chief Medical Officer for OHN who is board-certified by the American Board of Internal Medicine and has been on staff at Ochsner since 2016 and practicing medicine since 2000. These two leaders discuss what it takes to transform a health system in the “race to value” and how to ultimately improve the health for an entire state in the process!
Episode Bookmarks:
01:30 Ochsner Health Network (OHN) is the value-based care arm of the Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana.
02:30 Through its collaborative efforts with patients, communities and employers, OHN is caring for nearly 1 million patients in Gulf South communities.
04:00 Introduction to Eric Gallagher (CEO, OHN) and Dr. Sidney “Beau”Raymond (Chief Medical Officer, OHN)
05:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts!
06:00 A recent Kaufman Hall report on the mounting pressures facing providers (e.g. staffing shortages, labor costs, supply chain disruptions, inflation, rising interest rates, volatile markets).
07:30 Eric Gallagher discusses the critical challenges of staffing shortages and the skyrocketing cost of labor.
08:30 “Staffing shortages and rising costs of labor is a critical challenge. It serves as a catalyzing environment for value-based care.”
09:30 Investments in value-based infrastructure has forged collaborative relationships within the entire system.
11:00 Dr. Raymond on how post-pandemic workforce pressures have impacted primary care access and care delivery innovation.
13:00 The number of Americans ages 65 and older is expected to more than double over the next 40 years.
14:00 Approximately 10,000 Americans are aging into Medicare each day.
15:00 The Ochsner value journey in caring for seniors — from global capitation risk in Medicare Advantage to the Ochsner Accountable Care Network (OACN) ACO.
15:30 OCN/OACN have saved CMS over $100 million in the last 5 years! (recent press release on OACN Shared Savings Results)
16:30 Ochsner Health Plan – the only Medicare Advantage plan sponsored by and fully integrated with Ochsner Health.
17:30 Oschsner 65 Plus – a new initiative consisting of freestanding, PCP value-focused clinics delivering high touch, team-based primary care for seniors.
20:00 In the last three years, OACN MSSP ACO has doubled in size to 63,000 attributed beneficiaries.
21:30 How Ochsner has improved quality results performance in the ACO and is scaling it through continued growth.
23:00 The importance of value-focused leadership in building infrastructure and culture to drive performance outcomes.
23:45 “You can’t undervalue the importance of having the talent, leadership-buy-in, and investment to drive value-based outcomes.”
26:00 How senior-level engagement and alignment creates an environment for care delivery innovation.
27:45 The elevation of value-based care to one of four pillars of success for Ochsner Health.
28:00 Hardwiring VBC success into the compensation model for both system executives and physicians in the Ochsner Health enterprise.
28:30 How primary care engagement has led to next-level partnerships with specialists in the network.
30:00 How compensation plans and bonus incentives have driven provider engagement in value-based performance.
33:00 Ochsner’s partnership with Walmart to provide integrated, coordinated, high value care for employees across Louisiana.
34:30 The importance of employer-provider partnerships in improving the health and wellness of a workforce.
35:30 Sharing of financial-risk with self-funded employer-sponsored health plans.
37:00 Negotiating PMPM prospective payment with employers for a care management team model that improves clinical outcomes.
40:00 How Ochsner has been very intentional in building a population health data infrastructure to support its partner physicians.
41:00 Using claims groupers and population-based analytics to evaluate the totality of care spend for specific patient populations.
41:45 Collaborating with partner hospitals and community physicians to democratize population health data analytics at the point-of-care.
43:00 “HIT infrastructure capability and democratization of data at the point-of-care are the dual challenges in reaching greater depths of analytical precision.”
43:45 Ochsner’s patient population: 14-percent have diabetes and 40-percent have hypertension.
44:00 Improving outcomes for patients through enrollment in the Ochsner Digital Medicine program.
46:30 The use of algorithms for personalized care interventions to better engage chronically ill patients.
47:00 Overcoming physician concerns that the use of digital medicine is competitive to in-person E&M encounters.
47:30 The digital medicine program has improved outcomes (e.g. screenings, care gap closures, patient engagement) without diminishing office-based RVUs.
48:30 Piloting digital medicine for Medicaid populations and how that has increased care access and engagement.
50:00 Digital Health as a core component of Ochsner Health’s strategy (along with value-based payment).
51:00 The role of innovationOchsner (iO) as an important think tank and lab for digital health innovation.
52:00 Piloting the Ochsner Connected Stability Fall Prevention digital health program for MA members who are the highest risk of falls.
56:30 How the Ochsner population health enterprise delivers integrated behavioral health in the primary care setting.
58:00 Virtual behavioral health integration as the next big opportunity for care delivery innovation.
59:00 The Office of Professional Well-Being at Ochsner that has been established to improve the well-being of the workforce.
60:00 The growing concern of burnout and moral injury with physicians, APPs, and other clinicians.
61:30 A conscious effort to minimize inbox messaging for providers as a way to eliminate administrative burdens that contribute to provider burnout.
62:30 Integration of pharmacists in primary care setting to help manage prescription refills.
63:30 Team-based care (e.g. social workers, nurses, care coordinators, dieticians, patient engagement specialists) as an opportunity to improve overall workforce outcomes.
66:30 Partnering with Higher Education for interprofessional upskilling opportunities (e.g. Delgado Community College partnership in training nurses and CHWs).
69:00 The Healthy State by 2030 initiative as a catalyst to improve health equity in marginalized and underserved communities in Louisiana.
71:00 Community partnerships that recognize the impact of education as an opportunity equalizer.
74:00 Parting comments on the importance of health equity as a societal priority that is a shared responsibility in communities.
The 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.
Physicians are looking for novel solutions to streamline and improve care delivery in our ever-changing industry. They already don’t have enough time to do all that they want, and they are always being asked to do more! They want more time with patients, but the fee-for-service machine demands they see more patients more quickly. It’s a system that demands more and more and offers less to accomplish it.
But there is potential for more success via risk-based reimbursement in value-based programs is on the horizon. Doctors in private practice or employed by systems are excited to know that there is a way they can provide the care they’ve always envisioned, to be that caring individual who spends time getting to know and serve the patient. When they discover the possibilities in VBC they oftentimes turn to seek a partner that can help them adapt, so that they can take advantage of the opportunity to really care for patients.
This week on the Race to Value we are interviewing Dr. Keith Fernandez to discuss physician enablement and how helping doctors helps patients. Dr. Keith Fernandez is the Chief Clinical Officer of Privia Health, and CEO at Privia Quality Network South Texas, located in Arlington, Virginia and Houston, Texas, respectively. Privia Health is a national physician practice management and population health technology company that partners with leading doctors to keep people healthy, better manage disease, and to reward providers for delivering high value care. Privia is dedicated to providing value based care to its patients, and an improved lifestyle to its physicians.
Episode Bookmarks:
01:30 Creating physician enablement is key to population health success.
03:30 Introduction to Dr. Keith Fernandez, Chief Clinical Officer at Privia Health
04:45 Subscribe to the Race to Value newsletter for weekly updates on new episodes!
06:30 Establishing governance to ensure a high degree of physician engagement.
07:45 Creating a National Clinical IT Advisory Council to provide feedback on Clinical Decision Support and AI.
08:30 The impact of clinical-decision support and data at the point-of-care.
09:30 Using data to understand specific populations covered under value-based arrangements.
11:00 Surfacing data in a team-based care environment drives quality patient care.
12:00 Using technology and remote scribing to ameliorate physician burnout.
13:45 Technology tools for billing and coding to alleviate provider documentation requirements.
14:30 Providing an “unencumbered interaction between the physician and a patient” brings joy to medicine.
15:30 Supporting competency in revenue cycle management to optimize fee-for-service.
16:30 Workflow optimization in an interdisciplinary care team to support higher efficiency and improved patient outcomes.
17:45 The pandemic left independent primary care practices operating on razor thin margins.
19:00 How does stabilizing PCP finances help care teams devote more time and energy and resources to patients?
20:00 Automated technology is helping practices in fee-for-service claims appeals to improve revenue capture.
21:30 Dr. Fernandez discusses how a natural disaster during his career provided key learnings in RCM optimization.
23:45 The importance of ancillary revenue streams to support value-based contracting success.
25:00 Using a clinical research program focused on population health.
27:00 Rebuilding practices for the future through the National Physician Advisory Council at Privia Health.
28:00 Effective use of Nurse Practitioners and Physician Assistants to reach full clinical effectiveness.
30:00 Conducting a complete analysis of each practice joining a value-based network.
32:00 Onboarding contracted doctors into the population health platform.
35:00 Engaging all doctors – both PCPs and specialists – as a key to physician enablement success in VBC.
36:00 “We’re trying to empower doctors, improve their life, and help drive great care for their patients.”
36:30 Developing a Physician Leadership Program and how that leads to physician-led ACO success.
38:00 The challenges of improving Social Determinants of Health in managed patient populations.
39:30 Aligning physician compensation to value-based care performance, especially with populations that are SDOH-challenged.
41:00 Home care and remote patient monitoring to improve outcomes in underserved populations.
42:30 The role of consumerism in value-based care and how care teams should prioritize patient preferences and values.
45:00 The benefits of practicing medicine in a group and how peer learning dynamics drive VBC performance outcomes.
48:00 Convening physicians and attentively listening to their concerns will ultimately lead to operational efficiency.
50:30 “If you improve patient outcomes and satisfaction, you reduce the cost. It is a matter of fact that better care reduces the cost of care.”
52:00 “If we want to transform healthcare, we need to save money. That means we need to win on these contracts.”
52:45 Behavioral Health integration, referral management, CDS, and clinical research partnerships are future strategies for Privia Health.
54:30 Finding local partnerships in communities to address SDOH.
57:00 Evolving physician leadership in healthcare transformation as the ultimate inspiration.
Nearly 75% of Americans are overweight, including 42% who have obesity. The pandemic has heightened the problem, since many of us find comfort in food, and delivery services like Door Dash and Uber Eats make it easier than ever to consume calories while barely getting off the couch to answer the door. This obesity epidemic has huge implications on value-based care due to the impact it has on chronic morbidity, increased mortality, and unrelenting demands on the utilization of limited healthcare resources. Chronic conditions associated with obesity include, but are not limited to, type-2 diabetes, hypertension, hypercholesterolemia, and heart disease. These diseases have a destructive effect on the US healthcare system, and leaders in value-based care must start thinking about lifestyle medicine and evidence-based nutrition interventions. While there are many apps and tools for consumers or patients to use to lose weight on their own, programs that incorporate medically-assisted weight management and obesity care yield the best outcomes.
Rather than weight loss as a sidebar suggestion once a disease state is diagnosed, weight loss can be a potent catalyst for disease prevention within value-based care. Dr. Jamy Ard is the Co-Director of the Weight Management Center at Atrium Health Wake Forest Baptist. Joining him this week in the Race to Value is Rich Steinle, CEO of Carium – a technology company that partners with clinicians to offer a complete, virtual care platform ensuring every person – regardless of location, demographic or disease state – has access to quality, personalized care, education, and tools to support health and wellness goals. In this episode, we discuss the importance of partnerships between healthcare providers and technology companies to empower clinicians, patients, and their caregivers. Do you want to learn more about how real-time, aggregated health data and analytics can guide clinical decision-making in obesity? Well, this is an interview that you will not want to miss. Within a platform-enabled, virtual care ecosystem, weight management care teams can achieve positive outcomes that deliver on the promise of value-based care!
Episode Bookmarks:
01:30 An introduction to the concept of Virtual Weight Loss Management in Value-Based Care
02:00 Background on Dr. Jamy Ard (Atrium Health Wake Forest Baptist) and Rich Steinle(Carium)
03:30 Subscribe to our newsletter and leave us a Review and Rating on Apple Podcasts!
04:00 Chronic conditions associated with obesity include type-2 diabetes, hypertension, hypercholesterolemia, and heart disease.
04:45 Direct medical costs attributed to obesity account for $147 billion. Lost productivity due to obesity cost $303 billion. Adding chronic diseases make obesity a $1 Trillion problem!
06:00 Dr. Ard speaks to the economic challenges of obesity – “Obesity is a multifocal chronic relapsing disorder. It is a disease epidemic that can be addressed through patient engagement.”
07:00 The limitations of medical education in training doctors on nutrition and how to effectively treat and manage patient obesity.
08:30 Dr. Ard discusses the Weight Management Center at Atrium Health Wake Forest Baptist and the challenges with patient engagement in an obesogenic environment.
09:00 The impact of the COVID-19 pandemic on societal obesity and how technology empowers an effective patient engagement strategy.
10:00 Rich discusses the diametrically opposed reality that treating obesity is typically conducted as a prescription upon the onset of chronic disease (instead of as a prevention).
11:30 How technology can extend team-based care to provide a conduit for meaning patient engagement and treatment interventions.
12:00 Technology can be leveraged to address community health and equity, especially for patients living in food deserts.
13:00 How can a trusting business partnership between a care delivery organization and a technology company embolden relationship-based care for value transformation?
14:30 Dr. Ard on how technology can identify care gaps and then inform the agile development of intervention solutions.
15:00 “Technology doesn’t replace providers. It instead enables the provider to do more than what they can do alone.”
15:30 “A data-assisted approach to obesity care (e.g. patient-reported outcomes, physiologic monitoring) can enable personalized medicine.”
17:00 Rich outlines the tenets of relationship-based care – a common vision, trust, and innovation.
19:45 Demonstrating results with innovation can create expanded scale and reach in clinical efficacy.
21:00 How can research into the science of behavior change improve our understanding of how to influence health-related behaviors, such as diet, exercise, and medication adherence.
22:30 Lifestyle medicine as the starting point for any treatment strategy.
23:30 Uncontrollable variables in an obesogenic environment (i.e. Social Determinants of Health) determine the development of a personalized treatment strategy.
25:00 Having a trusted resource provided real-time feedback and guidance can guide better lifestyle choices.
26:30 Tailored feedback provides the opportunity for more sustainable changes (versus self-monitoring)
26:45 How automation of a “one-to-many” engagement strategy can be reinforced with individualized feedback.
27:30 The saturation of DIY health applications and how it differences from a patient-centered care model that emphasizes trusting relationships.
28:30 The real-time continuous learning of engagement algorithms used in weight management programs.
29:30 Incorporating biometric data from wearables to care management programs capturing self-reported data.
31:30 Rich on how the founders of Carium had a vision for data-enabled predictive analytics in healthcare (based on prior experience with telecommunications industry).
33:00 Creating data visualizations and actionable insights to drive value-based care outcomes.
35:00 In the conventional treatment of obesity, we often rely on a “one-size-fits-all” approach despite significant pathophysiological heterogeneity among people with obesity.
36:45 Dr. Ard provides perspective on the opportunity for precision medicine and individualized care planning in the personalized treatment of obesity.
38:00 The heterogeneity of treatment response for obesity allows for much faster realization of patient outcomes (i.e. a short-term ROI opportunity for medical cost savings)
39:30 Precision medicine and individualized care planning allows for a more effective utilization of healthcare workforce.
40:30 Rich discusses how virtual care delivery and remote patient monitoring can provide the enablement to help clinicians “deliver care at the point of life.”
41:30 White labeling or co-branding of technology supports the curation of a trusted engagement platform.
42:30 An example of how the technology relationship between Carium and Dr. Ard helped improve data capture and integrity.
43:30 The importance of shared goals between providers and technology companies.
45:00 Healthcare needs a renaissance of human experience design in technology solutions.
46:30 Moving medicine from an episodic, fee-for-service paradigm will require patient-centered technology design.
50:00 Approximately 13-percent of US households report food insecurity, meaning that they lack consistent, dependable access to enough food for active, healthy living.
51:45 Dr. Ard on how tech-enabled VBC can support the elimination of health disparities related to obesity with low-income and minoritized populations.
56:00 Rich describes how the proliferation of obesity-specific patient engagement can extend to other areas of medicine (e.g. fetal maternal health, oncology).
56:45 Technological scarcity is a social determinant of health and we must “bridge the digital divide” if it exists.
57:30 Does income fragility mean that people do not have access to smart phones and broadband access?
60:00 Are we in the beginning of a 4th Industrial Revolution where scalable disruption of our current care delivery model will occur through digital transformation?
60:45 Why hasn’t the Internet transformed healthcare like it has all other industries?
62:00 Rich discusses what the future look like in the next few years with emerging advancements in AI, internet of things, 5G, wearables, and gamification of consumer health apps.
63:00 Dr. Ard on how providers will eventually prescribe technology applications to their patients and provide automated meal planning based on context and geolocation.
This week on the Race to Value you will hear from Dr. Neil Wagle, the Chief Medical Officer at Devoted Health. This is a company we have been wanting to profile on the podcast for quite some time! Devoted Health is a healthcare company that designs Medicare Advantage plans for seniors; however, they are so much more than just a MA plan. Devoted Health has built a different model of care that starts with knowing their members on a personal level and earning their trust. By focusing on each member as a person and not as a chart, they are able to provide the best quality care for older Americans through an all-in-one healthcare solution combining the MA plan, access to high quality local providers alongside virtual and in-home care, and full-service guides—with world-class proprietary technology powering it all. This company is a leading innovator in value-based care.
Dr. Neil Wagle knows a thing or two about transforming healthcare. He is an internal-medicine physician by training, spent six years at Partners Healthcare (now Mass General Brigham) leading the health system’s efforts to improve the quality of care for patients. In 2017, he joined Devoted Health, a $12.7 billion health-insurance startup. As its chief medical officer, he’s spearheading the development of a model of care aimed at improving the health of older Americans by getting them the right care at the right time while saving costs for the US healthcare system.
In this episode, we discuss clinician burnout and moral injury, post-pandemic recalibration of the healthcare system, virtual care delivery, the benefits of a fully-integrated technology platform, health equity transformation, creating a virtual “Blue Zone”, patient-reported outcome measures, activation of chronically ill patients, and the importance of company culture in delivering relationship-based care.
Episode Bookmarks:
01:30 Introduction to Dr. Neil Wagle, the Chief Medical Officer at Devoted Health.
03:45 Dr. Wagle provides his background as a “synthesizer between medical-scientific world and the business world.”
04:15 Inspiration and mentorship from Dr. Tom Lee and being a part of Mass General Brigham’s first value-based contract.
04:45 “We’ll probably lose $70m in the first year, but we’re moving to value-based care because it is the right thing for patients.”
05:45 A chance coffee meeting with Ed Park led to the “ridiculously challenging” quest to build a system that could radically transform healthcare!
07:00 Provider burnout and moral injury is one of the major crises in healthcare (along with rising costs and inadequate care for aging Americans).
08:45 Dr. Wagle on how the pandemic has exacerbated moral injury and why we need to return to the altruistic underpinnings of medicine.
09:30 “The ability for physicians to connect with others has been decimated by overbooked 15-minute visits.”
09:45 How documentation requirements in fee-for-service medicine robs providers of “pajama time” with their families.
10:00 The Great Resignation in healthcare is being driven by the perpetuation of the fee-for-service business model.
10:30 Resolving the three crises of healthcare (i.e. Provider burnout, aging population, and rising healthcare costs) through care delivery transformation.
11:00 The good news in VBC: providers want to practice medicine in this way and patients actually have better outcomes with lower costs!
11:45 “You have to be able to monetize fewer hospitalizations. If you can’t, the value-based model of care won’t work financially.”
12:30 The emotional fuel of seeing better patient outcomes in VBC drives continual value-based care transformation.
13:00 The new wave of healthcare consumerism from the pandemic is causing a much-needed recalibration of care delivery.
14:00 “COVID exposed cracks in our fee-for-service model…”
15:45 “Value-based care is actually the ideal home for virtual care services because you don’t have to worry about over-utilization.”
16:00 Dr. Wagle describes how Devoted Health dramatically improves the health and wellbeing of Americans through person-centered care.
16:30 The “all-in-one healthcare” offering of Devoted Health as a virtual in-home medical group and MA plan, enabled by full-service guides and integrated technology.
17:30 Medicare Advantage patients receive this “all-in-one” care for free as part of their enrollment in the health plan.
17:45 Scaling a virtual care model further enhanced Devoted Health’s mission to treat members like family.
19:15 Overcoming the challenges of loss aversion in the perception of patients when adopting a virtual-first care delivery model.
20:00 The benefits of a virtual-first mentality when it comes to organizational scalability and culture.
21:30 Devoted Health has developed an end-to-end data and technology system that choreographs care delivery in a single, vertically integrated, tech-enabled model.
22:00 Dr. Wagle on the well-deserved skepticism of technology as a panacea…but how that is balanced with the practical vision of Ed and Todd Park.
22:45 Building a full-stack technology platform from the ground up was necessary (market-based solutions are based on FFS medicine and are incredibly fragmented).
23:00 Full-stack tech platform at Devoted does everything! (e.g. sales, enrollment, pharmacy, medical claims, prior authorizations, customer service, full EHR)
23:30 “Having a full-stack technology platform with all information in a single place allows us to deliver on the promise of complete, coordinated, and customized care.”
24:00 How human-centered technology design drives targeted population health interventions and personalized care delivery.
27:00 Human connection (relationship-based care) can be fostered with a full-stack technology platform because people don’t have to remember minute details.
28:00 Enabling tech-enabled rapid cycle innovation to deliver improved population health outcomes.
29:00 The challenges of defining “value-based care” and how health equity is changing how we understand value.
30:30 The historical debate about the adjustment of outcome measures to account for demographic factors.
31:00 “The world has moved to a different place where we have put a spotlight on health equity itself, rather than burying it in adjustment methodologies.”
31:45 How “Community Guides” at Devoted Health correlate the overcoming of SDOH with the Maslow Hierarchy of Needs to help members achieve full potential.
32:30 An example of how helping a member successfully enroll for public benefits can give them an extra $ 325/mo.
33:00 The development of a Health Equity Dashboard to measure their impact in closing equity gaps.
34:00 The product goal of Devoted Health is to be the world’s first virtual “blue zone” where people enjoy much longer, healthier lives than average.
35:00 “Longevity is not the ultimate goal. The first task of a health system is to make sure we treat people like family so they are happy and fulfilled.”
36:30 Dr. Wagle on what it really means to create a virtual Blue Zone at Devoted Health.
37:45 Creating the “Devoted Social Club” to help members overcome loneliness and social isolation through human connectedness and resilience tools.
39:30 Dr. Wagle on why the people and the culture is the foundation of Devoted Health.
41:30 “As we go out and look for new team members we look for experience, clinical acumen, and love in your heart.”
43:00 Caring for the clinician workforce so they can cultivate the love in their heart for the caring of others – it is a self-perpetuating phenomenon.
45:00 Keeping the mission as a “prime directive” by closing your eyes and imagining someone you love…than take action.
46:45 How Community Guides cultivate trusting relationships with members and help people overcome their mistrust of the healthcare system.
47:30 Spending time with members as an enabler of trust and empathy (e.g. a 90-minute phone call).
49:00 Trusting relationships are why Devoted Health has such a high net promoter score of 79 (higher than Apple, Netflix, and Amazon).
50:30 Starting with “Patient Priorities Care” in member engagement first…and then moving to data-enabled, rapid-cycle deployment of interventions.
51:30 Dr. Wagle discusses the importance of Patient-Reported Outcome Measures in value-based care.
54:00 6 in 10 adults have a chronic disease, and it is the leading driver of the nation’s $3.8T healthcare spend.
54:30 Dr. Wagle provides examples of how Devoted Health is making an impact in medication adherence and Hgb A1c reduction.
56:00 85% of diabetic members have their blood sugar under control, with an average A1c reduction of 2.3 within 100 days.
56:30 77% of hypertensive members now have their blood pressure under control, with an average reduction in systolic BP of 15.2 within 40 days.
57:00 Reduction of acute events related to Congestive Heart Failure by 50%.
57:45 Dr. Wagle shares an a research example of “learned helplessness” in dogs and how that behavioral pattern relates to most chronically ill patients managing their disease.
60:00 “We must relate clinical outcomes back to patient priorities. Those cycles are what capture momentum.”
61:30 Dr. Wagle discusses company growth and expansion and how Devoted Health is entering eight new states in 2023.
62:15 How will Devoted Health consistently replicate and scale as it enters into new markets at a national level?
64:00 Parting thoughts of appreciation from Dr. Wagle and how gratitude makes dreams come true in value-based care!
64:45 “Value-based care is more than possible…it is coming. The arc of history is bending towards progress, and I am grateful to be a part of that journey.”
Are you ready for the risk-based tsunami on the horizon? If you are a frequent listener to this show, you understand just how seismic this shift to value-based care really is and why we need the right culture, people, processes — fueled by capital – to spawn care delivery innovation. It is in reimagining care delivery that we can truly deliver on the aims of improved outcomes, lower cost, better patient experience, and equity for all populations. Joining us in this Race to Value this week are two outstanding leaders in the value movement, Drs. Brian Silverstein and Yates Lennon. We discuss how organizations should be preparing for the risk-based tsunami on the horizon through care delivery innovation.
Dr. Brian Silverstein is the Chief Population Health Officer for Innovaccer, a leading healthcare technology company committed to helping healthcare care as one. He is an expert in value-based care delivery and health system transformation with vast experience in helping providers improve population health initiatives. And joining him in this interview is Dr. Yates Lennon, the President of CHESS Health Solutions – a population health MSO empowering physicians and health systems to make the transition to value-based care. Dr. Lennon has extensive experience in quality, practice transformation, and physician engagement and has been instrumental in teaching health systems and providers across the country how to transform patient care and shift to value-based payment. If you are looking to understand the state and science of value-based care, look no further than this conversation with two of the leading minds in industry transformation!
Episode Bookmarks:
01:30 The seismic shift towards value-based care and the risk-based tsunami on the horizon.
02:00 Introduction to Dr. Brian Silverstein and Dr. Yates Lennon
04:30 Progressing in the value journey by understanding the landscape
05:45 Dr. Lennon provides an overview of the value ecosystem with varying adoption of risk in provider organizations.
07:00 “The days of sitting on the sideline are running out. It is time to get started with value-based care if you haven’t already.”
08:00 The State and Science of Digital Maturity at U.S. Healthcare Providers (a recent report from Frost & Sullivan, commissioned by Innovaccer)
09:30 Dr. Silverstein on the legitimacy of the value movement with perspective on how digital infrastructure impacts the pacing of adoption.
10:45 The differentiation of the technology stack utilized by providers accepting full risk-based payment.
12:00 Traversing the value landscape with emerging changes in payment model design focused on the reduction of health disparities.
13:30 Dr. Lennon on how VBP and population health technology tools are perfectly suited to address problems in health disparities.
14:00 Codifying the health equity design of the ACO REACH payment model into operational programs.
14:30 Ensuring access to care in a medical home – an example from Atrium Health Wake Forest Baptist
15:30 “Access is important in value-based care when attempting to address health equity.”
16:00 Focusing on the quality and performance improvement measures that can improve equity.
16:30 Clinical workflow optimization and the use of Community Health Workers to conduct patient outreach.
17:00 Leveraging community resources to address Social Determinants of Health (SDOH).
17:30 findhelp (formerly Aunt Bertha) and Unite Us as examples of technology platforms that can improve SDOH interventions and community partnerships.
18:15 Lifestyle coaching to improve health outcomes with dual eligible populations.
19:00 Dr. Silverstein explains how traditional healthcare will not able to improve population health outcomes in a silo.
20:00 The correlation between a patient’s zip code and their overall health and wellbeing.
20:30 Dr. Lennon provides perspective on how the creativity of value-based care will improve models for patient engagement and care delivery.
21:30 Organizations that are in a “payment straddle” trying to figure out where the fee-for-service curve and the value curves can intersect.
22:30 Capitalizing on both FFS and VBC through Annual Wellness Visits (AWVs), Advanced Care Planning (ACP), Chronic Care Management (CCM), and Transitional Care Management (TCM).
24:45 “I can’t emphasize enough how important providing patient access is for primary care physicians in value-based care.”
25:30 The importance of coding and documentation in risk stratification and compliance.
26:00 Making quality “second nature” by leveraging teams to close care gaps.
26:45 The challenges of finding a competent workforce and retaining physician independence to ensure care delivery innovation.
28:30 The plight of primary care and the struggle to retain independence.
29:00 Referencing recent article from Dr. Mai Pham on how a hybrid payment model will be a lifeline for primary care physicians.
30:00 Dr. Silverstein discusses the inherent complexity of value transformation and the importance of local market dynamics and the art of timing.
32:00 Dr. Lennon on the climate for value-based payment in the North Carolina market and PCP considerations to reach a critical mass in value.
33:00 Should independent PCPs consideration a physician aggregation model to pool lives and access capital?
34:00 Managing contract availability with available cash flow and the timing of investment decisions.
34:45 The difficulties of ensuring holistic patient care delivery while simultaneously maximizing fee-for-service revenue.
37:00 Dr. Lennon discusses the insufficiency of Risk Adjustment in truly understanding the needs of vulnerable populations.
38:00 Educating providers on risk adjustment coding on the connection between good patient care and financial accountability.
39:30 Optimizing an EHR workflow for risk adjustment data capture and clinical data visualizations at the point-of-care.
40:45 Dr. Silverstein on the importance of accurate risk adjustment coding to appropriately plan population health interventions.
42:00 Dr. Lennon discusses the need to importance of coding accuracy to eliminate compliance scrutiny.
42:30 The shift in changing the mindset of FQHCs to focus on diagnosis code specificity.
43:00 How point-of-care tools embedded in the EHR can improve risk adjustment data capture.
43:45 “EMRs and digitization in patient care is just the beginning – not the end state.” (referencing the use of transaction engines from other industries)
44:30 Focusing more on patient care than the sophistication of tech stacks will ensure long-term success.
45:30 Are mandated risk-based payment models the right thing to do in ensuring value-based care adoption?
47:00 Dr. Silverstein on the “multi-level complex Chess” of payment model innovation and provider adoption.
48:30 Dr. Lennon speaks against the mandating of APMs in the current healthcare delivery environment.
49:00 The beauty of the natural progression of value-based care innovation at the physician-level.
50:30 Dr. Lennon reflects on the inability of fee-for-service to create sustainable population health models.
52:30 Drs. Lennon and Silverstein speak about controversies associated with Medicare Advantage upcoding and potential abuses in value-related plans.
55:30 Why don’t we shift the industry coverage of Medicare Advantage to the benefits and opportunities of the program?
57:30 The burdensome regulations that hinder those providers who are not the bad actors. (ex: the SNF 3-Day rule, home-based infusions)
60:00 Referencing recent report from Morning Consult, commissioned by Innovaccer onThe State and Science of Value-Based Care.
61:45 Parting thoughts from Drs. Lennon and Silverstein on the moral imperative of value transformation.
Value-Based Care is at a tipping point. But it’s not just about whether providers adopt alternative payment models (APMs) or ACOs. The real tipping point is whether traditional health systems ...
How can primary care physicians retain their independence in planning for future success in value-based care? A medical practice must have access to capital to optimize physician workflow and improve ...
Chronic Obstructive Pulmonary Disease (COPD) afflicts 24 million adult Americans and represents the 3rd leading cause of death. COPD is also the 5th most costly chronic disease in the US ...
In the uncertainty of today’s healthcare industry, we must continue to persevere towards our true north. The moral imperative to improve the quality of care for patients through better care ...
One of the silver linings of the pandemic has, in fact, been, the expansion of telehealth services and virtual care delivery. The pandemic has also accelerated the healthcare industry’s transition ...
As we talk about the current zeitgeist moving us towards value and equity, we also have to think about how polarized our country is politically. Democrats and Republicans live in ...
Have you ever had an idea that you just had to make real? No matter what it took… no matter what obstacles were in your way… no matter how many ...
This week, we have as your guest the legendary Dr. Robert Pearl, a Stanford University professor, Forbes contributor, bestselling author and former CEO of The Permanente Medical Group. Coming off ...
Patient Engagement is of paramount importance in value-based care. Healthcare organizations are increasingly turning to solutions that promise more targeted patient outreach, more coordinated care management, and more potential for ...
Our guest this week is Micky Tripathi, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, where he leads the formulation of the ...
Sydney Townsend was diagnosed with cancer in June 2018, three months after giving birth to her first child. As a former boxer, she realized she was in the fight of ...
Our guest this week, Matt Miclette, is military veteran and a psychiatric and mental health board certified registered nurse. He is the Senior Director of Clinical Operations at NeuroFlow – a digital health ...
Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region or community. In 2009, Congress attempted to modernize HIE processes by passing the ...
The movement to value-based care will necessitate a major paradigm shift in how physicians practice medicine. They can no longer be “cowboys” in the wild west of fragmented, uncoordinated care ...
When Billy Beane decided to employ a recent Harvard graduate to use advanced statistical analysis to build a championship major league baseball team, he changed the game forever. While Beane’s famous early ...
Fixing the behavioral health crisis is an absolute imperative in the movement to value-based care. Currently, 1 out of 5 Americans (over 51 million) are living with a behavioral health ...
The health care industry is experiencing a digital transformation that has been decades in the making. In this era of COVID-19 disruption and heightened consumer expectations for care delivery, the ...
Welcome back for part 2! This episode further explores Klasko’s vision of health assurance, an industry that focuses on consumer’s health, and that is enabled through innovative partnerships between health ...
Dr. Stephen Klasko is the President and CEO of Thomas Jefferson University and Jefferson Health. His newest book, co-authored with venture-capitalist Hemant Teneja, is a manifesto that advocates for bringing ...
Most people know that 3M as a massive industrial conglomerate, a Fortune 500 company with 60,000 products that include Post-It notes, Scotch tape, sandpaper, hanging hooks, band-aids and more. A ...
How does an organization have a banner year in 2019, start 2020 with additional momentum, and then continue to grow despite COVID-19 making them change their whole approach? Because they ...