The Race to Value Podcast

Accountable Care Learning Collaborative

We are in a race to make health value work.

Join Dr. Eric Weaver and Daniel Chipping of the Accountable Care Learning Collaborative as they interview top executives, physicians, and entrepreneurs leading the transformation to health value.

All Episodes

A special Thanksgiving message from Dr. Eric Weaver, host of the Race to Value, about gratitude, suffering, and the movement to value-based care.

Nov 24

3 min 39 sec

Grief support and empathy education is so important in the context of value-based health care as it connects us to our own humanity.  It speaks to why we entered into the altruistic practice of providing care, yet our fee-for-service model overvalues transactional activities without a whole-person orientation.  This leads to medical professionals becoming detached from the grieving process of patients, families, and caregivers and results in our own moral injury along the way. Providers who lack an understanding in the grieving process or fail to adequately express empathy will also have patients with diminished clinical care outcomes.  Moreover, doctors without empathy are more likely to get sued for malpractice compared to doctors who make the same mistake but do emphasize the human connection. In this week’s episode, we invited one of the leading experts in grief and empathy, Lisa Keefauver to discuss a health system’s role in supporting patients, families, and caregivers through the grieving process. Lisa is the Founder & CEO of Reimagining Grief and is working to shift the narratives of grief at the individual, community, and organizational levels. Her wisdom as a grief and empathy leader runs deep and wide, rooted in her personal and professional experiences over the past 20+ years. You can find out more about Lisa’s work at her website: https://reimagininggrief.com/ Episode Bookmarks: 01:45 Introduction to Lisa Keefauver – a Speaker|Educator|Writer|Podcaster|Social Worker turned grief and empathy activist 03:30 Grief during the season of Thanksgiving and the important message of transcending it 05:30 Lisa shares the personal story of her harrowing experience with the healthcare system preceding her husband’s death from brain cancer 08:50 Lack of empathy and compassion from providers leads to missed information at the point-of-care 10:30 The assumption of clinical expertise at the expense of accounting for the humanity of patients 11:00 Anticipatory Grief - feeling of grief occurring before an impending loss, i.e. the forthcoming the death of someone close due to illness 11:40 Research shows that a direct correlation exists between anticipatory grieving and the caregiver's quality of life. 12:40 The importance of grief support and empathy education in the context of value-based health care and how anticipatory grief is so widely misunderstood 13:00 Pronounced anger and loss of control during anticipatory grief and how conventional medical misunderstanding pathologizes that behavior 14:00 Using tools (e.g. mindfulness, sleep, rest, and nutrition) to help patients, family, and caregivers with anticipatory grief 16:00 Stress-related health problems are responsible for up to 80% of visits to the doctor and account for the third highest health care expenditures, behind only heart disease and cancer. 16:30 Meditation programs could translate into health care savings as much as $25,500 per patient each year because of the lowered utilization of medical services and emergency room visits. 17:20 “As we move to value-based care, we need to think about covering mindfulness meditation as an integral service for patients, families, and caregivers.” 18:00 What mindfulness is (and what it isn’t) and the power of the present moment in eliminating stress and supporting emotional regulation. 19:45 Referencing Kristin Neff’s book, “Self-Compassion: The Proven Power of Being Kind to Yourself” 20:20 The need for mindfulness to be an important part of medical education training 22:15 Heart condition associated with grief - takotsubo cardiomyopathy (“broken heart syndrome”) 23:15 The role of social workers as part of an interdisciplinary team, particularly in the disease prevention aspect of grief counseling and support 26:40 How people of color can grieve differently and the reliance of human connectivity in BIPOC communities 29:00 The shared experience in dealing with the m...

Nov 22

55 min 37 sec

How does a 3-physician practice sell for over $100 million dollars? The answer is simpler than it seems – full-risk contracting is better for providers and patients. Aligned incentives promote better outcomes for patients, and better reimbursement for those providing the care. It comes down to this - full risk unlocks the door to a true relationship with the patient, a relationship that provides more information than sophisticated AI models, risk coding and predictive analytics. And Medicare Advantage plans are the most accessible vehicle to achieve full capitation. We are pleased to welcome back Dr. Tom Davis as our guest. Dr. Davis is an expert in value-based care, a family physician, angel investor, founder of 6 companies, consultant, and speaker. In this episode, he articulates how Medicare Advantage is a critical strength in the race to value. You can find more from Dr. Davis at his website: https://www.tomdavisconsulting.com/ Episode Bookmarks: 01:40 Introduction to Dr. Tom Davis 03:30 Dr. Davis started a small primary care practice that took full-risk Medicare Advantage (MA) and sold it for $132M! 06:30 Dr. Davis explains the “spectrum of value-based care” in MA and how he took the first full-risk contract in his market. 09:00 Analyzing cost drivers in patient population and how that prompted investment to capitalize on a site-of-service arbitrage 11:00 Implementing internal systems to optimize on physician workflow efficiencies in value-based care 12:00 Dr. Davis describes how it felt the first time he saw that he earned $1M+ in income as a primary care physician. 14:00 Dr. Davis explains “the offer we couldn’t refuse” when his full-risk MA practice was acquired. 14:40 “Value-based care under a full-risk Medicare Advantage model allowed me to be the family physician that I had always wanted to be.” 15:30 The enrollment growth trajectory in Medicare Advantage and the continued potential for rewarding economics for PCPs 17:15 “Devolving the financial consequences of the clinical decision down to the POS unleashes the most valuable asset in healthcare--the clinicians themselves.” 18:40 How to take full advantage of Medicare Advantage – Dr. Davis explains how to take full financial responsibility in a risk contract! 20:00 Full financial risk is only up to the attachment point of the stop-loss insurance. 21:00 The pool of capital in private insurance markets and the delegation of risk to both providers and the private liability market. 22:00 “Fee-for-service medicine sucks your will to live as a clinician.” 23:30 The economics of the MA Stars system and how it aligns with improved patient outcomes 24:45 Proxy Value vs. True Value in measurement 25:15 Full-risk contracts as the only true way to unlock value. 26:15 Moving from 3 to 5 Stars in Medicare Advantage equates to an 18% increase in practice revenue. 27:00 Deriving true value in MA contracts as the most sustainable and optimal ROI opportunity 28:30 The advantages and disadvantages of physician-led risk-bearing entities 29:45 “You will never learn to swim if you only stay in an ACO.” 31:00 Working with smaller MA plans because they are more likely to collaborate with physicians. 31:45 The rise of Direct Contracting Entities (DCEs) leaves no excuse for physicians to not up their risk profile. 33:00 The value of the patient relationship in driving business performance (versus short-term revenue generation to goose the bottom line in FFS) 34:40 Referencing the father of the modern container ship system in how we unlocked true value. 36:00 “Everything, everything, everything in your organization wraps around the value between the patient and the clinician.” 37:00 Dr. Davis shares a personal story of how a patient relationship supported colorectal cancer screening compliance. 38:00 How patient relationships trump sophisticated AI models and predictive analytics 39:00 The moral,

Nov 16

1 hr 6 min

Health care is the largest employment sector in the US, and women account for 75-percent of the workforce. Gender equity in medical leadership is of paramount importance in value-based care to provide more meaningful and culturally-competent care with improved relational and clinical outcomes between patients and providers. Despite a female majority in the healthcare workforce, they are not proportionally represented within top leadership positions, where they account for less than 15-percent of executives. While women account for just over half of all medical school enrollments, they have consistently graduated from medical school at rates below their male colleagues, although that gap has narrowed in recent years. Further, only 18-percent of hospital CEOs are women. Our special guest for this bonus episode is Dr. Charlotte Collins, Division Chief for The Center for Professionalism and Well-Being at Geisinger. Her work focuses on the provider experience to improve engagement, recruitment, retention, and communication, while benefitting patient care and experience, and reducing the risk for medical errors. The Center promotes cultural goals such as transparency, decentralized decision-making, and continuous quality improvement for the organization. In 2020, the National Business Group on Health awarded Geisinger with the platinum Best Employers: Excellence in Health & Well-Being Award for supporting the “enhancement and maintenance of personal and professional well-being” for staff. In this episode, Dr. Collins shares insights garnered from her efforts to better understand women’s needs in the health care workforce. During this time of consistent burnout among clinicians, and heightened awareness of the need for improved equity, it is critical to recognize the opportunity for women to take a more prominent role in leading value-based care transformation. This discussion will provide you with important insights on gender and pay equity, creating a female-friendly workplace, empowerment, and workforce resiliency. The value proposition of gender equity in leadership is crucial in the transition to whole-person care models that deliver on improved population health outcomes. Episode Bookmarks: 01:40 Referencing the ACLC Intelligence Brief on Women in Medicine and Introduction to Dr. Charlotte Collins 04:00 Kimberly Mueller explains the purpose of the ACLC in accelerating the transition to value-based care 05:00 Recent efforts in healthcare to support the advancement of DEI and Dr. Collins work at Geisinger 07:20 75% of the healthcare workforce is female, but there is an imbalance between men and women in leadership roles 08:30 The role that women leaders play in value-based care and how more women in medical leadership could improve clinical outcomes 09:30 The three pillars of Geisinger that inform population health and how the pandemic has impacted that work 10:15 The exodus of the healthcare workforce due to burnout and retirement, coupled with nursing shortages, has created a crisis 11:15 The development of the Geisinger Center for Professionalism and Well-Being and how it supports women in medicine 13:00 Overview of Geisinger’s survey on women-centered medicine and clinical practice 17:45 How patients have potentially been impacted by sexual harassment, and the opportunities to address burnout and workplace fairness 19:30 Pay equity and transparency within the workforce and the creation of a “female-friendly workplace” 21:10 Addressing workforce policies that disproportionately impact women 22:10 The choice that women face in being a “good Mom” or a professional in the workplace 24:00 Geisinger’s program to support workforce resiliency and emotional well-being (RISE - Resilience in Stressful Events) 29:00 Emergent design and the “bottom-up approach” to developing programs that foster ideas from front-line staff 32:00 How women and men can bind together and support the...

Nov 12

49 min 49 sec

The financial stats of healthcare are all too familiar – the 18% of GDP, $3 trillion spend, and the $11k per capita cost are frightening to consider. We are on an unsustainable financial trajectory, as those numbers are projected to increase. The costs for cancer care, which include both medical services and drugs, are no different. In 2015, national costs for cancer care were estimated to be $190 billion and just 5 years later, in 2020, the costs ballooned to $209 billion. The 10 percent increase is primarily attributed to the aging and growth of the U.S. population. As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, there are many examples of practices participating in CMS’ Oncology Care Model (OCM) that have made impactful workflow changes to achieve cost and quality improvements. The OCM was the first cancer-specific alternative payment model for Medicare recipients as well as Medicare's first APM for outpatient specialty medicine. Despite several practices succeeding in the OCM, many have not. At this point, the overall results of the APM have been underwhelming. Since the OCM was originally implemented in 2016, the program has led to a $155 million net loss to Medicare. While originally set to expire this summer, to be replaced by Oncology Care First (OCF), the date was pushed back by a year. CMMI can apply lessons learned when launching the OCF, and Texas Oncology is where they can find oncology care that is thriving in the race to value. Our guest this week is Debra Patt, M.D., PH.D., MBA, a practicing oncologist and breast cancer specialist in Austin, Texas. Dr. Pratt serves as the Executive Vice President for Public Policy, Payer Relations, and Strategic Initiatives at Texas Oncology, a network of 210 sites of service and 490 doctors, serving half of the cancer patients in Texas. In this role she advocates for effective cancer policy at the state and federal level, and advises on strategy for various initiatives, such as telemedicine, optimizing growth and development of advanced practice providers, development of service lines, informatics initiatives and contracting. Her research is in clinical decision support, predictive analytics, telemedicine, health economics and outcomes, tools for patient symptom management and quality improvement. As an expert in healthcare policy, she has testified before Congress to protect access to care for Medicare beneficiaries. She is the editor-in-chief of the Journal of Clinical Oncology- Clinical Cancer Informatics. Episode Bookmarks: 01:45 Background information on Dr. Debra Patt and her work in Value-Based Oncology Care 05:00 The Country’s Financial Burden of Cancer Care – Why we need to transition from Volume to Value 07:00 The need to anchor our expectations for value differently based on the aging of the population and the advancement of treatment 08:15 Investments inpatient care and drug research is more like a “mortgage” instead of paying “rent” 09:00 How cancer care is bankrupting patients due to out-of-pocket burden 09:25 Many forms of cancer are now being treating like an acute illness instead of a chronic disease akin to HTN or diabetes 09:45 The societal and economic benefits of people living longer upon the initial diagnosis of cancer due to advances in care 10:10 Referencing the book, “The Great American Drug Deal: A New Prescription for Innovative and Affordable Medicines” 10:40 Other investments, outside of new innovations in drugs and therapeutics, that are still needed in value-based oncology care 12:00 The Oncology Care Model (or OCM) -- the first cancer-specific alternative payment model for Medicare recipients 12:45 The underwhelming results of OCM, a $155 million net loss to Medicare, largely due the model’s complexity 14:00 Correlating the assessment of OCM’s success to the value equations, i.e.

Nov 8

1 hr 7 min

You are about to be inspired and challenged about how you think about value-based care. Since 1991, Rosen Hotels & Resorts has offered an innovative in-house healthcare program called RosenCare that has been improving lives for employees and the community, as well as saved the company approximately $450 million since its inception. Our guests this week are Harris Rosen, businessman, investor and philanthropist who founded Rosen Hotels & Resorts and serves as the company's president and COO; Kenneth Aldridge, Director of Health Services for Rosen Medical Center, the onsite medical home and primary care ecosystem; and Ashley Bacot, President of Provinsure, an independent insurance consulting arm owned by Rosen. The takeaways from this conversation are multi-faceted and can be applied to ACOs, health plans, and employers. This interview will allow you to re-think how local community engagement and partnerships fit into your healthcare strategy. RosenCare’s approach will force you to reconsider how you approach access, quality, service, costs, innovation. Saving costs and improving lives, this model is ripe for replication and needs to become the norm in our race to value. In the words of Mr. Rosen, “We need to, as a nation, build a much better health system. If we replicated the RosenCare program nationally, we would save over a trillion dollars annually!  Let’s use that money to pay off our national debt. Health care can be the treasure that changes America.” Episode Bookmarks: 01:45 Background on Rosen Hotels & Resorts and its innovative in-house healthcare program (RosenCare) that saved $450 million! 03:45 Introduction to Harris Rosen, Kenneth Aldridge, and Ashley Bacot 07:00 Rosen Hotels & Resorts spends 50% less per capita than the average employer (cost “per covered life” is ~$5,500) 08:20 Mr. Rosen explains how the military adages of the 6P’s and KISS guides his entrepreneurial vision 09:20 The birth of RosenCare in 1991 due to uncontrollable and rising health insurance premiums (Mr. Rosen) 10:00 Lowering healthcare costs 20% but still facing premium escalations…time to become a self-insured plan and build our own clinic! (Mr. Rosen) 14:20 “Our success wasn’t that complicated. Scary…yes. Uncertain…of course. But we did it, and we saved $450-500M in healthcare costs over the last 40 years.” 16:05 How Mr. Rosen leads others and built a such a strong culture that company associates want to be a part of (Ashley) 18:40 How working diligently to keep people healthy drives both good outcomes and a healthy bottom line (Mr. Rosen) 19:05 Social determinants of health and the challenges of keeping associates healthy (Kenneth) 20:20 “This is advanced, direct primary care on steroids!” 22:00 The strength of Rosen’s self-insurance plan, Third Party Administrator, and direct contracting model (Ashley) 24:00 Designing steerage into the benefit design (Ashley) 25:30 The unfounded fears by employers in redesigning health insurance benefits (Ashley) 27:30 An Overview of Rosen Medical Center, A Place for Healing and Wellness 29:00 The importance of relationship-based care at Rosen Medical Center (Kenneth) 34:30 How RosenCare addresses the issue of low value care with PBM formulary selection and surgery options (Kenneth) 36:00 How non-traditional treatment (e.g. medical marijuana) have a role to play in eliminating traditional options of treatment that are of lower value (Kenneth) 39:00 How RosenCare approaches direct contracting with hospitals (Ashley) 40:15 The importance of employers having the courage to be self-insured and the need for reforms in hospital reimbursement (Mr. Rosen) 42:00 “Hospitals must try to be fair and equitable.  They should publish costs and outcomes online.” 43:20 The powerful hospital lobby and its concern for income preservation at the sake of ethical business behavior (Mr. Rosen) 45:00 The horrible financial situation that patients fa...

Nov 1

1 hr 13 min

Every year, millions of Americans are overcharged and underserved while the health care industry makes record profits. We know something is wrong, but layers of complexity make it confusing and discouraging to do anything about it - it seems impossible for most. Our guest this week is Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. Drawing on 15 years of investigating the health care industry, reporter Marshall Allen reveals the industry’s pressure points and how companies and individuals have fought overbilling, price gouging, insurance denials, and more to get the care they deserve and protect against the system’s predatory practices. The key message is that we, the consumer, can take back control of our health care. It is up to the American people to equip ourselves to fight back for the sake of our families–and everyone else. Consumers must lead the race to value. Episode Bookmarks:  01:40 An introduction to Marshall Allen and his work investigating the American healthcare system 03:35 The need for a grassroots consumer movement and employer-based disruption to reform a broken system 04:45 How Marshall’s work in investigative healthcare journalism was informed by his work in ministry 05:50 Marshall explains how the healthcare system’s business design violates the Golden Rule 08:15 “The business of medicine is conducted to maximize the profit for the industry, even at the financial harm of patients.” 08:30 Marshall’s new book: “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.” 10:00 The victimization of patients that occurs through flawed system design and the “normalized deviance” by those delivering care 11:30 The importance of reframing the health system to eliminate the exploitation of patients for profit 12:15 “Our healthcare system is allows for the exploitation of sickness for profit.” 13:00 Marshall discusses the lack of an ethical position to exploit consumers for non-discretionary choices 13:20 The escalating price of insulin as an example of how inelastic demand is exploited for profit 15:00 Marshall explains how employers and patients can demand better value by no longer tolerating profit maximization 16:30 Referencing the recent JAMA Study on Medical Debt showing that 1 in 5 Americans have medical debt in collections 17:00 Using Marshall’s new book as a step-by-step, tactical guerilla guide for patient and employer empowerment 19:30 The approval of non-effective drugs and pricing scams conducted by Big Pharma (e.g. the recent approval of Aduhelm) 20:20 Marshall explains how the specialty drug, Vimovo, is an egregious example of a Big Pharma profiteering scheme combining two common drugs with no additional therapeutic benefit (Marshall’s article on Vimovo) 24:00 Motivated to write book to help patients facing financial ruination by healthcare 25:00 185 million Americans in the employer-sponsored insurance market as an opportunity for grassroots reform 25:30 Marshall’s explains his family’s personal experience of financial exploitation by the healthcare system (the Introduction to his book) 28:30 The need for patients to gather evidence when disputing medical billing errors and upcoding 31:30 The effectiveness of small claims courts in empowering patients who are being financially exploited 34:00 Marshall provides guidance on how patients can avoid unnecessary care 37:00 Comparing the financial incentives between capitated models vs. fee-for-service 38:00 Always ask for the cash price as a patient! (you don’t always have to use insurance) 38:30 The massive price variation based on the site of service (e.g. MRIs in hospital vs. freestanding imaging center) 39:45 “You’re not getting more for your money when you pay extra for healthcare.” 42:00 Marshall explains his mission to help patients develop financial literacy by developing co...

Oct 25

1 hr 2 min

This week on Race to Value, we are excited to celebrate Pharmacy Week – it is a time to recognize the invaluable contributions pharmacists and technicians make to patient care in hospitals, outpatient clinics, and other healthcare settings, and to raise patients’ and colleagues’ awareness about the vital role pharmacists play on the healthcare team. Our guests this week are mavens in aligning pharmacy and value-based care. In this episode, we discuss the importance of women in leadership, the impact of drug prices on minoritized communities, vaccine equity, the relationship between SDOH and medication adherence, pharmacy integration, and vaccine science and effectiveness research. Melissa Murer Corrigan was founding Executive Director and CEO of the Pharmacy Technician Certification Board (PTCB) in Washington, D.C. from 1994-2011. Melissa’s leadership launched the PTCB program that has now certified over 600,000 pharmacy technicians working across the United States. Murer Corrigan embraced ambition, took risks, and was the only woman on the PTCB Board of Governors during her 17-year tenure as CEO. In 2012 Melissa joined the ACT as Vice President of Social Impact and sits on the Board of Directors for the American Institute for the History of Pharmacy. Melissa has served as adjunct faculty with the University of Iowa College of Pharmacy since 2013. She has been named a Fellow of both the American Society of Health-System Pharmacists Association and the American Pharmacists Association. Jacinda Abdul-Mutakabbir, also known as “JAM," is an Assistant Professor of Pharmacy Practice at Loma Linda University, School of Pharmacy and a Critical Care Infectious Disease pharmacist, and an Infectious Disease Pharmacokinetics/ Pharmacodynamics (PK/PD) Research Fellow at Wayne State University under the tutelage of Dr. Michael J. Rybak PharmD, MPH, PhD. Her dedication to improving public health has been recognized by the United States Public Health Services, as she was the 2017 recipient of the USPHS Outstanding Service Award. Additionally, her research has led her to be recognized by the European Congress of Clinical Microbiology and Infectious Diseases one of their 30 under 30 outstanding young scientists, for their ECCMID 2021 31st annual meeting.   Episode Bookmarks: 02:00 Introduction to Melissa Murer Corrigan and Dr. Jacinda Abdul-Mutakabbir (Dr.JAM) 04:00 The importance of National Pharmacy Week 05:30 Overcoming the dominant idea of patriarchy in business and medicine and honoring strong women by allowing them to lead 07:30 Melissa on the celebration of women in leadership and how men can serve as allies and advocates 08:30 Reflecting on women in pharmacy leadership (e.g. Rosalind Brewer, the CEO of Walgreens Boots Alliance) 09:20 Overcoming Imposter Syndrome to create a “growth mindset” within women 10:30 Dr. JAM on the steps taken to towards improving gender equity within the pharmaceutical workforce 12:00 Prescription drugs are the fastest growing healthcare expenditure and consistently outpace other health spending 13:00 Biden administration support for legislation to empower the government to negotiate Medicare drug prices with Big Pharma 14:00 Melissa on providing patients with the access to medications they need so they are “not making choices between treatment and buying groceries” 14:30 Dr. JAM on how drug prices impact individuals in minoritized communities 15:30 Utilizing the approach to equitable distribution of COVID-19 vaccines to the provision of lifesaving medications to underserved communities 17:00 The role that pharmacies have to positively impact and address the systemic health disparities in communities of color and low-income neighborhoods 17:30 Referencing AJMC research showing that Black individuals who received medication therapy management services from a pharmacist significantly improved their diabetes 18:30 Dr.

Oct 18

1 hr 1 min

Our guest this week is Dr. Tamarah Dupervahl-Brownlee, Chief Health Officer for Accenture, and recently, Chief Community Impact Officer for Ascension. A Physician leader with 20+ years of experience practicing medicine, she has served in various healthcare leadership roles that focus on optimizing the physical, mental, and financial health and wellbeing of communities. Dr. Dupervahl-Brownlee is fiercely determined to create and implement strategies for people to thrive and live healthy and well. Throughout her career, she has served as a champion for providing high quality healthcare and advancing health equity that has impacted thousands of lives.  In recognition of that work, she was named by Modern Healthcare as one of the Top 25 Women Leaders in 2021 and one of the Top 25 Minority Leaders in Healthcare in 2020. She is nationally recognized for her leadership in collaborating with partners across the industry and nonprofit community to advance community health improvement initiatives, with a particular focus on health equity. Her strong patient-centered approach to medicine, with a special interest in women, children, and underserved populations, makes her a clear leader in the race to value. Episode Bookmarks: 05:30 Dr. Dupervahl-Brownlee speaks to her personal leadership journey 07:30 Lessons in servant leadership and the importance of “stepping out of one’s self” and investing in others 08:15 The influence of Dr. Dupervahl-Brownlee’s mother, an immigrant from Haiti, who laid a great foundation for her to pursue a career in medicine 11:00 “The pandemics of both COVID-19 and social injustice show us just how inextricably linked we are as people. This is the time to examine opportunities to improve health equity.” 13:20 The need to reposition the healthcare workforce to address human pain and suffering 14:20 “Profitability in healthcare has led us astray by ignoring vulnerable communities and creating opportunities to innovate.” 16:00 “If we all head a lens of equity, just think about we could do as leaders in healthcare.” 17:40 Dr. Dupervahl-Brownlee speaks about how value-based care and emerging payment models can be leveraged to improve health equity 18:20 The leadership of CMS Administrator Chiquita Brooks-LaSure to tackle health equity and better understand the social determinants of health through value-based care 19:30 Understanding how social risk factors and community-based investments to improve population health 20:45 The need for research in patient-reported outcomes to assess how healthcare can help patients thrive 22:40 Referencing her early beginnings practicing medicine in the South side of Chicago and how Social Determinants of Health prevented improvement in patient outcomes 25:00 How structural biases and racism negatively impact health in communities and the need for health policy reforms 26:30 The need for more curiosity and inclusivity in healthcare to know “the rest of the story” 27:45 How we can use data from outside the traditional healthcare system in improving the health of vulnerable populations 30:00 Dr. Dupervahl-Brownlee on the future of hospitals as healthcare moves more towards value and consumerism (“The hospital of today will be extinct in the future”) 31:00 The reordering of the healthcare solar system to patient-centeredness 32:00 Referencing her prior work in Patient-Centered Medical Home transformation 35:00 Dr. Dupervahl-Brownlee provides perspective on how our country can achieve better integration of behavioral health in the primary care environment 38:30 The irreparable harm of the pandemic on societal mental health and the use of digital health in integrated care models 41:30 Acknowledging the resilience and fortitude of healthcare heroes during these challenging times 42:30 The importance of physician leadership with a shared and lived experience in practicing medicine to create empowerment within the p...

Oct 11

59 min 3 sec

Gender-affirming care offers a model for all of health care, one that is patient-centered and based on the human story.  In this episode, you will learn about “The Truth and Beauty of Gender-Affirming Care” from a leading transgender health provider and value-based care thought leader. Dallas Ducar is the founding CEO of Transhealth Northampton. In this role, Dallas brings experience constructing clinical, research, and education services in community-based, gender-affirming, healthcare systems. She combines this leadership experience with frontline clinical experience in emergency, inpatient, and outpatient care. Prior to assuming the CEO position, Dallas served as the Clinical Lead for Mental Health Services at the Massachusetts General Hospital Transgender Health Program, where she worked with an interdisciplinary team to provide novel gender-affirming care.  In her career, she has advised international research groups in best practices and has carried out community-based participatory action research programs dedicated to empowering gender-diverse voices in a community setting. As a nationally recognized leader in transgender health, Dallas is on a personal crusade to improve the quality of care for gender-diverse individuals. Topics covered in this episode include gender-affirming care, health equity, social determinants of health, mental health in the transgender community, culturally-competent care, mindfulness and meditation, telehealth expansion, pediatric transgender care, insurance barriers, and the recognition of transgender rights as civil rights. Episode Bookmarks:  05:40 Overcoming gender dysphoria to realize “gender euphoria” as her truest self 07:40 Using her “trans superpowers” to become a more resilient human being 09:10 Dallas speaks about the period in her life when she was transitioning in Charlottesville, VA 12:00 Recognizing the opportunity to address trans rights in the healthcare arena 14:50 Dallas explains the concept of gender-affirming care and how it is an example of patient-centeredness and compassion 15:40 “What is gender-affirming care? It is patient-centered, whole-person care that addresses every part of one’s life that intersects with gender.” 16:40 “The simple truth and beauty of gender-affirming care is that it affords every human being the freedom to be who they are.” 17:10 Dallas explains the value-based care delivery model of Transhealth Northampton, the nation’s first independent comprehensive trans health care center 17:40 Gender-affirming care that delivers value (ex: improved behavioral health outcomes, less suicidality, more effective SUD treatment) 19:40 “Patients in a value-based gender-affirming care model have lower healthcare spending, higher patient satisfaction, and improved clinical outcomes.” 20:40 What is Health Equity?  (a definition from the Robert Wood Johnson Foundation) 21:10 Transgender individuals are more likely to be in the lower income brackets with 44 percent of trans community living on an income of $35,000 or less 22:10 Published Reporting of trans discrimination in healthcare (Referencing the Center for American Progress Report) 23:40 Dallas discusses the observed impact of trans discrimination in healthcare and the interrelatedness of SDOH barriers 25:40 The importance of culturally-competent care and the provision of care by people with the same “lived experience” 27:40 Expanding access to gender-affirming care with telehealth 28:40 40% of the transgender community have attempted suicide in their lifetime (9X the attempted suicide rate of the entire US population) 30:10 Dallas speaks of the importance of behavioral health integration in the primary care setting 32:40 Dallas explains why providing care in a “celebratory and open-hearted queer-friendly healthcare environment” improves outcomes 34:10 The importance of families staying together within a gender-affirming care model

Oct 4

1 hr 3 min

As one of the leading integrated health systems in the country  -- serving more than 3 million residents throughout 45 counties in Pennsylvania and New Jersey with 30,000 employees, nine hospitals, 1,600 employed physicians, 13 hospital campuses, 70 primary care sites, two research centers, and a 550,000-member health plan -- Geisinger has become a standard for value-based payment innovation and care delivery transformation. Geisinger was also an early adopter of value-based payment as a member of the Keystone Accountable Care Organization (ACO), which is a group of nearly 5,000 physicians and advanced practitioners and 9 hospitals who deliver over $800 million annually in coordinated healthcare services to more than 80,000 Medicare patients in Pennsylvania.  Additionally, Geisinger has been engaged in Medicare’s Bundled Payment for Care Improvement program since 2014, and currently has more than $140 million in healthcare services delivered as part of Medicare’s Bundled Payment for Care Improvement Advanced (BPCIA) program. Our guest this week is Dr. Jaewon Ryu, M.D, J.D, President and CEO of Geisinger. Dr. Ryu has led the system with a spirit of innovation and transformation, driving new approaches to some of healthcare’s most complex problems, including primary care redesign, home care and senior-focused, concierge healthcare centers for those 65 and older. His commitment to making health easier by improving outcomes, engagement and affordability are evident in his work and make him an exemplar in the race to value. Episode bookmarks: 05:30 Dr. Ryu describes Geisinger’s Value Journey that has been taking place over the last 35 years 06:30 “Value-based care allows us to innovate around care models by marrying the payment with delivery.” 08:15 Dr. Ryu provides advice to other health systems looking to invest in an infrastructure for population health 11:30 Dr. Ryu discusses how “Primary care is the backbone of the delivery system” and why it is so important in managing chronic disease 13:10 The Abigail Geisinger Scholars Program that offers medical students entering the Geisinger Commonwealth School of Medicine free tuition if entering primary care 14:30 The importance of Geisinger physicians understanding its different care models (e.g. Geisinger 65 Forward, Geisinger At Home, LIFE Geisinger) 17:30 Dr. Ryu discusses the impact of the COVID-19 pandemic on frontline providers and staff and importance of workforce resiliency during challenging times. 19:00 How Geisinger’s Value-Based orientation positioned it favorably during the COVID-19 pandemic (e.g. upstream capabilities and care at home program) 20:00 How strong partnership with employers, school districts, and nursing homes created a pandemic response ecosystem to improve community care 21:00 “Our value-based care orientation provided us with a public health lens to better care for our communities during the pandemic.” 23:30 How the Steel Institute for Health Innovation provided human-centered design thinking, AI/ML, automation, and other innovations to further catalyze VBC at Geisinger 28:30 Dr. Ryu describes the importance of risk stratification and population segmentation in providing better care to seniors with chronic disease 29:30 Geisinger 65 Forward clinics that provide VIP-level personalized care and appointments, longer visits, one-stop shopping, and social and educational activities for seniors 30:45 Unlike other high-touch senior-focused primary care models, Geisinger 65 Forward is fully-integrated with the health system 32:40 How primary care redesign at Geisinger focusing on team-based care improved clinical outcomes 35:20 Dr. Ryu on how we need to move care away from “Field of Dreams” facilities (i.e. the “if you build it, they will come” model) towards a more asset-light model of care delivery 36:45 Geisinger At Home as a national example for home-based care delivery 40:30 Dr.

Sep 27

59 min 26 sec

In this week’s episode, we spotlight the recently released Future of Nursing report, “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.” The report is a landmark consensus study supported by the National Academy of Medicine and the Robert Wood Johnson Foundation. It charts a 10-year path for the nursing profession, to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the US population in the 21st century. The COVID-19 pandemic has exposed serious inequities in the nation’s healthcare system, with frontline healthcare workers often lacking the necessary PPE and other equipment to safely and effectively do their jobs, and the murder of George Floyd shined a spotlight on the structural racism that exists in the workplace and society at large. In the wake of these challenges, the Future of Nursing report provides us with a north star to guide the nursing profession over the next 10 years, with a particular focus on reducing health inequities and improving health outcomes in value-based care. Our guests are both important thought leaders in nursing. Dr. Susan Hassmiller is the Senior Advisor for Nursing at the Robert Wood Johnson Foundation, and Senior Scholar in Residence for the National Academy of Medicine. Dr. Janelle Sokolowich is the academic Vice President and Dean for the College of Health Professions at Western Governors University. Their voices are united in sharing this important message: nurses are key to health, healthcare, and the future success of our healthcare industry, and educational programs that provide equity in access and learning will ensure our nursing workforce has both the cultural humility and clinical competence to address the needs for greater health equity and diversity. Episode Bookmarks: 01:40 Introduction to the “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity” 04:40 The need for diversity in the nursing workforce and how to eliminate bias in teaching and learning 06:55 Historical contrasting between stories of Florence Nightingale and Lillian Wald with occurrences of racism in nursing (e.g. Black Angels) 07:20 Recognizing bias in nursing curriculum through population exclusion (e.g. transgender), stereotypes, colloquialisms, and standardized testing 09:00 The lack of training with nursing faculty on how to have uncomfortable, yet crucial, conversations on race and health equity 10:00 The importance of diversity and cultivating inclusive learning environments 11:00 Holistic recruiting and competency-based learning as an opportunity equalizer for students of color 11:30 “Health equity is our end goal, but in order to even achieve that, we have to create pathways to education.” 12:50 The “Diversity Tax” – dependence on faculty of color to do all of the mentoring for underrepresented minority students 14:20 Raising awareness for health inequities to bring about industry-level commitment to SDOH and health equity 15:20 The importance of holistic admissions, diversity, and cultural humility to build models for culturally-competent care 16:20 “Our goal as educators is to empower our students to have cultural currency in their communication so that they can provide competent care that is enhanced and enlaced with humility.” 17:00 The need for kindness and patience for others to elevate crucial conversations 20:00 Competency-based education in nursing as an opportunity to increase diversity in the workforce and improve health equity for populations 22:00 “Competency-based education is a promising way to integrate equity, social determinants of health, and population health into the nursing curricula all at one time.” 24:00 Confronting Institutional Racism in Nursing Practice and the need for more open conversations to overcome health inequities 25:00 “Inequities in this country lead to very poor outcomes.

Sep 20

1 hr 7 min

  Oak Street Health has an amazing vision to rebuild Health Care as It Should Be: Personal, Equitable, and Accountable. The business was launched with a belief in value-based care that was patient-centered, evidence-based, and ensured equal opportunity for good health outcomes across populations, despite the economics being unproven. The business model depends on global capitation and allows the best service for patients in some of the poorest and most vulnerable communities. The high touch, relationship-based, tech-enabled primary care model includes support with medications, transportation, social work, home visits, and more – the sickest 10% of patients receive 78% of Oak Street’s dollars. This week, our guest is Dr. Griffin Myers, CMO and co-founder of Oak Street Health. In his own words, the challenge is not providing treatment but winning patients’ “trust and building relationships,” something Oak Street has demonstrated successfully with its ability to rapidly scale, to a network of 90 centers in 15 states. The Oak Street Platform is redefining Primary Care by bringing technology-enabled, value-based care to the seniors that represent the highest proportion of healthcare spending in the country. Winning the race to value will depend on many more following in the footsteps of these leaders! Episode Bookmarks: 05:35 The “insane” journey of starting a company that takes full-risk on very sick populations 05:55 “The downstream microeconomics of fee-for-service reimbursement has created a janky, inequitable, low quality health care system.” 06:30 The importance of segmenting your patient population within a payment model that is better aligned with care outcomes 06:40  “We take care of community-dwelling older adults with multiple chronic conditions and adverse social determinants.” 06:50 Full risk, global capitation enabled the development of the Oak Street Health platform. 07:00 Oak Street platform: 1) Community-Based Primary Care Centers, 2) Proprietary Technologies, 3) Value-Added Services to Primary Care 07:35 Dr. Myers discusses how the culture at Oak Street, coupled with the power of global capitation, drives value-based care results. 08:45 Oak Street’s Results: 50% reduction of hospital admissions, 52% reduction of ED visits, 35% reduction in 30-day readmission rates, 5-star quality ratings, and a 91 NPS 10:40 Dr. Myers discusses the concept of relationship-based care and how it improves outcomes for underserved populations. 11:20 Referencing Viktor Frankl’s “Man Search for Meaning” and how deeply meaningful and trusting relationships provide purpose 12:05 “Trust is the core input to us being able to help patients navigate adverse social determinants.” 12:10 Critical Success Factors: 1) Spending more time with patients with a consistent presence from a longitudinal care team, 2) Deep sense of accountability (“a promise”), 3) Culturally-Competent Care 12:55 “Having people who live in the neighborhoods to which we serve that share a cultural connection with patients helps form trusting relationships.” 13:30 “A value-based model is simply superior technology compared to fee-for-service. Value allows you to incubate and foster relationships to drive outcomes.” 14:40 Inspiration from John Lewis (“Try to be the pilot light not the firecracker.”) when it comes to building a safer, higher quality, more equitable, more affordable health system. 17:35 Referencing the HBS Case Study: “Oak Street Health: A New Model for Primary Care” 17:45 The role of the Clinical Informatics Specialist at Oak Street 18:30 Dr. Myers discusses the evolution of EHR technology at Oak Street and the development of Canopy (winner of the 2021 EHR Innovation Award) 19:40 The Value Flow of the Canopy EHR: “Data, Insights, and Action” 20:15 Deep and long-term relationships between the patients and providers that allows for enhanced data capture.

Sep 13

52 min 1 sec

Let’s face it - the healthcare system is broken. It will never be fixed unless we fundamentally redesign our industry towards a more consumer-centric model. That will require courageous leadership, and our guest this week provides "the path of hope for human-centered care delivery".  Leaders must overcome the cultural malaise that has been formed after years  being conditioned by the current model. We know that our healthcare system causes 200-400k avoidable deaths each year (which is like having two or three jumbo jets crashing every single day), however, we’ve become desensitized to the consequences of our flawed model for delivering care. Each and everyone in the system bears responsibility for other people’s lives and has a role to play in reimagining the future of healthcare. We clearly need urgency for change. Dr. Zeev Neuwirth is the author of “Reframing Healthcare: A Roadmap For Creating Disruptive Change” and produces and hosts the popular podcast series, “Creating a New Healthcare.” He is currently serving as Atrium Health’s Chief Clinical Executive.Dr. Neuwirth is reorienting the way individuals and organizations think about healthcare, to catalyze movement towards an affordable, accessible, effective and safe healthcare system.His ultimate goal is to humanize healthcare for those who serve within the system, and especially for those who are served by the system.   Episode Bookmarks: 03:15 Referencing Dr. Neuwirth’s book:  “Reframing Healthcare: A Roadmap for Creating Disruptive Change” 06:30 The challenges of practicing medicine in the pandemic era and recognition of those on the frontlines of care delivery 08:20 A shift in focus from Internal Medicine to care redesign, human-centered care delivery, and process improvement 08:50 Dr. Neuwirth explains his passion in seeking out people who are making a difference 09:40 “Creating a path of hope for health care delivery” by providing a platform for those transforming healthcare 11:30 “Health care transformation is already happening across the country. It’s just a matter of aligning payment to it.” 12:30 “Are we collectively ready to have the courage to change a system in fundamental ways? The answer is YES or NO – there is no in-between.” 13:00 The catalyst for Dr. Neuwirth’s work in health care transformation started twenty-five years ago (seeing the “inhumane” system). 15:00 “You cannot improve this system.  You actually have to reframe it.” 16:00 Dr. Neuwirth explains how his mother died from a completely preventable hospital-acquired infection 18:00 Avoidable deaths due to medical errors happen to over 400,000 families a year! 18:30 Dr. Neuwirth discusses the human tragedy of a close friend and physician colleague who committed suicide 19:45 “I am going to go down fighting against a system that strips the humanity out of every single person who tries to do the best they can to help their fellow man.” 21:00 Dr. Neuwirth’s déjà vu “Groundhog Day” moment realizing that we keep talking about the same answers (but the system never changes) 22:30 “Technology is an enabler – no question about it.  But it is not the transformative thing needed to create a new orientation.” 26:30 Courageous leadership to re-instill humanism in health care sometimes requires people to make sacrifices in their career. 27:20 “The people are not the problem in health care…the system is.” 28:00 “If there is an evil in health care, it is the fee-for-service payment model.” 29:00 When piecemeal payment and patient churning ultimately becomes the key performance indicator -- choosing to leave or live with it! 30:30 “We have turned physicians into visit vendors.” 31:30 “It is mind boggling that we continue to drag our feet In this shift from fee-for-service to value-based payment.” 32:00 Looking for collective courage in industry – why don’t CEOs link arms in solidarity for value-based care?

Sep 6

1 hr 5 min

We’re excited to share this special edition episode with Dr. Tony Dale, an “Old World” doctor from England who has since become a successful healthcare entrepreneur in the United States.  Despite practicing socialized medicine early in his medical career, Dr. Dale has become a champion for free market reforms to our nation’s healthcare system.  As the founder and Chairman of The Karis Group and Sedera, he has brought cost transparency and consumerism to the forefront.  Dr. Dale’s entrepreneurial vision has directly impacted the lives of millions of patients seeking the best possible care at fair and affordable prices. In this podcast conversation, we discussed his newest book “The Cure For Healthcare: An Old World Doctor’s Prescription for the New World Health System”. This episode was recorded in collaboration with the Point Health podcast and its hosts Steven Cutbirth. Episode Bookmarks: 01:20 Intro to Dr. Tony Dale -- from practicing family medicine in London to his work as an American healthcare entrepreneur dedicated to affordable care 02:30 Early experiences with his father, a family doctor in Taiwan, who led him into a career in medicine 04:30 What Dr. Dale learned from his work as a physician in the UK’s NHS within a socialized model of medicine caring for the poor 06:30 Access to care in a socialized model does not necessarily mean access to quality 07:30 Seeing 40-60 patients per day, on top of doing home visits, led to bad medicine 08:15 Relocation to the United States with an inspiration to help doctors treat the “whole person” in a holistic way 10:00 How the British system prevented family medicine doctors from helping their patients who were hospitalized 10:45 Dr. Tony Dale’s new book, The Cure for Healthcare 11:10 Inspiration from “The Price We Pay” by Dr. Marty Makary 12:00 Fascinating examples of the “power of the free market” from his work with Sedera to provide medical cost sharing 12:45 Dr. Dale’s experience in influencing health policy and how that convinced him that a grassroots effort is really the true cure for healthcare 13:45 Albert Einstein’s famous maxim, “The thinking that got us to where we are is not the thinking that will get us to where we want to be” 14:30  The issues of waste, inefficiency, and outright fraud -- how current health policies enrich the very few, at the expense of the “ordinary American” 16:30 “The answer to changing the system isn’t incremental.  It is dramatic.” 16:40 Parallels to the disruption of the transportation system from Uber/Lyft (ridesharing) and Priceline (airline and hotel booking) 17:40 How Cristen Dickerson (a radiologist in Houston) and her company Green Imaging is bringing “the Priceline model to Radiology” 19:30 Inspiration from radical change agents who bring a “stroke of genius” to fixing healthcare 20:30 President Obama and the passage of the Affordable Care Act that led to an exemption of Christian healthcare sharing ministries 22:45 Finding a way to make the medical sharing model (a non-insurance solution) mainstream through the founding of Sedera 25:00 The story of his founding of The Karis Group (now Point Health) to help patients shop for cash pay options for healthcare services 27:40 The exploitation of government regulations related to the Medical Loss Ratio in order to drive health insurance profits 28:30 “The system is working perfectly for what it is designed for.  It is designed to let the big hospitals consolidate and drive up prices.” 29:20 The “smoke and mirrors” tactic of  duping patients to pay more for urgent care by billing as an ER (paying 3X more for the same care!) 30:30 How a free market based on innovation and cash payment can improve the patient-provider relationship 31:40 Referencing the work of Dr. Keith Smith (Surgery Center of Oklahoma) in creating lower costs and transparent prices 32:30 The transformational potential of Direct Primary Care

Sep 1

48 min 11 sec

Historically, health systems in low- and middle-income countries (LMICs) have taken a volume-based approach to health rather than a value-based one. The public sector has focused on coverage rates or access, and the private sector profits when it drives quantity of expensive, hospital-based care. Adhering to this path will create long-lasting structural flaws that increase costs without delivering desired results, similar to what we see in the US and many other developed economies. Our guest this week is Dr. Chintan Maru, founder and executive director of Leapfrog to Value, a health initiative to advance value-based care in lower- and middle-income countries. Dr. Maru is a medical doctor and public health expert who has dedicated his career to maximizing the value of health systems. The race to value is not limited to fixing health care in the US – lessons learned and shared internationally will have world-wide impact, and will help lower- and middle-income countries leapfrog past hurdles and accelerate their own race-to-value. Join us as we learn from Dr. Maru about his efforts to leapfrog to value in Ghana, South Africa, Kenya and India! Episode Bookmarks: 01:45 Low- and middle- income countries (LMICs) are at-risk of replicating system flaws from higher-income countries 02:10 The Leapfrog to Value strategy: Building a robust ecosystem for VBC experimentation 04:00 How Dr. Maru’s father dealing with Parkinson’s Disease provided a personal perspective on the work he does in value-based care 06:00 “In low- and middle-incomes countries now, quality has eclipsed access as a prime driver of outcomes.” 08:30 “There is a big focus in low- and middle-incomes countries on primary care and community-based health delivery, often via community health workers.” 09:15 How Value-Based Care differs In LMICs: focus on how to spend more on health to achieve universal health coverage! 09:45 “Instead of volume versus value, you are trying to get both volume and value.” 11:00 Ensuring localization by directing donor-funded programs for health system development with local stakeholders 13:15 Dr. Maru explains how the definition for “value” differs in LMICs when implementing universal healthcare 14:00 “The phrase ‘value-based care’ hasn’t really shaped the dialogue for universal health coverage for places like India or Kenya yet. It’s just coming into the conversation.” 14:15 How can payment models in LMICs prioritize health over healthcare? 15:15 Feasibility versus point of path feasibility in creating value-based care systems 16:30 “There is a ‘leapfrog to value’ opportunity in low- and middle-income countries to build a value-based health care system somewhere between the point of feasibility and  the point of path dependency.” 17:00 Building new national health insurance models in Kenya, India, South Africa, and Ghana to experiment in value-based care 18:45 Dr. Maru cites mobile banking penetration in Nairobi as an example of how we can learn from the ingenuity of others when there isn’t already an entrenched ecosystem 20:15 Partnering with USAID Center for Innovation, the Gates Foundation, and the Rockefeller Foundation on the Leapfrog to Value flagship report 21:45 Getting buy-in from local stakeholders in LIMCs for value-based care experimentation and innovation 23:00 “Value-based care is partnership-driven.” 24:00 The role of global health donors in providing risk capital to cover the costs of value-based care pilots in LMICs. 25:00 Comparing climate change and the need for environmental sustainability to the value-based care movement 26:30 Determining appropriate hospital bed capacity in places like Mumbai, India, Lagos, and Nigeria 27:30 Sensitizing healthcare investors to take a bit of a civic-spirited point of view--perhaps even before any value-based payments really shape the market 28:45 Creating the right incentives for patients to be responsible for perso...

Aug 30

54 min 19 sec

The traditional definition of post-acute care (PAC) represents the legacy of a fragmented approach to healthcare that segments care into “silos” and finances institutions to care for a “slice” of the patient instead of incentivizing whole-person, coordinated care. As post-acute care is the largest driver of overall Medicare spending variation, establishing a coordinated, whole-person care network across the PAC continuum is essential for organizations to successfully operate under value-based payment models and to optimize patient outcomes. However, without transparent, market-wide data with longitudinal analytics, a comprehensive network, and relationships with hospitals, it seems like an  insurmountable challenge to overcome. Our guest this week is Ian Juliano, founder and CEO of Trella Health. Trella Health, is dedicated to creating optimal care networks that yield superior outcomes and greater efficiencies. Employing sophisticated longitudinal analytics on its massive, proprietary database, Trella enables providers and payers to compete and thrive in the new world of Value Based Care. For Ian, value-based care and PAC network optimization is a personal calling. His individual commitment provides a clear path to follow in the race to value! Episode Bookmarks: 05:00  Advocating the benefit of data democratization in VBC to Andy Slavitt 06:00 Working with Niall Brennan, the Chief Data Officer of CMS from 2010-2017 07:00 Building one of the largest proprietary databases of CMS claims data through a partnership with the CMS Virtual Research Data Center (VRDC) 08:40 “Transparency in data can lead to better treatment decisions that result in improved outcomes and lower costs” 09:40 How Trella’s massive database is helping hospital systems, post-acute providers, and ACOs make better decisions 11:30 The challenge of ineffective transitions of care post-discharge and the cost differentials between different PAC settings 13:00 Ian speaks about how hospital ownership of home health agencies or IRFs leads to inappropriate referrals post-discharge 14:40 “As a nation, we have been overly, myopically focused on the cost of a post-acute care setting versus the impact and cost trajectory of the patient.” 16:00 Ian provides an eye-opening example of how $1million in costs were saved (along with better outcomes) through appropriate transitions to home health instead of SNFs 18:30 Ian provides another example of a system saving $1-2M in spend by sending patients to on-time hospice at the  end-of-life 21:00 “In some academic medical centers, over two-thirds of inpatient discharges that meet high-acuity guidelines receive no post-acute care whatsoever! And one-third of those patients are back in the hospital within two days, leading to higher costs.” 23:00  Ian speaks about how ACOs and DCEs can ensure access to outstanding SNF and home health agencies by aligning incentives 25:00 “Developing the right post-acute care provider network is not all about narrowing.  It’s about finding the right network that meets all of the specialized needs, to get best-in-class care for all of the different categories of patients.” 25:50 The importance of physician training in building an optimized PAC network 26:20 Using data to look at patient flows, identify gaps in care, and monitor cost performance KPIs over time 28:40 Ian speaks about the future of the skilled nursing industry in relationship to value-based care 30:30 “If I were an ACO, I would be quite mindful anytime a hospital recommends a hospital IRF. I would make sure to see whether a SNF is more appropriate.” 31:30 How did occupancy rates in long-term care impact SNFs during COVID-19? 32:00 How do increased referral rates to home health instead of SNFs lead to lower adherence rates? How can home health agencies ensure that patients actually receive care? 34:40 Primary PAC Optimization Strategies: 1) Sending appropriate patients to SNF instead of IRF.

Aug 23

1 hr

We are pleased to release a special bonus episode and do our part to address the nation's concerns around the pandemic and the COVID vaccine. As it stands right now, around 164 million people, or 50% of the total U.S. population, have now been fully vaccinated. Ultimately, with a large portion of the U.S. population still unvaccinated, it seems that COVID-19 is not going to disappear soon. The U.S. will continue to see outbreaks of the virus in communities with low vaccine uptake. Our guest is Dr. Rodney Rohde, a virologist and clinical laboratory expert with 30 years of experience in Public health, virology, and zoonotic disease, and is a Professor in the College of Health Professions and Associate Director for the Texas State University Translational Health Research Center. This episode is for anyone who wants to hear a scientific discussion about SARS-CoV-2/COVID-19 to combat misinformation that is out there about the pandemic. Episode Bookmarks: 04:30 Dr. Rohde shares a brief overview of the medical laboratory profession and the Clinical Laboratory Science degree programs 08:30  The impact of the pandemic on the medical laboratory staffing crisis 09:50 Dr. Rohde speaks about the importance of laboratory medicine in improving value-based care and health equity 13:00 Did SARS-CoV-2 originate from a laboratory leak at the Wuhan Institute of Virology?  Or did the virus originate from a zoonotic spillover event? 18:15 Referencing Dr. Rohde’s recent article discussing how the US is split between the vaccinated and unvaccinated – and how the deaths and hospitalizations reflect this divide 20:00 Dr. Rohde discusses how “99.5% of all the people dying from COVID-19 in the U.S. are unvaccinated” and how to understand breakthrough infections happening with the vaccinated 22:30 How to eradicate a virus and why current immunization rates will not support disease eradication 24:50 "Viruses, especially RNA viruses, are the most diabolical microbes on the planet.” 25:30 Viral mutations that create infectious variants and the opportunism of infection 28:20 The global achievement of smallpox eradication 28:50 Dr. Rohde explains vaccine efficacy and what people should ask their physicians if debating whether or not to receive the vaccine 31:00 The low of mRNA vaccines 34:00 Dr. Rohde explains what the Delta variant is and provides a scientific overview of viral mutations 37:00 The changing pathology of the virus and how younger, unvaccinated people are now being affected by the Delta variant 38:00 Booster shots for immunocompromised individuals and the likelihood of boosters for the general population 39:20 The transmissibility of the Delta variant. what the R-naught number means in understanding viral contagion, and how Delta variant compares to Ebola transmission 45:00 Referencing the COVID-19 thought leadership and insights from Scott Gottlieb, Tom Frieden, and Peter Hotez 46:20 The three-year cycle of unchecked pandemics, the development of herd immunity, and the potential for an endemic transition in 2022 47:50 The significance of the landmark scientific achievement of developing a mRNA vaccine technology (the first time in history!) 50:00 Viewing public health as part of our public defense and why we need to learn that one lesson from this pandemic!

Aug 20

53 min 3 sec

Employers are on the frontlines in the battle against rising healthcare costs. Legendary investor Warren Buffett said that rising health care costs, not the tax system, are the number one problem that American businesses face. “If you go back to 1960, or thereabouts, corporate taxes were about 4% of GDP. And now, they’re about 2% of GDP,” “At that time, health care was 5% of GDP, and now it’s about 17% of GDP.” In Buffett’s view, this says a lot of what’s playing a bigger role in hindering business activity in the economy. He is famously quoted as saying that “medical costs are the tapeworm of American economic competitiveness.” Direct Primary Care (DPC) is a unique solution for employers to win the “race to value.” Our guest this week is Dr. Gaurov Dayal, the President and COO for Everside Health and a nationally recognized physician leader, who, in 2019, was selected as a finalist as the Director for CMMI to replace Adam Boehler. Everside Health is tackling employer healthcare costs head on by offering direct primary care services to employers. Their DPC model redirects health care from fragmented care sites such as inpatient and outpatient settings, specialists’ offices, ER and urgent care clinics into the optimized primary care setting. In the longer term, Everside works to deliver cost savings by diagnosing, treating efficiently, and managing the health of a covered population across 32 states with 350 health clinics located at or near the facilities of its employers, unions, and other benefit sponsor clients. Episode Bookmarks: 02:25 Dr. Dayal shares his recent “once-in-a-lifetime” experience traveling to Iceland! 03:30 Recent APM delays and pullbacks from CMMI – what does this mean for the value movement? 05:05 “The progression to Value-Based Care is a fairly bipartisan issue.” 05:45 Is the COVID-19 pandemic detracting from the current health policy focus on value? 06:45 The deficiencies of the healthcare system highlighted by COVID-19 08:30 Dr. Dayal reflects on his experience interviewing for the Director of CMMI position in 2019to replace Adam Boehler 09:45 “There is a lot of passion at the federal level to push ideas that can improve care for the US population.” 10:40 The challenges of balancing stakeholder interests in the political process and the need for more clinical leadership and influence 13:45 Is capitation truly needed to have value-based care?  Or can you pay for outcomes in a FFS model? 14:45 “The linkage of the payment to the delivery system creates value-based care.” 15:30 Dr. Dayal discusses the capitalistic model of healthcare and how FFS domination prevents large scale change 17:00 “In the history of companies, very few companies are able to successfully transform themselves from one business to another.” 17:30 “We are entering an era of new providers disintermediating in value-based care, rather than old incumbents successfully bridging the gap.” 18:00 Dr. Dayal discusses disruption in the Medicare Advantage space (e.g. ChenMed, Oak Street Health), employers collaborations (e.g. Everside) 19:00 The germination of specialty-focused companies in VBC (e.g. renal care, oncology, orthopedics) 19:30 Dr. Dayal compares the “race to value” to the automobile industry transitioning from combustion engines to electrical power 21:00 Referencing legendary investor Warren Buffett’s position on rising health care costs as the number one problem that American businesses face 22:00 Everside Health’s Direct Primary Care (DPC) model operating in 32 states with 350 health clinics located at or near the facilities of its employers 22:45 The average family spends $20k on healthcare at a time when working Americans are facing wage stagnation and looming inflation 23:00 The rising costs of healthcare benefits provided by employers and how the lack of transparency contributes to the problem 24:30 “Overutilization of healthcare services is as dangerous as...

Aug 16

1 hr 4 min

Our guest this week is Dr. Jim Walton, President and CEO of Genesis Physicians Group. Dr. Walton was drawn into medicine at an early age – he followed his dad making house calls, going to nursing homes, and forging deep ties in the community. His clinical work throughout his medical career was focused in poor communities, coordinating care for complex patients from diverse backgrounds. As an experienced and innovative physician leader, Dr. Walton provides executive leadership to more than 1,700 physician and allied health members in a North Texas independent practice association. He also established and leads the group’s ACO which is focused on creating physician-led risk-based solutions. Dr. Walton’s passion is engaging physicians to stay independent by providing them with a population health infrastructure for succeeding in risk. Add that to his passion for treating the underserved and caring for those living on the extreme fringe of vulnerability, it’s easy to see why he is an ideal leader in the race to value. Episode Bookmarks: 05:05 Dr. Walton shares his prior experiences in treating marginalized populations 06:30 A personal patient story that had a profound impact on Dr. Walton’s career in service to the underserved 08:20 Establishing rural clinics to care for the uninsured and AIDS patients in the early nineties 10:00 Developing community medicine strategies to mitigate racial disparities in care 11:40 “The role of the profession of medicine is to design solutions to improve community health.” 14:00 Starting a value journey with a legacy model, fee-for-service physician IPA 15:40 Succeeding in a Medicare ACO provided confidence to take risk with Medicaid 18:20 The importance of solving community-based social issues and lessons learned fromMedical Home Network 19:30 Integrating both clinical and social determinants of health data to develop an AI-based predictive analysis 20:00 Building an infrastructure for social interventions to better care for Medicaid patients 22:00 Value-based care as an enabler of physician independence 23:00 Physician leadership involvement in the structure of financial rewards to incentivize practice transformation 25:00 Dr. Walton discusses how his physician-led risk-bearing entity is competing with PE-backed firms and hospital systems 25:30 “The joy of practicing medicine can be found in a team-based, physician-led model that promotes independent practices.” 27:30 Dr. Walton on how managed care contributes to physician burnout and why value-based care is different when built by physicians 30:30 Tapping in to both the intrinsic and extrinsic motivations of physicians to improve patient care 33:30 How diminishing fee-for-service rates creates a deleterious treadmill effect with doctors (unless they adopt value-based care) 36:00 Developing a compelling value proposition for payers 39:30 COVID-19 as the ultimate crucible for testing the resiliency of physicians 41:00 The siphoning of patients by urgent care facilities and retail primary care models 42:00 Primary care redesign of patient panels leading to specialization in chronic disease 43:00 Responding to emergent physician needs during the pandemic 43:45 “Prospective payment is the destination” 45:00 Dr. Walton discusses how the ACO Provider Relations team engages physicians 47:00 Tapping into the clinical intuition when stratifying risk in a patient population 48:30 Dr. Walton speaks about how younger physicians will find purpose in their practice of medicine 53:20 Parting thoughts about the inspiration of Dr. Don Berwick and the Triple Aim 55:00 “Value-based care allows us to reimagine our professional duty to improve quality, reduce unnecessary suffering, and eliminate health disparities.”

Aug 9

57 min 23 sec

This is one of the most health challenging times in modern history. Healthcare systems and practitioners face dire circumstances in delivery of care to scores of citizens. A reverential ethic in healthcare leadership that promotes an informed and respectful approach towards life is key to health system success in population health. This core value is how Trinity Health, one of the largest integrated care delivery systems in the nation that serves more than 30 million people across 22 states, approaches their transition to value-based payment.  They believe the “race to value” is a moral imperative to improve community outcomes and ensure health equity, instead of just a business opportunity. Our guest this week is Akil McClay, System Director of APM Operations at Trinity Health. Akil is responsible for the implementation, deployment and operational CIN/ACO/APM activities across four states (Delaware, Pennsylvania, Indiana and New York) with approximately 290,000 covered lives. Additionally, Akil serves as the Executive Director for the Trinity Health Integrated Care MSSP Enhanced ACO and successfully led Trinity Health Integrated Care to achieve $45M in shared savings for performance years 2017−2019. Most importantly, Akil lives the value of reverence, and his insights spark a similar passion in each of us.   Episode Bookmarks: 04:00 Akil’s formative years that led him to understand the need for minority health and health equity 05:30 How charity care hospitals impact the health of vulnerable communities 06:30 How an educational path in neurosciences led to a healthcare administrative career 07:45 “When you are a healthcare leader, you have the opportunity to impact millions of lives across the country.” 10:00 “It starts with us.  You need to have leaders that are reflective of the communities that we serve.” 10:30 Akil reflects on the presence of institutional racism in our country’s healthcare system and how Mike Slubowski is committed to DEI in leadership 11:15 Akil discusses the inequitable distribution of vaccines in the Philadelphia market and how Trinity was able to operationalize equity through a rapid-cycle innovation approach 15:35 How the VA system is an exemplar of value-based care innovation and why the private sector should learn from them as it moves to fully-capitated payment 17:40 A fully-capitated, total cost of care model gives us the best ability to care for our patients.” 18:05 How Trinity is moving to a fully-integrated EHR system across all of its markets 19:20 Engaging patients in healthcare by creating a community-based center (a lesson learned from the VA) 21:40 Akil discusses how Trinity Health has been able to navigate the COVID-19 pandemic 24:00 Trinity Health’s deployment of a unified telehealth platform 25:00 High-speed internet access as a social determinant of health 27:40 Trinity Health’s early beginnings in value-based care led by Rick Gilfillan and the aspirational goal of having 75% of revenue derived from the APM portfolio 29:00 The future of VBC is in risk-based payment and how early adoption of CMMI programs allowed for innovation 30:00 “We want to have the majority of our revenues come from value-based contracts because we believe that is what’s best for the patient.” 31:20 Do we need as many hospitals as we currently have in the United States?  What is the impact of COVID-19 on the movement to VBC? 33:00 Akil discusses how Trinity Health is building out capabilities for risk coding and documentation to better reflect burden of illness in their patient population 37:40 Trinity Health’s approach to building an integrated EHR and digital health platform for patient engagement 42:00 EHR optimization through provider-led workgroups and use of internal teams to build a homegrown analytics platform 44:35 Overcoming the limitations of digital tools by listening to patients

Aug 2

57 min 45 sec

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 company that provides an industry-leading solution for Technology-Enabled Psychiatric Collaborative Care.  Matt is also the Co-Founder and Executive Director of a nonprofit organization called Action Tank.  As a recipient of the prestigious Pat Tillman military scholarship, Matt is living with the passion that Pat Tillman spoke of, “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits … A passion for life is contagious and uplifting.” Matt’s passion is bright and shines through in his service for people with mental health needs. In value-based care, it is clear that primary care is at the tip of the spear in dealing with Ambulatory Care Sensitive Conditions like CHF, COPD, and diabetes that drive up costs. In that model for managing chronic disease, the position of primary care providers being upstream to specialists allows them to curb 80-90% of healthcare costs by preventing unnecessary specialist visits and avoidable inpatient stays and ED visits.  With behavior health, it is a little bit different though.  Behavioral health conditions (for the most part) can’t be addressed by specialists because there aren’t any access points for them to even be seen! Although 70% of primary care appointments include problems with significant psychosocial issues, less than half of those receive any mental health treatment at all, because there is a such a shortage of specialists. To put this in context, the Substance Abuse and Mental Health Services Administration estimates that by 2025, the U.S. will have a shortage of over 15k psychiatrists and 26k mental health counselors! Research shows that a Psychiatric Collaborative Care Model (CoCM) is an effective and efficient way of delivering integrated care for more complex patient behavioral health needs – CoCM is a model that enhances “usual” primary care by adding two key services: care management support for patients receiving behavioral health treatment and regular psychiatric inter-specialty consultation to the primary care team. Join us as we consider this and other important solutions with Matt in this week’s race to value! Episode Bookmarks: 04:45 “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits.” – Pat Tillman 05:40 Matt discusses the inspiration of Pat Tillman and his passion into lifelong learning 06:00 How caring for wounded warriors recovering from combat trauma drove Matt’s future work in treating the “indivisible injuries” impacting behavior health 07:00 Realizing the stigma associated with behavior health from his time leading a military psych unit in Fort Hood 07:50 Making an impact through facility-level hospital policy, e.g. 75% reduction in restraint use 08:10 Matt discusses his experience working in public health policy related to substance use disorder 08:30 A shared passion for “changing the world” with Christopher Molaro, CEO/Co-Founder of Neuroflow 09:30 Alarming stats about behavioral health and SUD in our country! 11:10 Matt on the recent CDC report showing that the U.S. hit the highest level of annual overdose deaths ever recorded (93,000) – a 30% increase from prior year! 11:45 “The shortage of mental health providers is most acutely seen in rural communities. Over 50% of the counties in the U.S. don’t have a single psychiatrist.” 12:05 Understanding the population and identifying which individuals have the most acute behavioral health needs through upfront screening and measurement-based care 13:00 Matt explains how we can more effectively use primary care and interdisciplinary teams to treat behavior health...

Jul 26

50 min 40 sec

Our guest this week is driven by an inner purpose to alleviate suffering for those in the poorest of communities, recognizing that health care can only truly be transformative in providing superior health outcomes if it advances health equity.  Over the years, he has used his voice to advocate for underserved communities in the belief that the equitable attainment to health is a human right. Dr. Derek J. Robinson is Vice President and Chief Medical Officer for Blue Cross and Blue Shield of Illinois (BCBSIL) and is responsible for care management operations, clinical leadership and strategic oversight in providing high value health care to more than 8 million members. Dr. Robinson is also the founding chair of the Health Equity Steering Committee, which was established to develop health equity strategies across markets and lines of business. For nearly two decades, Dr. Robinson has led community efforts to promote diversity and inclusion in undergraduate and post-graduate education at the local, state, and national level. He is a member of the Office of Diversity and Inclusion advisory committee at the Accreditation Council for Graduate Medical Education. Additionally, Dr. Robinson is vice-chairman of the board of trustees at Xavier University of Louisiana. His deep experience in health care and education give him a unique and meaningful perspective, one that we will all do well to regard as we endeavor to advance in the race to value!   Episode Bookmarks: 04:30 Dr. Robinson discusses his journey in emergency medicine and what now drives him as a value-based care leader 06:15 Creating “impact at scale” in his work in clinical leadership and strategy at the health plan level 07:30 In 5 years, life expectancy fell for everyone except for non-Hispanic white Chicagoans (3,500 excess deaths for Black people in Chicago every year) 09:00 The impact of COVID-19 on highlighting disparities among racial lines and national trends in life expectancy amongst African Americans 09:30 Dr. Robinson discusses the root causes of social determinants of health (e.g. housing policies, racial segregation) that lead to racial disparities in care 10:45 Chicago has ~30-year life expectancy gap between neighboring communities (larger than any other American city) 11:00 Housing policies also impact infant and maternal mortality, elevated lead in children, etc. 11:15 “Your zip code is more important than your genetic code.” 11:45 Dr. Robinson explains how investments in community infrastructure and resultant economic development creates public health 13:30 Referencing landmark reports confirming the presence of racial and ethnic disparities within the care delivery system 14:00 “Opportunities for focus” by governments, corporations, philanthropic partners, and the healthcare community 16:30 Dr. Robinson describes the Blue Door Neighborhood Center to provide a community-based hub for health and wellness 18:00 Creating a social impact fund to help small businesses impact health in communities 18:30 Providing housing stability for those dealing with chronic conditions 19:00 BCBSIL investments in community benefit organizations and social services to improve health equity and SDOH in Chicago 22:10 Health disparities persisted prior to COVID-19, but the spotlight from the pandemic has served as an accelerant to addressing them 23:00 That health equity journey that BCBSIL is focused on through partnerships with 24 provider-led ACOs and 44 IPAs/PHOs 23:30 Dr. Robinson explains the $100M investment by BCBSIL in the Health Equity Hospital Quality Incentive Pilot 24:30 The importance of hospitals collecting data on race, ethnicity, language, sexual orientation, and gender identity to assess disparities 26:00 Expanding telehealth and bridging the digital divide amongst underserved patients 26:30 Addressing the underrepresentation of diversity in the physician workforce

Jul 19

53 min 33 sec

                While the health care system has been gradually transitioning to a more tech-enabled industry for several years, in a matter of months, the global pandemic has fast-tracked digital health care trends that have been primed and ready for greater investment and implementation. The increased investment in and use of technology-enabled care protocols like telehealth and remote patient monitoring during the crisis has accelerated the acceptance and adoption of digital solutions for both health care professionals and their patients. As a greater number of payers and providers adopt value-based payment arrangements and innovative data management and analytic solutions emerge, digital tools will enable the collection and analysis of robust patient data to inform population health management strategies and equip providers to creatively inform and transform their approach to care delivery. In this episode, we share the audio from a recent webinar where we discuss the digital health landscape with two foremost experts, Dr. David Nace, Chief Medical Officer of Innovaccer, and Ed Marx, Chief Digital Officer of The HCI Group.  Additionally, we offer the recent ACLC Intelligence Brief, Overview of the Digital Health Landscape. The brief offers a detailed review of the digital health landscape, analyzing major trends and recent merger and acquisition activity, and outlines expectations for the future. The intelligence brief, combined with this episode, will give you valuable insights to inform your own race to value!   https://www.accountablecarelc.org/publications/overview-digital-health-landscape

Jul 15

51 min 51 sec

Only 25% of health is in the control of the healthcare system. So why does our country continue to pump the majority of its health care spending into a deficit-based health care model that focuses solely on the science of doing something to the individual? Aspirational Healthcare is a better answer, spending 75% on supporting the individual in the ownership and management of their own health. And employer-driven reform is the key that will unlock aspirational healthcare for millions nationwide. Our guest this week is Darrell Moon, CEO of Orriant, a company that changes the dynamics of health care and gives employers control over the ever-increasing costs of the health care benefits they offer their employees. Join us as we discuss the Nuka System of Care in Alaska, employer-driven reform, and the principles of Aspirational Healthcare – all are important milestones on the race to value!   Episode Bookmarks: 1:45 What is an Aspirational Healthcare System? 2:50 Background on Darrell Moon, CEO of Orriant 3:20 Background on Nuka System of Care (the role model for Aspirational Healthcare) 4:30 The Aspirational Healthcare Conference (July 14-15, 2021) 5:20 Darrell talks about his recent discovery of Nuka System of Care and how it inspired him 6:00 Southcentral Foundation instituted a total system-wide transformation of care with Nuka 7:30 Referencing Dr. Doug Eby of Nuka and the requirements of an ideal health system 8:45 Training workers to be “partnering influencers” rather than just diagnosticians and treatment planners 9:40 The current healthcare system has an improperly skilled workforce (Aspirational Healthcare addresses this first!) 11:55 CQI drives us to meet the needs of the customer, but it doesn’t work in FFS 12:45 Business Leaders and the Federal Government are really the true customer in the American healthcare system (not the patient!) 14:00 Darrell talks about why employers are a transformational force to a more customer-centric health ecosystem 16:00 Employers need to create incentives in their healthcare purchasing model to empower change 17:00 Why would the system ever change on its own?  Employers must take the lead! 18:00 Darrell explains an Aspirational Healthcare investment strategy for employers to follow 19:00 Creating a “massively powerful” primary care system 19:30 The importance of influencers in improving patient outcomes 20:30 Investing in Health Savings Accounts (HSAs) for employees to pay deductibles and copays 21:50 ‘Poor health’ costing employers $530B on top of the $880B they already spend in premium dollars! 23:30 Southcentral Foundation demanded “perfect healthcare” in creating Nuka twenty years ago (and it worked!) 24:30 Lessons learned from Haven’s failure being applied with Amazon Care and Walmart Health 24:50 The founding of employer-sponsored group health insurance in WWII 25:50 The leadership of Regina Herzlinger in creating Health Reimbursement Accounts 27:20 Darrell discusses what Amazon Care will look like when it completes its’ healthcare strategy! 28:30 Employers will move away from Employer-Sponsored Group Health Insurance in the next ten years! 30:00 Nuka’s relationship-based healthcare system is centered around “massively powerful primary care” 31:00 Building a Direct Primary Care practice based on a prescription model 32:45 Primary Care Quarterbacking to reduce medical errors associated with lack of specialty care coordination 33:30 Direct Primary Care is doing what Nuka did by creating a “massively powerful primary care” model. 35:30 Darrell discusses the impact of behavioral health integration on improving cost and clinical outcomes 37:30 Implementing strategies to address Complex Behavioral Change to improve population health 39:00 Creating relationships based on trust is key to helping patients 39:45 Balancing the amygdala (emotion) and prefrontal cortex (reasoning) func...

Jul 12

55 min 11 sec

There is an immediate opportunity for value-minded medical practices and health systems in joining a Direct Contracting Entity (DCE) that is already established.  Many of these DCEs (typically existing health care delivery organizations or newly-organized physician aggregators) are now seeking formal partnerships with providers in their area. These partnerships may facilitate an entry point for organizations who have not participated in prior CMMI models or those organizations more advanced in risk who wish to increase their value profile in a model that emphasizes beneficiary engagement and improved patient outcomes. If you have been approached to join a DCE, the ACLC wants to support you in the consideration of this opportunity. To that end, we are pleased to share this bonus episode, with our guest Dr. Tom Davis. Dr. Davis is an expert in value-based care, a family physician, angel investor, founder of 6 companies, consultant, and speaker. In this episode, he helps simplify the decision process for the independent physician who wants to know whether they should consider participating in the GPDC model. Independent physicians now is an important time to consider your participation in value – whether you join the GPDC model or do something different, this episode will accelerate your move to value! In addition to listening to this episode, make sure to read our blog post with additional details: https://www.accountablecarelc.org/publications/global-and-professional-direct-contracting-starter-checklist-prepare-dce-partnerships Episode Bookmarks: 03:00 What are Direct Contracting Entities (DCEs) and how did they come about? 04:15 What types of DCEs are currently recognized by CMS and should I consider joining one? 06:45 What are the potential benefits to medical practices that are considering joining a DCE? 12:00 How is Value-Based Care innovation better addressed by DCEs than other payment models? 13:15 Is there a competitive disadvantage to not participating in a DCE? 14:30 How should an organization evaluate a prospective DCE suitor when approached to join one? 17:30 Why is joining a DCE such a rare and historic opportunity? 18:30 Parting comments and contact information for Dr. Tom Davis

Jul 8

19 min 59 sec

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 HITECH Act, offering grants and incentives to states and municipalities for developing regional HIE initiatives. Although there has been some progress toward effective mechanisms for data exchange, in many regions of the country it is no easier to share medical information than it was over a decade ago. That is not the case in the State of Nebraska and neighboring states where CyncHealth has achieved health care transformation through data democratization and community betterment collaboration.  They have done this by becoming more than a HIE; instead they have become a true “population health utility” by building the roads and the infrastructure for better workflows and better patient care (not just improved data exchange). This week, we are pleased to welcome three important guests from CyncHealth, Dr. Jaime Bland, President and CEO , Dr. Larra Petersen-Lukenda, Vice President of Population Health, and Dr. Joy Doll, Vice President of Community and Academic Programs. Their vision for a ‘population health utility’ builds upon the ONC’s vision for interoperability through data democratization and cross-sector collaboration. In this episode, we interview these leaders to better understand how to leverage data to create the greater good in societal health outcomes. You will hear from them how health care transformation can be realized through community partnerships and data sharing across the continuum of care, collaborative research in population health, and an empowered “health data competent workforce” to meet clinical and social needs in a more holistic way.   Episode Bookmarks: 03:45The purpose of a ‘population health utility’ is to create better workflows and improved patient care, not just improved data exchange 04:45 Fewer than half of office-based physicians can exchange patient health information outside their organization electronically 05:30 The HIE market is projected to double from $1 billion in 2020 to $2 billion in only 5 years 06:00 Jaime discusses how CyncHealth’s 15-year journey to build a HIE infrastructure to support population health in Nebraska 07:20 Jaime and Larra’s vision for leveraging a HIE as the basis for a clinically integrated network/ACO 08:00 Improving upon the cumbersome query-based exchange model to deliver better patient outcomes in complex care scenarios 09:00 Jaime explains how they have reframed the HIE into a “population health utility” 09:40 Joy describes the application of the population health utility to address the Quadruple Aim and improve patient outcomes 10:25 Larra on reaching the ONC’s 10-year vision for interoperability can improve clinical decision support and patient engagement 11:55 Larra on how “The ability to influence the future of healthcare through data is an amazing responsibility to benefit the greater good of the community.” 12:30 Jaime on the Nebraska Prescription Drug Monitoring Program (PDMP) -- a stand-alone medication query platform integrated into the CyncHealth HIE 16:15 Larra on the benefits of the PDMP in improving completeness of the overall medical record, with impact on patient safety and care interventions 18:30 The Opioid Crisis and SUD (23.4 million have SUD causing 81,000 drug overdose deathsannually -- two-thirds of which are related to opioids) 20:00 Jaime on how CyncHealth has responded to the Support for Patients and Communities Actin order to address the Opioid Crisis 21:15 Larra emphasizes the importance of the Support Act as a way to leverage technology in response to the national opioid epidemic 24:30 Joy on the opportunities for health policy and public sector funding to address disparities in care 27:30 Jaime on how transforming an HIE into a “Population Health Utility...

Jul 6

1 hr 6 min

We are discussing “Price Transparency and Free Market Healthcare” with Dr. Keith Smith, co-founder of Surgery Center of Oklahoma and Sean Kelley, Founder & Managing Partner of Texas Medical Management. Keith and Sean are the forefathers of price transparency as they have been providing upfront, transparent prices to patients for decades. This is one of our more controversial episodes to date, as we cover with brutal honesty, the systemically broken healthcare system that allows patient fleecing, price gouging, excessive profiteering, and limited competition to establish a market clearing price.  This provocative interview will raise important concepts such as the needs of the buyer, the importance of price transparency, and why free market principles and bundled pricing for surgical procedures are necessary.  Is there any difference between the healthcare industry and a Mexican drug cartel?  Is the value-based care movement flawed? Should the government recuse itself from any conversation having to do with health value? Tune in to find out! This is a special joint episode between Race to Value and Point Health, released alongside the ACLC Intelligence Brief entitled “Revealing Value? Hospital Price Transparency”.  This brief can be downloaded here. Episode Bookmarks: 02:00 Download the ACLC and Point Health Intelligence Brief entitled, “Revealing Value? Hospital Price Transparency” 02:30 Introduction to Keith Smith and Sean Kelley – the forefathers of price transparency 05:00 Dr. Smith shares the story of his founding of Surgery Center of Oklahoma – a free market ASC with fully transparent, bundled procedure pricing 06:00 The “rising terminator class of Administrators” and why Dr. Smith started seeing Medicare patients for free! 07:00 “We were accomplices to financial crimes that were devasting to patients.” (The fleecing of patients by profiteering hospitals) 09:00 Sean discusses the founding of Texas Medical Management (formerly Texas Free Market Surgery) 10:30 85% of all surgical dollars go to facilities! (Motivation to move cases out of the hospital that should be done in a surgery center) 12:00 “Really good doctors are not paid more than bad doctors.  In fact, it is often the opposite.” 13:45 Sean reflects back on the early leadership and inspiration of Dr. Keith Smith in starting TMM 14:50 “The only reason I stayed in medicine is to be a part of a solution that brings doctors and patients back into relationship models that eliminate all the BS.” 15:30 Only 25% of all healthcare dollars spent actually go to people providing care! 17:00 “Changing the way that healthcare is purchased by employers and TPAs is the most critical part of the survival of free market providers.” 18:30 Medical Tourism and how patients are travelling from all over the country (and the world) for free market surgeries! 22:30 “The healthcare system is working as it is designed – it is a cartel; there is no mistaking that.” 24:30 Dr. Smith expresses his frustration with influencing peddling in health policy and how industry consolidation is driving up prices 26:20 Self-funded buyers are demanding transparent pricing and a stop to price gouging. 27:00 “The DC regulatory machine, brokers, and consultants needed a good thumping.” 29:00 Helping other surgery center disruptors with price transparency models to build critical mass across the country 33:00 The challenge of industry insiders and lobbyists to fight price transparency (“Washington is not the solution.”) 34:40 Sean discusses how a local employer challenged the “cartel” which led to Direct Primary Care and Free Market Surgeries 36:00 Referencing Rick Scott (former HCA CEO) on why hospitals are not going to fix the problem of high healthcare costs 37:30 Dr. Smith on why the new Hospital Price Transparency regulations won’t work…but it will change the narrative 39:30 Correcting the definition of price transparency so it i...

Jun 30

1 hr 19 min

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 delivery where information technology is focused on fee-for-service. Instead of cowboys, we need “quarterbacks”, communicating with an interdisciplinary care team and facilitating hand offs across the care ecosystem. In this environment, information technology is like the offensive line, protecting the physician and creating the opening for a meaningful play. Our guest this week is Dr. Matt Lambert, Chief Medical Officer of Curation Health, an advanced clinical decision support platform for value-based care that drives more accurate risk adjustment and improved quality program performance by curating relevant insights from disparate sources and delivering them in real time to clinicians and care teams. Author of two books, and with more than 20 years of experience as a clinician, CMIO, and change leader in value-based care, Matt’s insights will expand your vision of health value! Episode Bookmarks: 4:00 Physician Workflow Optimization in the movement to Value-Based Care (Cowboys vs. Quarterbacks) 6:30 VBC is requiring providers to optimize workflow to support team-based care (the Quarterback role) 7:00 APIs will enable EHR systems to evolve over time to better support value-based care 7:30 Curating meaningful information (and minimizing noise) to providers at the point-of-care 8:00 Using AI to decrease cognitive load for providers 8:20 “Healthcare doesn’t have a data problem. It has a clinical workflow problem.” 9:00 Physician Burnout ("a public health crisis that urgently demands action") 10:30 How VBC is changing regulations and documentation standards for electronic health records 12:00 “The CMIO role is the bridge, it’s the translator between the clinical world and the technical world." 12:25 NLP models often overwhelm providers with data that is not meaningful 12:45 Reducing disruptions and hard stops in provider workflow with technology-enablement 13:00 Dr. Lambert discusses his own personal experience with physician burnout 14:45 Simplicity as the ultimate form of sophistication and the artful design of clinical documentation solutions 17:00 How healthcare technology companies come short when they don’t have strong clinical leadership 18:00 Expanding focus beyond point-of-care to clinical documentation integrity teams 18:30 HCC recapture for risk adjustment and how algorithms can help capture new HCCs 19:30 Using NLP to identify new diagnoses from discharge summaries 20:30 Dr. Lambert discusses a use case for HCC coding optimization with RAF lift to improve ACO performance 21:45 How HCC coding optimization can improve patient engagement and better address SDOH 24:20 Referencing Trenor Williams, MD and his work in SDOH and social risk intelligence 24:45 Social applications of the risk adjustment model 25:45 The impact of COVID-19 on the future of value-based care 26:00 Referencing his recent HIStalk article on subscription revenue models 26:15 Post-pandemic interest from providers in subscription models and VBC 27:00 Deferred care during the pandemic and how that will affect population health 27:50 Risk adjustment over FaceTime and over the telephone 28:30 The similarities between post-COVID healthcare in US and the National Insurance Act of 1911 in the UK 29:30 Post-viral syndrome and long-term sequelae related to COVID-19 33:00 Eric Neil (Chief Information Officer, UW Medicine):  “There are no old and bold CIOs!” 33:45 Providers have the best technology at home but are averse to new HIT solutions in the ambulatory care setting 34:00 A design flaw of the EHR Meaningful Use program that encouraged only platform adoption 34:30 How the Pareto Principle applies to Health Information Technology and workflow automation

Jun 28

1 hr 1 min

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 2000s team never won a World Series, multiple 100-win seasons and a new record for the longest winning streak got the attention of teams across the MLB, all while on one of the league’s lowest payrolls. Most people know Beane’s story as it was popularized in the book—and later in the movie—Moneyball. In healthcare, we are overdue for a “Moneyball” revolution. The shift towards value-based payment has made it clear that our system needs to do a better job generating outcomes that matter to patients — a positive health-care experience, improved health, and good quality of life. The machine learning techniques that were used to algorithmically determine a player’s value were light-years ahead of the archaic methods that had been used in baseball up to that point. Similarly, many of our conventions in delivering care come from an era when healthcare was delivered primarily by doctors and nurses with elite training whose success depended mostly on content expertise. A key component to value-based transformation in healthcare will be artificial intelligence. Without AI, medicine will never advance to a state where the totality of a patient’s data can be used to find predictive signals that will lead to enhanced treatment and population health interventions that improve outcomes. Our guest this week is Andrew Eye, the founder and CEO of ClosedLoop.ai, the recently announced winner of the CMS Artificial Intelligence Health Outcomes Challenge. Listen and find out why Andrew and ClosedLoop are exemplars in the race to value!   Episide Bookmarks: 02:00 The Billy Beane story and how, in healthcare, we are overdue for a “Moneyball” revolution 03:00 A key component to value-based transformation in healthcare is artificial intelligence 04:00 Andrew Eye – a national leader in AI in Value-Based Care – and his company ClosedLoop.ai 06:45 Partnership with Dave DeCaprio following his work with the Human Genome Project 07:30 How Andrew’s daughter’s medical condition provided “WHY” inspiration to build a next-gen predictive analytics platform 09:20 How ClosedLoop.ai beat out the world’s leading technology and healthcare organizations to win the CMS AI Health Outcomes Challenge! 11:25 “Physician trust in AI is crucial.  Algorithms never saved anybody’s life. We predict the future so that you can change it.” 12:50 Creating an open source, AI-based predictive model for predicting COVID-19 Vulnerability 13:00 Andrew discusses what it was like to submit the winning submission for the CMS AI Challenge without electricity in the Texas Snowpocalypse! 14:00 CMS’ focus on AI Explainability and how ClosedLoop was “born to win” 17:00 “Explainable AI” (XAI) versus “Black Box” machine learning algorithms 19:00 Early AI firms were reluctant to share “secret sauce” of proprietary algorithms and the impact on physician trust and external validation of bias 20:00 “We’re not building models.  We are building a machine that builds models.” 20:20 “The idea that there is one algorithm that is best for every healthcare organization in the country is a total fallacy.” 21:00 “Explainability in AI is absolutely critical to helping care teams have more effective interventions in population health.” 22:30 Physician paranoia about “machines taking over” where there work will be eventually outsourced to algorithms and other artificial tools of clinical reasoning 23:45 The impact of AI on Radiology and how that scenario differs from other instances in medicine where AI is applied to population health 25:20 The opportunity to augment clinician pattern recognition with AI that goes far beyond manual chart review for surface insights 26:15  “There is going to be a point in time where patients choose a doctor ...

Jun 21

56 min 15 sec

Sixty years ago, May 1961, President John F. Kennedy challenged the American nation in a speech to Congress, asking them to commit to “landing a man on the Moon and returning him safely to the Earth.” Eight years later, that bold goal was realized – in July 1969 Apollo 11 landed and returned safely with a crew. President Kennedy’s moonshot goal is an important reminder of courageous leadership that sets an inspiring goal that pushes us to think and achieve boldly.  That is not unlike the 10-year vision of Ochsner Health to transform the health of Louisiana, taking it from 49th out of 50 in America’s Health Rankings to a ranking of 40 by 2030. As a native Louisianan, Dr. David Carmouche is committed to transforming the health outcomes of his state.  Dr. Carmouche serves as President of the Ochsner Health Network, the accountable care network of the massive Ochsner Health System. The health system is committed to a value-based strategy and its CIN has generated returns north of $100M in its value-based contract portfolio over the last few years.  In this episode, Dr. Carmouche shares meaningful lessons from his value journey covering such topics as physician leadership in the value movement, partnerships with employers, community resilience, precision medicine and social determinants of health, and Ochsner's 40 by 30 vision to transform health in the state. Episode Bookmarks: 04:00 Dr. Carmouche’s leadership purview (and reflections from his glory days on the gridiron???) 07:20 Dr. Carmouche speaks to the national pursuit to value-based payment and looming Medicare insolvency 09:10 The experimentation phase of value-based care and the next-level commitment to pursue the most viable APMs 10:10 Subsidizing government contracts (Medicare, Medicaid) with commercial payers to spot margin and why that is no longer tenable 12:00 Dr. Carmouche discusses the financial results of Ochsner’s value-based contract portfolio 13:00 Board-level and CEO commitment to value as a strategy for population health and long-term economic success 13:25 Investment in care capabilities and realignment of incentives within large employed physician group as keys to success 14:10 The ‘muscle memory’ of owning a health plan and how that created orientation to risk at Ochsner 14:40 The importance of leadership in driving success in value-based payment with improved outcomes in patient communities 15:45 The three verticals of Ochsner Health’s business:  Care Delivery, Risk Operations and Insurance, and Digital Services 16:30 How Ochsner Health manages fee-for-service dependency in its legacy business model with its commitment to value 19:10 Building partnerships with insurance brokers and fully-insured employers to support appropriate steerage and drive cost savings 21:15 Creating economic alignment with self-funded employers and the challenges of creating meaning gainshare opportunities 22:50 Negotiating care management fees with self-funded employers as in interim step to full-risk 23:30 Dr. Carmouche discusses the network agreement they reached with Wal-Mart to provide high value care for employees across Louisiana. 26:45 “From Competition to Collaboration” – Dr. Carmouche’s contribution to a book that outlines the Health Ecosystem Leadership Model (HELM) 27:00 Dr. Carmouche reflects on the diverse experiences in his career that allowed him to learn about the different sectors of the healthcare ecosystem 28:15 “No one sector of the healthcare ecosystem can create significant value alone” 29:15 How an interaction with Dr. Paul Grundy inspired Dr. Carmouche to make the biggest impact possible in improving the health of Louisianans 31:00 Blending physician leadership with the business understanding of different sectors in the healthcare economy to drive value creation 34:00 How Ochsner worked to ameliorate the scourge of COVID-19 in New Orleans and lessons of community resilience from Hurric...

Jun 14

1 hr 8 min

The difference between average people and achieving people is their perception of and response to failure.  “Failing Forward” was a concept defined by John C. Maxwell several years ago, and that axiomatic truth could not be more readily apparent than in value-based care.  Transforming healthcare to lower costs and improve patient outcomes is tough work. PERIOD.  It requires many years of experimentation and “trial and error” innovation. The suffering index in the value movement can be immense, but the returns – in both financial success and personal/professional fulfillment – make it a purposeful endeavor. Dr. Jesse James, the Chief Medical Officer for CHESS Health Solutions, is a leader in the value movement who believes in Failing Forward as a key to success in value-based care.  In his role, he oversees quality and clinical services for a population health management company that supports more than 3,000 providers and 150,000 patients. Dr. James joins us this week to show us that as leaders in value, “We must be willing to fail forward. “It’s our scar tissue that makes us stronger.”  Tune in this week to learn from one of the best!  In this episode, Dr. James provides leadership and business insights that are profoundly helpful for physicians, executives, and entrepreneurs looking to win this Race to Value. Episode Bookmarks: 04:20 Dr. James’ “defining moment” when he found his calling to practice medicine 06:00 The decision to begin a medical career at the bedside and then working at the system-level to transform healthcare 07:30 Dr. James’ early work in clinical quality and the influence and mentorship of Dr. Cary Sennett (“The Godfather of Quality Measurement”) 08:45 The permission to fail bestowed by a mentor has been a constant reminder to “Be Humble” in the practice of medical leadership 11:00 The legendary basketball coach John Wooden on how "Failure is not fatal, but failure to change might be." 12:25 “As a leader, you have be willing to fail forward. It’s our scar tissue that makes us stronger.” 12:45 The story of how CHESS was borne out of an innovative medical practice that embraced value before the payment environment would support it 14:30 Lessons learned from hardships in the Value Journey (transitioning from FFS to P4P to Gainshare to Full Downside Risk) 15:30 “You have to remove the stigma around failure. These are opportunities to learn and grow.” 15:40 The story of Sir William Osler and how the ideal physician should be equally to call out failures as much as successes 16:50 The influence of the Institute of Medicine report “To Err is Human” on the culture of safety in the practice of medicine 17:00 The need for a new culture change in medicine to learn from mistakes and failed experiments to advance population health and VBC 19:00 Medicare payment model innovation and how CHESS isgetting as close to premium dollar as possible by taking downside risk with MA and commercial insurers 20:00 CMS experimentation with global capitation and why providers should be thinking about the Direct Contracting model 23:30 The use of “innovation cells” to effectively disseminate learnings within partner organizations 25:00 Addressing transportation as a social determinant of health in rural areas 26:00 Partnering with Wake Forest Baptist Health to deploy a “hospital at home” model 27:15 Creating wrap-around services in the technology and clinical domains to meet with needs of clients with varying degrees of maturity 29:30 Dr. James describes the value-based care landscape in North Carolina and the impact of the Atrium Health--Wake Forest Baptist Health merger 33:10 Developing a leading Medical Management program with service hubs in Care Management, Pharmacy, Quality, and Risk Adjustment 33:40 Data Analytics and Predictive Modeling and how CHESS partnered with Wake Forest to develop a frailty index 34:35 Implementing a high utilizer conference to re...

Jun 7

54 min 37 sec

Former President of South Africa, Nelson Mandela, made an important observation when he said, “There can be no keener revelation of a society’s soul than the way in which it treats its children.” Our children are wholly dependent upon us, their parents, teachers, and society for their education, their safety and their health. It is with this mindset that we proclaim, high-value pediatric care is critical for winning the race to value. Our guests this week are Ginger Hines, Executive Director, Seattle Children’s Care Network and Dr. Sheryl Morelli, Medical Director for Seattle Children’s Care Network, and Clinical Professor of Pediatrics, University of Washington School of Medicine. Seattle Children’s Care Network (SCCN) is a pediatric clinically integrated network comprised of Seattle Children’s Hospital, 600 specialists in Children’s University Medical Group, and 20 primary care pediatric practices comprising more than 200 providers and 6 specialty clinics. Member practices in the CIN support the health of 50,000 pediatric lives in value-based contracts. Episode Bookmarks: 03:20 Background on Seattle Children’s Care Network (SCCN) and Seattle Children’s Hospital 04:45 Pediatric value-based care being driven by employers and how SCCN formed direct-to-employer contracts 05:30 The movement to value-based care in Washington State’s Medicaid program 06:00 How SCCN engages with physicians to build trusting relationships and a shared vision 09:00 The long-term societal benefits to investing in children’s health 10:30 Children with high BMIs that become adults with diabetes, CHF, and depression 12:00 Parents missing work to take care of unhealthy children and how employers investing in children’s health care lead to productive employees 12:40 Leveraging data and analytics in the CIN and how vaccinations and well child visits are key to disease prevention 15:00 How pediatric value-based care is different than adult value-based care 15:30 Data integration within SCCN and how the HIT infrastructure is foundation to success in population health 17:20 The validation of data accuracy as a critical success factor to building trust and supporting evidence-based quality improvement 19:30 Operational efficiencies within the CIN as a more effective way to provide actionable insights to providers 21:00 Developing consistent pediatric quality metrics and standardizing care within the CIN 24:00 Benchmarking quality performance at both the regional and national level 25:00 Recognizing the opportunity in pediatric value-based care and how you have to look for cost savings and improvements in different areas 27:30 Establishing a secure intranet to provide resources and reports to providers in the CIN 29:30 Focusing on the full panel of patients in the presentation of data and how that leads to success in population health 30:00 Transitioning to telemedicine during the pandemic and how that will impact pediatric care delivery in the future 34:00 Financial results from value-based contracts by focusing on ED utilization, asthma management, well visit completion rates, transitions of care, and quality measures 36:00 Capitalizing on quality improvement projects to decrease exacerbations within asthmatic pediatric population 42:00 Expanding value-based contracts with payers, employers, and Medicaid to prepare for full capitation 44:00 Mental health of children nationally is more important than grades in school (mental health-related pediatric emergency department visits on the rise) 45:00 Integrating behavioral health within primary care and addressing social determinants of health through innovative partnerships 49:30 Food insecurity with children as a national problem (14 million children living with food insecurity, almost 6 times as many as in all of 2018) 50:00 How SCCN is looking to build a scalable, community-based approach to addressing SDOH and food insecurity

May 31

1 hr 1 min

The all-too-common visualization of balancing between the two canoes of fee-for-service (FFS) and value-based care (VBC) is an appropriate illustration of the pressure that providers feel, but maintaining balance is clearly focused on staying upright, on survival. The challenge is that the FFS canoe has a motor, and the paddle for the VBC canoe is not enough to change direction – clearly the tools used to optimize reimbursement in the two worlds are oftentimes diametrically opposed. The mission behind VBC (lower cost, better outcomes, better care) has not been sufficient for many to overcome the momentum of the status quo, the requirement for margin that is the focus of FFS. This week’s episode features two leaders in the race to value who have vital insights focused on achieving margin in risk, giving provider leaders more clarity to make the best decisions for their organizations in positioning for the future. François de Brantes serves as Senior Vice President of Commercial Business Development at Signify Health. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets. He has spent close to two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers in order to encourage value-based decisions.  He is the foremost expert on designing and implementing episodes of care programs for employers, providers and health plans. Joe Fifer is president and CEO of the Healthcare Financial Management Association. HFMA’s mission is to lead the financial management of health care. With more than 50,000 members, HFMA is the nation's leading membership organization of healthcare finance executives and leaders. Prior to assuming this position in 2012, Joe spent 11 years as vice president of hospital finance at Spectrum Health in Grand Rapids, Mich. He also spent time with McLaren Health Care Corporation, Ingham Regional Medical Center and Ernst & Young.   Episode Bookmarks: 02:00 Introduction to our Mission-Oriented Expert on Value-Based Care, François de Brantes (SVP, Signify Health) 02:20 Introduction to our Margin-Focused Healthcare Finance Executive, Joe Fifer (President & CEO, HFMA) 03:40 Healthcare organizations must position themselves for value-based payment without going bankrupt in the process! 05:00 The recently released report entitled, "The Future of Value-Based Payment: A Road Map to 2030” 07:00 François provides his perspective on the current state of value-based care and the current track record of CMS and CMMI payment models 11:30 Joe explains how excessive healthcare spending has forced the U.S. under-invested in infrastructure 13:00 Moving from payment model experimentation to a more focused set a models with the right incentives to move the industry forward 14:30 Performance Results of the Bundled Payments for Care Improvement (BPCI) initiative 16:00 How François and Joe initially met 10+ years ago while working on a bundled payment program 17:45 François explains how making better decisions in post-acute care when managing an episode of care can generate margin at the patient-level 21:00 Joe on why CFOs are leery of value-based payment because of the variation and uncertainty of the financial model, and how to create an attitudinal change 23:30 CMMI needs to develop a core set of APMs that show evidence in helping the delivery system make the right decisions around resource allocation to optimize their organizational structures. 25:00 Is there an organizational tipping point for value-based care based on the percentage of their revenue portfolio at risk? 26:00 François explains the “CFO’s Dilemma” (i.e. shifting a portion of FFS revenue to risk with increased associated margin per patient that can offset the decrease in the overall margin from the loss of incremental hospitalization revenue in FFS) 27:40 The “CFO’s Dilemma” is all about reaching a tipping point...

May 24

1 hr 13 min

This month is National Military Appreciation Month and with this week’s episode we take  opportunity to offer our solemn regard and deep gratitude to the brave men, women, and their families who have served our nation with selflessness, gallantry, and sacrifice in upholding our foremost ideals of liberty. We are grateful for their nobility, for their duty, and for their sacrifice and that they “loved country more than self” so that we may live in a nation that is free. We are grateful that our liberty and our pursuits of virtue, equity, and happiness continue to be protected by those who now serve. As we express our gratitude for all of those who have served and now serve to preserve our country, our security, and our liberty, we have invited a veterans advocate unlike any other. Our guest this week is The Honorable David Shulkin, M.D., former U.S. Secretary of Veterans Affairs, and one of the most courageous leaders in the value movement that we have had on our podcast! As Secretary, Dr. Shulkin represented the 21 million American veterans and was responsible for the nation’s largest integrated health care system with over 1,200 sites of care, serving over 9 million Veterans. VA is also the nation’s largest provider of graduate medical education and major contributor of medical research and provides veterans with disability payments, education through the GI bill, home loans, and runs a national cemetery system. Episode Bookmarks: 01:45 A Special Message from Race to Value regarding Military Appreciation Month 03:15 Brief Background on The Honorable David Shulkin, M.D., the former U.S. Secretary of Veterans Affairs 05:10 Examples showing that the VA System is an exemplar of innovation 06:30 Dr. Shulkin on how the VA is a leader in behavioral health integration, use of non-traditional therapies, and addressing social determinants of health 07:45 How the VA is entirely unconflicted with fee-for-service reimbursement and why we should learn from it as we build a more value-based delivery system in the private sector 08:45 The national scandal that rocked the VA and how Dr. Shulkin was called to serve by President Obama to address the crisis 11:30 As the newly appointed Undersecretary, Dr. Shulkin describes how he addressed access issues for urgent care in the VA system, while also improving delivery of same-day services and publishing wait times for all to see 16:00 Speaking out against the Trump Administration during his time as a cabinet member (e.g. Charlottesville violence, Agent Orange benefits, privatization of the VA system) 17:45 “It Shouldn't Be This Hard to Serve Your Country”: the dual meaning of Dr. Shulkin’s book title 19:30 Accepting the consequences of staying true to your principles which means even losing your job 23:10 Dr. Shulkin reflects on the government’s response to COVID-19 and how it felt to be on the sideline due to his firing by President Trump 24:30 Self-inflicted and avoidable failures in bio-surveillance, testing, and communication strategies and how we can overcome them in the Biden Administration 27:45 Dr. Shulkin explains the Whole Health Model of Care at the VA that includes self-care, peer counseling, and team-based interdisciplinary care 29:20 Results of the Whole Health Model, e.g. decreased opioid use, lower utilization, better patient outcomes 30:30 Dr. Shulkin’s awakening to the effectiveness of non-traditional therapies when he visited the VA Winter Sports Clinic with 400 veterans who were paralyzed or had spinal cord injuries, lost limbs and prostheses 33:30 Veteran Suicide as the top priority for the VA health system and how technology and behavioral health integration can improve care delivery 37:15 Dr. Shulkin speaks about the need for private citizens to enter into public service and how we can restore trust in our government. 40:00 Dr. Shulkin provides parting thoughts of gratitude for our military and their families in ...

May 17

42 min 35 sec

Nurses have been rightly recognized as heroes during the pandemic – on top of their consistently tireless effort, providing sustained caring and empathy over long hours, nurses stepped up to do more, to meet their patients’ needs despite risk to themselves. For example, they innovated to find solutions that would allow families to stay connected despite the barriers of quarantine. Building on a tradition that has been evident since they first began, nurses have always innovated solutions to improve patient care and outcomes. Their humble service and willing advocacy for each of their patients have made them heroes. This week is Nurses Week, and in honor of nurses everywhere, we are proud to welcome Bonnie Clipper, DNP, MA, MBA, CENP, FACHE as our guest. Bonnie is an expert in the nursing innovation space and was the first Vice President of Innovation for the American Nurses Association and created the innovation framework that is inspiring 4 million registered nurses to transform health through nurse-led innovation. She has published the Amazon international best-seller The Nurse’s Guide to Innovation, The Innovation Roadmap: A Guide for Nurse Leaders, and has published on the impact of AI and robots on nursing practice, as well as authored The Nurse Managers Guide to an Intergenerational Workforce. Bonnie’s insights into nursing are important and clearly articulate that, where a race to value is concerned, nurses are the ones innovating and delivering the solutions that will get us to the finish line! Episode Bookmarks: 05:45 Nurses are more with patients and families than any other discipline 06:30 Nurses are in the best position to transform how care is delivered and how we view health 07:10 The scope of the nursing profession and how their problem-solving can drive cost-effective solutions 09:10 Where do nurses fit in this big picture? 10:00 Nurses in leadership and the 10th anniversary of the IOM’s landmark report, “The Future of Nursing: Leading Change, Advancing Health” 12:50 Interdisciplinary training of the current generation of nurses 13:40 Training nurses about the business of healthcare 14:30 The need for upgraded competencies in nursing (e.g. climate science, gun violence, AI and big data) 15:10 Virtual Reality as a crucial component of the future of nursing education 16:00 The pandemic as a catalyst for health equity, telehealth, and virtual care and how that will impact nursing education 17:45 The nursing workforce shortage and the trend of nurses leaving the bedside 19:00 Staffing ratios in nursing and how nursing can be amplified by Artificial Intelligence 21:30 The trend away from acute inpatient care and how nurses will provide care more home-based care in the future 22:10 “Nursing services should be paid for in relation to the value it brings in the care paradigm. It should not be built in the room rate like a commodity.” 23:00 Restructuring nurse compensation and how this will incentivize performance and promote retention 23:50 The agency-based nursing model and how nurses are finding this model more rewarding 25:00 Innovation in nursing and how that can be leveraged for human-centered design 27:30 Creating a culture of innovation for nursing to flourish and for patient outcomes to improve 28:30 Examples of nurse innovation on the frontlines during COVID-19 29:45 How younger nurses may lead the way in innovation and the “entreprenurse" 30:30 Teaching human-centered design in medical and nursing schools 31:00 The empathy and compassion of nurses and how the broken system can create moral injury 32:00 Eric reflects on a prior podcast interview with a patient and how it taught him the importance of culturally competent care 34:00 How to deliver culturally competent care with DEI coupled with artificial intelligence to reduce implicit bias 35:45 The accounting of the nurse labor structure as a challenge to provide patient-cente...

May 10

1 hr 5 min

This week’s episode is the second part of our conversation with Dr. Robert Pearl. In his book, Uncaring: How the Culture of Medicine Kills Doctors & Patients, Dr. Pearl asserts that doctors are taught how to cure people, but they don’t always know how to care for them. There are many contributing factors, ranging from how doctors are trained, to increasing workloads and lack of resources, a widening disconnect between patients’ and doctors’ values and expectations, and increased risk and death due to the pandemic, all of which are intertwined with systemic and cultural issues. These are people who, with the highest ideals of caring for people, have entered a system rife with misaligned incentives that undermine and contradict their own hopes and expectations, and a culture that shapes them into being unable to care in the way they originally intended. The book examines the elements of physician culture that need to be corrected, the ones that should be preserved, and how to accomplish both. Dr. Robert Pearl is the former CEO of The Permanente Medical Group (1999-2017), the nation’s largest medical group, and former president of The Mid-Atlantic Permanente Medical Group (2009-2017). In these roles, he led 10,000 physicians, 38,000 staff, and was responsible for the nationally recognized medical care of 5 million Kaiser Permanente members on the west and east coasts. He is the author of Washington Post bestseller “Mistreated: Why We think We’re Getting Good Healthcare—And Why We’re Usually Wrong,” and “Uncaring: How the Culture of Medicine Kills Doctors & Patients” which is scheduled to be published in spring 2021 (all proceeds from the book go to Doctors Without Borders). Dr. Pearl also hosts the popular podcasts Fixing Healthcare and Coronavirus: The Truth. Episode Bookmarks: 00:30 The cultural hierarchy in medicine 01:00 Research on effects of concentrated primary and specialty care on life expectancy 03:00 Dr. Pearl explains how primary care was once on top of the cultural hierarchy before technology advancements 04:00 The need for Primary care to adjust to the current world (The Acceptance stage of the Kübler-Ross grief cycle) 05:30 Leading innovation in Primary Care and the success of ChenMed as a primary care model that can lower cost and improve outcomes 06:30 How the current fee-for-service model creates ineffective primary care delivery to ensure population health (e.g. lack of access and availability) 08:00 The use of telemedicine in the primary care setting to improve patient outcomes 09:15 The need for interdisciplinary, technology-enabled primary care teams and the integration of specialty services 10:00 How Kaiser Permanente leveraged telemedicine and other digital tools for clinical integration 11:30 PCP/SCP collaboration to determine evidence-based practices in a consistent, technologically-enabled, efficient way 12:00 Redefining primary care to elevate its value. 12:20 “Primary care shouldn’t just be the gatekeeper for referrals; they should be the facilitators of higher quality care by collaborating with specialists." 12:40 Inefficient, low-value referrals from primary care for consultations that could be prevented with better integration 14:00 Onsite primary care clinics for Apple employees that are improving collaboration with specialists 14:30 Consumerism and Patient Experience -- patients feel disrespected by long wait times, short visits, and poor communication. 17:00 “Culture, to some extent, allows you to avoid the harm you inflict and take privilege in what you desire.  Some of that exists within the physician world.” 17:20 Physicians that refuse to value patients’ time as much as their own as seen by long wait times, limited access and availability, and limited consumer-driven technology 18:20 The culture of customer-focused technology and service, exemplified by Amazon, has changed patient expectations 18:50 Patients value empathy,

May 3

1 hr 2 min

In a year of great need, during the pandemic, Americans saw and celebrated an army of physician heroes. In doing so, they overlooked an uncomfortable reality. Doctors are humans who share a culture that produces both remarkable successes and abysmal failures. As in Robert Louis Stevenson's gothic novella The Strange Case of Dr. Jekyll and Mr. Hyde, it is possible that one person -- or this case, one culture -- can be both a virtuous force and a destructive influence. Until now, the negative aspects of physician culture have remained largely invisible. But like a virus, it affects people even if they can't see it. Physician culture wields tremendous influence over the lives of patients, doctors, and the nation, regardless of whether people acknowledge (or are even aware of) its existence. This week, we have as your guest Dr. Robert Pearl.  He will be discussing his new book which tells the story of a profession that is both triumphant and dangerously flawed, filled with people who aspire to help others, yet who sometimes act coldly, callously, and indifferent. This book takes you inside the doctor's world, revealing unique insights about their training, their daily practices, and the culture they share. It is a book about people striving for perfection and about the impossibility of achieving it. It sheds light on the norms, rules, and expectations of doctors, and shows how culture shapes their thoughts and beliefs. It deciphers their evolving language, symbols, and codes. It highlights what brings doctors together and what isolates them from their colleagues and patients. Finally, this book examines the elements of physician culture that need to be corrected, the ones that should be preserved, and how to accomplish both. If we are to win this Race to Value, we must fully understand and reform physician culture so it can be more caring. Episode Bookmarks: 2:00 “The Strange Case of Dr. Jekyll and Mr. Hyde” – Is it possible that one culture can be both a virtuous force and an equally destructive influence? 2:40 If we are to win this Race to Value, we must fully understand and reform physician culture so it can be more Caring. 3:00 Dr. Robert Pearl’s new book, “Uncaring : how physician culture kills doctors and patients.” 4:45 Physician culture tolerates low value care, inequitable outcomes, excessive profiteering, and perpetuation of institutional racism. 5:40 Despite the clear link between avoidable chronic disease and excessive COVID-19 deaths, physicians are not speaking out on this. 6:45 Dr. Robert Pearl defines what culture really is and how drives physicians to perform but also inflict harm 7:30 The “invisible” nature of physician culture 8:45 The heroism of physicians during COVID-19 10:00 Systemic issues and cultural issues go together – Why Mistreated and Uncaring are perfect companions in solving for healthcare. 10:45 Chronic diseases and the lack of accountability in physician culture 11:30 The focus on Prevention is not elevated in medicine, as illustrated by how we undervalue primary care 11:50 Research study showing that adding PCPs increases life expectancy in communities, while adding specialists does not have a comparable effect. 12:30 Primary care physicians are paid more in large multispecialty medical groups like Mayo Clinic, Kaiser Permanente, and Geisinger 12:50 Pre-Order information for “Uncaring” and all profits go to Doctors Without Borders/Médecins Sans Frontières (MSF) 14:00 How the “Art of Medicine” philosophy in physician culture prevents progress towards evidence-based medicine 15:30 Research showing that as much as one-third of physician services is low value care, offering little to no benefit for patients 16:30 The long lasting and pervasive effects of a physician culture that pre-dated scientific advancements 17:45 “It is not a question of how we maintain the esteem of the past, but how do we create the esteem of the future?”

Apr 26

53 min 4 sec

It’s not a secret, the broken healthcare system is exquisitely tuned to react after patients get sick. For the most part, profits are made after we FAIL patients. And it hurts all of the caregivers who face the daily internal conflict of doing what is right for the patient or doing what is right for the business. But there are a few who are positioned differently. When the strategy and business are unconflicted they’re not worried about demand destruction and leakage but are instead focused on prevention and true care management. It all begins with prioritizing and properly aligning primary care. A group of 100 adult primary care physicians can influence $1 billion in healthcare spend. This is the source of potential power and change in a value-based world, where health will improve for patients and their providers while costs are decreased. Aledade is such a place – by allowing providers to remain independent and unfettered by the constraints of fee for service, Aledade is blazing the path toward true health value. Episode Bookmarks: 03:30 Comparison of Healthcare Spending ($6M per minute) to Niagara Falls (6M cubic feet per minute) 04:55 Aledade’s success in short lifespan of company (now at 800 practice partnerships with $360 million in healthcare cost savings) 06:05 The misalignment of incentives creating a perverse incentive for poor outcomes (e.g. profitability of treatments following a stroke) 06:45 Dr. Mostashari spending his career trying to find answers to the question, “How do we save the most lives?” 07:20 Adoption of electronic health records (“We succeeded in the battle, but we lost the war.”) 07:45 Provider workflow redesign and optimization (Regional Extension Centers) 08:25 “How can we create incentives so that private profit creates public good?" 09:30 “The Paradox of Primary Care Physician Leadership”  (the influence of primary care on downstream healthcare spend) 11:30 Consolidation of primary care by Optum and private equity firms 12:00 The resiliency of independent primary care practices 12:30 “Independent practices can do what they believe is in the patients’ best interest, without worrying that they’re obligation to the patient conflicts with their obligation to the corporation.” 13:00 Data shows remarkably little change in hospital employment of PCPs, thereby showing resilience in the primary care market 15:00 Movements are led by effective storytelling and these stories can revitalize communities of people 17:00 Primary care heroes during COVID-19, and how society neglected them by failures in supply chains, testing, and vaccines 18:40 Aledade’s support of primary care practices during the pandemic 20:00 “It is remarkable what happens when you do the right thing.” 22:00 Dr. Mostashari’s terror in seeing early ER utilization data in knowing that a pandemic was coming (before the media was covering it) 23:00 Implementation of telehealth, finding PPE, and securing loans for practices in early stages of pandemic 23:25 “The idea of practices going out of business during the pandemic highlights the insanity of fee-for-service payment for primary care.” 24:00 The lessons of COVID-19: 1) Healthcare can change, 2) Primary care doesn’t have to be an in-person visit, 3) Capitation in primary care is preferrable to fee-for-service 25:40 “Primary care is about the relationship between a practice and patient --  it’s not about the 99213 visit.” 27:30 Dr. Mostashari addresses recent delays by CMMI in new APMs and what we should expect in future health policy 28:30 Scaling the models that work is the job of good health policy.  (MSSP compared to CMMI programs) 29:00 The ACO Investment Model (AIM) program was successful and a model for future provider and patient incentive programs 30:30 CMMI delays should not be considered as a question to the direction of value-based models. 32:00 The progress of the ONC in standardizing health in...

Apr 19

48 min 3 sec

Race to Value listeners -- April is National Minority Health Month, and this year, the HHS Office of Minority Health is focusing on the disproportionate impact the COVID-19 pandemic is having on racial and ethnic minority communities.  This Bonus Episode is a compilation of viewpoints on health equity and racial disparities of care from some of our former guests in the past year.  We hope you take the time to listen intently to their message. Certainly over the last many year we have been exposed to the great inequities that have existed in our society for far too long.  We have one major obligation we have to each other…that is to tell the truth.  And the truth is, there are so many inequities in our society for minorities, including the manifestation of institutional racism within our nation’s health system. As leaders in value-based care, we have to be accountable to the endeavor that we are about. We endeavor to, in fact, ensure every patient receives the best treatment possible so they can live the life they are intended to live. That we endeavor to create the opportunity for health equity, and that is true regardless of race, ethnicity, gender, sexual orientation, or otherwise. We hope you find meaning in this Bonus episode and gain awareness for how important health equity and social justice is to win this Race to Value. Episode Bookmarks: 1:39 Daniel Chipping introduces National Minority Health Month and its’ focus on COVID-19 impact on minority communities 2:10 Dr. Eric Weaver delivers a special message on overcoming institutional racism in our nation’s healthcare system 3:29 Dr. Farzad Mostashari reflects on the murder of George Floyd and how it was a reckoning for social justice (and health equity) 6:33 Dr. Lerla Joseph discusses how she has devoted most of her life committed to health equity, how ACOs are a vehicle for change 12:30 David Smith provides a powerful social commentary on how pervasive systemic racism is in our society and his awakening as a white male 18:41 Christina Severin on the country’s reckoning, how her white privilege as conditioned her to be a racist, and how health centers can address inequities 23:10 Dr. Ernest Grant on the public health crisis of systemic racism, the disproportionate burden of disease related to SDOH, and how nurses can call for change 30:19 Dr. Stephen Klasko on how the zip code of communities ultimately determine health, and how the pandemic has raised awareness of inequities 31:46 Christina Severin on how the calling for racial justice, coupled with the pandemic, has created urgency to “bridge the digital divide” 33:36 Dr. Gordon Chen on the social injustice of different lifetime expectancy rates between white and minority communities 36:04 Shannon Brownlee on how Black Lives Matter has forced hospitals to focus on health equity 38:24 Dr. Mark Gwynne on how investment in data analytics can help ACOs identify opportunities in populations where there are disparate outcomes 39:11 Dr. Christopher Crow on how health equity in communities can be addressed through reforms in education, health, and business 40:27 Cheryl Lulias on building community-based coalitions to address health equity 42:10 Robert Sepucha on the disproportionate burden of kidney disease in minority populations 42:57 Dr. Edwin Estevez on the vulnerability of the Hispanic population on the Texas/Mexico border and how his ACO focuses on nutrition and health literacy 46:17 Mike Funk on how health plans can address disparities in minority communities 48:15 Dave Chase on the opportunity for social impact investment to creative cooperative structures in disadvantaged communities 48:53 Dr. Mark McClellan on health policy approaches to address health equity 49:30 Andrew Croshaw on how the Biden Administration will define value through health equity

Apr 15

51 min 30 sec

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 condition, there are approximately 20 million individuals in the US with a substance use disorder, and 9 million people have had suicidal thoughts in the past year. The onset of a global pandemic has only exacerbated the behavioral health challenges in our country.  The solution is the integration of behavioral health with primary care.  Primary care is the “tip of the spear” as 70% of primary care appointments include problems with significant psychosocial issues, and less than half of those primary care patients receive any mental health treatment. Solving this crisis through integration, however, is simply not possible without digital health solutions that can facilitate coordination between behavioral and medical care. Innovation is our only gateway to value-based care at scale. Mark Redlus, Chief Executive Officer of Tridiuum, is a venture-backed start-up executive with significant leadership experience in corporate management, M&A, strategy, and business development. His personal story aligns with the company’s transformational vision to advance behavioral-medical integration by delivering capabilities to identify those who need behavioral help, speed their access to care, and deliver a measurable impact on outcomes. Leveraging digital behavioral health solutions is key to winning this race to value. Episode Bookmarks: 03:30 The inspiration of Apple and Steve Jobs on Tridiuum’s rebirth 04:30 “Digital intervention can make a difference in outcomes.” 05:40 Commercializing research to inform the development of new products in the behavioral health space 06:20 Challenging the status quo by designing digital behavioral health solutions with elegant design (Reference to Simon Sinek’s TedTalk) 06:50 The attempted suicide attempt of Mark’s daughter (Katherine) and how that informed his personal “Why” to improve behavioral health outcomes 08:20 Growing access problem for mental health services that has been exacerbated by COVID-19 08:50 The realization of the “inadequacy of care” in the immediate hours following Katherine’s attempt on her life 09:20 “We can do better about unlocking access to behavioral health services sooner.  People searching months for someone to talk to is unacceptable.” 10:45 1 out of 5 Americans (over 51 million) are living with a behavioral health condition, including 20 million SUD and 9 million with suicidal thoughts 12:50 “Technology is not the holy grail, but it has a role to play in a fully integrated behavioral health experience.” 13:20 The difference between co-located, multidisciplinary models and true integrated models of care 15:20 Integration of psychiatry and psychological counseling into primary care practices 15:40 Telepsychiatry and telepsychology in response to COVID-19 16:35 “Primary care is the tip of the spear where the broadest of array of behavior health demand is occurring.” 17:00 Only 14% of ACOs even have a behavioral health component in their care model 17:30 Patients who have a chronic disease have a 3-4X higher frequency of behavioral health comorbidities 18:00 Patients with a chronic disease and behavioral health comorbidity cost as much as 50 percent more and are likely to be noncompliant 18:30 $26-48 billion could be saved through behavioral health integration, representing a 5-10 percent decrease in overall healthcare costs 19:20 Partnership with Fresenius in managing behavioral health for CKD and ESRD patients to lower total cost of care 21:15 Projected 60-80% reduction in total cost of care per patient when ESRD patients are treated for behavioral health comorbidities 22:00 “Value-based contracts are difficult to justify if you can’t drive behavioral health access for members and patients.”

Apr 12

52 min 41 sec

Achieving health value demands the formation of a new social construct, one that puts aside self-interest and builds systems of care for the common good. One that prioritizes health and equity for all, including the underserved and most vulnerable among us. This effort requires stronger leaders and better leadership than ever before. Getting Medicaid right, transforming addiction and substance use disorder treatment, reframing behavioral health, and removing silos – these are a few of the efforts of this week’s guest as his work exemplifies the mission of achieving health as the seminal American institution to drive social connectedness and economic prosperity. Our guest is David Smith, CEO and founder of Third Horizon Strategies (THS), a Chicago-based, boutique advisory firm focused on maximizing human potential through a better health system. David serves on the Health Care Council of Chicago, the Alliance for Addiction Payment Reform, the board of the Sinai Hospital System, the Founder’s Council of United States of Care and as a Senior Advisor at AVIA and a Project Executive for their Medicaid Transformation Project. 04:55 Facts on Medicaid: 75 million Americans covered (1 in 5 Americans), 50% of US births, $600B annual spend 05:40 Medicaid beneficiaries may even approach 100M in the next five years 06:00 Background on the Medicaid Transformation Project (MTP) 08:00 “The Medicaid program is the single most important endeavor in our country, PERIOD. And that’s not just in healthcare, I’m talking about in total.” 09:00 Health is required to serve in the function in the full human capacity. 09:45 The neglect of the Medicaid program over the years and why we need to get it right to improve health in underserved communities 10:18 “Getting Medicaid right improves health, and improving health creates economic development.” 10:30 Disparities in public health are drawn across racial lines 11:00 Transformation Factor #1:  Evolution of payment models and realignment of incentives 11:45 Transformation Factor #2:  An evidence-based approach to Care Model research and implementation 12:15 Transformation Factor #3: Leveraging technology innovation for underserving communities 12:40 Transformation Factor #4: Social impact investments to fuel innovation 13:00 Transformation Factor #5: Social determinants of health 13:30 Transformation Factor #6: Growth in Medicaid enrollment requiring scalable solutions 14:10 Lack of government boldness, states not moving fast enough, MCOs not eager to develop new payment models 14:40 Partnering with health systems in the MTP to look for disruptive solutions that with financial self-sustainability 16:40 Facts about Substance Use Disorder (SUD): 23.4 million Americans affected, 81,000 drug overdose deaths per year, 1 in 5 Medicaid beneficiaries, 46% of the total Medicaid spending 18:40 David shares how he has personally been impacted by drug overdose through the loss of his father, brother, and sister 21:25 The role of Big Pharma in creating the opioid problem and how Addiction (the “dopamine rush”) is the #1 most common human failing 23:00 How the system of care is setup to treat patients with SUD as “bad people” 23:35 “If we think our fee-for-service system is bad for our physical health, it is a dumpster fire for people who struggle with addiction.” 24:15 The total cost of care for a patient with high acuity SUD is $31-32k per year, and how that creates a $17k value gap. 25:20 “There is no “cure” for Substance Use Disorder; there is only reducing a person’s risk to a baseline.” 25:50 The Value Gap due to waste and inefficiency in the treatment of SUD that also results in poor outcomes in long-term recovery. 27:05 The Alliance for Addiction Payment Reform and its role in advocating for a new value-based payment model for long-term recovery of SUD 29:30 Partnering with commercial payers to develop APMs for Substance Use Diso...

Apr 5

1 hr 9 min

When Thomas Edison created the electric light bulb, he didn’t stop with that one incredible invention. He took the next step and created the industry that would maximize the benefit of that light bulb, the infrastructure needed to make that light bulb become a permeating and permanent piece of society. This is the type of vision needed for the health care system as a whole, and the type of vision that is occurring in Dallas Texas. Catalyst Health Network’s physicians are intent on the vision of “Primary Care for All”, serving communities that are mired in a systemic, multi-generational crisis—where one in three children in Dallas lives in poverty, the third-highest rate of child poverty in the nation. This week’s guest, Dr. Christopher Crow, President of Catalyst Health Network, has connected and aligned a network of more than 1,000+ Primary Care Providers with nearly 1 million lives across North Texas, to build a better care model for patients that improves health and lowers cost. His work with Catalyst led them to be the first North Texas physician network to hold value-based contracts with the top four major carriers: Aetna, UnitedHealthcare, BCBSTX, and Cigna. To date, Catalyst has saved an impressive $100 million for the communities they serve. Dr. Crow and Catalyst are a bright example of leadership in the race to value! Episode Bookmarks: 04:00 Thomas Edison’s signature invention of the light bulb was a little more than a parlor trick without a system of electric power generation and transmission 05:00 How Catalyst you’ve been able to imbue a full spectrum of innovation with its value attempts 06:00 The origin story of Dr. Crow and Catalyst Health Network 07:20 Systems thinking design and strategy as a leading force to payer collaboration 08:20 Dr. Crow’s A-Ha moment when seeing Catalyst’s performance data and how value design and PCMH really does lowers cost and utilization 09:30 How growing up in the small town of Hillsboro, Texas inspired Dr. Crow to help communities thrive 10:50 The three pillars to helping communities thrive are health, education, and business. 11:20 Building a healthcare system to deliver more value starts with team-based primary care. 12:45 f an independent primary care practice can thrive (not just survive), the data shows that the community will thrive as well. 13:30 Centralization of population health management with deep personalization 15:00 Leveraging trust of the physician-patient relationship by extending it to the entire care team at scale 15:35 The concept of relationship compounding in value-based care and how it leads to lower costs and better health 16:40 The income and public health disparities in Dallas, Texas and how life expectancy differs by 24 years between neighboring zip codes! 18:10 Dallas is a tale of two cities – affluence and poverty.  What is Dr. Crow’s vision to help everyone in the community thrive? 19:30 Dr. Crow’s vision for “Primary Care For All” to improve longevity and prosperity 21:00 The impact of COVID-19 on building virtual care and telehealth capabilities within the practice 21:30 The importance of telehealth in addressing issues with Behavioral Health and “healthcare deserts” 23:00 Creating the Catalyst Community Foundation to provide access to affordable, quality care, starting with COVID-19 testing and vaccinations 25:15 “If you really want to create impact with high leverage, go upstream with primary care and social services”. 26:20 Building a business model for a self-sustaining, community-based foundation that will ultimately lead to Primary Care For All 27:30 Private Equity investment and provider consolidation – what does this mean for the future of primary care? 31:00 How Catalyst helps small primary care practices build the table stakes for value-based care from a technology and service standpoint 34:45 Catalyst receiving URAC’s full accreditation in Clinical Integratio...

Mar 29

1 hr 11 min

Decades of poor outcomes in terms of cost, quality, and access have not created societal commitment to confronting the issue of low-value care in hospitals. Despite medical errors serving as the #3 cause of death, unpaid hospital bills leading as the #1 reason for personal bankruptcy in our country, vast disparities in care prevalent across racial and sociodemographic lines, and a general sense of pricing opaqueness, we have not yet seen a community-led movement towards hospital accountability for health equity, quality of care, and avoidance of low-value care.   If hospitals are to equitably deliver the high-quality care that is essential to improving community health, the time is now. Assessing how well hospitals are serving all of their patients in their communities is a key first step in improving their quality of care. The Lown Institute, a think tank generating ideas for a just and caring system for health, has developed a tool to answer the question, “Are hospitals providing high-value care, achieving excellent patient outcomes, and meeting their obligation to advance health equity in their communities?”   Today we are joined Vikas Saini & Shannon Brownlee of the Lown Institute to discuss The Lown Institute Hospitals Index, a novel way of evaluating and ranking hospitals in order to help them better serve their patients and communities and to hold them accountable to addressing social determinants of health. This unique hospital ranking system is breaking new ground as we move forward in the race to value.   Episode Bookmarks: 02:00 Despite decades of dreadful outcomes, society has yet to confront the issue of hospitals providing low-value care 04:30 The legacy of Dr. Bernard Lown, as a pioneering cardiologist, humanitarian, and early advocate of value-based care 08:20 Dr. Lown’s philosophy of value-based care and the subtle distinction between doing as little “to” patients, but doing as much as possible “for” them 11:15 A new hospital ranking tool is needed in value-based care -- one that factors in civic leadership and racial equity 12:50 The Lown institute Hospitals Index is the first ranking system that actually measures overuse and unnecessary care 13:20 Economic tradeoffs matter when you look at racial equity 14:05 In ranking hospitals, the value of the care is as important as clinical outcomes. 15:05 Good hospitals are vital to healthy communities, but how you define and measure “good” matters. 15:30 The Civic Leadership component of the Hospital Index which accounts for spending on charity care, pay equity, and racial inclusivity 19:00 Variation in social and civic leadership metrics with academic medical centers, particularly inclusivity and pay equity 20:20 How Black Lives Matter has forced hospitals to reexamine their culture and commitment to health equity 21:45 Neighboring hospitals with drastically different racial inclusivity scores and the impact of residential segregation 25:00 Segregated (“separate and unequal”) hospitals with disproportionate impacts in COVID outcomes for those in low-income communities 26:30 The way we have organized and funded the hospital sector will not meet population health needs for communities 27:30 The need for regional coordination, changes in payment mechanisms, and global budgeting for health care transformation. 29:00 The Big Business of Healthcare and why “Health care is too important to leave to the Healthcare sector.” 30:00 Having a hospital system based on cooperation in population health versus having individual healthcare businesses competing against each other for volume 31:00 The disappointing, yet predictable, inequitable distribution model for COVID-19 vaccines 36:00 Low-value care is a significant portion of waste; estimates of spending on low-value care range from $100 billion to $700 billion each year! 39:00 Vikas discusses how his clinical training with Dr.

Mar 22

1 hr 2 min

Chronic kidney disease kills more people than breast or prostate cancer each year – it’s the 9th leading cause of death but you won’t see NFL players wearing socks and gloves to increase awareness. Thirty-seven million people in the U.S., or 15 percent of adults, are impacted by CKD, and around 90 percent of those with the disease don’t even know they have it! Treating kidney disease costs the Medicare program $130B and although patients with kidney failure account for only one percent of the Medicare population, they are responsible for over seven percent of all Medicare spending. Over the last 40-50 years, kidney care has experienced significantly less transformation than other areas like diabetes, cardiology, cancer, and HIV/AIDS. We have been failing in kidney care for far too long, and instead of focusing just on dialysis, we need to realize that kidney disease is more than just ESRD, and there is way more to ESRD than just in-center dialysis. This historic stagnation in kidney care with a large population now in crisis is a hugely abundant opportunity for innovative companies like Cricket Health to come in and change the game. In this week’s episode, we are joined by Bobby Sepucha, CEO of Cricket Health, a specialty care management company leading the way in the Value-based kidney care space. National Kidney Month is the right time to discuss how we can win this Race to Value with integrated nephrology and dialysis care for people with Chronic Kidney Disease and End Stage Renal Disease. Episode Bookmarks: 02:00 37 million people in the U.S., or 15 percent of adults, are impacted by CKD, and around 90 percent of those with the disease don’t even know they have it! 02:15 Medicare pays well over $100 billion for people with all stages of renal disease, which was nearly 20 percent of all Medicare spending last year. 02:45 While just one percent of Medicare beneficiaries have kidney failure, kidney failure accounts for over seven percent of all Medicare spending! 05:35 The system is designed to fail patients with chronic kidney disease 07:45 How the 1972 Medicare enrollment eligibility provision for ESRD patients created an unintended consequence of earlier stage CKD patients getting neglected 08:09 President Trump’s Executive Order on Advancing American Kidney Health (July 2019) 08:35 Bobby recalls his work with CMS and Congress to bring the ESRD Seamless Care Organization (ESCO) alternative payment model into fruition 09:00 “Unless we go upstream and start engaging patients prior to kidney failure, success in value-based kidney care will be limited.” 09:30 40% annualized mortality rate for dialysis patients can only be addressed by upstream CKD intervention 09:40 The new Kidney Care Choices (KCC) and the ESRD Treatment Choices (ETC) payment models 11:50 “Only 12% of ESRD patients today in America dialyze at home – that lags other nations to such an alarming degree.” 12:15 “If you were going to design the worst imaginable healthcare delivery system for kidney patients, you’d come up with the one we have here in America. Costs are astronomical, outcomes are terrible, mortality rates are through the roof, everyone is dialyzing in a center instead of home…it just doesn’t make any sense.” 12:55 60-65% of ESRD patients “crash” into dialysis with an ER visit 14:00 Cricket’s model for upstream CKD intervention 15:00 “Getting patients to dialyze at home is a multifactorial problem.” 16:15 The overlap of nephrology and palliative care 18:00 Telehealth is the silver lining to the pandemic 18:30 A patient story about the success of transitioning to home-based dialysis 19:55 The appalling lack of kidney care innovation over the last 40-50 years 22:20 The obesity epidemic and exploding kidney care costs over the last few decades 23:00 Working with payers for a more holistic approach to value-based kidney care 23:45 Payer goals: 1) reduce CKD hospital utilizatio...

Mar 15

59 min 4 sec

Last year, research at Johns Hopkins showed that healthcare consumes nearly half of all federal spending, which includes funding for Medicare, Medicaid, Social Security, military health benefits, health benefits for federal employees and their dependents, plus interest. Our federal government spends 48% of its money on health care and still healthcare devastates state budgets all across this country, with serious consequences in public health, education and other national priorities. This week’s guest, Dave Chase, is the Creator, Co-Founder, and CEO of Health Rosetta. Health Rosetta is an ecosystem enabling public and private employers and unions to reduce their health benefits spending by 20% or more while improving the quality of care for plan members. Dave is also the author of Relocalizing Health: Relocalization is a strategy to build communities based on the local production of food, energy and goods.  When applied to healthcare, a relocalization effort bring about systematic change – it could lead to strengthened local economies, improved population health, higher value in care delivery, and health equity. Dave expounds that health doesn’t start with a pill or in a hospital. It starts at home, with parents, with neighborhoods, with workplaces, and communities. Relocalization will be an important key for winning the race to value! Episode Bookmarks: 04:05 Defining the Relocalizing Health strategy and why it needs to be applied to healthcare 05:45 How to create systems change at a grassroots level 06:25 Applying a systems change model that focuses on adaptable replication (not scalability) 07:15 The Nuka System of Care in Southcentral Alaska as an example of a successful effort to relocalize health care 07:25 Rosen Hotels as another example of creating a consumer-oriented redesign of health care 07:40 Learning from the Jönköping Health System in Sweden 08:35 “Transformation moves at the speed of trust, and trust is built on complete transparency.” 08:50 How the legal and economic underpinnings of health plans are ‘completely rotten’ and must be made transparent 09:15 Seeking transparency in the way health insurance brokers are paid 09:27 “There is no well-functioning healthcare system in the world not built on proper primary care.” 09:35 “Healthcare isn’t expensive -- only 27 cents of every healthcare dollar goes to clinicians who are the value creators. What’s expensive is profiteering, price gouging, administrative bloat, and fraud.” 10:00 Dave discusses the advancements of modern-day computing as an example of why we need to work on the fractals of healthcare (i.e. the piece parts) 11:05 Research from Marty Makary showing that the federal government spends 48% of its money on health care 12:55 A broken financing model for hospitals steals from public health, kids, education, social services, and public infrastructure 13:15 Economic Development 3.0: Playing the Health Card 13:35 How considering every hospitalization as a failure is a starting point for reform 14:30 The economic depression of the middle class due to wage stagnation, and how that was caused by healthcare costs 15:30 The Millennial Generation is the first generation in American history where life will not be better for their parents because healthcare is stealing their future 16:35 Referencing David Goldhill’s Catastrophic Care: Why Everything We Think We Know about Health Care 16:55 “I believe the Millennial Generation can be the greatest generation of this century.” 17:45 Massive student debt and how healthcare has driven up the costs of Higher Education 19:51 The national opioid epidemic crisis that is devasting communities.  More than 760,000 people have died since 1999 from a drug overdose, and two out of three drug overdose deaths involve an opioid. 21:45 The opioid crisis isn’t an anomaly – it is our healthcare system.  The key unwitting enabler is the employer.

Mar 8

56 min 4 sec

Stephen Nuckolls grew up listening to his physician father talk about how healthcare could save money for Medicare if it was accountable for outcomes. It was with this intent that he built Coastal Carolina Health Care (CCHC) in 1998, a multi-specialty practice managing 36,000 patients with 60 providers across 16 sites of care in Eastern North Carolina. CCHC serves in both urban and rural communities, with a mission is to promote the health of its patients by providing high quality, compassionate, comprehensive, and personalized health care. It’s no surprise that Stephen and his team formed one of the first 27 MSSP ACOs, Coastal Carolina Quality Care. Currently in the 8th year of the Medicare Shared Savings Program (ENHANCED Track), the ACO performs at the highest quality levels nationally and has saved consecutive years. The ACO exemplifies the vision of Stephen’s leadership, captured in the ACO’s slogan, “Tomorrow’s Health Care Delivered Today.” Episode Bookmarks: 05:00 Stephen reflects on the influence of his physician father who championed value-based care early on 05:40 Setting up Coastal Carolina Health Care, PA (CCHC), a multi-specialty group practice, in 1998 to be accountable for cost and quality 06:00 Leveraging ancillary services and electronic health records to prepare for the future state of value-based care 06:45 The passage of the Affordable Care Act in 2010 as an opportunity for Stephen’s practice to demonstrate value 07:00 Stephen and his physicians head to Washington, D.C. to collaborate with CMS on the early design of the Medicare Shared Savings Program 07:20 The struggles of balancing FFS and VBC in the early years of Coastal Carolina Quality Care (CCQC) ACO 08:45 “It’s not the actual doctor services that are expensive.  The real big costs are in hospitalizations.” 09:00 ACO Care Management dropped Hospital Admissions per 1000 by 22% 11:00 Engaging physicians in the early years of the ACO before Shared Savings performance 12:30 Mandatory transition to downside risk in the “Pathways to Success” MSSP final rule and how ACOs should evaluate potential for future success 13:30 Getting comfortable and fully understanding the ACO benchmarking methodology 13:50 “Ultimately we need to have risk in the game, but we need to recognize that different ACOs are in different periods in their transformation.” 14:00 How CCQC ACO is consistently ranked among the top performers nationally in quality measure performance, clinical outcomes, and Shared Savings returns 16:00 How having one practice in the ACO with one electronic health record supported quality outcomes 17:00 Selecting “true north” standardized quality measures that are managed consistently across the entire payer contract portfolio for all patients 17:20 Implementing a successful point-of-care quality measure reporting dashboard 18:00 Developing an equitable physician compensation/incentive structure as a key to success for driving quality 19:00 ACO concerns related to diminishing returns over time due to sustained performance in comparison to the benchmark 21:00 Advantages in specialist integration within the ACO due to multispecialty practice model 23:00 Capital investments required to build an ACO population health management infrastructure 26:00 Efficiencies gained by being a one-TIN/one practice ACO and how Advanced Payment ACO Model funds were used to build a Chronic Care Management program 27:00 Investments in automated dashboards for quality reporting to identify and manage gaps in care 28:00 Annual Wellness Visits (AWVs) as a source of funds for practice transformation in primary care 29:00 Reinvesting funds back into the ACO versus distribution to physicians 29:30 A recent investment in an “extended care” clinic  (a higher acuity center with ER physicians, hospitalists, and nurses) 31:00 How the extended care clinic resulted in an ER visit per 1000 rate of 25 for self-i...

Mar 1

52 min 32 sec

In this episode, reflect on the importance of Black History Month, an important time to recognize and honor the contributions and achievements of the millions of African Americans who have helped build our nation and enrich our culture. We also address racial disparities in care, which have become increasingly evident during the pandemic and vaccine distribution response. And we consider how value-based care can work to ensure true population health and parity in health outcomes for all. This week we are honored to speak with Dr. Lerla Joseph, an African American physician, businesswoman, humanitarian, role model, mentor, and philanthropist. In 2012, she founded the Central Virginia Coalition of Healthcare Providers (CV-CHIP) one of the nation’s few minority-owned Accountable Care Organizations. Dr. Joseph not only leads a successful ACO, she has also led medical missionary trips to Haiti for the last 16 years. As a community leader, she has also served on boards for Richmond Community Hospital and the Bon Secours health system and was the 1st woman elected President to the Richmond Medical Society. This year she was a "Strong Men & Women in Virginia History" Honoree, a program that honors prominent African Americans past and present who have made noteworthy and admirable contributions to the commonwealth, the nation, and their profession. Dr. Joseph is a shining example that black history is around all of us. Episode Bookmarks: 01:45 Black History Month is a time to contemplate the faith and sacrifice of every black ancestor. 03:00 “As leaders in value-based care, we endeavor to create the opportunity for health equity.” 03:30 Intro to Dr. Lerla Joseph, Founder and CEO of CVCHIP ACO (one of the few African American-led ACOs in the country) 05:30 “Of all the forms of inequality, injustice in health is the most shocking and inhumane” – Martin Luther King, Jr. 06:30 Outcomes research on racial disparities of care showing that inequities are built into the healthcare system. 07:45 A medical career devoted to bring about health equity to African Americans 08:20 "Having a health insurance card is not enough in terms of getting the proper care that African American need. Our populations needs physicians like them that understand their cultural background.” 09:20 The Accountable Care model as a vehicle for both access to care and health equity 10:50 How do we begin to have an open conversation as a society when it comes to recognizing systemic racism exists? 12:15 “Your health should not be determined by your zip code.” 14:15 Dr. Joseph speaks about her experience growing up with segregation and benefiting from affirmative action 16:05 An opportunity for America to overcome supremacy 16:55 Creating a movement for African Americans and White Americans to come together to have a conversation on race 18:20 Unwillingness of African Americans to take the COVID-19 vaccine due to past experiences that created distrust of health system 20:55 “As long as there are disparities in health care, the costs will remain high.” 21:20 Creating CVCHIP ACO with the recognition that African Americans were getting left behind in the value-based care movement 24:20 A recent study showing that life expectancy dropped sharply to its lowest level in 15 years, and even lower for Black Americans, during the first half of the coronavirus pandemic 25:35 The mission of CVCHIP to sustain the viability of the independent practice and how Dr. Joseph’s ACO helped practices during COVID-19 27:30 Implementing telehealth and ensuring patient access during the pandemic 29:00 The impact of COVID-19 on African American patients 30:00 Dr. Joseph’s medical missionary work in Haiti and her commitment to help others in the world 31:40 The most rewarding experience in her life and how she inspired others to serve 33:50 “Living in America, even with all of the disparities and inequities,

Feb 22

55 min 54 sec

Our health care industry excels at rescue care – when a patient needs to be saved, our system has answers. However, we are not well suited to address the challenges associated with serious illness, death and dying. Evidence shows that palliative care and advanced care planning improve health value. These tools lead to better management of pain and symptoms and improve both the quality and length of life. The preferences of patients and their families and caregivers are better accounted for, and their satisfaction is much higher. Healthcare utilization is reduced and outcomes are improved. ACOs that have successfully implemented a palliative care program have demonstrated reductions in 30-day readmissions, avoidable hospital admissions, and ED visits. So why do only 10% of ACOs have palliative care as one of their foremost strategies? Our guest this week is Stephen J. Bekanich, M.D., the co-founder and Chief Medical Officer of Iris Healthcare, a disease-specific advance care planning service. Prior to this he served as the CEO of Ascension Health’s Texas ACO (with 2,500 physicians and shared savings across government and commercial contracts), as well as the Chief Medical Officer of the health insurance joint venture between Cigna and Ascension Health. Before moving to Austin, he held the rank of Associate Professor of Medicine at the University of Miami Miller School of Medicine and the University of Utah’s Medical Center where he started and directed their palliative medicine programs. Episode Bookmarks:  05:00 A journey in health value that is heartfelt and deeply personal, as it is associated with a personal tragedy 06:45 The loss of grandparents to serious illness and the call to change medical specialization to palliative care 07:21 “The era of antibiotics and airbags” – people no longer dying from infections and trauma like they did historically 08:10 Serious illnesses (COPD, Dementia, late stage malignancies, CHF, etc.) have become the new killer in an evolved society 08:31 Society is not prepared to deal with serious illness and the inevitability of death 10:30 “It is incumbent upon us to get people better prepared for what they will be facing. Almost 85% of us will face serious illness, yet healthcare literacy skills are so low. Something is clearly wrong.” 11:00 Research showing 70-80% of people with incurable cancer believing they will be cured is a failure of physicians to appropriately set expectations. 12:30 Stephen’s shares the personal story of his grandmother’s terminal illness and the difficulty of confronting death 14:00 Palliative care as a force for value and the appointment of a palliative care expert to lead CMMI (Brad Smith) 15:00 “Over the past five to ten years, a number of studies have repeatedly demonstrated how 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%.” (Brad Smith) 16:00 Algorithms in population health incorrectly focus on last 6-12 months of life instead of providing a pathway to earlier intervention with Advanced Care Planning (ACP) 17:20 “In the last year of life, we are often delivering care that is unwanted, unnecessary, or nonbeneficial. That is not a good experience for patients and their loved ones.” 17:45 Patients with high symptom burden and in distress cannot focus in discussions about setting goals in care. 19:00 A calm environment prior to serious illness onset results in a better ACP conversation (better for patients). 19:30 Nonbeneficial care starts to occur in the last 12-15 months of life as a second reason to move interventions upstream (better for ACO bottom line) 20:20 Treatment plans should occur only after a patient is educated 22:35 “So much of palliative care is Advanced Care Planning.” (>70% of palliative care consults related to goals of care and ACP)

Feb 15

1 hr 6 min

An industry inflection point is coming in the transition to value: federal and state governments are feeling an insurmountable level of pressure as public debt and spending increase, large employers are reeling from high healthcare costs, and provider organizations are being crushed by the current environment as they realize that FFS is perilous in the middle of a pandemic. Health system executives not leading with a strategy in health value are increasingly facing significant financial uncertainty. The coming industry shift to value is all but inevitable, however, pivoting successfully will require long-term strategic planning and investment in cultural alignment, technology and infrastructure, and partnerships. When Travis Turner heard Dr. Don Berwick speak about the transformation to population health and value-based payments, he listened. Berwick had said the worst position to be in when transitioning from fee-for-service is static, stuck with a foot in each canoe – the change must be fast to achieve critical mass that enables modifying provider behavior. This became a priority for Travis, something that has been aggressively pursued and which has driven to his organization’s success. This week, we speak with Travis Turner, SVP Chief Population Health Officer and COO of Mary Washington Medicare Advantage at Mary Washington Healthcare. Mary Washington Health Alliance is a physician-led, physician governed CIN – founded in 2013, the ACO has 437 participants that cover around 60,000 lives. During the 2017 MSSP performance year, the ACO achieved $11.9 million in savings. For the first three years it participated in the CMS Bundled Payment for Care Improvement program, it achieved $12.6 million in savings. The ACO now participates in the Next Generation ACO model and is active in the BPCI Track 2 for all 48 episodes of care. Episode Bookmarks: 3:30 The inflection point in value-based care for employers, providers, and government 4:40 The value-based care journey of Mary Washington Health Alliance (MWHA) over the last 7 years 6:15 Transitioning from the upside-only MSSP to taking institutional risk in the NextGen ACO and BPCI programs 7:25 Entering downside risk by applying lessons learned from other value-based contracts 7:40 Reaching a critical mass in value to change the behavior of providers 8:00 Don Berwick’s influence on MWHA’s fast transition to value 10:00 “There has to be a bottom-up, top-down acceptance at every level for population health to succeed in a value-driven organization.” 10:30 Travis reflects on the slow uptake of value-based care in the national landscape and how learning environments will catalyze adoption 11:10 VBC is key to partnering with independent physicians 11:30 “Reaching critical mass in value is all about achieving the Triple Aim. That will overcome any perceived risks of demand destruction.” 12:15 The challenges of adapting to CMS changes to payment models 13:30 NEJM on care patterns in Medicare and the challenges of fragmented, uncoordinated care 14:30 “A true, clinically integrated network will be able to drive enterprise-level change with data.” 15:30 The challenges in siloed initiatives like Oncology Care Model and ESRD Treatment Choices Model in driving system change 16:00 Democratization of data with FHIR-based technologies and how that will improve population health analytics 16:45 Success in clinical integration means treating all patients the same (even those that are not attributed to value-based contracts) 19:15 Taking advantage of clinical integration by entering into single-signature commercial agreements 19:45 Stark and Anti-Kickback concerns associated with clinically integrated networks 20:15 The win-win-win advantages of employer and health system partnerships 20:45 Single negotiated rate advantages with clinical integration 22:25 How FFS can co-exist with VBC in reaching critical mass in value

Feb 8

1 hr 3 min