Welcome to Episode 292, Part 2. This is the second part of a two-part episode, but, in a way, you can listen to whichever part you want first. So, if you wound up here first, no worries. Just go back when you have a sec and listen to Part 1. There’s some good stuff there you don’t want to miss, including some background information that might be good to have.

This episode, as well as the last one, is about Teladoc buying Livongo. I am going to call the combined organization T&L because I heart acronyms as much as you do.

Here’s the thing with T&L: They are not alone in their quest to disrupt the traditional health care delivery market. You also have Aetna making a plan design that advantages CVS clinics. You got Humana doing the home health thing. You got Walmart and Oak Street hooking up in Texas and risk contracting with managed Medicaid and Medicare Advantage. You have employers across the country direct contracting with Centers of Excellence and buy in perspective bundles. Also, speaking of employers, on the on-site clinic space, Premise Health just recently acquired CareHere. These two organizations will reach 11 million eligible lives at 2200 customers in 300 markets.

All this being said, let me make a fairly obvious point: Increasingly, the competition is going to be about outcomes—or perceived outcomes. Competition is going to be around the value delivered (ie, quality divided by cost). This I like. To me, it’s a tragedy that the health care industry can get away with charging prices no one would consider fair and delivering subpar health care let alone health.

I want some of these organizations that do a really nice job coordinating care and which patients really appreciate to do well by doing good. And I love that some of the payers out there—some of the employers and even some of the Medicare Advantage and other health plans—recognize the value that these organizations can deliver.

But let’s consider the implications of this—notably, here’s one: Few, probably even the very best, for example, endocrinology practices or maybe even cardiology practices, have a bead on how well they ultimately attenuate downstream medical costs. They might not even know, outside of what they are required to report for quality incentives, how well they are consistently creating better patient outcomes.

Livongo does—or at least claims they do—and lots of employers and plans buy the results they’re selling to the tune of something like $300 million in sales this year. Here’s what I don’t like: What is shaking out is a turf war, and the weapon of choice may or may not be authentically better patient outcomes. Some of the weaponry here is built on a marketing “chassis.” The one who has the best marketing shall triumph. People judge books by their covers, and that’s a cliché for a reason.

You can read Al Lewis’s blog post on Livongo, where he dug into their purported results. Then listen with your left ear to some of the chatter on the street about how Livongo is more of an employee retention tool than, you know, a clinical tool. I don’t kn0w where these rumors started, but I keep hearing that because the Livongo NPS (Net Promoter Score) is high and employees, including executives, think it’s pretty cool as a service, that maybe, given this, that it’s okay if many of the Livongo charts and graphs don’t have labels on their Y axes. And it kind of, you know, makes sense if you actually sit there and stare at them as I have done.

All this I just said? Background noise. The games have begun, and the winners will be those who consumers/patients love. It’ll be the ones who know how to market to employers or Medicare Advantage plans. It’ll be the ones who can succeed in risk-based models. There you go. There are your three success factors.

In this health care podcast, I speak with Matt Anderson, MD, MBA. Matt sees the ecosystem through the eyes of an innovation leader at a health system. And my finale interview of our two-part series here is Brian Klepper, PhD, principal over at Worksite Health Advisors. Brian will speak from the POV (point of view) of employers.

You can learn more at bannerhealth.com and drmatthewanderson.com and connect with Dr. Anderson on Twitter at @DrAnderson19 and on LinkedIn. You can also learn more at careandcost.com, by emailing bklepper@gmail.com, and by visiting validationinstitute.com.

Matthew Anderson, MD, MBA, has a passion for finding unique solutions to difficult problems in health care. He focuses on creating environments that allow patients and physicians to have frictionless experiences. Through insights gained in private practice, leading physician groups, and embedding himself in the health care innovation landscape, he can empower those looking to improve the health of communities and the well-being of those that dedicated their lives to providing care. He has been a business owner, medical director, and chief medical officer and now leads clinical innovation projects for Banner Health and advises several health care start-ups and venture teams.

Brian Klepper, PhD, is executive vice president of the Validation Institute, principal of Worksite Health Advisors, and a nationally prominent health care analyst and commentator. He speaks, writes, and advises extensively on high-performance health care, primary care clinics, and the management of clinical and financial risk.

His current consulting focus is on health care organizations that consistently deliver better health outcomes at lower cost than conventional approaches in high-value niches. In his role at the Validation Institute, he spearheads programs that identify, validate, celebrate, and promote true high-performance health care programming.

05:06 What is the viewpoint about this merger from an MD, MBA in a health system? 06:30 “They’re really starting to become someone who can provide that continuity of care in a way that I don’t think anyone’s really done before.”—Matt 07:38 “When you are competing for patients, by definition you’re competing for revenue.”—Matt 10:09 “At baseline, their goal is to provide care but at the lowest cost possible.”—Matt 12:17 What is a forward-thinking provider organization doing right now? 12:31 “This is going to be a space race for health care innovation right now.”—Matt 15:43 “Sometimes it just comes down to the basics, and if you get the basics right, you can apply it in any situation.”—Matt 16:29 What’s forced the inertia in the industry to become action? 17:23 “Things are moving slowly but surely in the right direction, and that’s something I’ve never seen during the course of my career.”—Brian 19:56 “Everybody and his wooden-legged brother claims that they have a high-value service, but very few actually do.”—Brian 21:13 “I think that the stakes have just gotten much higher for health systems … and physicians … of all types.”—Brian 23:46 EP252 with Chad Gray.25:12 “High-performance organizations represent a new paradigm in their niche.”—Brian 25:35 “It speaks to the core problem of American health care, which is that we’ve developed a culture of excess.”—Brian 27:42 Where’s the top of the bell curve right now? 28:10 “A lot of this is driven by policy … and that has sort of rigged the game.”—Brian 29:46 “There’s a tipping point, and then everything really, really will change quickly.”—Brian

You can learn more at bannerhealth.com and drmatthewanderson.com and connect with Dr. Anderson on Twitter at @DrAnderson19 and on LinkedIn. You can also learn more at careandcost.com, by emailing bklepper@gmail.com, and by visiting validationinstitute.com.

Check out our newest #healthcarepodcast with @DrAnderson19 and @bklepper1 as they discuss the Teladoc-Livongo merger. #healthcare #podcast #digitalhealth #telehealth

“They’re really starting to become someone who can provide that continuity of care in a way that I don’t think anyone’s really done before.” @DrAnderson19 discusses the Teladoc-Livongo merger. #healthcare #podcast #digitalhealth #telehealth #healthcarepodcast

“When you are competing for patients, by definition you’re competing for revenue.” @DrAnderson19 discusses the Teladoc-Livongo merger. #healthcare #podcast #digitalhealth #telehealth #healthcarepodcast

“This is going to be a space race for health care innovation right now.” @DrAnderson19 discusses the Teladoc-Livongo merger. #healthcare #podcast #digitalhealth #telehealth #healthcarepodcast

“Things are moving slowly but surely in the right direction, and that’s something I’ve never seen during the course of my career.” @bklepper1 discusses the Teladoc-Livongo merger. #healthcare #podcast #digitalhealth #telehealth #healthcarepodcast

“Everybody and his wooden-legged brother claims that they have a high-value service, but very few actually do.” @bklepper1 discusses the Teladoc-Livongo merger. #healthcare #podcast #digitalhealth #telehealth #healthcarepodcast

“It speaks to the core problem of American health care, which is that we’ve developed a culture of excess.” @bklepper1 discusses the Teladoc-Livongo merger. #healthcare #podcast #digitalhealth #telehealth #healthcarepodcast

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