The Healthcare Policy Podcast ® Produced by David Introcaso

Listen NowListeners may recall, I have previously discussed the opioid epidemic this past February 2 with Dr. Steve Passik concerning abuse deterrent formulations and on November 16, 2016 with Dr. Ann Lembke regarding her work, "Drug Deal MD."  Tragically, the opioid epidemic continues unabated.  In 2017 there were 72,000 drug overdose deaths, among these 29,000 were from synthetic opioids, predominately fentanyl.  While Mr Chase's work examines the cause of the opioid epidemic and what could be done to reduce fatalities, it is moreover a study that attempts to explain what accounts for massive dysfunction in health care delivery that causes, as I note in the podcast's introduction, Americans to spend $1 trillion annually on health care coverage and services that do not improve their health.During this 30 minute conversation Mr. Chase explains what prompted his writing this work and what explains, in his view, the opioid crisis.  Moreover, he explains the problem with health care as one moreover one of pricing failure, how payers, moreover self-insured employers, can more competently purchase more affordable coverage for their employers and provides examples or organizations that have lowered their health care spending.  He also discusses direct primary care, ERISA, insurance risk pool size, medical loss ratios (MLRs) and his efforts at credentialing use of The Health Rosetta blueprint. Mr. Dave Chase is the co-founder of The Health Rosetta, described as an open source blueprint for the next generation's health ecosystem.   Mr. Chase's first book, "The CEO's Guide to Restoring the American Dream: How to Delivery World Class Healthcare to Your Employers at Half the Cost," became a Kindle #1 best seller.  Mr. Chase and The Health Care Rosetta focus on replicating health economies that rebuild hope and community through improved outcomes, lower spending and higher performing models.   Information on Mr. Chase's book is at: https://healthrosetta.org/friends/For more on The Health Rosetta, go to: https://healthrosetta.org/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen Now The below November 7th podcast post provides a link to an essay that, in part, provides an overview of the United Nation's International Panel on Climate Change's (IPCC's) recent report titled, "Global Warming of 1.5°C."  As noted in the essay, what is particularly noteworthy about the IPCC's report is its conclusion that keeping or holding temperature increases to below 2°C, the goal of the Paris climate accord, would not avoid the more serious effects of global warming.  For example, at 1.5°C of warming a significant percent of vertebrates, insects and plants would lose half of their climatically-determined geographic range and 70 to 90 percent of coral reefs would be lost.   During this 28 minute conversation Professor Kirstie Ebi begins by briefly explaining the IPCC's work, she then discusses several of the findings in chapter 3, that she co-authored and is titled, "Impacts of 1.5°C Global Warming on Natural and Human Systems.," Professor Ebi makes note of the international climate change research communities' upcoming meeting in Poland, next issue of the US's Climate Science Special Report, anticipated in December, and comments on the health care industry's responsibility and opportunity to contribute to solving the climate crisis. Professor Kristie L. Ebi, is the Director of the Center for Health and Global Environment (CHanGE) and the Rohm and Haas Endowed Professor in Public Health Sciences at the University of Washington.  She is the author of multiple national and international climate change assessments, including the IPCC's recently published Report on Global Warming of 1.5C.  Professor Ebi co-chairs the International Committee on New Integrated Climate change assessment Scenarios (ICONICS) that created five scenarios of socioeconomic development over this century.  Professor Ebi's scientific training includes a MS in toxicology and a Ph.D. and a Masters of Public Health in epidemiology and two years of post-graduate research at the London School of Hygiene and Tropical Medicine  She has edited four books on aspects of climate change and over 200 publications.The IPCC report is at: http://www.ipcc.ch/report/sr15/ Though not noted during this discussion, it's worth noting here the much discussed essay by Will Steffen and colleagues published this past August in the Proceedings of the National Academy of Sciences (PNAS) regarding "hothouse earth."  The essay, "Trajectories of the Earth System in the Anthropocene," is at: http://www.pnas.org/content/115/33/8252 This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowSoon after the 9/11 attacks the Congress created the Victim Compensation Fund (VCF).  Initially, the VCF was created to award moneys to 9/11 victims or their families.   Awards were made through 2004.  In 201o1 the Congress passed the James Zadroga 9/11 Health and Compensation Act, named after a 34-year old NYC policeman who died in 2006 of 9/11 related illness, was created to compensate first responders and individuals who later developed 9/11-related health problems including numerous forms of cancer and PTSD.   The fund was re-authorized in 2015 by President Obama for five years (it will will sunset in December 2020).  Because of the ever-increasing number of 9/11-related illnesses the VCF Special Master, Rupa Bhattacharyya, recently noted the fund could run out of moneys before all claims are resolved.  Ms. Bhattacharyya recently posted a Federal Register notice soliciting comments asking the public how the remaining funds should be allocated.  During this 28 minute interview, Mr. Barasch discusses his firms 9/11 experience.  Located at ground zero, half his employees have since succumbed to cancer or are currently battling the disease.  He provides an explanation why the EPA came to determine the air quality at ground zero was safe (it definitively was not), provides an overview of the VCF and the related World Trade Center Health Program, his firms work in representing 9/11 victims seeking VCF settlements, efforts to solicit the Congress to further fund the VCF and the prospects of a wrongful death civil suit filed against the Saudi Arabian government (15 of the 19 9/11 terrorists were Saudis).  Michael Barasch is the Managing Partner of Barasch & McGarry, lawyers for the 9/11 community.  His firm has represented over 11,000 victims of 9/11 in their pursuit of a VCF settlement.  Ms. Barasch is a graduate of Fordham Law School.  For more on Barasch & McGarry go to: https://www.personalinjuryjustice.com/ Barasch and McGarry's VCF-related work can be found at: 911victimfund.comThe Department of Justice's VCF info is at: www.vcf.gov  & DOJ's VCF helpline is: 1.855.885.1555. Concerning the Federal Register notice "September 11th Victim Compensation Fund: Compensation of Claims" (comments due December 3), see:  https://www.federalregister.gov/documents/2018/10/03/2018-21490/september-11th-victim-compensation-fund-compensation-of-claims  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowEarlier this month the United Nation's Inter-governmental Panel on Climate Change (IPPC), the world's definitive body on the subject, concluded we have just 12 years, or until 2030, to avoid global temperatures rising above 1.5 degrees Celsius (or 2.7F).  We've already warmed by 1C.   Among other consequences, if we warm to 2.0C (or 3.6F) we will lose 99 percent of our coral reefs.  We are presently on track to warm to 4C by the end of this century - that the Trump administration, via a National Highway and Traffic Safety Administration (NHTSA) environmental impact stated, admitted in August.  This means we will have to reduce carbon emissions by 50% by 2030 and achieve net zero emissions by 2050.  (The US is historically the largest emitter of greenhouse gasses and currently second behind China.  Worldwide, we currently dump 42 billion tons of greenhouse gasses into the atmosphere annually and the amount has been again climbing since last year.)  As I noted in a November 13, 2017 3 Quarks Daily essay (a link to which was posted on this podcast that month), there is no climate analog for this century for at least the past 50 million years.  Should the atmosphere warm by 2C (the Paris Climate Accord goal was between 1.5 to 2), the earth as we know it will largely cease to exist.   Therefore, it is a particularly good time to examine what the health care industry, the second largest emitter of greenhouse pollution after the food industry, is doing to reduce its carbon footprint. During this 28 minute podcast Ms. Jessica Wolff discusses, in sum, efforts  by Health Care Without Harm (HCWH) to achieve reductions in the health care industry's carbon footprint.  She explains why HCWH was formed, provides an overview of its current mission is to reduce the industry's carbon footprint, discusses how specifically the industry is addressing the problem (via mitigation, resilience and leadership), highlights related initiatives, e.g., the recently formed California Health Care Climate Alliance, identifies leaders in the industry and what they are doing, e.g., Kaiser, and discusses opportunities the industry is and can take to influence and/or reform state and federal climate change policy.Ms. Jessica Wolff is the US Director of Climate and Health for Health Care Without Harm (HCWH).   Prior to her current position she was the Environmental Sustainability Adviser at Dartmouth-Hitchcock Health.  Prior still she worked as a women's health nurse practitioner and as a health center director.  She holds an MBA from the Isenberg School of Management at the University of Massachusetts, Amherst, a degree in Environmental Studies from Oberlin College and a Master's in Nursing from the University of Pennsylvania.For information on HCWH go to: https://noharm.org/.The IPCC report is at: https://www.ipcc.ch/report/sr15/.On August 3 , 2017, I interviewed David Wallace Wells regarding his global warming article published in July 2017 in  New York Magazine.  It was titled, "The Uninhabitable Earth."  It is at: https://nymag.com/intelligencer/2017/07/climate-change-earth-too-hot-for-humans.html?gtm=bottom>m=top.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowCurrently, CMS is accepting public comment on a proposed Medicare Shared Savings Program (MSSP), known more commonly as the Accountable Care Organization (ACO) program, rule.  The MSSP, created under the 2010 Affordable Care Act, is Medicare's flagship pay or performance program currently providing care to over 10 million Medicare beneficiaries.  MSSP or ACO performance, or to the extent the program has reduced Medicare spending growth, has been widely debated largely because CMS has failed to evaluate the program  Under this administration the program has come under substantial criticism.  The proposed rule, published this past August 17 in the Federal Register, is this administration's effort to improve the program's performance moreover by reducing the number of years an provider can participate in the program, from six years to two, without taking financial risk or participate in what are termed upside only contracts.  The administration argues absent financial risk providers do not fully engage in practice reforms to reduce spending.  This assumption is also widely debated.  Absent other substantial payment innovations, the success of the MSSP or ACO program is vital to the Medicare program, now forcasted to go bankrupt in 2026. During this 30 minute conversation Mr. Gronniger begins with a a brief overview of Caravan's work, he discusses or explains what success the ACO program has achieved to date and the program's background.  He moves onto discussing numerous elements of the proposed rule including earned shared savings percents, risk adjustment, aspects of financial benchmarking, low and high revenue ACOs, and beneficiary engagement and incentives, among others.     Mr. Tim Gronniger is currently the Senior Vice President of Development and Strategy at Caravan Health.  Previously, he served as Chief of Staff and Director of Delivery System Reform at CMS.  Previous to that, Mr. Gronniger  was Senior Adviser for Health Care Policy for the White House Domestic Policy Council.  Before that he served as senior professional staff to the Ranking Member of the House Committee on Energy and Commerce, Rep. Henry Waxman (D-CA, now retired).  Mr. Gronniger began his career in Washington, D.C. at the Congressional Budget Office where he studied or scored Medicare and Medicaid legislation.  Mr. Gronniger holds a Masters in Public Policy and Health Services Administration from the University of Michigan and a BA in Biochemical Sciences from Harvard. The proposed ACO rule is at: https://www.federalregister.gov/documents/2018/08/17/2018-17101/medicare-program-medicare-shared-savings-program-accountable-care-organizations-pathways-to-successFor information concerning Caravan Health go to: https://caravanhealth.com/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowDespite the fact social circumstances and environmental factors account for approximately 20% of an individual's health status, twice that of medical care at approximately 10%, social circumstances or social determinants of health are frequently unaddressed by health or medical care providers.  This is largely because medical care providers are neither trained to provide social service supports such as housing and transportation nor compensated for doing so.   As a result persons left with unmet health-related social needs suffer more disease burden leaving them to over-utilize or seek comparatively more health care services, for example ED visits, - or services that could have been avoided had their health-related social needs been initially addressed.      During this 24 minute conversation Ms. Moore begins by noting the current state of Medicaid expansion efforts in Utah.  She proceeds to explain Intermountain's reasons or motivations for creating the Alliance, she provides an overview of the Alliance's programming activities in Ogden and St. George that will address, for example, housing, transportation, food security and behavioral health services related, in part, to interpersonal violence, the initiative's relation to Intermountain's Medicaid insurance plan, SelectHealth, to the Medicare program's Accountable Health Communities demonstration, and what the Alliance's evaluation will measure in tracking the initiative's progress or success.  Ms. Mikelle Moore is the Senior Vice President for Community Health at Intermountain Healthcare.  Her work is moreover focused on prevention and population health.  Prior to her current position, she served as Administrator of the LDS Hospital.  She joined Intermountain as an Administrative Fellow in 1998, serving as Assistant Administrator and Operations Officer in the Central Region.  She is a Fellow in the American College of Healthcare Executives and serves on the national Advisory board for the Association for Community Health Improvement. She is also active on other not for profit boards and community initiatives.  Ms. Moore earned her MBA in health services administration from Arizona State University and her undergraduate degree in physiology from the University of Arizona.  For more information on the Alliance go to, e.g., https://intermountainhealthcare.org/blogs/topics/transforming-healthcare/2018/07/new-alliance-seeks-to-address-the-social-determinants-of-health/. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowIn the recent past the federal government has made several efforts to expand the use of telehealth and Remote Patient Monitoring (RPM) services.  Related provisions can be found, for example, in the 2017 CONNECT Act, the Bipartisan Budget Act of 2018 and in federal regulatory rule making, for example, the current 2019 proposed Medicare Physician Fee Schedule (PFS) rule, and in payment waivers for certain Medicare pay for performance models, for example, ACOs, where telehealth "originating site" and service area use restrictions are waived.  Even with these reforms telehealth/RPM spending in, for example, the Medicare program still amounts to approximately $30 million annually, or an almost immeasurable fraction of the program's $700 plus billion in annual spending.   Increased spending under Medicare (and Medicaid) aside, few are convinced adoption of these technologies should occur at the so called speed of government, where old or current IT solutions are largely validated, is adequate.   During this 24 minute conversation Mr. Shankman briefly describes AMC Health's work, what explains the lag in telehealth/ RPM adoption and why now or what circumstances today hold promise for far more rapid adoption or use of telehealth/RPM.  He provides several examples or telehealth/RPM use and what outcomes are or can be achieved. Jonathan Shankman is currently Senior Vice President of Clinical Innovation at AMC Health, a New York-based remote and real time healthcare monitoring company.  Mr. Shankman has more than 25 years of experience as a research gerontologist, developing and analyzing new paradigms of chronic care delivery for the elderly and disabled across all segments of the care continuum.  At AMC Health, Mr. Shankman is responsible for development of products that weave technology and clinical best practices into virtual care solutions that address a broad array of chronic and acute illness challenges.  He also focuses on the application of analytics that support the development of clinical decision support tools.  Previously, at the Metropolitan Jewish Health System, Mr. Shankman held progressive leadership positions with the nonprofit, geriatric services organization serving the New York metropolitan area.  Mr. Shankman was graduated from Columbia University with a Masters of Public Health in gerontology, an MBA and a BA.  For more on AMC Health go to: www.amchealth.com.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowAccording to a recent Kaiser/Washington Post survey 59 percent of Americans support Medicare for All (M4A).  Per a March New England Journal of Medicine poll 61 percent of physicians said single payer would make it easier for them to deliver cost-effective, quality health care.   Currently, before the House is legislation titled the "Expanded and Improved Medicare for All Act" with over 120 sponsors.  (The legislation has been introduced every session since 2003.)   The House has recently also formed a Medicare for All caucus with 70 Democratic members and if the Democrats win back the House this November they have promised M4A hearings.  The Senate has a parallel bill, the "Medicare for All Act of 2017," currently with 16 cosponsors, several of whom are potential 2020 presidential candidates.  Though there is, again, substantial criticism of M4A, e.g., CMS Administrator, Seema Verma, recently denounced it as "government run socialized health care" (an odd complaint since that is exactly what the current Medicare and Medicaid programs are).  Because of the disruption, dismantling or sabotage of the ACA under the Trump administration and moreover because health care continues to be ever increasingly unaffordable (and bankrupt, the Medicare Part A Trust Fund is now projected to be insolvent in 2026), as is frequently phrased, M4A is, again, on the table. During this 37 minute conversation Professor Friedman provides a general definition of Medicare for All healthcare, how it would be financed and how savings be derived and what amount.  He explains what is current public opinion, what are credible criticisms of M4A and what promising single payer efforts are underway in the states.   Dr. Gerald Friedman is Professor and Undergraduate Program Director of Economics at the University of Massachusetts at Amherst.  Prior to, he worked as research staff for the International Ladies' Garment Workers' Union.  Professor Friedman is the author of multiple books and articles on labor relations and healthcare economics.  He has been a correspondent to television and media outlets, a consultant to labor unions and has drafted funding plans for campaigns for single payer health insurance in several states including New York, Maryland, Pennsylvania, Colorado, Oregon and Washington and a federal plan for the US.  He serves on the Board of Advisers to the Business Initiative for Health Policy.  Professor Friedman earned his undergraduate degree from Columbia College and his Ph.D. in economics from Harvard.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowOver the past several years the Congress and Medicare regulators have discussed reforming the 1989 Ethics in Patient Referral Act.  Otherwise known as the physician self-referral or more commonly termed Stark law (named after the former California House member, Pete Stark, the initial sponsor of the bill).  Stark law is today widely viewed as an impediment to care coordination or payment models that financially incent providers to improve care, care coordination and reduce spending growth, or moreover Accountable Care Organizations (ACOs) and bundled payment arrangements, because as implied the law prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or immediate family member has a financial relationship.  Beyond the complexity of the law, its strict liability provision, potential substantial fines imposed under the law, exposure to False Claims liability and Medicare exclusion, there has been increasing sentiment the law generally does not have a place in today's pay for performance or pay for value world.   Most recently, this past June 25th DHHS published a Request for Information (RFI) soliciting stakeholders to offer comments on improving Stark law and most recently, or on July 17th, the House Ways and Means heard related testimony.      During this 27 minute conversation Ms. Hooper Kearbey discusses her work related to Stark law, the numerous current problems with the law and areas where the law can be improved.  She notes the current DHHS Stark RFI, e.g., to what extent improved transparency about a physician's financial relationships could help improve the law and and makes comment on the use of gainsharing in current pay for performance arrangements.    Ms. Amy Hooper Kearbey is a attorney and partner with the DC-based law firm, McDermott Will & Emery.  Her practice focuses on providing Medicare regulatory coverage, coding, reimbursement and compliance as well as advice regarding federal fraud and abuse regulations and clinical research compliance.   She is a member of the District of Columbia Bar Association, the American Health Lawyers Association and the National Blood Clot Alliance.  She earned her law degree from the Duke University School of Law and her AB from Dartmouth. The Stark RFI is at: https://www.gpo.gov/fdsys/pkg/FR-2018-06-25/pdf/2018-13529.pdf and related July 17 testimony by four witnesses before the House Ways and Means Committee is at: https://waysandmeans.house.gov/event/hearing-on-modernizing-stark-law-to-ensure-the-successful-transition-from-volume-to-value-in-the-medicare-program/.   This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

Listen NowWhile coverage under the Affordable Care Act (ACA), Medicare and Medicaid enjoy, deservedly, a great deal of discussion and debate, employer-sponsored insurance (ESI) insures approximately 55% of the non-Medicare eligible population, or approximately 152 million Americans.  (Medicaid insures 19.5% of the population and Medicare 16%).  Larger employers, or those with over 500 employees, are moreover (82%) self insured, 26% of smaller employers are as well.  What we know about ESI and what further we can learn is therefore of substantial importance.   During this 25 minute conversation among other comments Mr. Brennan outlines HCCI's research, he explains what drives ESI spending growth, what employers are doing to control prices, he provides an overview of his recent testimony before the Senate HELP Committee and makes comment on data transparency and the employer health insurance tax exclusion. Mr. Niall Brennen is the President and Executive Director of the Health Care Cost Institute (HCCI) since June 2017.  Immediately previously, he served as the Chief Data Officer at CMS.  He has also worked at the Brookings Institution, the Medicare Payment Advisory Commission (MedPAC), the Congressional Budget Office (CBO), the Urban Institute and Price WaterhouseCoopers.  He has published widely in leading academic journals including The New England Journal of Medicine and Health Affairs.  Mr. Brennan received his MPP from Georgetown University and his BA from the University College Dublin, Ireland.   For more on HCCI go to: http://www.healthcostinstitute.org/.  This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com