The Race to Value Podcast

We have a broken healthcare system. Too often, individuals today experience care that is fragmented, duplicative, wasteful, and confusing.  Through value-based care, we can improve the health care experience by coordinating care, creating care teams that communicate with one another, and supporting individuals in their care journey with services that address their medical and non-medical needs. Accountable for Health is a nonpartisan national advocacy and policy analysis organization accelerating the adoption of effective accountable care. Their members are advocating for value-based care on Capitol Hill so policymakers can understand how best to move American healthcare towards a model that achieves better outcomes, improved care experiences, increased access, and lower costs. Joining us on the podcast this week is Mara McDermott, the Chief Executive Officer for Accountable for Health.  She is an accomplished healthcare executive with deep expertise in federal healthcare law and policy, including delivery system reform, physician payment and payment models. Take this opportunity to learn from a leading expert on accountable care as she translates the truth in building a bridge towards a more broad-based understanding of health value.  And make sure to tune in to Mara’s special announcement about Health Care Value Week at the end of the interview so you don’t miss out on important educational events occurring January 29th thru February 2nd. Episode Bookmarks: 01:30  The need for accountable care policies that create better health outcomes and patient experiences. 02:00  Introduction to Accountable for Health (A4H) and its Founder/CEO Mara McDermott, JD, MPH 03:00  Interview topics discussed (e.g. the meaning of VBC, MSSP vs. MA, MACRA 2.0, advanced APMs, integrated specialty care, Medicaid transformation, and the upcoming Health Care Value Week event). 06:00  How A4H is translating thought leadership to action in the advocacy arena. 06:30  Accountable care as the solution to fragmented, uncoordinated care. 07:00  Political turnover in D.C. has made VBC a “new” health policy solution. 07:30  Educating the Hill comes down to conveying enthusiasm for health care transformation. 08:00  Accountable for Health Members are shaping the national conversation for payment and delivery system reform. 09:00  The health policy controversy of the Global and Professional Direct Contracting model (the precursor to ACO REACH). 11:30  If Direct Contracting was the natural evolution of a series of advanced ACO options, why was there such strong criticism? 12:00  The need to overcome misunderstandings about what ACOs are trying to achieve. 13:00  Providing education to dispel the myth that ACOs can actually limit services. 14:00  How uninformed policy decisions could potentially create a catastrophic blow to the value movement. 14:45  “Accountable care is integral to care delivery system reform.” 15:45  Confusion with the term “value-based care” and why it will fail unless people understand the truest aims of the movement. 17:00  The need for effective storytelling to advance care delivery transformation. 18:00  Prioritizing care experience over cost reforms (delivery innovation will address costs!) 20:00  The topline takeaways from CMS model evaluations and whether or not programs should be expanded. 21:00  What do most people think when they hear the word “value”? (the need to reframe the conversation with more precise language) 22:00  The MSSP and the Medicare Advantage programs as two distinct approaches to healthcare delivery and reimbursement. 24:00  Mara provides a brief comparison between MSSP and MA (e.g. beneficiary assignment, risk adjustment, benchmarking). 25:30  How strong relationships between MA plans and provider networks (underpinned by capitation) drive value. 26:30  Understanding provider compensation in MA value-based payment and the synergies between managing MSSP and MA populations. 27:00  Rethinking supplemental benefits in Traditional Medicare. 28:00  An overview of the Medicare Access and CHIP Reauthorization Act (MACRA). 30:30  The “cliff effect” of the Advanced APM Bonus reductions (and why that threatens the value movement). 31:30  “We need strong incentives to continue this work in accountable care transformation.  The Advanced APM Bonus has built important momentum.” 32:30  The MIPS program maximum bonus is at 9% — in what world would the Advance APM incentive make sense at only 0.5%? 33:00  Why are providers in the last year earning full bonuses in MIPS when 2-3% has been the historical average? 33:30  An overview of The Value in Health Care Act of 2023 and consideration of a full-risk ACO option in the MSSP. 35:45  The need for a long-term vision for MACRA (i.e. MACRA 2.0). 38:45  The integration of specialists in accountable care models. 39:30  Leveraging the physician fee schedule as a glide path for specialist adoption.  Providing data to ACOs to better engage specialists. 41:00  The responsibility of the Physician-Focused Payment Model Technical Advisory Committee (PTAC) to advance specialty-specific APMs. 41:45  The move to mandatory payment models to catalyze healthcare cost savings goals for CMMI. 45:00  How are Medicare-value based efforts aligning with Medicaid transformation? 47:00  Health Care Value Week is a week of action from January 29th to February 2nd, providing broad-based education on VBC. 48:30  The Virtual Value-Based Payment Summit is open to everyone (free registration) and the speaker lineup is incredible! 49:30  A4H’s Health Care Value Week Conference in D.C.on Feb. 1st to celebrate the progress of VBC in improving people’s lives! 51:00 Learn more about A4H and sign up for their newsletter at accountableforhealth.org.

The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.” As our planet grapples with the accelerating impacts of climate change, it is crucial that we adopt a climate lens in the value transformation of our healthcare industry. The repercussions of climate change extend far beyond environmental shifts; they manifest in various health issues, including challenges with clean water access, increased allergens, respiratory diseases, heat induced illnesses, and the proliferation of infectious diseases. It’s essential to acknowledge that while climate change affects everyone, the burden falls disproportionately on historically marginalized populations, highlighting the interconnectedness of climate impacts and social determinants of health in underserved communities. In our pursuit of delivering safe, effective, and efficient care amid the climate crisis, we as healthcare leaders also bear the responsibility to address the substantial greenhouse gas emissions generated by the sector. Accounting for nearly one fifth of the U.S. gross domestic product, the healthcare industry possesses considerable purchasing power that can be harnessed to steer the nation toward cleaner energy and a low carbon supply chain. Beyond mitigating environmental harm, embracing preventive models of care and enhancing care quality that lowers excess utilization naturally aligns with lower carbon footprints. Value-based care, therefore, can become a powerful catalyst in propelling us toward a net zero carbon future that will build a sustainable, resilient future for our planet. This week we are  interviewing Dr. Vivian Lee, a healthcare executive dedicated to the advancement of value-driven transformation in health and tackling climate change. Author of the acclaimed book,The Long Fix: Solving America’s Health Care Crisis with Strategies that Work for Everyone, she is an Executive Fellow at Harvard Business School and Sr Lecturer at Harvard Med School. Prior to her Executive Fellowship at Harvard, she was the founding President of Verily Health Platforms, an Alphabet company combining a data-driven, people-first approach to precision health.  Dr. Lee is also a former health system CEO, medical school Dean and member of the National Academy of Medicine. She is regularly listed among Modern Healthcare’s Most Influential Clinical Executives as well as Modern Healthcare’s Most Influential People in Healthcare.   Episode Bookmarks: 01:30  The World Health Organization has declared climate change as “the greatest threat to global health in the 21st century.” 02:00  Climate change burden falls disproportionately on historically marginalized populations. 02:30  The responsibility to address the substantial greenhouse gas emissions generated by the healthcare sector. 03:00  Introduction to Vivian Lee, M.D. 04:30  One in four deaths can be attributed to preventable environmental causes…and climate change is exacerbating these risks. 06:00  Climate change resilience as a lens for value-based transformation. 06:45  The irrefutable scientific evidence about the unprecedented levels of carbon dioxide in our atmosphere. 07:00  What are health care leaders going to do about this?  (The need to manage the crisis through an empowered workforce.) 08:30  Exposed vulnerabilities in our supply chain as a complication to address climate-related crises. 09:00  The healthcare industry is responsible for 8-10% of the overall carbon footprint of the country (more than twice the #2 country!) 10:00  How do we decarbonize healthcare in order to “do no harm”? 11:45  Pollution from health care–associated energy use results in an estimated 405,000 disability-adjusted life years annually (a burden comparable to that of preventable medical errors). 12:30  The strong business case for health care organizations to reduce their carbon footprint. 13:00  Tax credits offered by the Inflation Reduction Act to decarbonize hospitals. 14:30  “Renewable energy actually costs less than fossil fuel energy.” 14:45  The Inflation Reduction Act will cover about 30% of the capital needed to invest in a renewable energy system.  (Add another 10% each for serving underserved regions and buying American made!) 15:00  ROI in the tens of millions for health systems going green! (“doing good and doing well”) 16:00  Non-productive energy use (e.g. ~60% of energy consumed by MRI and CTs occur when offices are closed on evenings and weekends!) 17:00  Putting high intensity imaging machines in idle mode would reduce the carbon footprint at a level equivalent to the NHS! 18:45  Kaiser Permanente became carbon neutral.  (Referencing Kathy Gerwig article co-written with Dr. Lee – “Decarbonizing Healthcare“) 19:30  Boston Medical Center reduced carbon emissions by more than 90%. 20:00  Resources: Kathy Gerwig’s book, “Greening Health Care: How Hospitals Can Heal the Planet”, the AHRQ Climate Change Primer, and Health Care Without Harm, Medical Society Consortium on Climate & Health 22:00  “There are so many opportunities for aligning with the decarbonization effort that are completely synergistic with value-based care.” 22:45  “Primary care has a much lower carbon footprint than high intensity tertiary or quaternary care.” 23:20  How can we utilize telehealth and telenursing to reduce patient and clinician transportation needs? 24:30  Referencing the influence of Don Berwick in medical waste elimination. (see article “Eliminating Waste in U.S. Health Care“) 25:30  “Eliminating health care waste will do good for the planet, do good for the communities, and actually make ourselves financially healthier as well…all in the spirit of bringing more value to our health care system.“ 26:45 The AMA is encouraging physicians to assist in educating patients and the public on sustainable practices and to serve as role models in providing environmental sustainability (see AMA Code of Medical Ethics Opinion on Climate Change) 28:00  Dr. Lee discusses the role of clinicians to advocate for eco-friendly practices in patient communities. 30:00  An example of how a pediatrician conducts climate change counseling (see Dr. Andrew Lewandowski’s study) 34:00  The tech-based application of AI, data, and analytics to combat climate change through value-based care delivery. 35:45  Using a health meter to advise patients on how best to deal with extreme heat and bad air advisories. 37:00  Lowering the health care carbon footprint through supply chain optimization. 39:00  The need for more engineering and technical innovation to support innovation in climate resilience. 39:30 The White House and HHS launched the Health Sector Climate Pledge to cut greenhouse gas emissions by 50% by 2030 and net zero by 2050. 40:00  “Solving the climate crisis is the greatest and most complex challenge that Homo sapiens have ever faced. The main solution, however, is so simple even a child can understand it. We have to stop our emissions of greenhouse gases. And we either do that or we don’t.”  — Greta Thunberg 41:00  Parting thoughts from Dr. Lee on value-based care and climate change resilience. (“It doesn’t matter what political party or what socioeconomic class you are.  We can’t escape this issue of climate change.  We are all on this planet together.”)

     A new era in value-based care is emerging where employers are no longer sleeping giants willing to tolerate a broken fee-for-service healthcare system. ‘Poor health’ costs employers $575B in lost productivity on top of the $880B they already spend in premium dollars annually. Employers (and their employees) continued to get fleeced by unsustainable double-digit premium increases every year, with hospitals using that excess spend in commercial insurance to their subsidize losses on the public pay side. The paradigm shift to value-based purchasing is underway in employer-based health insurance; however, it will not achieve the aims of population health unless a similar transformation occurs in workforce wellbeing.      Joining us this week in the Race to Value is Dr. Richard Safeer, the Chief Medical Director of Employee Health and Well-being at Johns Hopkins Medicine, where he leads the Healthy at Hopkins employee health and well-being strategy.  Dr. Safeer is a highly influential thought leader on building a culture of health and is the author of the groundbreaking new book, “A Cure for the Common Company: A Well-Being Prescription for a Hopper, Healthier, and More Resilient Workforce.” In this interview you will hear from one of the leading experts on employee health in our country about what it takes to cultivate a healthy workforce. Episode Bookmarks: 01:30 Introduction to Richard Safeer, M.D. and “A Cure for the Common Company” 04:45 Developing a holistic view where we look at individuals as both patients and employees. 05:15 “Until we integrate a strategy that includes the workplace, we are not likely to optimize population health.” 06:00 The economic and cultural imperatives for workforce well-being. 06:30 A key factor in achieving health goals is the support of people you are closest to at home and at work. 07:45 Connecting the spectrum of employee health from well-being to chronic disease. 08:30 Why have attempts at corporate wellness failed so often in the past? 09:30 “Our health and well-being are greatly influenced by the relationships we have in the workplace.” 10:00 Most employers do not fully leverage the social sciences to optimize the support of their workforce. 10:45 Innovative self-funded health insurance as a requisite component of a corporate wellness strategy. 12:30 How a company benefits from a healthy workforce. 13:45 Innovations to create access to high quality primary care and lifestyle medicine (e.g. Direct Primary Care and onsite clinics). 17:00 Employers must fully leverage all resources (e.g. data from health insurers, EAPs, collaboration with local health systems). 18:30 The 6 Building Blocks of a Wellbeing Culture. 20:45 Making it easier for employees to make healthy choices. 21:30 The influence of social climate in the workplace. 22:30 The plight of healthcare workforce burnout and moral injury. 23:45 We need supportive work environments to produce good health (not paternalism). 25:00 “Employers who demonstrate genuine care and back it up with genuine resources to support health and well-being will be the ones to attract and retain talent.” 25:30 Resiliency does not rest solely on the individual! 26:00 Employees cannot maintain mental health if their work doesn’t align with education and skill set. 27:00 Social connections to team and trust in management improves resiliency. 29:00 70-80% of employees are willing to take a pay cut to get a job that better supports their mental health (see UKG study) 30:00 Balancing the need for social connection with remote work. 31:30 Referencing the new book, “Culture Shock: An Unstoppable Force is Changing How We Work and Live.” 32:00 One-size fits all decisions about onsite work doesn’t make sense for all employees. 33:30 Cisco Systems as an exemplar of a workplace culture for health and well-being. 36:00 The role of technology in health is superseded in importance by the workplace, home, and community settings. 37:00 How technology can be leveraged to foster community, communication, tracking, and data collection. 38:00 The over-reliance of biometrics. 39:00 Lifestyle Medicine as a foundation to a culture of wellness. 40:00 How LM at Johns Hopkins has been successful in improving employee health. 43:00 New Year’s Resolutions – advice from Dr. Safeer how to achieve success by using the workplace. 45:30 Connect with Dr. Safeer and learn more about his thought leadership.

The future of health will be shaped by consumer expectations for a mobile-centric experience with personalized insights and care services.  Information is determinant of health, where people already search for health information on Google hundreds of millions of times a day. Additionally people view YouTube videos about health conditions 100 billion times globally in a year. As consumers seek information ubiquity in their online experience, health information will also become more personalized through wearables and other mobile devices. Our future in health will also be enabled by AI. Artificial Intelligence has the potential to transform the health of people on a planetary scale akin to the discovery of penicillin.  If developed boldly and responsibly, AI will be a powerful for health equity on a global scale.  It will also bring the joy back to practicing medicine by reducing cognitive burden and giving providers more time to spend with patient. In this week’s episode, we explore health tech consumerism and AI enablement with Dr. Karen DeSalvo, Chief Health Officer at Google. Dr. DeSalvo is an internist and health leader working at the intersection of medicine, public health, and information technology.  She has dedicated her career to improving health outcomes for all with a focus on solutions that address all the determinants of health.  Dr. DeSalvo continues to be a powerful voice and advocate for eliminating inequities and improving the public’s health.  Under her watch, Google has optimized search and YouTube to better answer common health questions, updated its consumer health wearables to function more like medical devices and built artificial intelligence products to meet industry demands. This episode covers various topics in the realm of healthcare technology innovation from consumerism, Generative AI and LLMs, health equity by design, and various initiatives underway at Google to connect and bring meaning to health information. In the interview, we also discuss the role of technology in mitigating the health impacts of climate change and addressing the epidemic of loneliness and isolation at a global level.   Episode Bookmarks: 01:30 Introduction to Karen DeSalvo, Chief Health Officer at Google. 03:30 How Google understands “information as a determinant of health.” 05:00 “We see heavy consumer orientation to the way we see our opportunity to improve the health of everyone everywhere.” 05:30 The evolution of healthcare businesses to meet people in an increasingly virtual world with ever-changing consumer expectations. 06:00 Informing health empowerment through high quality information and personalized insights. 06:30 Personal reflections from clinical practice when the flow of information was not enabled by technology automation. 07:30 Modern-day tools for patient education and personal health tracking and measurement. 08:00 The optimization of Google search results to convey trust in the provision of health information. 08:30 “The conveyance of information through trusted messengers is an important way we address information as a determinant of health.” 09:00 Patients showing up with more knowledge and power – a priority goal for Google Health. 09:30 How AI can improve health for everyone everywhere. (Karen’s recent blog on the future of AI as a transformational path forward in population health.) 10:00 Leveraging AI at Google Health to advance medical research, improve accuracy and efficiency of diagnostic processes, and improve health information quality. 11:00 A future world were everyone has access to the best quality care on their phone (e.g. AI-enabled health agents combined with the human care team). 12:00 Developing health technology for the entire world. (“A billion people on the planet don’t have access to primary care.”) 12:15 AI can address workforce challenges by reducing cognitive load to address burnout and filling capability and capacity gaps. 12:45 Using large language models in high risk health scenarios (e.g. suicide-related searches, AFib detection on watch products). 13:45 How ChatGPT elevated the interest in front-facing, consumer-focused large language models. 14:15 Search generative experience and the development of Bard (a conversational AI tool by Google). 14:45 Enhancing the Fitbit experience with generative AI and large language models (seearticle) 15:00 Med-PaLM harnesses the power of Google’s LLMs in the medical domain to accelerate scientific advancement. 16:00 “Do no harm” as the ultimate guiding philosophy in AI innovation. 16:30 Human oversight needed to mitigate the risk of AI hallucinations. 18:30 Google use cases for generative AI in clinical care — from helping radiologists to detect breast cancer, to supporting diabetic retinopathy screening. 19:00 Using AI to enhance radiology clinician workflows in mammogram screening. 20:00 Using AI to identify multi-drug resistant tuberculosis in Sub-Saharan Africa. 21:00 Developing an AI model that can perform many tasks at once (e.g. medical record summary, presenting research evidence and recommended clinical pathways) 22:30 Reduction of algorithmic bias to improve health equity and quality of care. 22:30 “The next generation of AI models are going to bring joy back to medicine. They will reduce cognitive burden and give providers more time to spend with patients.” 26:45 Reduction of implicit bias and the “health equity by design” approach at Google. 28:00 Solving for global health inequities observed with the 4M’s (i.e. metabolic disease, malignancy, maternal health, and mental health). 29:00 Developing cloud partnerships and research collaborations for population health in action. 30:00 Ensuring effective deployment of tools and technology for everyone everywhere. 30:45 Diversity, equity, and inclusion of Google Health’s teams. 31:45 Challenges and risk in the early stages of AI foundation models. 33:00 Additional background on Med-PaLM as a medically-tuned, domain specific large language model. 35:00 Use cases for Med-PaLM in care delivery, payer, and life sciences environments. 36:00 Multimodal application of Med-PaLM with wide-ranging capabilities to enhance clinician workflows. 36:45 “Large language models have many capabilities. Constraining them to do the appropriate thing is such an important priority.” 38:30 There is no one-size-fits-all approach to LLMs – it depends on the preferred use case (e.g. writing contracts, customer chatbots, distilling research insights, pop health enablement). 40:00 Climate change is the biggest threat to global public health. 41:00 “Health is more than health care.” (The impact of social determinants and the physical environment on health and wellbeing). 42:00 Applying data and analytics during the pandemic to improve health equity. 43:00 Novel signals from Google searches on symptoms — identifying trends to inform public health priorities. 44:00 The need for timely, granular, and actionable data in the public health setting. 44:30 AI predictions for future climate risks associated with health, fire, and floods. 45:00 Notifying patients with pulmonary disease of air quality risks in real-time. 46:00 The impact of social isolation on public health due to its association with a range of negative physical, mental, and emotional outcomes. 46:45 The health impact of loneliness is so far-reaching that one study compares it to smoking up to 15 cigarettes a day! 47:45 Dr. DeSalvo’s important work on the WHO Commission on Social Connection to better address the global loneliness challenge. 49:00 Using technology to address loneliness and isolation (e.g. AI and robotics to augment human support for seniors). 50:00 The detrimental impact of social media on the youth – striking a balance between screen time and human interaction. 51:30 Parting thoughts from Dr. DeSalvo pm the importance of health for all and value for all.

Dr. Mark Angelo discusses the importance of a Care Continuum Blueprint for enhanced population health outcomes. They explore the shift from fee-for-service care to value-based care models. The podcast also covers topics like post-acute care strategies, improving equitable care, the impact of social isolation on the elderly, leveraging payvider models, and embracing an infinite game mindset for healthcare transformation.

With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy.  By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union.  While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country! On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington’s internal game.  He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care.  Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health’s first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health. Episode Bookmarks: 01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending. 02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers. 02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies. 05:30 The glacial pace of the value-based care movement.  Is there truly bipartisan consensus on the aims of health value? 07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”) 08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”) 09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.” 10:00 Explosive growth of the Medicare Advantage program. 11:00 Consumer-centric innovation and higher quality of care in MA plans. 11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”) 13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service” to those leery of privatization. 13:30 The incredible popularity of MA and the research showing it has superior outcomes. 14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years. 15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions). 16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell). 17:00 The importance of Patient-Reported Outcome Measures since process measures alone don’t achieve patient-centeredness. 19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.” 20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.” 21:00 If we are incentivized to keep patients healthy and out of the hospital, we will naturally do screenings. (Measuring number of screenings not as important as the outcome itself!) 21:30 NQF guidance on Risk Adjusting Social Risk Factors in quality measurement in order to pay for outcomes. 22:30 “Infusing SDOH, risk adjustment, and quality metrics into everything we do will shift the system to move towards outcomes.” 23:30 The role of CMMI in payment model innovation and the need for the continuation of the advanced APM bonus. 24:30 “True transformation cannot happen unless you have providers willing to take on full risk. Right now, there is not a full-risk track inside MSSP.” 25:00 The “courage of conviction” in knowing you can make people healthy. 25:30 The lack of value-based care training in medical schools and GME. 26:00 Capital requirements for full-risk. 27:00 Lack of clarity in VBC policy will perpetuate a multi-tiered system (e.g. specialists paid on FFS, primary care pushed more to capitation). 27:30 Full-risk is the only way forward to incentivize the entire system!  (Everything else is just half measures.) 28:00 How the medical establishment and generational divides in medicine are holding back the value movement. 30:00 Internal, professional government affairs expertise as an essential corporate positioning and sales function. 31:00 Positioning your views front and center to a government audience through internal advocacy. 32:00 Creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation. 33:30 Speaking to policymakers and elected officials is different than speaking to investors. 35:00 Figuring out the right model for advocacy (a hired gun lobbyist vs. an embedded government affairs function). 36:30 Leveraging the lobbying power of unified voice in a trade association (versus in-house government affairs that emphasizes the uniqueness of a company’s individualized and specific interests.) 38:00 Trade associations as the place where policy gets settled before it is advocated to elected officials. 39:00 Strategies for effective in-house government affairs collaboration with professional associations. 41:30 The need to teach incoming doctors about the benefits of value-based care to prepare them for success. 42:30 It is also important to teach medical students about the importance of advocacy and the effect of health policy on their career. 44:30 Medical school funding should be tied to solving a specific problem (e.g. integrating behavioral health into primary care). 45:00 “If we want to get to VBC and outcomes delivery, we have to start teaching advocacy and policy in medical schools to effectuate the future.” 47:00 Examples of effective advocacy (e.g. addressing the pediatric uninsured, the Chronic Care Act, direct billing of LSWs within Medicare, expansion of mental health workforce) 49:30 Private sector innovation in addressing health disparities in underserved communities (e.g. Oak Street Health). 50:30 “Forming a more perfect union” – always working towards perfection while knowing it will never be perfect. 51:30 How to follow and connect with Andrew!

The future of care is not confined by walls; it thrives in the heart of homes, where compassion meets innovation, and healing becomes a daily experience. Home-based primary care with full-risk Medicare Advantage is a transformative model that not only brings health care to the doorstep of our seniors but also places the responsibility for their well-being squarely in the hands of dedicated providers, creating a proactive and patient-centered approach to aging with dignity and comprehensive care. By making primary care easier to access for our nation’s seniors, we can deliver personalized care that meets their needs; help them stay healthy and feel better; and live well with existing conditions so they can prepare for what’s ahead. This week we are joined by two executive leaders from WellBe Senior Medical — the largest and fastest growing independent home-based medical group in the country. WellBe is a global risk medical group that provides longitudinal geriatric care to underserved, frail, complex, and homebound Medicare Advantage beneficiaries. In this episode, we feature Dr. Jeffrey Kang, Chief Executive Officer and Mike Stuart, Chief Growth Officer from WellBe Senior Medical. Dr. Kang is a geriatrician with extensive experience in global risk and primary care for frail, elderly, and disabled populations.  Mike Stuart has extensive experience in fostering partnerships with health plans, health systems, and provider groups and leads commercial strategy and partnership development for WellBe Senior Medical.  In this interview you will learn about the home-based care continuum, primary care innovation, mission-driven leadership, Medicare Advantage risk, and the future of value-based primary care. Episode Bookmarks: 01:30 An overview of WellBe Senior Medical – a global risk primary care group providing longitudinal geriatric care in the home. 02:30 Introduction to Dr. Jeffrey Kang, WellBe CEO (formerly served as ChenMed President, Walgreens SVP, Cigna CMO, and CMS CMO). 03:00 Introduction to Mike Stuart, WellBe Chief Growth Officer (formerly served in executive leadership roles at Somatus and Evolent). 05:00 An overview of the home care continuum (e.g. acute, post-acute, custodial, longitudinal primary care, DME, home infusion). 08:00 How WellBe is helping patients navigate and coordinate the fragmentation of home care point solutions. 10:30 A mission to help senior patients “lead healthier meaningful lives by delivering the most complete care”. 11:30 Opportunities to make care in the home more multidisciplinary, personalized, and SDOH-responsive. 12:00 Proactive vs. Reactive Care (leveraging analytics and unique provider skillsets for population health). 13:30 The clinical persona of the “frail elderly” and why WellBe focuses on this target population. 14:30 “Everything done in a primary care office can actually be done at home.” 15:30 “Home-based primary care is the best thing to do. You get better outcomes and better patient satisfaction.” 15:45 Is it possible to deliver high quality primary care (like ChenMed or Oak Street) in the home setting? 16:30 Referencing Marcus Welby, M.D. as an example of an empathetic approach to delivering care in the home (see Season 1 Trailer) 17:00 Care Fragmentation Challenges – NEJM found that the average Medicare patient sees a median of two PCPs and five specialist physicians per year. 18:00 “Quality of Life” is more important than “Quantity of Life” (why empathy and compassion matter most in caring for frail seniors). 19:30 Patients define a good doctor by bedside manner and respect given. 20:30 How the economics of full global risk enable complete care models for seniors. 20:30 Scalable home-based primary care is a new approach in value-based care. 23:00 WellBe’s results (e.g. >50% neighborhood engagement, patient satisfaction is at 95%, and MLR improvement >40% in 3yrs). 23:30 The importance of reaching a 4 Star Rating in a Medicare Advantage plan. 24:45 Key Measures of success:  Patient Engagement, HEDIS, Medical Costs and MLR 25:45 Bringing health plan leaders on a ride-along to see high quality care in action. 26:00 Negotiating global risk deals with MA plans that offer favorable economics for both parties. 27:00 The starting HEDIS Stars score of a typical WellBe patient is 2.3-2.5 (polychronic, frail, high-risk). 27:45 “When you are at full global risk, it is in your interest to do care innovation.” 28:00 Innovation #1 = Access (“Primary care in the home needs to be both convenient and responsive.”) 29:00 How WellBe developed a mobile paramedic program to enhance responsiveness to emergent acute care needs. 30:00 Mobile paramedic program reduced emergency room visits by 33%! 31:00 Dr. Kang’s recent article in Health Affairs responding to concerns from Berwick and Gilfillan about Risk Adjustment in MA. 31:30 The CMS-HCC V28 changes to the Risk Adjustment model that begin the phasing in next year. 33:00 The evidence for Medicare Advantage being overpaid relative to FFS? 33:45 Eliminating disease-based risk adjustment is the wrong policy (e.g. need for fair payment for complex populations, avoidance of cherry picking healthy populations). 35:30 The case for HCC under-coding in Traditional Medicare (due to lack of incentives in FFS). 36:45 “The bulk of the problem with HCC coding is under-diagnosis in fee-for-service Medicare – not over-coding in MA.” 38:00 Modern Healthcare Best Places to Work 2023 – WellBe Senior Medical 38:30 WellBe Senior Medical providers see 4-5 patients per day allowing them to build trusting relationships. 39:30 A recent study from Elation Health and the AAFP confirms that VBC can ameliorate the suffering of the physician workforce! 40:30 The culture of WellBe that empowers workforce collaboration with a “patients first” mentality. 42:00 Examples of how risk-based economics improve patient care. 43:00 Creating a foundation of values to underpin a culture of collaboration is crucial before accepting risk! 43:30 A clinically-led culture vs. a financially-led culture (“If you take good care of the patients, the financials will follow in a value-based model.”) 45:00 A financially-led organization will focus almost exclusively on risk adjustment (as opposed to delivering patient-centered care). 45:30 “Most of our MLR improvement is from medical cost reduction, not HCC coding.” 46:45 Wellbe Senior Medical is now in 7 states caring for 107,000 MA patients (20% of them which are dual eligibles). 48:00 Proving the scalability of a home-based primary care model. 48:45 Expansion into rural areas. 49:45 Future growth plans. 50:00 Advantage in Scalability: (“When launching new markets, we could actually be up and running in 90-days – we don’t have the problem of bricks and mortar.”) 51:00 Disadvantage in Productivity: (ChenMed and Oak Street providers can see 20 patients a day in the office, while we are only seeing 4-5.”) 52:30 The ethno-geriatric imperative (one-third of older Americans are projected to be from one of the minority populations by mid-century). 54:00 Dr. Kang discusses how the Chinese cultural significance of taking care of elders informs his leadership at WellBe. 54:45 Healthcare disparities are driven by inadequate access to care. 56:00 An example of how WellBe provides linguistically appropriate and culturally competent care in Chicago. 57:00 The number of Americans aged 65 and older will more than doubling over the next 40 years — reaching 80 million in 2040. 58:00 Optimism for the value-based future of caring for seniors – does hope mostly reside only with Medicare Advantage and ACO REACH? 61:00 Multi-payer alignment in value-based care as an imperative to a hopeful future.

Debbie Welle-Powell, a healthcare executive veteran, discusses the importance of information as a social determinant of health. They emphasize the need for equitable access to reliable health-related knowledge and the role of clinicians in empowering patients. The podcast also explores the significance of patient-centric care, adapting to new concepts, precision medicine, and strategies for creating an effective information sharing environment in healthcare.

A revolution is imminent in American healthcare, and “the revolution will not be televised” for passive observation.  Value-based care transformation, like any other important movement, requires the active participation of all leaders on the frontlines. However, for these leaders to make the right decisions, they need to embrace innovation in order to realize the fullest potential of generative AI and predictive analytics.  Through the reengineering of care delivery, we can achieve a more personalized, proactive, and efficient outcomes-based model that can ultimately transform population health. As we navigate this transformative journey, data will play a pivotal role in reshaping the landscape of care delivery.  And no one knows this better than Nassib Chamoun, Founder President & CEO of Health Data Analytics Institute (HDAI), our guest this week on Race to Value.  In this episode, you will hear from a leader and primary inventor of a broad-based population health data analytics platform, enabling healthcare providers to make informed decisions based on real-time information. Tune in to an informative conversation covering such topics as data aggregation, predictive analytics, digital twinning, network management, generative AI in clinical care, and future advancements in technology-enabled value-based care. Episode Bookmarks: 01:30 The Imminent “Big Data” Revolution in Value-Based Care 02:00 Introduction to Nassib Chamoun of Health Data Analytics Institute 03:00 As a teenager living in Beirut, Nassib experienced the horror of a civil war. 04:00 The inventor of Bispectral Index monitoring – a technology standard in operating rooms around the world. 05:00 Nassib discusses the pivotal moments in his life that shaped a passion for data analytics in healthcare. 07:00 80% of health information in EHRs is unstructured and entirely unusable unless converted to discrete data. 07:45 CMS provided HDAI a highly coveted Innovator’s License that allows the company access to data on 100 million Medicare beneficiaries. 09:00 How Big Data drives powerful AI algorithms and predictive models in healthcare. 10:00 “If you can’t measure something, you can’t improve it.” 11:00 Understanding the intersection between cost, outcomes, and utilization. 11:30 Making data actionable in order to effectuate change in care delivery. 11:45 Data overload can actually lead to clinical inefficiencies if it isn’t curated appropriately. 12:30 The artful curation of data to drive operational improvements at point-of-care. 14:00 The limitations of claims data in making timely clinical decisions and treatment interventions. 15:00 Interpretation of unstructured EHR data to extract potential new conditions and HCC coding opportunities. 16:00 The importance of clinical judgement in augmenting AI-based recommendations in value-based care. 17:00 Combining behavioral, psychosocial, and biometric data with the existing sciences of epidemiology and clinical medicine. 18:00 Generalized clinical use cases of AI at the point-of-care to improve costs, outcomes, and utilization. 19:00 “To be successful in value-based care, you must operationalize two separate goals: Prevention and Avoidance of Complications.” 20:30 “The goal of AI is to very simply do what a clinician does, but do it repeatedly and do it continuously for every patient in their cohort.” 21:00 How staffing limitations and an aging populations necessitates a more optimal use of technology in VBC. 22:00 In 2032, U.S. healthcare spending will reach $8 trillion (ahead of the economy of Japan) making it the third largest economy in the world! 22:45 Leveraging predictive models to drive more effective care coordination and interdisciplinary team-based care. 24:30 Patient engagement as one of the more challenging aspects of value-based care. 26:30 The integration of predictive analytics and digital twinning for individualized patient care. 28:45 Using multiple predictors to serve every component of the care team. 29:30 How the use of RAF scores to normalize utilization creates noise within a dataset. 30:30 Using digital twin matching for improved predictive modeling of patient outcomes. 32:30 Aggregation from the patient level as an opportunity to reduce predictive variance. 34:00 Benchmarking against clinical exemplars in population health management. 35:00 Empowering the care team through AI and predictive analytics to drive clinical interventions. 36:30 How Houston Methodist Coordinated Care leveraged the HDAI analytics platform to enable care teams. 38:30 Using AI as a core capability in a health system (for both FFS and value-based care). 40:00 Leveraging AI to make appropriate care management resource allocation decisions at the network level. 41:00 Using analytics to better understand post-discharge outcomes and mortality. 42:30 Early interventions driven by predictive analytics have reduced both hospital mortalities and readmissions. 44:00 AI insights to drive network management decisions in building a clinically integrated network. 45:00 With the explosion of ChatGPT, we are seeing Generative AI emerge as a technology offering transformative opportunities across society. 47:00 “A lot of the big tech companies have jumped into healthcare without the appreciation of what’s involved here.” 48:00 “There are three components of trustworthy AI in healthcare:  Transparency, Explainability, and Reduction of Bias.” 49:00 Transparency 50:00 Explainability 51:30 Bias 52:30 Overcoming implicit bias in algorithms to reduce disparities in care. 53:30 The complexity of Generative AI algorithms. 54:00 HDAI’s approach to generative AI in the creation of transparent, explainable, and bias-free models. 56:30 Connecting the source code in generative AI to the recommendations made to clinicians. 58:30 Will we eventually see AI models enriched with crime data, geospatial analytics, food availability data, climate change impacts, consumer purchasing data, and biometrics? 60:00 The potential harm of applying negative use cases of AI to restrict care. 61:30 Arthur C. Clarke:  “Any sufficiently advanced technology is indistinguishable from magic.”  61:45 The 4th Industrial Revolution of technology in healthcare. 63:00 EHR data has been largely underutilized until the recent tidal wave of AI. 64:00 Creating synergies within care teams on the basis of synthesized information and AI recommendations. 64:45 The application of AI in the future of health genomics. 65:30 Parting thoughts of optimism for the future of AI-enabled value-based care transformation.

Everyone needs access to quality, affordable health care regardless of health status, social need or income.  To reach this paradigm shift, healthcare leaders must evangelize within industry and communities they serve.  There is a better path forward for American health care – one that is people-centered and transformational; however, to get there we must unite the power of one at the intersection of people, policy, and politics. By listening to people’s needs, jointly developing policy solutions, and partnering with others, we can ensure our health care system works for everyone. This week on the Race to Value, we bring to you Natalie Davis and Dr. Venice Haynes at the United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. It brings together stakeholders from various backgrounds, including healthcare experts, patients, policymakers, and advocates, to develop and implement practical, bipartisan solutions to improve the healthcare system in the United States. By fostering dialogue and collaboration, conducting research, and advocating for policies that enhance access, lower costs, and improve healthcare outcomes, the organization finds common ground and works across party lines and ideological divides to address the healthcare challenges facing the nation. As CEO and Co-Founder of the United States of Care, Natalie Davis is on a mission to reshape and implement American health care policies that improves the lives of all people.  Dr. Venice Haynes, the Director of Research & Community Engagement for United States of Care, is a social and behavioral scientist focused on an overarching research agenda to address social determinants of health and health disparities in underserved populations using qualitative and community-based participatory approaches.  In this episode we talk about the tenets of patient-first care (a.k.a. value-based care) including affordability, dependability, personalization, and understandability.  We also have an in-depth conversation on the power of storytelling in health care transformation and the imperative to overcome structural barriers in the creation of health equity. Episode Bookmarks: 01:30 United States of Care, a nonprofit organization focused on an ambitious goal to achieve universal access to quality and affordable healthcare for all Americans. 02:00 Introduction to Natalie Davis, Chief Executive Officer and Co-Founder. 02:45 Introduction to Venice Haynes, PhD, Director of Research & Community Engagement. 05:00 Natalie shares her personal story that led her towards an entrepreneurial career path in health care policy transformation. 07:30 Mentorship from Andy Slavitt and his advice to get out of Washington, D.C. to make an impact on health policy. 08:30 Venice discusses how her science and public health background inspired her to lead people-centered health care change. 11:45 Inspiration from Camara Phyllis Jones, a physician, epidemiologist, and anti-racism activist who specializes in the effects of racism and social inequalities on health. 14:30 When offered an alternative, by a 4:1 margin, people favor a model that compensates providers for improving overall health, delivering superior care, and coordinating patient care. 15:30 What it means for United States of Care to be at the intersection of people, policy, and politics in health care transformation. 16:00 Research and listening to people as a way to overcome tribalism and build an agenda of reform for the whole country! 16:45 The 4 goals and 12 solutions of United States of Care to meet the needs of people across demographics and can drive collection action to build a better health care system. 18:30 “The 4 goals of United States of Care – Affordability, Dependability, Personalization, and Understandability – comprehensively cannot be done in a fee-for-service model.” 19:00 The need to bring new health policy leaders into the value-based care movement (at the risk of the movement stalling out altogether for lack of emerging leadership). 20:00 Reframing the value-based care movement to the specific vocalized needs of constituents in the general public (instead of just payment models, quality measures, etc.) 21:00 “There is a resounding drumbeat in our community-focused value-based research — people want more whole-person care.” 22:30 Selectively using the right language when engaging communities (“using a new approach” instead of “reforming the system”). 23:00 Communities are overwhelmingly expressing their anger about the greed of the American healthcare system. 24:00 “When engaging our communities, language matters so very much. We must find the commonality in language to resonate with people.” 25:30 The storytelling project, “Voices of Real Life”, as a vehicle to galvanize healthcare experts, patients, policymakers, and advocates around a human-centered focus.  26:00 Movements are led by effective storytelling and these stories can revitalize communities of people. (Is a social movement like civil rights or gay marriage any different than the movement for value-based care?) 27:30 The fear that people have in making large scale changes to American healthcare. 30:00 The importance of everyone feeling like they are a part of the change that is needed.  (Reframing health care failures from “individual” to “systemic.”) 31:00 Venice shares personal stories from her work with community focus groups and how people often feel alone when it comes to navigating health care challenges. 32:45 An example of poor maternal health care – a patient driving an hour for a prenatal checkup only to find that her doctor was not at that clinic on that day. 33:00 People often make life altering decisions over health care (e.g. marrying someone they don’t love, taking a second mortgage on their own). 34:00 People that are “satisfied” with their health care do not really exist! (They are just “satisfied” because they are one of the lucky ones with health insurance and access to care.) 37:00 Health Care Affordability and USofCare Poll showing 42% of voters have foregone health insurance in the past, and 41% of those under 30 have opted not to seek medical treatment in the last year. 38:00 Driving a multi-state approach to expanding coverage through public option. 39:00 “Affordability is always the #1 issue that comes up in our community conversations, regardless of the entry point where people enter the health care system.” 39:45 The breaking point of health care costs (e.g. federal deficits, employer cost shifting) and the levers that can be utilized to reign in costs through a public option. 40:30 The “hidden fees” passed on to patients by hospitals. 41:00 The different levers of change at the state level, and how they can impact change at the federal level. 41:30  The equity component to reforming health care costs at both an individual and societal level. (Check out the USofCare Health Equity Report) 42:00 Enhancing primary care access will lower overall health care costs in our country in the long-term. 43:00 Dependable healthcare coverage is an anchor in the storms of life, providing individuals and families the peace of mind that their health and well-being will be safeguarded in times of need. 43:45 More than 9 million people have been disenrolled by Medicaid redeterminationsresumed several months ago. 44:45 Common stories of people fearing lack of health care dependability (e.g. contractors, employees in the gig economy, pregnant women worried about repercussions from employers). 47:45 The challenge of health policies being written by people without the lived experiences of those directly impacted. 48:00 “Policy is nothing if not implemented well.” 49:00 The Texas Court Case (Braidwood v. Becerra) —  may cause nearly half of Americans (more than 151 million people ) the loss of access to free preventive services! 49:45 How the United States of Care is fighting to preserve the rights of Americans to retain their access to free preventive primary care. (See USofCare Preventive Services Resource Hub) 52:00 Personalized care to support to caregivers, improve mental health coverage, enhance maternal and newborn care, make care more convenient, and ensure that people can equitably access care virtually. 53:30 “We cannot reimagine health care with a one-size-fits-all approach.” 54:00 The work in Colorado to build a public option and culturally responsive networks. 55:30 How do we ensure that access to virtual care doesn’t exacerbate health inequities? 58:30 For people to get behind value-based care, we must relate to them at a personal level. 59:45 Speaking in terms of “quality over quantity” when personalizing the message of value-based care to patients. 60:00 Why “Value-Based Care” is such a poor choice of wording and causes confusion with patients. 62:00 A much-needed wave of patient consumerism is needed; however, the complexity of the system stifles innovation and creates a lack of understanding. 64:00 Natalie provides perspective on the need for community feedback on people-centered change in health care. 65:00 “We need to change the way we do change in health care.  This is not working!” 65:30 Can health care be as consumer-friendly as Uber or Chick-fil-A? 67:00 The importance of asking the right questions and engaging stakeholders before implementing a new technology innovation. 68:00 Creating trust in the system through co-creation and rightsizing of change management. 70:00 The amazing opportunity in engaging patient communities! 73:00 Support the work of United States of Care and follow Natalie on LinkedIn– “Be a part of the narrative change to follow the more systemic change that is necessary.”