The Race to Value Podcast

Healthcare costs due to Chronic Obstructive Pulmonary Disease (COPD) is in excess of $32 billion due to high rates of re-hospitalizations and ED visits, complex and inefficient clinical pathways during transitions of care, and intensive resource burden on clinical and administrative staff. The average cost per COPD patient readmission in the U.S. typically falls between $9,000 and $12,000. Unlike other high cost chronic conditions like CHF and diabetes, it seems that many ACOs are not as purposeful in their targeting of COPD as part of their population health playbook. This is a massive unmet need with many COPD patients experiencing fragmented and inconsistent care that drives poor clinical outcomes and high economic burden. Consequently, COPD now represents the 3rd leading cause of death and the 5th most costly chronic disease in the US. What is it about this particular chronic condition that makes it so less prone for population health management with ACOs and other risk-bearing entities?  Why is this chronic disease so universally undiagnosed? How can we implement chronic care management programs that actually make an impact on patient lung health and clinical outcomes? For anyone that wants to know more about “Effective COPD Management to Achieve Value-Based Care Goals”, look no further than this week’s episode with Dr. MeiLan Han. She is Professor and Chief of Pulmonary and Critical Care Medicine at the University of Michigan who is widely known for her expertise on Chronic Obstructive Pulmonary Disease. Dr. Han is a leading pulmonologist, researcher, lung health advocate, consultant, and national volunteer spokesperson for the American Lung Association. She is also the author of the new book, “Breathing Lessons: A Doctor’s Guide to Lung Health.”   Episode Bookmarks: 01:30 Introduction to Dr. MeiLan Han (pulmonologist, COPD researcher, lung health advocate, author, and speaker) 05:30 Origins in rural, small town America that led to a career in pulmonary medicine and research 07:00 “Many people that have lung damage and don’t know it. We don’t do a good job of diagnosing lung disease in this country.” 07:30 Only half of the 25-30M Americans with COPD even have a diagnosis! 08:00 Undiagnosed lung disease led to server morbidity and increased mortality during COVID-19 pandemic 08:30 Research continues to be under-funded due to lack of awareness of lung health importance 09:20 11M Americans suffering from long-haul COVID 09:40 Societal threats to lung health (ex: air pollution, hazardous chemicals, plastic microparticles in lungs) 10:00 “The pandemic was a golden opportunity to raise awareness for lung health, but now people are starting not to listen.” 12:00 The impact of race and socioeconomic status on COVID death rates, and overall poor lung health in marginalized communities 13:30 COPD is more common in rural communities where there is less access to care 14:20 Virtual care is not a perfect solution in areas where there is a “digital divide” 16:00 Half of adult Americans have at least one chronic condition and more than two thirds of Medicare patients have two or more. 17:00 Ambulatory Care Sensitive Conditions as an opportunity for ACOs to achieve cost savings 18:30 The challenges of developing and implementing COPD Quality Improvement Measures 19:00 Difficulties in collecting data from spirometry and PFTs in the Electronic Medical Record 20:00 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations and the difficulties of tracking symptoms and exacerbations 22:00 The lack of reporting requirements on COPD has limited progress of health systems and EHR companies 23:00 The relative ease of collecting Blood Pressure and A1c results and why capturing data related to COPD is so much more difficult 24:45 Diagnosis gaps of COPD in the early stages due to “therapeutic nihilism” 26:15 Lack of spirometry testing possibly due to the fact that smoking cessation is already such a big part of healthcare 27:00 More studies needed to demonstrate the absolute necessity of early COPD intervention 27:45 Managing patients with lung health exacerbations that don’t yet qualify for a COPD diagnosis 29:00 “Perfect is the enemy of good in assessing lung health screening results.” 30:30 COPD costs total $32 billion due to excessive rates of re-hospitalizations and ED visits 33:00 How limited diagnoses hinder the impact of Chronic Care Management programs to more effectively manage COPD patients 35:00 Engaging patients through medication optimization and suggested use of inhalers and how virtual care can help 36:00 The use of social workers and respiratory therapists to manage COPD on interdisciplinary care teams 36:30 The challenges of Pulmonary Rehabilitation, especially in a virtual setting 39:30 The opportunity to use remote patient monitoring of cardiorespiratory parameters for patients with COPD 42:00 Physicians being overwhelmed with data and how that may hinder adoption of RPM 43:00 The limited reduction impact of the Hospital Readmissions Reduction Program (HRRP) on COPD readmissions 45:00 Dr. Han speaks about the limited number of health system success stories in lowering COPD readmissions 46:00 Disease exacerbations are one-third of COPD readmissions (as opposed to comorbidities and psychosocial issues) 48:00 The impact of climate change and greenhouse gas emissions on people’s lung health 49:00 Children’s lung health impacted by schools being placed by highways and the excess deaths of COVID-19 due to air pollution from wildfires 50:00 The responsibility of the health sector to minimize its role as a contributor to greenhouse gases 51:00 Recommendations for patients in assessing indoor and outdoor pollution 52:30 COPD and Lower Respiratory infections as the leading causes of death globally (but they receive limited grant funding for research) 53:30 Referencing Dr. Han’s book, “Breathing Lessons: A Doctor’s Guide to Your Lungs” 54:30 “Our society doesn’t focus on keeping lungs healthy – we instead focus on diagnoses.  This is why lung disease was the #1 cause of death in the US last year.” 56:00 The need for health policy and public health funding for promoting improved lung health

This week we are talking about how value-based care transformation is related to the “Hero’s Journey” monomyth that was initially described by Joseph Campbell, an intellectual known for his work in comparative mythology and religion. Campbell studied religions, all of the greatest literary achievements, mythologies, folklores, and fairytales and discovered that they all involve a hero who goes on an adventure, is victorious in a decisive crisis, and comes home changed or transformed.  Leaders in healthcare transformation are on a Hero’s Journey, not unlike Jesus, Buddha, Krishna, Apollonius of Tyana, Odysseus, Superman, Luke Skywalker, and Harry Potter! We all have one thing in common — we follow our bliss in becoming captivated by population health and health equity and then reach for the stars! Joining us this week in the Race to Value is the one and only Dr. Zubin Damania.  Dr. Damania (aka “ZDoggMD”) is a physician Leader, internet personality, and healthcare influencer with 2.5M Facebook followers and 75M YouTube views.  In this special podcast episode (a recording from the closing keynote at the Advancing Health Value Summit), Zubin discusses the transition to Health 3.0 through the monomyth of the Hero’s Journey. In this podcast, we pay special attention to the issues of burnout and moral injury in the healthcare workforce and how we forge a new way for delivering care that is compassionate, relationship-based, and technology-enabled.  Can our nation’s healthcare industry successfully make the transition from Health 2.0 to Health 3.0 in this Hero’s Journey?  Will health leaders heed the call for adventure and come back home completely transformed?  Meet Dr. Damania, your mentor in this journey to provide you (the Hero) with guidance and inspiration to dispel your doubts and fears, while also giving you strength and courage to begin the quest. Episode Bookmarks: 03:00 Introduction to ZDoggMD (and how Eric first met him at a 6-day silent mediation retreat!) 05:00 “We are all trying to forge a new way of being in the world when it comes to health care.” 05:20 COVID-19, system fragility, and workforce burnout 06:20 An opportunity for optimism and the two sides of “hero’s work here” 07:30 The Hero’s Journey in healthcare (Health 1.0 à Health 2.0 à Health 3.0) 08:20 Zubin explains “Health 1.0” as a way physicians practiced holistic medicine based on relationship and intuition 10:15 Physician paternalism in Health 1.0 began the Hero’s Journey (just like Luke Skywalker on Tattooine deciding to forge a new path forward) 11:00 The excessive utilization, care variation, and escalating costs of Health 1.0 12:00 The dominator physician hierarchy of Health 1.0 and how that relegated nurses to a lower status 13:30 The origins of “Health 2.0” – a technology-enabled, data-driven business model 15:30 Right-brain (holistic care) vs. Left-brain (reductionist care) that led to a clash in medicine between 1.0 and 2.0 16:30 The shadow side of Health 2.0 (reductionist de-humanization, commodification, and de-personalization) due to the dominator administrator hierarchy 17:30 “Burnout is like renal failure. You are being dialyzed due to chronic moral injury.” 18:00 What is moral injury and how does it apply to healthcare? 19:00 The suffering created by Health 2.0 and how looking inward can help the workforce find equanimity (Awakening) 20:00 The negative feedback loop caused by a flawed system and how that contributes to moral injury 20:20 The Empire of 2.0:  How de-personalized EHR systems defeat healthcare heroes by turning them into data entry clerks 22:00 How Zubin reached the apex of 2.0 due to pressures to practice medicine on an assembly line 23:30 Health 1.0 is the old shore, Health 2.0 is the boat we’re in, Health 3.0 is the shore we’re trying to get to. 24:00 How Zubin found inspiration from “The Happiness Hypothesis” by Jonathan Haidt 25:00 The Elephant and the Rider: Human behavior from the emotional side (Elephant) versus the analytical, rational side (Rider) 27:00 “The Rider is not the master of human decision-making in a society based on tribalism.” 28:30 How understanding the moral matrix of “the elephant” leads to more informed and compassionate decisions 30:00 The dichotomy between rider and elephant explain the difference between Health 1.0 and 2.0! 31:20 Referencing the book, “Switch: How to Change Things When Change is Hard” in understanding the path to true transformation 32:00 “The new shore of Health 3.0 is the transformative integration of Elephant, Rider, and Path.” 32:30 The promise of “Health 3.0” – a transcendent physician-led model that integrates relationship-based care and technology 35:00 The path to Health 3.0 is paved by capitation that aligns financial incentives with outcomes 37:00 Lessons learned from Turntable Health: Zubin explains how relationship-driven, preventative, team-based primary care exemplifies Health 3.0 38:30 How does mindfulness and meditation relate to Health 3.0? 40:00 How “Understanding the Elephant” relates to patient behavior change and SDOH interventions 42:30 Capability requires the autonomy to make decisions.  (Reference: athenahealth studyshowing that workforce capability leads to high performing organizations) 43:30 Transforming the path (e.g. payment models, dominator hierarchies) leads to capability 44:00 How Health 3.0 leads to antifragility in healthcare 45:30 Zubin explains the “sacred connection” and why we need to get technology out of the way to empower human relationships in healthcare 47:00 Why AI will only replace mechanical processes but never replace humanity in medicine 49:30 The wisdom of Warren Buffet in how to beat inflation by investing in yourself (and why we need to invest in our healthcare workforce) 52:00 The transformation of the caterpillar to the butterfly as a corollary to the Health 3.0 movement 55:00 The monomyth of the Hero’s Journey and the importance of living authentically to “Follow your Bliss.” 57:00 “The Hero’s Journey gives purpose to suffering.” 59:00 “The deepest altruism is to turn inwards and transform yourself on this Hero’s Journey.” 60:00 Recognition of the moral imperative for value-based care through Alt-Middle awareness and moral intuition 64:00 How an Alt-Middle perspective can elevate one from “hive mind” groupthink 66:00 The recent homicide conviction of Nurse RaDonda Vaught due to a medication error 68:00 How can you have trust and autonomy in a system when it is dishonest with itself? 69:30 The mental health issues of the healthcare workforce (how it is created by a flawed system and why that creates adverse patient outcomes) 71:00 Referencing the book House of God by Dr. Samuel Shem in exposing physician suicide 72:00 The need for healthcare leaders to support the communalization of pain 73:00 The difference between affective empathy and compassion 74:00 Compassion — an unconditional and infinite expression of love – as a solution to moral injury 76:00 Join the ZPac Supporter Tribe to meet other hero’s in the Health 3.0 Movement!

George Halvorson is a retired American healthcare executive who served as CEO of six health plans over the last 30 years.  From 2002-2013, he was the CEO of Kaiser Permanente and was listed several times on Modern Healthcare‘s “Most Influential People in Healthcare”. During his tenure at Kaiser Permanente, he led the nation’s largest nonprofit health plan and hospital system, which is also a leader in the adoption of technology to advance community health outcomes and reduce health inequities.  Under Halvorson’s leadership, Kaiser Permanente’s investment in electronic medical records and physician support systems resulted in diminished infection rates and scalable population health outcomes within partnering communities. Since his retirement from Kaiser, George Halvorson has devoted his time to promoting the benefits of early childhood education and to addressing social difference and tensions through his own Institute. George Halvorson is currently the Chair and CEO of the Institute for InterGroup Understanding, a nonprofit organization that works on issues of racism, prejudice, discrimination and intergroup stress and conflict by facilitating a collective understanding of what children need to achieve safe and productive lives. George is someone who leads with a passion to help create intergroup Peace for our nation so that we may intellectually overcome our more negative and damaging instinctive behaviors. In this episode, you will learn the truth about the Medicare Advantage program from one of the leading intellectuals in healthcare.  We also discuss Health IT transformation and the power of organizational culture to reshape care delivery. In the last 20 minutes of the interview, George Halvorson also discusses his mission to improve the culture of our world by helping others overcome negative and instinctive behaviors that lead to intergroup conflict.  This is a powerful discussion about the impact of tribalism in our world and how we have a collective and ethical obligation to help each child from every ethnic, economic, cultural, and racial group in America to overcome the hardwiring of societal conditioning that leads to “us versus them” intergroup conflict. “We need to steer ourselves away from the easy abyss of anger through tribalism, into a higher level of interaction. This is a just-in-time learning opportunity.”   Episode Bookmarks: 01:20 George Halvorson’s legacy as a healthcare executive and former CEO of Kaiser Permanente 02:20 The Institute for InterGroup Understanding, a nonprofit organization that works on issues of racism, prejudice, discrimination and intergroup stress and conflict 03:10 George’s extensive experience in international healthcare reform and his authorship of several books related to healthcare reform and intergroup peace 04:20 “The fragmented nature of care delivery and siloing of data creates an expensive plethora of uncoordinated, unlinked, economically segregated, operationally limited microsystems, each performing in ways that too often create suboptimal performance” 06:30 “We are on the cusp of the golden age of healthcare delivery, and it’s going to be made golden by information, data, and systems.” 07:15 Innovation at Kaiser Permanente led to a 40% reduction in congestive heart failure crisis events 08:15 Leveraging biometric data and predictive algorithms for disease detection and prevention 09:45 George Halvorson as a national leader in mitigating health disparities and his 2013 book, “Ending Racial, Ethnic and Cultural Disparities in American Health Care” 11:15 Medicare Advantage has become a successful social services program for millions of people (and our most important vehicle to reduce health inequities) 12:15 How Kaiser Permanente reduced prostate cancer death rates for Hispanic Americans 13:30 “I believe that we should deliver better care to every single American, and we have done a pretty miserable job for many subsets of our population.” 14:30 Linkage of uterine infection during pregnancy and childhood asthma (and how this disproportionately affects African Americans) 15:20 Dual-eligibility in Medicare Advantage and Medicaid is leading to better care outcomes and higher satisfaction scores 17:00 How fee-for-service Medicare failed COVID patients 18:00 Health plan competitive bidding, benefit design, and economics of MA leads to better care and lower costs (“a clearly superior model”) 20:00 Misinformation about health plan profitability (MA plans make 4% profit; whereas, all other American businesses make 10-20% profits) 21:00 Debate with MedPAC regarding benefit enhancements that improve patient outcomes for low-income members 22:15 Richard Gilfillan and Don Berwick’s two-part series of articles in Health Affairsexpressing their grave concerns related to Medicare Advantage (Part 1 and Part 2) 23:30 Response to Gilfillan and Berwick’s concerns related to health plan profitability and PE investment in companies driving MA care delivery innovation 26:50 Response to MA critics concerns of upcoding and how current coding limitations in the program prevent abuses in the MA program (“You can’t upcode into a system that doesn’t exist”) 29:00 Reinvestment of profit surpluses to provide better benefits for members and how MA 5-Star plans are “the best care plans anywhere in the world” 31:00 George Halvorson discusses the financial and cost savings differential between traditional fee-for-service Medicare and Medicare Advantage 32:30 MA beneficiary enrollment in urgent need counties and why spending concerns in that part of the program may be misrepresented 36:00 The importance of organizational culture in value transformation (“When the student is ready, the teacher appears.”) 37:15 “Organizational culture needs to be centered around the patient, built around transparency and data sharing, and focused on continuous improvement.” 38:45 The success story of care process redesign at Kaiser Permanente that led to reduction in death rates due to sepsis (reduced from 30% to 3%) 41:00 What culture in health care delivery do we want in our country? 42:00 George’s mission to improve the culture of our world by helping others overcome negative and instinctive behaviors that lead to intergroup conflict 43:00 “We are all creatures of instincts. Every one of us is instinctively tribal, instinctively hierarchical, instinctively territorial, instinctively emotional.” 43:40 The slippery slope of tribalism that leads to “us versus them” behaviors without values and ethical standards 45:00 The Truth Agenda – how the Institute is working on making public and political discourse honest and respectful 45:40 Epigenetic neurogenesis in children and why intergroup conflict is so harmful in early childhood brain development, i.e. hardwiring tribalism 47:30 The case for universal and affordable healthcare and how tribalism in American undermines true progress in healthcare transformation 48:20 “When people realize that an instinctive behavior is not an underlying value for the universe, you get a lot more flexibility, both in your own emotions and in your own interaction.” 49:00 George Halvorson’s books on intergroup activity that are available for free online 49:40 The Cusp of Chaos:  how tribalism leads to genocide, mass killings, intertribal bloodshed, rapes, mutilation, ethnic cleansing, and other genocidal behaviors 50:45 How tribalism relates to the current Ukrainian conflict 51:30 How George Floyd and the Me Too movement was a powerful learning experience for America 53:00 “We need to steer ourselves away from the easy abyss of anger through tribalism, into a higher level of interaction. This is a just-in-time learning opportunity.” 54:00 Predicting future and understanding history by interpreting the pattern of intergroup interaction (how George predicted the Russian atrocities in Ukraine 5 years ago) 56:00 The danger of alpha instincts —  the January 6th insurrection and lifelong conquests of political leaders to stay in power at all costs 57:30 “We’ve got a relatively short time in this country to steer us back to a good and safe place.” 58:00 Websites of interest:  Three Key Years and the Institute for InterGroup Understanding

This week is Nurses Week – a time for all of us to reflect on the contributions that nurses make to our society. During this important time of observance for one of our most valued professions in caring for those most in need, we invited Dr. Sharrica Miller to join us for an important conversation.  Dr. Miller is a Cal State University, Fullerton nursing professor who teaches several nursing classes, including pediatrics, writing, research, and mentoring. But she brings more into her classroom than just her vast knowledge and experience in nursing; Dr. Miller also shares the 12 years she spent in the foster care system. This period left an indelible impression on her, and she decided that once she made it out of the foster care system, she would reach back and help others.  To that aim, she has become a national leader in helping nurses use their platform to advocate for vulnerable populations in the community. Casey Family Programs recently awarded Dr. Miller with the 2021 Casey Excellence Award, a national recognition for her work with foster youth in several organizations, including California Youth Connection. Dr. Sharrica Miller is not only a nurse educator, renowned public speaker, and DEI strategist — she is a servant leader and advocate for the most vulnerable in our society.   Episode Bookmarks: 01:25 Reflections on Nurses Week and Introduction to Sharrica Miller, PhD, RN 02:25 National recognition for her service in helping children transition out of foster care 03:25 The hardship and instability of Dr. Miller’s childhood and how she broke the intergenerational cycle of disadvantage 05:35 Determination to take control of her life once emancipated from the foster care system 06:20 A mission in service to others as an advocate began when gaining custody of her siblings as a young adult 07:30 Lessons in mentorship that inspired her to “speak for those who can’t” and how COVID-19 impacted the foster care system 09:20 The promise of education in breaking the cycle of poverty and despair (“Education was my ticket to freedom.”) 11:00 How the learning environment and minority representation at Howard University propelled her to success 12:00 The importance of mentorship and creation of “safe spaces” on college campuses for minority nursing students 12:40 “Nursing programs need to be actively anti-racist to identify structural barriers.  It is not enough to just value diversity.” 14:00 Why representation from minorities is so important in Higher Education 15:00 Overcoming a victimhood mindset brought about by old emotional pain through hardship 16:30 “You must develop an internal locus of control.  You can either change your perspective of a problem or change your situation.” 18:40 Inspiration from Eckhart Tolle in overcoming a victim mentality by stopping “pain-bodies”that control our thinking. 19:40 The dangers of over-internalizing success or failure 21:30 “In preparing to lead transformational change, you must first do the work inside. That allows you to show up with the stamina to fail forward.” 23:20 Using failure as a learning opportunity to adapt one’s approach to change management 24:30 The plight of racial injustice in our society and the disparities that are built into the American healthcare system 26:00 “Minorities are expected to be majority by 2050.  We need to think about this in preparing the healthcare workforce for tomorrow.” 28:00 “Teaching nursing students about Social Determinants of Health can actually do harm if we only teach at the surface level.” 29:00 “Racism is a social determinant of health.” 30:00 A recent study confirming that racism exists in nursing (63% of nurses have experience acts of racism in the workplace) 31:30 Dr. Miller discusses the history of racism in nursing and how leadership should addresses reported incidents of “Nursing while Black” 35:00 Addressing the “race card” response when attempting to foster a better understanding about the presence of racism in our society 38:00 Leveraging value-based payment models to explicitly incentivize health equity and disparities reduction 40:20 The challenge with nurses finding their voice to speak up about social injustice, and the opportunity for nursing education to cultivate broader activism 43:30 The moral responsibility of health system leaders to listen to nurses at the bedside who vocalize concerns about structural barriers 45:30 Cultural competence as the bedrock of a great nurse-patient relationship 47:30 Social and emotional intelligence as a competency for culturally competent care 49:00 Developing nursing education pipeline programs and inclusive recruitment practices for historically excluded populations 50:00 Protecting the sanctity of “safe places” in nurse learning environments to foster the idealized minority student experience 52:45 Referencing a recent article in Health Affairs showing a decline in registered nurse employment in 2021—the sharpest decline in the last 40 years 54:00 The recent criminal conviction of an individual nurse for a medical error and how that could have a longstanding negative impact on the nursing profession 55:00 The lack of support for young nurse early careerists (and the inability of more experienced nurses to support them during COVID-19) 56:00 Out of touch leaders who are addressing nursing burnout with pizza parties and pats on the back 56:45 AACN report showing enrollment increases in nurse education programs 57:30 The passionate commitment of nurses and how that compares to police officers and the military 61:00 The prioritization of a nurse protecting his or license over keeping their job 62:00 Dr. Miller provides parting thoughts on Nurses Week  – the importance of prioritizing working environments over pizza parties 63:00 Check out Dr. Miller’s new documentary, “Still Waters Never Crash” about her resilient journey from foster care to nurse leader and educator!

As leaders in the value-based care movement, we must think about the synergism between lifestyle medicine and traditional Western medicine. The tenets of lifestyle medicine force us to think more holistically about medical treatment and prevention.  Under this construct, “Sleep is Medicine” because poor sleep is linked to obesity, heart disease, stroke, cancer, and dementia.  “Exercise is Medicine” because of its impact on a healthy heart, mind, and body.  “Love is Medicine” because mindfulness and gratitude is the key to peace and equanimity. And lastly, “Food is Medicine” because a whole food plant-based diet is proven to improve every aspect of health.  These four time-tested tenets encompass the SELF Principle of lifestyle medicine promoted by Dr. Sean Hashmi. Sean Hashmi, MD, is the adult weight management lead for Southern California Kaiser Permanente. He is a board certified Internist, Nephrologist and Obesity Medicine Specialist practicing at Kaiser Permanente, Woodland Hills, California. In this role as Regional Director for Clinical Nutrition and Weight Management at Kaiser Permanente, Southern California, he’s responsible for developing a comprehensive obesity management strategy involving lifestyle medicine and obesity medicine for the 4.6 million members that Kaiser Permanente serves. He is driven by a lifelong commitment to be of service to others. He also provides evidence-based health, nutrition, and wellness research through his nonprofit organization, SELF Principle. In this episode, you will learn how Sleep, Exercise, Love, and Food (SELF) translate into hope. And hope is the most powerful thing we can possibly have in health care. With hope, we can transform our broken “sick care” system to a true health care system.  And in doing so, we will win this Race to Value.   Episode Bookmarks: 01:30 Background and Introduction to Dr. Sean Hashmi 04:30 Life-defining experiences and personal challenges that led to the practice of lifestyle medicine 06:30 Dr. Hashmi’s Personal Why:  HOPE 08:30 “The greatest way to be selfish is to do something kind for someone.” 09:00 How a lack of financial resources led to a lack of healthcare access for Dr. Hashmi’s sister 09:45 Lessons in lifestyle medicine learned from his own wife’s health issues 10:45 The American College of Lifestyle Medicine and Dr. Hashmi’s SELF Principle 11:00 “Sleep, Exercise, Love, and Food translate into hope. And hope is the most powerful thing we can possibly have in health care.” 13:30 “Lifestyle medicine needs to be looked at synergistically with Western Medicine.  Everything in health begins and ends with lifestyle.” 14:30 The impact of lifestyle medicine on chronic disease (ex: dialysis treatment coupled with plant-based eating) 16:30 Healthcare providers need to learn more about evidence-based lifestyle medicine 17:00 How lifestyle medicine can improve life’s “moments” (quality of life and longevity) 17:45 Incorporating lifestyle medicine into everything we do (instead of it being a standalone program), e.g. prevention of 30-day rehospitalizations 22:00 Is the heart healthy benefit of eating vegetables only when they are consumed in raw form? 24:20 The Healthy Plate Model:  50% fruits and vegetables, 25% complex carbohydrates, and 25% protein (tofu, beans) 25:20 Consumption of whole fruits will lower HgbA1c results in diabetics in the long-run. 26:20 “Healthy” plant-based eating lowers incidence and prevalence of kidney disease. 27:00 The problems with plant-based meats and why whole vegetables are always preferable 28:20 Why the Blue Zones have such healthier people that live longer 31:00 Dr. Hashmi explains his work in obesity management at Southern California Kaiser Permanente 32:00 How clinicians can effectively counteract societal influences that lead to poor eating and other unhealthy lifestyle choices 34:00 The benefits of bariatric surgery will be undermined without a foundation of good lifestyle 35:00 Understanding the impact of poor food choices (ex. 3-5 hours of walking to undo one slice of cheesecake) 36:00 Creating ambassadors to carry the message of lifestyle medicine 38:45 The toll of physician burnout (“In real life, our heroes do get tired.”) 39:30 “Of all the people who need lifestyle medicine, healthcare workers need it the most.” 40:00 “Physician burnout often occurs because they didn’t follow the tenets of lifestyle medicine.” 41:00 Fill your own well.  (“Put your own oxygen mask on first before trying to help others”) 42:00 The expression of gratitude in the healing environment (finding hope) 43:30 Getting deep, restful sleep for the recommended 7-9 hours leads to weight loss and better health 44:30 The feeling of making an impact on a patient’s health (“the greatest drug in the world”) 45:00 Administrators often misunderstand the joy of medicine 46:00 Lifestyle medicine can help physicians restore their personal “Why” 47:30 Food insecurity is associated with $77 billion in excess health care expenditures each year. 48:00 How can you eat affordably on a plant-based diet? 49:30 Startup companies trying to address food insecurity and poor nutrition in underserved communities 50:30 The current trend in society to move away from red meat consumption 51:30 Making waves in society by raising awareness of lifestyle medicine 53:00 As much as one-third of health care spending in the U.S. each year is wasted, upwards of $700 billion each year 54:00 The misaligned financial incentives of fee-for-service medicine 55:00 The affordability of implementing lifestyle medicine programs and how they will improve population health outcomes 56:20 Leveraging technology to bring social connection and engagement (applying lessons learned in social media to lifestyle medicine) 58:00 “In lifestyle medicine, a physician doesn’t get paid by telling someone to eat more broccoli.  Instead, it aligns with value-based care by preventing disease and improving outcomes.” 59:00 Treating kidney disease costs the Medicare program $130B (7% total spending) even though it is 1% of the Medicare population 60:00 Dr. Hashmi discusses how lifestyle medicine can create a better way to care for patients with kidney disease  61:00 How patients with kidney disease end up dying from heart disease! 62:00 Cutting down salt intake with patients suffering from CKD 63:45 Medications become more effective when combined with lifestyle medicine 65:00 “Value-based care is all about making outcomes better.” 66:00 The power of love and gratitude as a healing medicine 68:00 Making others feel valued is the most important virtue of a leader 69:30 Expressing gratitude to others in your family who allow you to do what you love. 70:00 Life’s moments define your legacy.  Create change by expressing gratitude. 72:00 “Value-based care is not just about the metrics and outcomes.  Take care of people first, and then focus on the process.”

Have you ever had an idea that you just had to make real? No matter what it took… no matter what obstacles were in your way… no matter how many times people told you no… you just couldn’t stop until it existed? Well, this is one of those stories. It begins with an idea in 1988 and leads to the first-ever autonomous AI to be approved by the FDA for diagnosis without physician input. Dr. Michael Abramoff, MD, Ph.D. is the Founder and Executive Chairman of Digital Diagnostics, the autonomous AI diagnostics company which was the first in any field of medicine to get FDA authorization for an autonomous AI.  Dr. Abramoff is a neuroscientist, a practicing physician, and holds a Ph.D. in Artificial Intelligence and Machine Learning. In 1988, Michael was working on artificial intelligence during his residency and began to think a computer could diagnose diabetic retinopathy. Given the technology available at the time, this idea may have been a bit of a stretch. Still, Michael set out to prove it could be done. Joining him in this interview is Seth Rainford, the President and COO at Digital Diagnostics.  Seth focuses on expanding market opportunities and driving operational excellence within the company. He brings more than a decade of executive experience to Digital Diagnostics including the successful management of large-scale P&L’s, strong organic & inorganic business development expertise, as well as complex multi-site operations leadership within the healthcare industry. In this episode, we talk with Dr. Abramov and Seth about the 30-year journey that led to the founding of Digital Diagnostics, and the first-ever FDA-approved Autonomous AI in healthcare. Plus, we explore the challenges they continue to work through as they commercialize their product to support organizations looking to win in value-based care! Episode Bookmarks: 01:30 Introduction to Dr. Abramoff and Seth Rainford and how the first-ever autonomous AI solution became FDA-approved for diagnosis without physician input 03:30 The scalability of Artificial Intelligence in healthcare and the recent failure of IBM Watson Health 06:00 “We are at an inflection point with AI…specifically with Autonomous AI.” 06:30 The parallel paths between AI and the discovery of DNA and its eventual use in the courtroom. 07:45 Why should we limit diagnosis to human cognition when autonomous AI has been proven to be safe and effective? 08:45 An overview of the history of AI, from advancements in neuroscience and sensory processing, ML, artificial neural networks, to autonomous AI in healthcare. 10:45 Where IBM Watson failed – it started with “glamour AI” (i.e. winning at Jeopardy) instead of trying to solve problems in healthcare 12:00 Most of what we hear about in healthcare is assistive AI — not autonomous AI. 13:20 There is no need for human oversight in autonomous AI for making FDA-approved diagnoses in healthcare. 15:15 Referencing a recent NEJM Catalyst Op-Ed that criticizes autonomous AI in healthcare 16:30 Lessons learned from the challenges of assistive AI and how the develop of a completely autonomous AI solution started with FDA approval 18:30 “In considering the best ways to improve population health outcomes, we must include autonomous AI.” 19:00 Humans are not necessarily better than AI when it comes to diagnosis of diabetic retinopathy 19:20 Referencing NEJM study using assistive AI diagnosis of breast cancer and how radiologist involvement with AI didn’t improve outcomes 22:00 Health inequities with diabetic retinopathy in various minoritized populations 23:00 Recent CMMI focus to advance health equity in value-based care 23:45 “Diabetic Retinopathy is the main cause of blindness and this is disproportionately impacting minorities and rural populations due to lack of access to care.” 25:00 The importance of the diabetic eye exam and how to make testing more accessible through autonomous AI 26:10 Democratizing access to diabetic retinopathy exams in underserved areas through scalable platforms and innovative partnerships 29:30 Should Autonomous AI systems replace traditional testing approaches as a standard of care? 30:30 Diagnosability that is comparable between all population segments 31:30 The difference between “screening” and “early detection” 32:00 Using telemedicine to overread diagnostic findings in autonomous AI will cause unnecessary delays and avoid real-time referral and immediate treatment 34:00 Testing autonomous AI at the point-of-care in the primary care setting demonstrates effectiveness and scalability potential 35:00 “Our AI platform is eminently scalable.  Getting a point-of-care diagnostic in real-time with a low-skilled operator democratizes access at one-third of the cost.” 36:00 Unlocking value for all stakeholders – payers, patients, and providers 39:00 How does early diagnosis and detection of diabetic retinopathy supports risk bearing entities with risk adjustment coding and closing care gaps? 42:40 The simplified CPT coding for early diagnosis and detection of diabetic retinopathy with Autonomous AI 45:00 How autonomous AI improve physician productivity and effectiveness, while also reducing burnout and suffering in the physician workforce 47:30 The concern of algorithmic bias in AI and how that may contribute to health inequities and disparities in care 49:30 How clinical trials and AI training design mitigate risk of implicit biases within AI algorithms 50:40 Referencing “Coded Bias” (show on Netflix that investigates the bias in algorithms using facial recognition technology) 53:30 How does black-box AI versus biomarker-based AI compare in bias mitigation and patient safety? 55:30 The future applications of autonomous AI in value-based care (e.g. emerging use cases and the potential intersection of precision health and genomics) 58:00 Learn more about Digital Diagnostics on their website and on LinkedIn

The impact of investment activity on our industry cannot be overstated, with the velocity of capital pouring into the health sector reaching stratospheric proportions. The valuation of private equity deals in the US health care sector is nearly $100 billion dollars—a twentyfold increase from 2000 (when it was less than $5 billion). Before COVID-19, we were already seeing mass provider consolidation, expansive funding in digital health, and significant M&A activity…and the appetite for capital investment in healthcare has only increased in recent years. The amount of capital being poured into the health sector, and the velocity at which it has been deployed, is reshaping the landscape and a driving force in the future of value-based care. Joining us this week is Don McDaniel, the CEO of Canton & Company. Don engages with pioneering healthcare firms across the industry, all striving to win in the new health economy. A true market-maker, he focuses on advancing innovation, elevating market positions, and connecting complementary players to disrupt and reshape the industry.  Don McDaniel is a healthcare visionary, master economist, serial entrepreneur, and lover of a good debate.  In this episode, he will provide insight into the continued increase in the appetite of private equity and other institutional investors.  He will discuss whether this interest is good or bad for consumers, patients, providers, payers and other stakeholders.  He will also overview the interest level and forecast of investment activity, explore pros and cons from various stakeholders’ perspectives, and consider the implications of such investment on the value movement.  If you are a business leader trying to understand current investment trends and whether or not institutional equity actually improves the overall industry health of healthcare, this episode is for you! Private equity (PE) has been ramping up investments in healthcare over the last several years. Read this brief to learn more about the intersection of PE and value-based care, including potential negative and positive impacts, and recommendations for industry stakeholders. https://institute.smallworldlabs.com/files/354   Episode Bookmarks: 01:30 The valuation of private equity deals in the US health care sector is nearly $100 billion dollars—a twentyfold increase from 2000 (when it was less than $5 billion). 02:45 Introduction to Don McDaniel, the CEO of Canton & Company 04:45 The number of healthcare services deals among institutional investors has more than doubled in the last six years, with 356 deals in 2015 and a whopping 733 deals in 2021. 06:30 “The system is broken.” – Investment fervor is based on the “train wreck” that is American healthcare. 07:20 The arbitrage opportunity for capital investment based on historical spending and inefficiencies 08:10 Referencing Jim Collins: Confront the Brutal Facts (from Good to Great) 08:30 How negative labor productivity in healthcare contributes to dysfunction 09:30 “If the airline industry had the safety record of healthcare, no one would get on a plane.” (iatrogenic errors creating bad outcomes) 10:00 “Healthcare lacks true consumer sovereignty.” 10:30 Adam Smith’s “invisible hand” has been missing from healthcare since 1965. 11:30 Consumer dissonance drives system inefficiencies and how that is attractive to investors. 12:10 “Healthcare is a credibly inefficient business backed by massive tailwind demand.” 12:30 The impact of an aging population on our nation’s healthcare system 13:45 Opportunities with massive consumerization and privatization of Risk 14:30 Private Equity investment activity at an all-time high 15:20 The international opportunity for healthcare disruption across the globe as the American system undergoes transformation 15:40 Early indications of inflationary pressures and other macroeconomic factors on private equity investment activity 16:15 Referencing “It’s the Prices, Stupid: Why the United States is so Different from Other Countries” with regard to lack of cost transparency 16:50 Dry powder and competition for deals in private equity 17:30 Health care spending is projected to grow at an average annual rate of 5.4 percent until 2028 where it will then reach $6.2 trillion 19:00 Referencing recent Credit Suisse report illustrating single-digit VBP penetration 20:00 Value-based payment transformation from CMMI in the Medicare and Medicaid payer segments 20:30 How employers transitioning from unfunded pension liabilities compares to the value shift in American healthcare 21:50 Medicare Advantage risk transference and how other payers are replicating that model to transfer risk to providers 22:40 How capital investment drives innovation in provider risk sharing 23:00 The lack of financial incentives and capital access for primary care providers 23:45 The misappropriation of “value-based care” and how the multidimensional aspects of industry transformation often get overlooked 25:00 Fee-for-service Medicare as a regulator (more than it is an actual payment modality) 26:15 Investments to “build a better mousetrap” in fee-for-service (without actually transforming payment models, population health, safety, etc.) 27:30 How the third party payer system creates an obscuring of economic benefits without actual consumer-centric orientation 29:30 “Global payment and risk transference is ultimately where we are going in American healthcare.” 30:00 Referencing Livongo’s value-based care innovation for diabetes and how that propels the concept of Regina Herzlinger’s “focused factories” 32:15 How value-based care is bringing about a more holistic view of healthcare investments (e.g. loneliness prevention, food insecurity, housing) 33:20 Upstart health plans that have already raised hundreds of millions in funding with $1 billion+ valuations (e.g. Oscar Health, Clover, Bright Health, Collective Health, and Devoted Health) 33:45 1 in 5 physician transactions involved in primary care practices where they are getting acquired for $5k – $10k per MA life! 35:00 The misnomer of excessive profit margins with publicly-traded payers 35:30 The need for physicians to be leading value-based care transformation and the opportunity for advancing primary care 37:30 Reimagining the mental model for a consumer-centered and omnichannel approach to primary care 38:45 How to leverage capital investments to support a value-focused business model for specialists 40:00 The future of specialty-based mixed payment models (e.g. FFS, sub-capitation) 41:00 The antiquated nature of legacy payers and how that has stymied value-based care innovation 42:00 How “digital MA payers” are leveraging data to impact social determinants of health 43:00 Referencing commentary from ACP and a recent JAMA study suggesting undue influence and corporatized influence of profit-focused investors 44:20 How concerns about PE-backed Direct Contracting Entities led to the launch of the ACO REACH model 45:20 The importance of having a lens to balance scrutiny of private equity with the perceived benefits of innovation 46:30 Where would we be if we didn’t have the private infusion of capital in the healthcare sector? 47:00 Do nonprofit hospitals provide more community benefit (i.e. uncompensated and charity care) than for-profit hospitals? 48:00 Federally Qualified Health Centers (FQHCs) and how they approach Board Governance representation from community members 49:30 Are concerns about physician equity ownership warranted? 50:00 “Value-based care is raising the stakes for how we view overall value.” (e.g. hospital-acquired infections, cost transparency, variance reduction) 51:30 A free market perspective on why excessive regulation on capital investment may not be in our best interest 52:00 Referencing the moratorium on physician-owned hospitals while they were, in fact, better performers 52:40 “There is massive information asymmetry in healthcare and private equity forces transparency to facts.” 53:00 Much of the horizontal consolidation among hospitals and other providers and business arrangements in the supply chain have resulted in higher costs. 54:30 “COVID was the conducer, but not the creator for value-based care adoption.” (e.g. workforce development, virtual care) 55:30 “Inflation will accelerate the pathway to global budgets and value-based payments.” 56:40 How fast will the movement to value happen? 58:00 Is alignment of value-based care incentives to process measures the right way to go? 58:40 “Investment capital is the lifeblood.  It is the forcing innovation driver…and we need it!” 59:30 Large retailers like Walmart, CVS, Amazon, Walgreens, and Target are all bringing consumerism to the forefront in healthcare 61:30 “The definition of health is broadening in a way that includes enhanced economics and social determinants.” 63:00 How non-traditional healthcare participants are creating disruption through workflow innovations 64:00 Referencing Best Buy, Walgreens/VillageMD, and Dollar General as examples of innovations in the distribution channel for care delivery 66:00 Fiat disruption through regulation may hurt investment potential in healthcare.

ChenMed is a family-owned, physician-run organization that was created to better serve low-moderate income elderly patients. Starting in 1985, Dr. James Chen created ChenMed as a one-stop shop where physicians are held accountable for their patients, and now ChenMed operates over 100 senior health centers across the US. The full-risk, capitation model of ChenMed aligns economic incentives where preventative value based care is the foundational framework.  However, what really allows ChenMed to transform care delivery in the U.S. is how they honor the sacred nature of the physician-patient relationship. The ChenMed model for primary care exemplifies the power of the provider-patient relationship and realigns physicians with their altruistic calling.  In doing so, clinicians are able to address the moral determinants of health that lead to improved health equity and social justice in our society. Joining us this week is Dr. Faisel Syed, the National Director of Primary Care at ChenMed. Dr. Syed believes a physician-led culture can improve primary care influence and lead to a new era of transformation in the United States.  He is on a mission to restore the intimate and sacred nature of the doctor-patient relationship and, in doing so, create care models that can replicate at scale.  In this episode, Dr. Syed discusses how ChenMed honors seniors with affordable, VIP care that delivers better health. He shares how this moral consensus has an enormous impact on patients and the health of communities.  A physician-led culture in primary care, coupled with trusting relationships, can truly change the world! Episode Bookmarks: 01:30 Background on Faisel Syed, M.D. and the full-risk capitation model of ChenMed 03:30 The ChenMed model as “old-fashioned medicine with technology that treats patients like family” 04:30 How family influence and emerging technologies created a calling to practice medicine 07:15 “We should restore the intimate and sacred nature of the doctor-patient relationship.” 09:20 Don Berwick’s article on “The Moral Determinants of Health” 10:20 “ChenMed starts with the mission to honor seniors with affordable, VIP care that delivers better health. That is our moral consensus.” 11:00 Healthcare as a right – everyone deserves access to primary care, especially those in underserved communities 12:45 Referencing Michael Marmot’s book, “The Health Gap: The Challenge of an Unequal World” and the impact of income inequality on health 14:30 “Understanding pathophysiology alone is not enough to improve health. We must address social determinants of health.” 15:30 Faisel provides an excellent overview of SDOH and how ChenMed’s relationship-based care model improves population health outcomes 18:30 1 out of 5 Americans (over 51 million) are living with a behavioral health condition and 20 million individuals have a substance use disorder 19:30 How a holistic (non-transactional) approach to primary care with aligned financial incentives impacts behavioral health outcomes 22:00 The sacred nature of healing relationships that goes back to the roots of shamanism (and how transactional economics limits healthcare effectiveness) 24:00 Reflections on how the ChenMed model supports healing through trusting relationships 25:00 How openness and trust between a doctor and a patient prevents avoidable ER visits 28:30 How a famous clip from “I Love Lucy” sums up physician burnout that results from the culture of a fee-for-service system 29:30 How ChenMed allows physicians to truly fulfill their purpose in practicing medicine (and how that prevents the burnout all too common in FFS) 32:30 Referencing the article “Primary Care, Specialty Care, and Life Chances” and how PCPs in a given geography correlate with lower mortality and improved societal health 34:00 Primary care doctors need “influence and leadership” to catalyze a national transformation of healthcare in our country 35:30 How PCPs must first become better influencers and then become a disruptive force in value-based care transformation 36:00 Referencing recent Deloitte survey of physicians that predicts a forthcoming shift in the U.S. healthcare model towards value-based care 38:00 Faisel discusses how medical schools should approach the redevelopment of their curriculum to support the future of value-based care 39:00 “IQ versus EQ” – the role of emotional intelligence in medicine to build powerful relationships that drive superior health outcomes 42:00 How financial risk in an accountable care model leads to enhanced profitability (and improved patient outcomes) 42:45 Unnecessary hospitalizations as the main contributor to waste in the U.S. healthcare system 44:00 How ChenMed is replicating their care model in low income neighborhoods across the country 45:45 “Replication at scale”: ChenMed now has 100 centers in 12 states (quadrupling of size since Faisel joined ChenMed 4 years ago 46:30 How ChenMed develops doctors into mentor, coaches, and business leaders to influence the next generation of healers 47:20 “Our goal is to transform healthcare delivery in the United States.” 48:30 How a physician-led culture can improve primary care influence and lead to a new era of transformation 50:20 Serving the greatest generation of patients and how health equity creates social justice 51:00 Visit www.chenmed.com to learn more and explore career opportunities

We have reached a milestone moment, as we are celebrating 100 episodes of the Race to Value – the nation’s leading podcast on value-based care transformation in the country! In this special episode, Dr. Eric Weaver and Daniel Chipping conduct a countdown of the Top 10 episodes so far, playing select clips from the most downloaded Race to Value episodes. They also discuss the recent launch of the Institute for Advancing Health Value (formally known as The Accountable Care Learning Collaborative). The Race to Value and the Institute bring together the nation’s leading accountable care organizations, top performers, and industry leaders who know what it takes to succeed in the value-based care environment.  We are committed to advancing health value, not only through industry collaboration but through education and workforce development as well! Episode Bookmarks: 01:30 Eric and Daniel reflect on the 100th Episode milestone of the Race to Value 02:20 The announcement of the newly-launched Institute for Advancing Health Value (formerly the ACLC) 03:10 Register now to attend the Advancing Health Value Virtual Summit on May 5th, 2022 04:00 #10:  “Creating Optimal Post-Acute Care Networks in the New Value Paradigm” with Ian Juliano 06:30 Other PAC insights in prior episodes featuring Dr. Stephen Bekanich, Andrew Croshaw, and Dr. Tim Ihrig 07:00 #9:  “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity” with Susan Hassmiller and Janelle Sokolowich 11:00 Other VBC workforce insights in prior episodes featuring Christina Severin, Cheryl Lulias, Lisa Trumble, and Dr. Gordon Chen 12:00 #8: “The Path of Hope for Human-Centered Care Delivery” with Dr. Zeev Neuwirth 14:40 Other “Big Thinkers” in prior episodes featuring the Honorable Dr. David Shulkin, Dr. Robert Pearl, and Dr. Elizabeth Teisberg 15:00 #7: “The Role of Direct Primary Care in the Value Movement” with Dr. Gaurov Dayal 17:40 Other transformational insights in prior episodes featuring Dr. Tom Davis, Farzad Mostashari, and Harris Rosen 18:10 #6:  “Care Beyond Medicine: Addressing SDOH and Health Inequities in Marginalized Communities” with Mike Radu and Dr. Greg Foti 19:40 Other Health Equity insights in prior episodes featuring Dr. Lerla Joseph, David Smith, Dr. Jesse James, Akil McClay, and John Bluford 21:00 #5: “The Future of Value: Lifestyle Medicine and the Reversal of Chronic Disease” with Dr. Dean Ornish 24:30 Other unique insights in prior episodes featuring Dallas Ducar (gender-affirming care), Ginger Hines and Dr. Sheryl Morelli (pediatric VBC), Dr. Keith Smith and Sean Kelley (cost transparency), Dr. Debra Patt (oncology VBC), Dr. Angelo Dilullo (mindfulness and resilience) 25:40 #4: “Analyzing the New ACO REACH Model” with Rick Goddard and Joe Satorius 27:50 Other health policy insights in prior episodes featuring Jeff Miklos, Michael Leavitt, Dr. Mark McClellan, Micky Tripathi and Liz Fowler 28:20 #3: “The Geisinger Value Journey” with Dr. Jaewon Ryu 30:50 Other insights from industry leaders in prior episodes featuring Dr. Clive Fields, Jen Moore, Dr. Stephen Klasko, Dr. Tim Peterson, Dr. Paul Grundy, Dr. Mark Gwynne, and Dr. David Carmouche 31:30 #2: “COVID-19 & SARS-CoV-2 Delta Variant: Scientific Insights from a Leading Virologist” with Dr. Rodney E. Rohde 33:50 #1:  “Value-Based Care: A Superior Technology to Create Trusting Relationships” with Dr. Griffin Myers 37:40 Parting thoughts on the future of the R2V podcast and the launch of the Institute for Advancing Health Value.  Thank you for tuning in and supporting us!

Jeff Micklos is the Executive Director of the Health Care Transformation Task Force, an industry consortium that brings together patients, payers, providers and purchasers to align private and public sector efforts to clear the way for a sweeping value transformation of the U.S. health care system. Under Jeff’s leadership, the Task Force provides a critical mass of business, operational and policy expertise from the private sector that, when combined with the efforts of the Centers for Medicare & Medicaid Services and other public and private sector stakeholders, can accelerate the pace of delivery system transformation. Jeff is a great ally in this Race to Value, and the Task Force is doing its part to catalyze value-based payment adoption.  In January 2015, the task force was formed based on a commitment to the triple objective of better care, better health and lower costs. As a unique private sector coalition under Jeff’s executive leadership, the task force has an unrelenting vision to accelerate the pace of value-based care transformation.  Consequently, they have set the goal for payer and provider members in the Task Force to have 75% of their business in value-based payment arrangements by the end of 2025. Listen to this episode to learn everything you need to know about the health policy landscape, strategic implications for payment and delivery transformation, and how redesigned payment models will help us seek sustainable improvements in health equity, patient outcomes, and consumer experience. Episode Bookmarks: 01:40 Introduction to Jeff Micklos and the Health Care Transformation Task Force 03:30 The grim stats on the U.S. health system and the need to accelerate value-based care transformation 05:00 “Change is hard. And change is even more difficult when the status quo is so lucrative in fee-for-service medicine.” 05:30 30% of fee-for-service healthcare is related to low-value care (changing this is a major opportunity to sustain in the long-term!) 05:45 Changes to payment models and the market-driving force of Medicare reforms in healthcare transformation 06:00 HCTTF Transformation Goal: 75% of members operating under value-based payment arrangements by 2025 (progress made by reaching 61% in 2020) 06:55 CMS Innovation Center (CMMI) Strategy Refresh Target Goal:  All Medicare FFS beneficiaries in a accountable care relationship by 2030 07:15 “A financial spend metric (in and of itself) is not an indicator of success in value transformation.” (qualitative measures just as important!) 08:20 COVID-19 has only emphasized the need for significant payment and delivery transformation 09:30 The uncertain political climate and how that is shaping current delivery system reform efforts and private sector momentum for value-based transformation 10:00 Extension of the MACRA 5-percent Advanced APM incentive payment (currently scheduled to sunset in 2024) 11:00 The Build Back Better Act and its potential impact on improving health care and lowering costs 11:30 Increased coverage in the ACA marketplace exchanges as a success of the Biden Administration 11:50 The impact of the Russia-Ukraine situation on advancing health policy objectives in the near term 12:00 The upcoming midterm election and how the projected electorate change towards full GOP control may shift the political dynamics of the value movement 12:45 The CMMI Strategy Refresh as a guidepost for the future direction of the value movement 15:00 Reflecting back on the 1st 10 years of the CMS Innovation Center and lessons learned from theMedicare Shared Savings Program (MSSP) 15:50 “ACOs overall have played a key role in transforming the health care system by creating incentives for providers to deliver high quality, cost efficient care.” 16:10 Leveraging MSSP as a platform to scale provider adoption of other APMs 16:45 The failure to reach rural areas with APMs and the need for continued investment initiatives like the ACO Investment Model (AIM) 17:20 Next Generation ACO Model has increased appetite of advanced providers for new full risk track in the MSSP 18:00 MedPAC recommendations that CMS streamline the CMMI APM portfolio by using MSSP as a platform for model testing 18:30 The need for predictable and sustained provider participation in the MSSP to advance the value movement 19:00 Payment model evaluation studies to overcome challenges with accurate counterfactuals, spillover effects with other APMs, minimum attribution, etc. 20:00 The challenges of translating model evaluation findings into broader policy actions 21:30 The stringent process of certifying payment models to justify APM expansion 23:30 CMS has tested over 50 models and only expanded 5 of them at this point 24:20 Recent HCTTF recommendations to CMMI for improving model evaluations and certification 26:00 How ACO overlap with bundled payment models is working against scalable value transformation 27:20 The need for increased specialist integration to further align and improve coordination with primary care 30:00 Medicare Advantage (MA) as an effective driver of value transformation and consumer-centric innovation 32:00 “The flexibility inherent in the MA platform is allowing us to move clinical care transformation forward more expeditiously than traditional Medicare.” 33:00 The growth in MA enrollment and how it has doubled in market penetration over the last 14 years (from 10 million in 2008 to 28 million in 2021) 34:00 MA flexibility in benefit design allows for better service to beneficiaries in meeting unmet needs 35:00 MA plans are able to pass savings to beneficiaries (e.g. 83% of MA plans offer $0 monthly premiums) 35:30 Other aspects of MA as a effective value driver (e.g. full capitation, quality incentives, benefit design that focuses on preventive services) 36:00 Better outcomes for MA patients (e.g. high cost-high need patients, pneumonia vaccinations, eye exams for diabetics, depression screening rates, PCP office visits) 36:30 The slow rate of driving value in commercially-insured populations 37:20 Task Force Priorities for 2022, including the promotion of Medicare Advantage as an effective driver of value transformation 40:00 The current heated debate in Health Affairs right now between Richard Gilfillan/Don Berwickand George Halvorson 43:00 The recently announced revamp and relaunch of the Direct Contracting (GPDC) model withACO REACH (Links to recent ACLC Brief and Prior R2V Podcast) 45:15 How ACO REACH will improve health equity and access to care through a capitated model 46:45 Lack of capital investment will limit impact of ACO REACH in expanding access to underserved areas 48:00 The application process for ACO REACH 48:45 Addressing inequities through adjustments to ACO REACH benchmarking methodology 49:30 Governance changes to Board representation to ensure stronger physician leadership and consumer engagement 51:00 Uncertainty of increased transition to risk adoption for providers with new ACO REACH model 51:30 Model evaluation and perceived differences between GPDC and ACO REACH 52:30 Referencing recent study denoting lack of consumer engagement in value-based care 53:45 The leadership of Task Force Founding Chair Rick Gilfillan in addressing lack of consumer engagement 55:00 CMS Resources to improve ACO Beneficiary Engagement (recent listening session and toolkit) 56:00 Medicare Advantage marketing guidelines and how it may limit opportunities for patient education 58:40 How consumer feedback from ACO beneficiaries can drive performance improvement in the private sector 61:00 How the Task Force is advancing purchaser and employer engagement to drive value in commercially-insured populations 66:00 “The priority of health equity is unassailable” (how ACOs and other risk-bearing entities will advance health equity) 70:00 The lack of self-reported data on race, ethnicity, sexual orientation, gender identity, disability status, and veteran status 71:00 The longer term return horizon on investments in Health Equity reporting infrastructure and SDOH interventions 74:00 Parting thoughts on health care resiliency and current tailwinds for value transformation