The Race to Value Podcast

Grief support and empathy education is so important in the context of value-based health care as it connects us to our own humanity.  It speaks to why we entered into the altruistic practice of providing care, yet our fee-for-service model overvalues transactional activities without a whole-person orientation.  This leads to medical professionals becoming detached from the grieving process of patients, families, and caregivers and results in our own moral injury along the way. Providers who lack an understanding in the grieving process or fail to adequately express empathy will also have patients with diminished clinical care outcomes.  Moreover, doctors without empathy are more likely to get sued for malpractice compared to doctors who make the same mistake but do emphasize the human connection. In this week’s episode, we invited one of the leading experts in grief and empathy, Lisa Keefauver to discuss a health system’s role in supporting patients, families, and caregivers through the grieving process. Lisa is the Founder & CEO of Reimagining Grief and is working to shift the narratives of grief at the individual, community, and organizational levels. Her wisdom as a grief and empathy leader runs deep and wide, rooted in her personal and professional experiences over the past 20+ years. You can find out more about Lisa’s work at her website: https://reimagininggrief.com/ Episode Bookmarks: 01:45 Introduction to Lisa Keefauver – a Speaker|Educator|Writer|Podcaster|Social Worker turned grief and empathy activist 03:30 Grief during the season of Thanksgiving and the important message of transcending it 05:30 Lisa shares the personal story of her harrowing experience with the healthcare system preceding her husband’s death from brain cancer 08:50 Lack of empathy and compassion from providers leads to missed information at the point-of-care 10:30 The assumption of clinical expertise at the expense of accounting for the humanity of patients 11:00 Anticipatory Grief – feeling of grief occurring before an impending loss, i.e. the forthcoming the death of someone close due to illness 11:40 Research shows that a direct correlation exists between anticipatory grieving and the caregiver’s quality of life. 12:40 The importance of grief support and empathy education in the context of value-based health care and how anticipatory grief is so widely misunderstood 13:00 Pronounced anger and loss of control during anticipatory grief and how conventional medical misunderstanding pathologizes that behavior 14:00 Using tools (e.g. mindfulness, sleep, rest, and nutrition) to help patients, family, and caregivers with anticipatory grief 16:00 Stress-related health problems are responsible for up to 80% of visits to the doctor and account for the third highest health care expenditures, behind only heart disease and cancer. 16:30 Meditation programs could translate into health care savings as much as $25,500 per patient each year because of the lowered utilization of medical services and emergency room visits. 17:20 “As we move to value-based care, we need to think about covering mindfulness meditation as an integral service for patients, families, and caregivers.” 18:00 What mindfulness is (and what it isn’t) and the power of the present moment in eliminating stress and supporting emotional regulation. 19:45 Referencing Kristin Neff’s book, “Self-Compassion: The Proven Power of Being Kind to Yourself” 20:20 The need for mindfulness to be an important part of medical education training 22:15 Heart condition associated with grief – takotsubo cardiomyopathy (“broken heart syndrome”) 23:15 The role of social workers as part of an interdisciplinary team, particularly in the disease prevention aspect of grief counseling and support 26:40 How people of color can grieve differently and the reliance of human connectivity in BIPOC communities 29:00 The shared experience in dealing with the murder of George Floyd and the epigenetic passage of grief and trauma across generations 30:00 Culturally-competent care from providers with shared lived experiences and the importance of understanding mourning practices in different cultures and populations 31:30 Disenfranchised grief – when your grieving doesn’t fit within larger society’s attitude about dealing with death and loss 32:30 Whole-person care models requires us to realize the impact of grieving in minoritized populations 33:30 Complicated Grief Disorder – prolonged grief symptoms for at least twelve months after bereavement 34:00 Lisa speaks about the long-term impact of COVID-19 in the manifestation of complicated grief in our society and the importance of rituals 36:40 Delayed grief and the potential for a new wave of societal grieving once we reach post-pandemic normalcy 37:30 The grieving of physicians due to moral injury within the profession 39:20 The importance of valuing patient relationships over transactional experiences in care delivery 41:00 Support for providers during their own grieving process and how a lack of resiliency will compromise patient outcomes 43:00 The role of Palliative Care in helping patients overcome the grief associated with their own death 44:15 Reference Atul Gawande’s book, “Being Mortal: Medicine and What Matters in the End” 44:40 The over-fixation of preventing death in the curative care model and how we should instead ask patients how they want to live 46:50 The reduction of suffering through palliative care comes down to what we actually value 48:00 Referencing Malcolm Gladwell’s book, “Blink: The Power of Thinking Without Thinking” 49:30 The opportunity for empathy education to build stronger relationships with patients, improve clinical outcomes, and reduce moral injury 53:00 How to find out more about Lisa Keefauver’s work in grief and empathy activism at Reimagining Grief and the Grief is a Sneaky B Podcast

How does a 3-physician practice sell for over $100 million dollars? The answer is simpler than it seems – full-risk contracting is better for providers and patients. Aligned incentives promote better outcomes for patients, and better reimbursement for those providing the care. It comes down to this – full risk unlocks the door to a true relationship with the patient, a relationship that provides more information than sophisticated AI models, risk coding and predictive analytics. And Medicare Advantage plans are the most accessible vehicle to achieve full capitation. We are pleased to welcome back Dr. Tom Davis as our guest. Dr. Davis is an expert in value-based care, a family physician, angel investor, founder of 6 companies, consultant, and speaker. In this episode, he articulates how Medicare Advantage is a critical strength in the race to value. You can find more from Dr. Davis at his website: https://www.tomdavisconsulting.com/ Episode Bookmarks: 01:40 Introduction to Dr. Tom Davis 03:30 Dr. Davis started a small primary care practice that took full-risk Medicare Advantage (MA) and sold it for $132M! 06:30 Dr. Davis explains the “spectrum of value-based care” in MA and how he took the first full-risk contract in his market. 09:00 Analyzing cost drivers in patient population and how that prompted investment to capitalize on a site-of-service arbitrage 11:00 Implementing internal systems to optimize on physician workflow efficiencies in value-based care 12:00 Dr. Davis describes how it felt the first time he saw that he earned $1M+ in income as a primary care physician. 14:00 Dr. Davis explains “the offer we couldn’t refuse” when his full-risk MA practice was acquired. 14:40 “Value-based care under a full-risk Medicare Advantage model allowed me to be the family physician that I had always wanted to be.” 15:30 The enrollment growth trajectory in Medicare Advantage and the continued potential for rewarding economics for PCPs 17:15 “Devolving the financial consequences of the clinical decision down to the POS unleashes the most valuable asset in healthcare–the clinicians themselves.” 18:40 How to take full advantage of Medicare Advantage – Dr. Davis explains how to take full financial responsibility in a risk contract! 20:00 Full financial risk is only up to the attachment point of the stop-loss insurance. 21:00 The pool of capital in private insurance markets and the delegation of risk to both providers and the private liability market. 22:00 “Fee-for-service medicine sucks your will to live as a clinician.” 23:30 The economics of the MA Stars system and how it aligns with improved patient outcomes 24:45 Proxy Value vs. True Value in measurement 25:15 Full-risk contracts as the only true way to unlock value. 26:15 Moving from 3 to 5 Stars in Medicare Advantage equates to an 18% increase in practice revenue. 27:00 Deriving true value in MA contracts as the most sustainable and optimal ROI opportunity 28:30 The advantages and disadvantages of physician-led risk-bearing entities 29:45 “You will never learn to swim if you only stay in an ACO.” 31:00 Working with smaller MA plans because they are more likely to collaborate with physicians. 31:45 The rise of Direct Contracting Entities (DCEs) leaves no excuse for physicians to not up their risk profile. 33:00 The value of the patient relationship in driving business performance (versus short-term revenue generation to goose the bottom line in FFS) 34:40 Referencing the father of the modern container ship system in how we unlocked true value. 36:00 “Everything, everything, everything in your organization wraps around the value between the patient and the clinician.” 37:00 Dr. Davis shares a personal story of how a patient relationship supported colorectal cancer screening compliance. 38:00 How patient relationships trump sophisticated AI models and predictive analytics 39:00 The moral, ethical, and a functional advantages of value-based care over the industrialized business model 42:00 The importance of the Annual Wellness Visit (AWV) as a key component to the MA patient relationship 44:30 Using the AWV as a reflection of the amount of engagement that a clinician has with their panel 45:30 Balancing short-term P&L “gun to your head” pressure with long-term R&D success in value-based care 47:00 “Value-based care is here to stay. The government has no interest in shouldering this burden anymore.” 48:20 Capturing SDOH data with Health Risk Assessments (referencing podcast interview with Cheryl Lulias) 49:30 Identifying the rising risk as early as possible to mitigate preventable costs 50:30 A PCP can fight the counter influences of the food industry, but you can still have meaningful interventions. 51:30 Care management as an opportunity for engagement (but never as good as a F2F visit with the physician) 54:00 Dr. Davis shares everything you need to know about Risk Adjustment Coding! 59:20 “Your job as a leader, is to stand there like superman, let those non-clinical tasks ping off your chest like bullets, and protect your clinicians to let them generate the value that only they can generate, and they generate so well.” 61:15 Dr. Davis on healthcare waste and how the easiest way to avoid it is by controlling inpatient admissions through the emergency room 63:00 Cultivation of trusting patient relationships will cause patients to call their PCP before going to the ER! 64:30 Disruption of the primary care landscape through private-equity backed practices (and how you compete with them!)

Health care is the largest employment sector in the US, and women account for 75-percent of the workforce. Gender equity in medical leadership is of paramount importance in value-based care to provide more meaningful and culturally-competent care with improved relational and clinical outcomes between patients and providers. Despite a female majority in the healthcare workforce, they are not proportionally represented within top leadership positions, where they account for less than 15-percent of executives. While women account for just over half of all medical school enrollments, they have consistently graduated from medical school at rates below their male colleagues, although that gap has narrowed in recent years. Further, only 18-percent of hospital CEOs are women. Our special guest for this bonus episode is Dr. Charlotte Collins, Division Chief for The Center for Professionalism and Well-Being at Geisinger. Her work focuses on the provider experience to improve engagement, recruitment, retention, and communication, while benefitting patient care and experience, and reducing the risk for medical errors. The Center promotes cultural goals such as transparency, decentralized decision-making, and continuous quality improvement for the organization. In 2020, the National Business Group on Health awarded Geisinger with the platinum Best Employers: Excellence in Health & Well-Being Award for supporting the “enhancement and maintenance of personal and professional well-being” for staff. In this episode, Dr. Collins shares insights garnered from her efforts to better understand women’s needs in the health care workforce. During this time of consistent burnout among clinicians, and heightened awareness of the need for improved equity, it is critical to recognize the opportunity for women to take a more prominent role in leading value-based care transformation. This discussion will provide you with important insights on gender and pay equity, creating a female-friendly workplace, empowerment, and workforce resiliency. The value proposition of gender equity in leadership is crucial in the transition to whole-person care models that deliver on improved population health outcomes. This bonus episode is a recording of an ACLC Peer Learning Session – watch here if you would like to see Dr. Collins’ slides and hear the full audio. Episode Bookmarks: 01:40 Referencing the ACLC Intelligence Brief on Women in Medicine and Introduction to Dr. Charlotte Collins 04:00 Kimberly Mueller explains the purpose of the ACLC in accelerating the transition to value-based care 05:00 Recent efforts in healthcare to support the advancement of DEI and Dr. Collins work at Geisinger 07:20 75% of the healthcare workforce is female, but there is an imbalance between men and women in leadership roles 08:30 The role that women leaders play in value-based care and how more women in medical leadership could improve clinical outcomes 09:30 The three pillars of Geisinger that inform population health and how the pandemic has impacted that work 10:15 The exodus of the healthcare workforce due to burnout and retirement, coupled with nursing shortages, has created a crisis 11:15 The development of the Geisinger Center for Professionalism and Well-Being and how it supports women in medicine 13:00 Overview of Geisinger’s survey on women-centered medicine and clinical practice 17:45 How patients have potentially been impacted by sexual harassment, and the opportunities to address burnout and workplace fairness 19:30 Pay equity and transparency within the workforce and the creation of a “female-friendly workplace” 21:10 Addressing workforce policies that disproportionately impact women 22:10 The choice that women face in being a “good Mom” or a professional in the workplace 24:00 Geisinger’s program to support workforce resiliency and emotional well-being (RISE – Resilience in Stressful Events) 29:00 Emergent design and the “bottom-up approach” to developing programs that foster ideas from front-line staff 32:00 How women and men can bind together and support their colleagues to advocate for more gender equity 36:00 The power of an organizational competency and scorecard for Equity (“you can’t manage what you don’t measure”) 37:30 Dr. Collins provides advice to other women who are looking to advance in their careers by being proactive and taking risks 40:20 Dr. Collins shares her thoughts on the presence of ‘imposter syndrome’ with women in medicine 42:00 Why “women leaders are better listeners” and  how we need to foster collaboration and autonomy in the female physician workforce 45:30 The importance of scoring priorities in workforce resiliency and gender equity-related programs (e.g. child care options for workers) 48:00 The most important workforce benefit is work-life balance (not compensation!)

The financial stats of healthcare are all too familiar – the 18% of GDP, $3 trillion spend, and the $11k per capita cost are frightening to consider. We are on an unsustainable financial trajectory, as those numbers are projected to increase. The costs for cancer care, which include both medical services and drugs, are no different. In 2015, national costs for cancer care were estimated to be $190 billion and just 5 years later, in 2020, the costs ballooned to $209 billion. The 10 percent increase is primarily attributed to the aging and growth of the U.S. population. As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, there are many examples of practices participating in CMS’ Oncology Care Model (OCM) that have made impactful workflow changes to achieve cost and quality improvements. The OCM was the first cancer-specific alternative payment model for Medicare recipients as well as Medicare’s first APM for outpatient specialty medicine. Despite several practices succeeding in the OCM, many have not. At this point, the overall results of the APM have been underwhelming. Since the OCM was originally implemented in 2016, the program has led to a $155 million net loss to Medicare. While originally set to expire this summer, to be replaced by Oncology Care First (OCF), the date was pushed back by a year. CMMI can apply lessons learned when launching the OCF, and Texas Oncology is where they can find oncology care that is thriving in the race to value. Our guest this week is Debra Patt, M.D., PH.D., MBA, a practicing oncologist and breast cancer specialist in Austin, Texas. Dr. Pratt serves as the Executive Vice President for Public Policy, Payer Relations, and Strategic Initiatives at Texas Oncology, a network of 210 sites of service and 490 doctors, serving half of the cancer patients in Texas. In this role she advocates for effective cancer policy at the state and federal level, and advises on strategy for various initiatives, such as telemedicine, optimizing growth and development of advanced practice providers, development of service lines, informatics initiatives and contracting. Her research is in clinical decision support, predictive analytics, telemedicine, health economics and outcomes, tools for patient symptom management and quality improvement. As an expert in healthcare policy, she has testified before Congress to protect access to care for Medicare beneficiaries. She is the editor-in-chief of the Journal of Clinical Oncology- Clinical Cancer Informatics. Episode Bookmarks: 01:45 Background information on Dr. Debra Patt and her work in Value-Based Oncology Care 05:00 The Country’s Financial Burden of Cancer Care – Why we need to transition from Volume to Value 07:00 The need to anchor our expectations for value differently based on the aging of the population and the advancement of treatment 08:15 Investments inpatient care and drug research is more like a “mortgage” instead of paying “rent” 09:00 How cancer care is bankrupting patients due to out-of-pocket burden 09:25 Many forms of cancer are now being treating like an acute illness instead of a chronic disease akin to HTN or diabetes 09:45 The societal and economic benefits of people living longer upon the initial diagnosis of cancer due to advances in care 10:10 Referencing the book, “The Great American Drug Deal: A New Prescription for Innovative and Affordable Medicines” 10:40 Other investments, outside of new innovations in drugs and therapeutics, that are still needed in value-based oncology care 12:00 The Oncology Care Model (or OCM) — the first cancer-specific alternative payment model for Medicare recipients 12:45 The underwhelming results of OCM, a $155 million net loss to Medicare, largely due the model’s complexity 14:00 Correlating the assessment of OCM’s success to the value equations, i.e. it is not just about cost containment 15:00 The implementation of an individualized treatment care and coordination plan (an example of OCM success) 15:30 Investments in nurse navigators, 24/7 EHR access, just-in-time symptom control, nursing triage systems, patient-reported outcome measures, and biosimiliars 16:30 90% utilization of biosimiliars as key measure of value-based success 16:50 Depression Screening and discussion of Advanced Directives as another area of focus within the OCM 17:20 Diminishing information asymmetry between doctors and patients – a key improvement resulting from OCM! 17:50 Financial Counseling for patients to help them manage their journey in cancer care 18:35 Using lessons learned from OCM to enter into value-based arrangements with commercial payers 19:00 The transition gap between the OCM and the Oncology Care First (OCF) model 19:50 Potential improvements in OCF (building on lessons learned from OCM), e.g. symptom management and patient-reported outcomes 21:00 The controversial, mandated Radiation Oncology (RO) Model that will address the current flaws in reimbursement for radiation therapy 23:00 “Radiation Oncology is ripe for value-based care transitioning, but the currently proposed RO model has several challenges.” 24:00 Dr. Patt explains why a voluntary payment model for value-based radiation oncology is the more prudent course of action in the current environment 24:30 Patient radiation dosing exceptions (the need for specialized treatment and higher fractionations) are incredibly important when considering how to spare organ toxicity 25:30 How specialized radiation oncology treatments can pose financial risk to an organization if participating in a mandated payment model 25:50 The distress experienced by oncology medical practices due to COVID-19 and the current shortage of nurses (why we need to reconsider mandated models) 27:20 “Community  oncology practices are overwhelmingly the lowest cost and highest value site of service where patients can receive cancer care.” 29:00 How interdisciplinary team-based care supports reduced hospitalizations, reduced ED visits, increased adherence to treatment plan, and better patient experience 30:00 “Improving the health literacy of patients is critical to cancer care.” 30:30 The use of telehealth and virtual care delivery to improve palliative care services 31:30 Integrating social workers, nutritionists, palliative care, and psychology services within a community oncology practice 32:30 Virtual support groups for patients to help them deal with social isolation during the pandemic 33:20 The importance of communication between interdisciplinary providers in a value-based oncology practice (“the huddle”) 37:00 More complicated treatments in cancer care that require patients to have heightened awareness in toxicity and knowing how to navigate treatment optimally. 38:30 Financial Toxicity in Cancer Care – the financial burden of cancer treatment for an individual patient may be $20-30k per year! 40:20 Financial counseling for patients to better understand out-of-pocket burden and how best to augment financial support 41:20 How imatinib (the treatment of chronic myelogenous leukemia) shows us the impact of price sensitivity in cancer treatment 41:50 The need for reform in insurance products that leave patients exposed to significant levels of financial risk with limited coverage 42:40 The need for reforms in the Medicare program to optimize cancer treatment and survivorship options 44:00 Clinical Pathways – how value-based care models are standardizing cancer care with pathways adopted from the National Comprehensive Care Network (NCCN) 46:00 The importance of “nudges” in clinical decision support 47:00 Referencing the book “Nudge: Improving Decisions about Health, Wealth, and Happiness” and how it promotes choice architecture in making good, autonomous decisions 48:30 “Not all pathway systems are the same.” 49:30 The difference between Biologics (complex medicines made from living cells or organisms) and Biosimiliars (a biologic that is highly similar with no clinically meaningful difference) 50:30 Dr. Patt discusses the role that biosimilars play in value-based oncology care 52:30 Advanced Care Planning can consistently provide high patient and family satisfaction, reduce hospitalization by nearly 50%, and decrease costs in the last year of life by 20% to 25%. 53:40 Dr. Patt discusses how Advanced Care Planning helps prevent ineffective interventions near the end of life and the role it plays in human-centered care delivery and value-based oncology. 55:30 Referencing Iris Healthcare (see prior Race to Value episode with Dr. Stephen Bekanich) 56:00 Health Equity and Racial Disparities in Care – 34% of all deaths from cancer in those aged 25 to 74 could be prevented by 2035 if disparities in access to care were eliminated! 57:30 Dr. Patt discusses how socioeconomic challenges typically manifest into inadequate and unfavorable treatments in both cancer care and primary care 60:00 How COVID-19 has greatly altered the cancer care landscape 63:00 The delays in cancer screenings during the beginning of the pandemic and how that presents challenges to current operating capacity for many practices

You are about to be inspired and challenged about how you think about value-based care. Since 1991, Rosen Hotels & Resorts has offered an innovative in-house healthcare program called RosenCare that has been improving lives for employees and the community, as well as saved the company approximately $450 million since its inception. Our guests this week are Harris Rosen, businessman, investor and philanthropist who founded Rosen Hotels & Resorts and serves as the company’s president and COO; Kenneth Aldridge, Director of Health Services for Rosen Medical Center, the onsite medical home and primary care ecosystem; and Ashley Bacot, President of Provinsure, an independent insurance consulting arm owned by Rosen. The takeaways from this conversation are multi-faceted and can be applied to ACOs, health plans, and employers. This interview will allow you to re-think how local community engagement and partnerships fit into your healthcare strategy. RosenCare’s approach will force you to reconsider how you approach access, quality, service, costs, innovation. Saving costs and improving lives, this model is ripe for replication and needs to become the norm in our race to value. In the words of Mr. Rosen, “We need to, as a nation, build a much better health system. If we replicated the RosenCare program nationally, we would save over a trillion dollars annually!  Let’s use that money to pay off our national debt. Health care can be the treasure that changes America.” Episode Bookmarks: 01:45 Background on Rosen Hotels & Resorts and its innovative in-house healthcare program (RosenCare) that saved $450 million! 03:45 Introduction to Harris Rosen, Kenneth Aldridge, and Ashley Bacot 07:00 Rosen Hotels & Resorts spends 50% less per capita than the average employer (cost “per covered life” is ~$5,500) 08:20 Mr. Rosen explains how the military adages of the 6P’s and KISS guides his entrepreneurial vision 09:20 The birth of RosenCare in 1991 due to uncontrollable and rising health insurance premiums (Mr. Rosen) 10:00 Lowering healthcare costs 20% but still facing premium escalations…time to become a self-insured plan and build our own clinic! (Mr. Rosen) 14:20 “Our success wasn’t that complicated. Scary…yes. Uncertain…of course. But we did it, and we saved $450-500M in healthcare costs over the last 40 years.” 16:05 How Mr. Rosen leads others and built a such a strong culture that company associates want to be a part of (Ashley) 18:40 How working diligently to keep people healthy drives both good outcomes and a healthy bottom line (Mr. Rosen) 19:05 Social determinants of health and the challenges of keeping associates healthy (Kenneth) 20:20 “This is advanced, direct primary care on steroids!” 22:00 The strength of Rosen’s self-insurance plan, Third Party Administrator, and direct contracting model (Ashley) 24:00 Designing steerage into the benefit design (Ashley) 25:30 The unfounded fears by employers in redesigning health insurance benefits (Ashley) 27:30 An Overview of Rosen Medical Center, A Place for Healing and Wellness 29:00 The importance of relationship-based care at Rosen Medical Center (Kenneth) 34:30 How RosenCare addresses the issue of low value care with PBM formulary selection and surgery options (Kenneth) 36:00 How non-traditional treatment (e.g. medical marijuana) have a role to play in eliminating traditional options of treatment that are of lower value (Kenneth) 39:00 How RosenCare approaches direct contracting with hospitals (Ashley) 40:15 The importance of employers having the courage to be self-insured and the need for reforms in hospital reimbursement (Mr. Rosen) 42:00 “Hospitals must try to be fair and equitable.  They should publish costs and outcomes online.” 43:20 The powerful hospital lobby and its concern for income preservation at the sake of ethical business behavior (Mr. Rosen) 45:00 The horrible financial situation that patients face in typical American health care (Mr. Rosen) 45:45 Removing barriers to care allows people to make good choices (e.g. deductibles, transportation, missing work) (Ashley) 49:00 How RosenCare eliminated out-of-pocket financial risk burden for its associates who undergo hospitalization (Mr. Rosen) 50:00 How Rosen Medical Center is able to care for high-risk patients to achieve better outcomes and lower PMPY (Kenneth) 51:00 The acceptable risk of adverse selection when “the word gets out” (Ashley) 53:00 The importance of massively powerful, relationship-based primary care (Kenneth) 55:00 The need to spend time with patients in the primary care setting (Kenneth) 56:00 Behavioral health integration and telepsychiatry within the RosenCare health ecosystem (Kenneth) 57:00 Addressing SDOH to improve patient compliance (Kenneth) 58:00 Patient compliance rates are 2-3X the national average and how behavioral health spend lowers medical spend (Ashley) 60:00 The egregious flaw in the health system that under rewards primary care (Ashley) 61:00 Community investments in Tangelo Park (free preschool, free college tuition) and how that has reduced crime and improved high school graduation rates (Mr. Rosen) 67:45 How other employers can replicate the RosenCare model through leadership (Ashley) 69:30 The economic imperative to fix healthcare through employer-based reforms (Kenneth) 70:00 How fixing healthcare at a national level can save trillions of dollars, pay off our national debt, and save America (Mr. Rosen)

Every year, millions of Americans are overcharged and underserved while the health care industry makes record profits. We know something is wrong, but layers of complexity make it confusing and discouraging to do anything about it – it seems impossible for most. Our guest this week is Marshall Allen, author of Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win. Drawing on 15 years of investigating the health care industry, reporter Marshall Allen reveals the industry’s pressure points and how companies and individuals have fought overbilling, price gouging, insurance denials, and more to get the care they deserve and protect against the system’s predatory practices. The key message is that we, the consumer, can take back control of our health care. It is up to the American people to equip ourselves to fight back for the sake of our families–and everyone else. Consumers must lead the race to value. Episode Bookmarks:  01:40 An introduction to Marshall Allen and his work investigating the American healthcare system 03:35 The need for a grassroots consumer movement and employer-based disruption to reform a broken system 04:45 How Marshall’s work in investigative healthcare journalism was informed by his work in ministry 05:50 Marshall explains how the healthcare system’s business design violates the Golden Rule 08:15 “The business of medicine is conducted to maximize the profit for the industry, even at the financial harm of patients.” 08:30 Marshall’s new book: “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.” 10:00 The victimization of patients that occurs through flawed system design and the “normalized deviance” by those delivering care 11:30 The importance of reframing the health system to eliminate the exploitation of patients for profit 12:15 “Our healthcare system is allows for the exploitation of sickness for profit.” 13:00 Marshall discusses the lack of an ethical position to exploit consumers for non-discretionary choices 13:20 The escalating price of insulin as an example of how inelastic demand is exploited for profit 15:00 Marshall explains how employers and patients can demand better value by no longer tolerating profit maximization 16:30 Referencing the recent JAMA Study on Medical Debt showing that 1 in 5 Americans have medical debt in collections 17:00 Using Marshall’s new book as a step-by-step, tactical guerilla guide for patient and employer empowerment 19:30 The approval of non-effective drugs and pricing scams conducted by Big Pharma (e.g. the recent approval of Aduhelm) 20:20 Marshall explains how the specialty drug, Vimovo, is an egregious example of a Big Pharma profiteering scheme combining two common drugs with no additional therapeutic benefit (Marshall’s article on Vimovo) 24:00 Motivated to write book to help patients facing financial ruination by healthcare 25:00 185 million Americans in the employer-sponsored insurance market as an opportunity for grassroots reform 25:30 Marshall’s explains his family’s personal experience of financial exploitation by the healthcare system (the Introduction to his book) 28:30 The need for patients to gather evidence when disputing medical billing errors and upcoding 31:30 The effectiveness of small claims courts in empowering patients who are being financially exploited 34:00 Marshall provides guidance on how patients can avoid unnecessary care 37:00 Comparing the financial incentives between capitated models vs. fee-for-service 38:00 Always ask for the cash price as a patient! (you don’t always have to use insurance) 38:30 The massive price variation based on the site of service (e.g. MRIs in hospital vs. freestanding imaging center) 39:45 “You’re not getting more for your money when you pay extra for healthcare.” 42:00 Marshall explains his mission to help patients develop financial literacy by developing consumer empowerment curriculum 45:00 Massive surprise, out-of-network medical bills as an opportunity to fight the system and change the game 48:00 Marshall discusses how employers are “sleeping giants” and have the power to tip the scales in creating a new healthcare system 52:00 Reducing wasteful spending and fraud can reduce healthcare costs by at least 25% (upwards of $1T in savings per year) 53:00 Marshall explains how a phony doctor defrauded health plans by billing with fake NPI numbers 56:30 Marshall explains how an unethical health system in Las Vegas was exploiting foreign-training doctors (“Indentured Doctors”) 58:50 Marshall on the new Hospital Price Transparency rule and the increased exposure of unjustified price variation

This week on Race to Value, we are excited to celebrate Pharmacy Week – it is a time to recognize the invaluable contributions pharmacists and technicians make to patient care in hospitals, outpatient clinics, and other healthcare settings, and to raise patients’ and colleagues’ awareness about the vital role pharmacists play on the healthcare team. Our guests this week are mavens in aligning pharmacy and value-based care. In this episode, we discuss the importance of women in leadership, the impact of drug prices on minoritized communities, vaccine equity, the relationship between SDOH and medication adherence, pharmacy integration, and vaccine science and effectiveness research. Melissa Murer Corrigan was founding Executive Director and CEO of the Pharmacy Technician Certification Board (PTCB) in Washington, D.C. from 1994-2011. Melissa’s leadership launched the PTCB program that has now certified over 600,000 pharmacy technicians working across the United States. Murer Corrigan embraced ambition, took risks, and was the only woman on the PTCB Board of Governors during her 17-year tenure as CEO. In 2012 Melissa joined the ACT as Vice President of Social Impact and sits on the Board of Directors for the American Institute for the History of Pharmacy. Melissa has served as adjunct faculty with the University of Iowa College of Pharmacy since 2013. She has been named a Fellow of both the American Society of Health-System Pharmacists Association and the American Pharmacists Association. Jacinda Abdul-Mutakabbir, also known as “JAM,” is an Assistant Professor of Pharmacy Practice at Loma Linda University, School of Pharmacy and a Critical Care Infectious Disease pharmacist, and an Infectious Disease Pharmacokinetics/ Pharmacodynamics (PK/PD) Research Fellow at Wayne State University under the tutelage of Dr. Michael J. Rybak PharmD, MPH, PhD. Her dedication to improving public health has been recognized by the United States Public Health Services, as she was the 2017 recipient of the USPHS Outstanding Service Award. Additionally, her research has led her to be recognized by the European Congress of Clinical Microbiology and Infectious Diseases one of their 30 under 30 outstanding young scientists, for their ECCMID 2021 31st annual meeting.   Episode Bookmarks: 02:00 Introduction to Melissa Murer Corrigan and Dr. Jacinda Abdul-Mutakabbir (Dr.JAM) 04:00 The importance of National Pharmacy Week 05:30 Overcoming the dominant idea of patriarchy in business and medicine and honoring strong women by allowing them to lead 07:30 Melissa on the celebration of women in leadership and how men can serve as allies and advocates 08:30 Reflecting on women in pharmacy leadership (e.g. Rosalind Brewer, the CEO of Walgreens Boots Alliance) 09:20 Overcoming Imposter Syndrome to create a “growth mindset” within women 10:30 Dr. JAM on the steps taken to towards improving gender equity within the pharmaceutical workforce 12:00 Prescription drugs are the fastest growing healthcare expenditure and consistently outpace other health spending 13:00 Biden administration support for legislation to empower the government to negotiate Medicare drug prices with Big Pharma 14:00 Melissa on providing patients with the access to medications they need so they are “not making choices between treatment and buying groceries” 14:30 Dr. JAM on how drug prices impact individuals in minoritized communities 15:30 Utilizing the approach to equitable distribution of COVID-19 vaccines to the provision of lifesaving medications to underserved communities 17:00 The role that pharmacies have to positively impact and address the systemic health disparities in communities of color and low-income neighborhoods 17:30 Referencing AJMC research showing that Black individuals who received medication therapy management services from a pharmacist significantly improved their diabetes 18:30 Dr. JAM: “Pharmacists are the most accessible healthcare professional and have a role to play in improving health equity.” 19:50 Minoritized individuals are less likely to have a primary care physician 20:20 Dr. JAM on how she applies her specialty training in infectious disease to provide education to patients during the COVID-19 pandemic 21:40 Dr. JAM: “Pharmacists are drug information experts, and that knowledge needs to be utilized to improve the health of communities.” 22:00 Melissa on recent events of racial injustice and social unrest and how Dr. Lakeesha Butler(President of the National Pharmaceutical Association) provided leadership during this time 24:30 Melissa on how the pharmacy profession is dealing with systemic racism and the realization that there is “still so much to do” 25:30 Melissa: “The pharmacy profession is taking action to become better patient advocates in order to address health equity and social justice.” 27:30 Dr. JAM on the underrepresentation of minorities in the pharmacy profession and the importance of diversity in culturally competent care 29:30 Dr. JAM: “Racial concordance equates to better patient outcomes.” 30:30 Melissa on the action-oriented work of national pharmacy associations to provide more diversity and inclusion to re-shape the profession 33:00 Dr. JAM on the importance of a multi-modal approach that includes different types of interdisciplinary stakeholders (including faith leaders) to co-develop strategies for equity 36:30 The role that pharmacy integration plays in value-based care and the medication adherence impact on costs through reduced inpatient hospital stays and emergency visits 38:00 Melissa: “A team-based multidisciplinary approach to care is needed.  We need to move away from silos and into integration, with the patient at the center.” 38:45 Broadening our thinking to a community-based approach to healthcare (e.g. churches and beauty shops) 40:00 Medication non-adherence most commonly among low-income, uninsured patients initiating therapy for chronic conditions 40:45 Dr. JAM reflects on the impact of social determinants of health on medication adherence and how minoritized communities are adversely impacted 43:45 Melissa on pharmacy practice transformation by adopting a holistic view of the patient to address SDOH in community-based pharmacies 44:45 Melissa on the role of pharmacists in supporting improvement of behavioral health for patients in need 48:00 Dr. JAM explains mRNA vaccine technology vs. the traditional viral vector-based vaccine technology to provide guidance to those experiencing vaccine hesitancy 50:00 Dr. JAM provides a research-based overview and scientific explanation of the effectiveness of COVID-19 vaccines, including those within populations disproportionately affected by COVID-19 54:00 “You are more likely to be protected should you be vaccinated. 95-99% in this hospital and on ventilators are those that are not vaccinated.” 55:30 Dr. JAM speaks about her work with Faith-based organizations to boost vaccine equity in minoritized communities 60:00 Parting thoughts from Melissa and Dr. JAM on the pharmacy profession during National Pharmacy Week

Our guest this week is Dr. Tamarah Dupervahl-Brownlee, Chief Health Officer for Accenture, and recently, Chief Community Impact Officer for Ascension. A Physician leader with 20+ years of experience practicing medicine, she has served in various healthcare leadership roles that focus on optimizing the physical, mental, and financial health and wellbeing of communities. Dr. Dupervahl-Brownlee is fiercely determined to create and implement strategies for people to thrive and live healthy and well. Throughout her career, she has served as a champion for providing high quality healthcare and advancing health equity that has impacted thousands of lives.  In recognition of that work, she was named by Modern Healthcare as one of the Top 25 Women Leaders in 2021 and one of the Top 25 Minority Leaders in Healthcare in 2020. She is nationally recognized for her leadership in collaborating with partners across the industry and nonprofit community to advance community health improvement initiatives, with a particular focus on health equity. Her strong patient-centered approach to medicine, with a special interest in women, children, and underserved populations, makes her a clear leader in the race to value. Episode Bookmarks: 05:30 Dr. Dupervahl-Brownlee speaks to her personal leadership journey 07:30 Lessons in servant leadership and the importance of “stepping out of one’s self” and investing in others 08:15 The influence of Dr. Dupervahl-Brownlee’s mother, an immigrant from Haiti, who laid a great foundation for her to pursue a career in medicine 11:00 “The pandemics of both COVID-19 and social injustice show us just how inextricably linked we are as people. This is the time to examine opportunities to improve health equity.” 13:20 The need to reposition the healthcare workforce to address human pain and suffering 14:20 “Profitability in healthcare has led us astray by ignoring vulnerable communities and creating opportunities to innovate.” 16:00 “If we all head a lens of equity, just think about we could do as leaders in healthcare.” 17:40 Dr. Dupervahl-Brownlee speaks about how value-based care and emerging payment models can be leveraged to improve health equity 18:20 The leadership of CMS Administrator Chiquita Brooks-LaSure to tackle health equity and better understand the social determinants of health through value-based care 19:30 Understanding how social risk factors and community-based investments to improve population health 20:45 The need for research in patient-reported outcomes to assess how healthcare can help patients thrive 22:40 Referencing her early beginnings practicing medicine in the South side of Chicago and how Social Determinants of Health prevented improvement in patient outcomes 25:00 How structural biases and racism negatively impact health in communities and the need for health policy reforms 26:30 The need for more curiosity and inclusivity in healthcare to know “the rest of the story” 27:45 How we can use data from outside the traditional healthcare system in improving the health of vulnerable populations 30:00 Dr. Dupervahl-Brownlee on the future of hospitals as healthcare moves more towards value and consumerism (“The hospital of today will be extinct in the future”) 31:00 The reordering of the healthcare solar system to patient-centeredness 32:00 Referencing her prior work in Patient-Centered Medical Home transformation 35:00 Dr. Dupervahl-Brownlee provides perspective on how our country can achieve better integration of behavioral health in the primary care environment 38:30 The irreparable harm of the pandemic on societal mental health and the use of digital health in integrated care models 41:30 Acknowledging the resilience and fortitude of healthcare heroes during these challenging times 42:30 The importance of physician leadership with a shared and lived experience in practicing medicine to create empowerment within the profession 44:00 Dispersion of leadership to everyone on the interdisciplinary care team 48:00 Strategies for equitable distribution of COVID-19 vaccines and building trust with the “vaccine inquisitive” in vulnerable communities 56:00 Dr. Dupervahl-Brownlee provides parting comments on what success means to her, how to live an authentic life, and importance of following your North Star

Gender-affirming care offers a model for all of health care, one that is patient-centered and based on the human story.  In this episode, you will learn about “The Truth and Beauty of Gender-Affirming Care” from a leading transgender health provider and value-based care thought leader. Dallas Ducar is the founding CEO of Transhealth Northampton. In this role, Dallas brings experience constructing clinical, research, and education services in community-based, gender-affirming, healthcare systems. She combines this leadership experience with frontline clinical experience in emergency, inpatient, and outpatient care. Prior to assuming the CEO position, Dallas served as the Clinical Lead for Mental Health Services at the Massachusetts General Hospital Transgender Health Program, where she worked with an interdisciplinary team to provide novel gender-affirming care.  In her career, she has advised international research groups in best practices and has carried out community-based participatory action research programs dedicated to empowering gender-diverse voices in a community setting. As a nationally recognized leader in transgender health, Dallas is on a personal crusade to improve the quality of care for gender-diverse individuals. Topics covered in this episode include gender-affirming care, health equity, social determinants of health, mental health in the transgender community, culturally-competent care, mindfulness and meditation, telehealth expansion, pediatric transgender care, insurance barriers, and the recognition of transgender rights as civil rights. Episode Bookmarks:  05:40 Overcoming gender dysphoria to realize “gender euphoria” as her truest self 07:40 Using her “trans superpowers” to become a more resilient human being 09:10 Dallas speaks about the period in her life when she was transitioning in Charlottesville, VA 12:00 Recognizing the opportunity to address trans rights in the healthcare arena 14:50 Dallas explains the concept of gender-affirming care and how it is an example of patient-centeredness and compassion 15:40 “What is gender-affirming care? It is patient-centered, whole-person care that addresses every part of one’s life that intersects with gender.” 16:40 “The simple truth and beauty of gender-affirming care is that it affords every human being the freedom to be who they are.” 17:10 Dallas explains the value-based care delivery model of Transhealth Northampton, the nation’s first independent comprehensive trans health care center 17:40 Gender-affirming care that delivers value (ex: improved behavioral health outcomes, less suicidality, more effective SUD treatment) 19:40 “Patients in a value-based gender-affirming care model have lower healthcare spending, higher patient satisfaction, and improved clinical outcomes.” 20:40 What is Health Equity?  (a definition from the Robert Wood Johnson Foundation) 21:10 Transgender individuals are more likely to be in the lower income brackets with 44 percent of trans community living on an income of $35,000 or less 22:10 Published Reporting of trans discrimination in healthcare (Referencing the Center for American Progress Report) 23:40 Dallas discusses the observed impact of trans discrimination in healthcare and the interrelatedness of SDOH barriers 25:40 The importance of culturally-competent care and the provision of care by people with the same “lived experience” 27:40 Expanding access to gender-affirming care with telehealth 28:40 40% of the transgender community have attempted suicide in their lifetime (9X the attempted suicide rate of the entire US population) 30:10 Dallas speaks of the importance of behavioral health integration in the primary care setting 32:40 Dallas explains why providing care in a “celebratory and open-hearted queer-friendly healthcare environment” improves outcomes 34:10 The importance of families staying together within a gender-affirming care model 35:40 Dallas discusses how mindfulness and meditation can help those in the LGBTQ community 40:10 Dallas’ political advocacy in reforming interstate licensure rules and why expanding telehealth is vital to the trans community 46:10 Dallas debunks myths about gender-affirming care for pediatric populations and explains what this type of care actually is 51:10 Insurance-related barriers to gender-affirming care and reimbursement issues for healthcare organizations 57:40 Dallas on how transgender rights and how we foster acceptance within our deeply divided and polarized country 61:40 “Gender-affirming care is a profound expression of patient-centered care – one that is really based on the human story…”

As one of the leading integrated health systems in the country  — serving more than 3 million residents throughout 45 counties in Pennsylvania and New Jersey with 30,000 employees, nine hospitals, 1,600 employed physicians, 13 hospital campuses, 70 primary care sites, two research centers, and a 550,000-member health plan — Geisinger has become a standard for value-based payment innovation and care delivery transformation. Geisinger was also an early adopter of value-based payment as a member of the Keystone Accountable Care Organization (ACO), which is a group of nearly 5,000 physicians and advanced practitioners and 9 hospitals who deliver over $800 million annually in coordinated healthcare services to more than 80,000 Medicare patients in Pennsylvania.  Additionally, Geisinger has been engaged in Medicare’s Bundled Payment for Care Improvement program since 2014, and currently has more than $140 million in healthcare services delivered as part of Medicare’s Bundled Payment for Care Improvement Advanced (BPCIA) program. Our guest this week is Dr. Jaewon Ryu, M.D, J.D, President and CEO of Geisinger. Dr. Ryu has led the system with a spirit of innovation and transformation, driving new approaches to some of healthcare’s most complex problems, including primary care redesign, home care and senior-focused, concierge healthcare centers for those 65 and older. His commitment to making health easier by improving outcomes, engagement and affordability are evident in his work and make him an exemplar in the race to value. Episode bookmarks: 05:30 Dr. Ryu describes Geisinger’s Value Journey that has been taking place over the last 35 years 06:30 “Value-based care allows us to innovate around care models by marrying the payment with delivery.” 08:15 Dr. Ryu provides advice to other health systems looking to invest in an infrastructure for population health 11:30 Dr. Ryu discusses how “Primary care is the backbone of the delivery system” and why it is so important in managing chronic disease 13:10 The Abigail Geisinger Scholars Program that offers medical students entering the Geisinger Commonwealth School of Medicine free tuition if entering primary care 14:30 The importance of Geisinger physicians understanding its different care models (e.g. Geisinger 65 Forward, Geisinger At Home, LIFE Geisinger) 17:30 Dr. Ryu discusses the impact of the COVID-19 pandemic on frontline providers and staff and importance of workforce resiliency during challenging times. 19:00 How Geisinger’s Value-Based orientation positioned it favorably during the COVID-19 pandemic (e.g. upstream capabilities and care at home program) 20:00 How strong partnership with employers, school districts, and nursing homes created a pandemic response ecosystem to improve community care 21:00 “Our value-based care orientation provided us with a public health lens to better care for our communities during the pandemic.” 23:30 How the Steel Institute for Health Innovation provided human-centered design thinking, AI/ML, automation, and other innovations to further catalyze VBC at Geisinger 28:30 Dr. Ryu describes the importance of risk stratification and population segmentation in providing better care to seniors with chronic disease 29:30 Geisinger 65 Forward clinics that provide VIP-level personalized care and appointments, longer visits, one-stop shopping, and social and educational activities for seniors 30:45 Unlike other high-touch senior-focused primary care models, Geisinger 65 Forward is fully-integrated with the health system 32:40 How primary care redesign at Geisinger focusing on team-based care improved clinical outcomes 35:20 Dr. Ryu on how we need to move care away from “Field of Dreams” facilities (i.e. the “if you build it, they will come” model) towards a more asset-light model of care delivery 36:45 Geisinger At Home as a national example for home-based care delivery 40:30 Dr. Ryu describes what Geisinger is doing to take upstream actions in address SDOH (e.g.Fresh Food Farmacy to provide nutritious food and diet coaching for diabetics) 42:00 Reducing HbA1c’s by 40% in diabetic population by addressing food insecurity and nutrition! (“Food has proven to be more impactful than medicine.”) 44:30 Geisinger’s use of NeighborlyPA to help refer patients to social, health, and human services in the community 46:30 Dr. Ryu describes Geisinger’s MyCode Community Health Initiative, a precision health and genomics program that analyzes DNA to diagnose medical conditions earlier 52:30 “Necessity is the mother of innovation” when it comes to reforming health policy to create better value in healthcare. 53:30 Dr. Ryu provides perspective on the future of health policy and the value-based care movement. 56:30 Dr. Ryu describes Geisinger’s strategy for direct contracting with self-insured employers as a Center of Excellence and narrow network.