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The Race to Value Podcast

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Sep 20, 2021 • 1h 7min

Ep 69 – The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity, with Susan Hassmiller, PhD, RN, FAAN and Janelle Sokolowich, PhD, RN

In this week’s episode, we spotlight the recently released Future of Nursing report, “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.” The report is a landmark consensus study supported by the National Academy of Medicine and the Robert Wood Johnson Foundation. It charts a 10-year path for the nursing profession, to help our nation create a culture of health, reduce health disparities, and improve the health and wellbeing of the US population in the 21st century. The COVID-19 pandemic has exposed serious inequities in the nation’s healthcare system, with frontline healthcare workers often lacking the necessary PPE and other equipment to safely and effectively do their jobs, and the murder of George Floyd shined a spotlight on the structural racism that exists in the workplace and society at large. In the wake of these challenges, the Future of Nursing report provides us with a north star to guide the nursing profession over the next 10 years, with a particular focus on reducing health inequities and improving health outcomes in value-based care. Our guests are both important thought leaders in nursing. Dr. Susan Hassmiller is the Senior Advisor for Nursing at the Robert Wood Johnson Foundation, and Senior Scholar in Residence for the National Academy of Medicine. Dr. Janelle Sokolowich is the academic Vice President and Dean for the College of Health Professions at Western Governors University. Their voices are united in sharing this important message: nurses are key to health, healthcare, and the future success of our healthcare industry, and educational programs that provide equity in access and learning will ensure our nursing workforce has both the cultural humility and clinical competence to address the needs for greater health equity and diversity. Episode Bookmarks: 01:40 Introduction to the “Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity” 04:40 The need for diversity in the nursing workforce and how to eliminate bias in teaching and learning 06:55 Historical contrasting between stories of Florence Nightingale and Lillian Wald with occurrences of racism in nursing (e.g. Black Angels) 07:20 Recognizing bias in nursing curriculum through population exclusion (e.g. transgender), stereotypes, colloquialisms, and standardized testing 09:00 The lack of training with nursing faculty on how to have uncomfortable, yet crucial, conversations on race and health equity 10:00 The importance of diversity and cultivating inclusive learning environments 11:00 Holistic recruiting and competency-based learning as an opportunity equalizer for students of color 11:30 “Health equity is our end goal, but in order to even achieve that, we have to create pathways to education.” 12:50 The “Diversity Tax” – dependence on faculty of color to do all of the mentoring for underrepresented minority students 14:20 Raising awareness for health inequities to bring about industry-level commitment to SDOH and health equity 15:20 The importance of holistic admissions, diversity, and cultural humility to build models for culturally-competent care 16:20 “Our goal as educators is to empower our students to have cultural currency in their communication so that they can provide competent care that is enhanced and enlaced with humility.” 17:00 The need for kindness and patience for others to elevate crucial conversations 20:00 Competency-based education in nursing as an opportunity to increase diversity in the workforce and improve health equity for populations 22:00 “Competency-based education is a promising way to integrate equity, social determinants of health, and population health into the nursing curricula all at one time.” 24:00 Confronting Institutional Racism in Nursing Practice and the need for more open conversations to overcome health inequities 25:00 “Inequities in this country lead to very poor outcomes. We spend trillions of dollars on healthcare, and we still have the worst outcomes of all other countries because of these inequities.” 29:00 Drs. Hassmiller and Sokolowich discuss powerful examples of institutional racism in healthcare and why we must use them in open conversations 33:00 Social and Emotional Learning as an opportunity to support nurse wellbeing by helping them integrate their thoughts, emotions, and behaviors 37:30 The need to increase the number of nurses from underrepresented groups in leadership positions in practice and in academia 41:40 The need for more structure in providing mentorship and leadership programs for the nursing programs 43:30 The imperative that the nursing profession must unite and work and pursue interprofessional collaborations to solve problems in health equity 48:00 Drs. Hassmiller and Sokolowich discuss the current challenges with nurse understaffing and how we should improve the environment of care to better support nurse wellbeing 53:00 Drs. Hassmiller and Sokolowich how the nursing profession should prepare to lead the inevitable transition to value-based care 60:00 “If we overcome institutional barriers and allow nurses to practice to the top of their education, more value-based care would be at hand for us.” 62:00 The societal need to value nurses much more than they are today and considerations for how to align compensation and incentives to recognize that value. 64:00 Parting thoughts on nurses can improve patient care outcomes and health literacy within value-based care models
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Sep 13, 2021 • 52min

Ep 68 – Value-Based Care: A Superior Technology to Create Trusting Relationships, with Dr. Griffin Myers

  Oak Street Health has an amazing vision to rebuild Health Care as It Should Be: Personal, Equitable, and Accountable. The business was launched with a belief in value-based care that was patient-centered, evidence-based, and ensured equal opportunity for good health outcomes across populations, despite the economics being unproven. The business model depends on global capitation and allows the best service for patients in some of the poorest and most vulnerable communities. The high touch, relationship-based, tech-enabled primary care model includes support with medications, transportation, social work, home visits, and more – the sickest 10% of patients receive 78% of Oak Street’s dollars. This week, our guest is Dr. Griffin Myers, CMO and co-founder of Oak Street Health. In his own words, the challenge is not providing treatment but winning patients’ “trust and building relationships,” something Oak Street has demonstrated successfully with its ability to rapidly scale, to a network of 90 centers in 15 states. The Oak Street Platform is redefining Primary Care by bringing technology-enabled, value-based care to the seniors that represent the highest proportion of healthcare spending in the country. Winning the race to value will depend on many more following in the footsteps of these leaders! Episode Bookmarks: 05:35 The “insane” journey of starting a company that takes full-risk on very sick populations 05:55 “The downstream microeconomics of fee-for-service reimbursement has created a janky, inequitable, low quality health care system.” 06:30 The importance of segmenting your patient population within a payment model that is better aligned with care outcomes 06:40  “We take care of community-dwelling older adults with multiple chronic conditions and adverse social determinants.” 06:50 Full risk, global capitation enabled the development of the Oak Street Health platform. 07:00 Oak Street platform: 1) Community-Based Primary Care Centers, 2) Proprietary Technologies, 3) Value-Added Services to Primary Care 07:35 Dr. Myers discusses how the culture at Oak Street, coupled with the power of global capitation, drives value-based care results. 08:45 Oak Street’s Results: 50% reduction of hospital admissions, 52% reduction of ED visits, 35% reduction in 30-day readmission rates, 5-star quality ratings, and a 91 NPS 10:40 Dr. Myers discusses the concept of relationship-based care and how it improves outcomes for underserved populations. 11:20 Referencing Viktor Frankl’s “Man Search for Meaning” and how deeply meaningful and trusting relationships provide purpose 12:05 “Trust is the core input to us being able to help patients navigate adverse social determinants.” 12:10 Critical Success Factors: 1) Spending more time with patients with a consistent presence from a longitudinal care team, 2) Deep sense of accountability (“a promise”), 3) Culturally-Competent Care 12:55 “Having people who live in the neighborhoods to which we serve that share a cultural connection with patients helps form trusting relationships.” 13:30 “A value-based model is simply superior technology compared to fee-for-service. Value allows you to incubate and foster relationships to drive outcomes.” 14:40 Inspiration from John Lewis (“Try to be the pilot light not the firecracker.”) when it comes to building a safer, higher quality, more equitable, more affordable health system. 17:35 Referencing the HBS Case Study: “Oak Street Health: A New Model for Primary Care” 17:45 The role of the Clinical Informatics Specialist at Oak Street 18:30 Dr. Myers discusses the evolution of EHR technology at Oak Street and the development of Canopy (winner of the 2021 EHR Innovation Award) 19:40 The Value Flow of the Canopy EHR: “Data, Insights, and Action” 20:15 Deep and long-term relationships between the patients and providers that allows for enhanced data capture. 20:30 Referencing the recent NEJM Catalyst Article on Oak Street Health: “Interpretable Machine Learning Models for Clinical Decision-Making in a High-Need, Value-Based Primary Care Setting” 21:00 Surpassing off-the-shelf algorithms for patient risk stratification through enhanced data capture in a relationship-based primary care model 21:45 Dr. Myers discusses the difference between Machine Learning and Artificial Intelligence 22:15 Reducing readmissions by 15% with virtual hospital rounding of patients using a data-driven checklist 25:20 Dr. Myers discusses the core value of health equity at Oak Street Health 26:15 “Health disparities are the opportunity in value-based models.” 27:40 Being deliberate about addressing health equity requires three things: 1) Be Local, 2) Focus on Cultural Competence, 3) Prioritize Health Equity and Incorporate in your Values 29:45 The exacerbation of health disparities with COVID-19 and how Oak Street’s innovative care delivery model met needs for underserved communities 30:40 Oak Street delivered 185,000 COVID-19 vaccines across communities 33:25 Dr. Myers discusses Oak Street’s approach to behavior health integration 33:55 Inspiration from Rumi (“Keep your gaze on the bandaged place. That’s where the light enters you.”) when it comes to addressing suffering due to poor behavioral health 34:30 Referencing the IMPACT Study and the Collaborative Care Model (CoCM) in creating successful integration between primary care and behavioral health care 35:25 Cost savings from BH Integration doesn’t come from reduced admissions related to mental health (it instead comes from improved wellbeing that reduces downstream spending on organic illness) 37:15 Dr. Myers discusses “What it means to be Oaky” and Oak Street’s approach to workforce development and company culture 39:55 Oak Street Health earns the “Joy in Medicine” recognition from the AMA in fighting physician burnout through “enlightened clinician leadership” 41:15 Dr. Myers discusses how Oak Street Health is doing in physician satisfaction and retention 44:20 Dr. Myers on the transition to telemedicine during the pandemic and where it fits in within a high touch primary care model 46:10 Dr. Myers discusses the rising role of retail-based primary care and references Oak Street’s partnership with Wal-Mart 47:20 “How beautiful is it that we now have a space in this country where organizations are putting blood, sweat, tears, and capital to serve vulnerable and low-income communities?” 44:80 Inspiration from Viktor Frankl: “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” 49:10 Parting thoughts on celebrating the optimism of the moment and seeing hope for the future of value-based care
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Sep 6, 2021 • 1h 6min

Ep 67 – The Path of Hope for Human-Centered Care Delivery, with Dr. Zeev Neuwirth

Let’s face it – the healthcare system is broken. It will never be fixed unless we fundamentally redesign our industry towards a more consumer-centric model. That will require courageous leadership, and our guest this week provides “the path of hope for human-centered care delivery”.  Leaders must overcome the cultural malaise that has been formed after years  being conditioned by the current model. We know that our healthcare system causes 200-400k avoidable deaths each year (which is like having two or three jumbo jets crashing every single day), however, we’ve become desensitized to the consequences of our flawed model for delivering care. Each and everyone in the system bears responsibility for other people’s lives and has a role to play in reimagining the future of healthcare. We clearly need urgency for change. Dr. Zeev Neuwirth is the author of “Reframing Healthcare: A Roadmap For Creating Disruptive Change” and produces and hosts the popular podcast series, “Creating a New Healthcare.” He is currently serving as Atrium Health’s Chief Clinical Executive.Dr. Neuwirth is reorienting the way individuals and organizations think about healthcare, to catalyze movement towards an affordable, accessible, effective and safe healthcare system.His ultimate goal is to humanize healthcare for those who serve within the system, and especially for those who are served by the system.   Episode Bookmarks: 03:15 Referencing Dr. Neuwirth’s book:  “Reframing Healthcare: A Roadmap for Creating Disruptive Change” 06:30 The challenges of practicing medicine in the pandemic era and recognition of those on the frontlines of care delivery 08:20 A shift in focus from Internal Medicine to care redesign, human-centered care delivery, and process improvement 08:50 Dr. Neuwirth explains his passion in seeking out people who are making a difference 09:40 “Creating a path of hope for health care delivery” by providing a platform for those transforming healthcare 11:30 “Health care transformation is already happening across the country. It’s just a matter of aligning payment to it.” 12:30 “Are we collectively ready to have the courage to change a system in fundamental ways? The answer is YES or NO – there is no in-between.” 13:00 The catalyst for Dr. Neuwirth’s work in health care transformation started twenty-five years ago (seeing the “inhumane” system). 15:00 “You cannot improve this system.  You actually have to reframe it.” 16:00 Dr. Neuwirth explains how his mother died from a completely preventable hospital-acquired infection 18:00 Avoidable deaths due to medical errors happen to over 400,000 families a year! 18:30 Dr. Neuwirth discusses the human tragedy of a close friend and physician colleague who committed suicide 19:45 “I am going to go down fighting against a system that strips the humanity out of every single person who tries to do the best they can to help their fellow man.” 21:00 Dr. Neuwirth’s déjà vu “Groundhog Day” moment realizing that we keep talking about the same answers (but the system never changes) 22:30 “Technology is an enabler – no question about it.  But it is not the transformative thing needed to create a new orientation.” 26:30 Courageous leadership to re-instill humanism in health care sometimes requires people to make sacrifices in their career. 27:20 “The people are not the problem in health care…the system is.” 28:00 “If there is an evil in health care, it is the fee-for-service payment model.” 29:00 When piecemeal payment and patient churning ultimately becomes the key performance indicator — choosing to leave or live with it! 30:30 “We have turned physicians into visit vendors.” 31:30 “It is mind boggling that we continue to drag our feet In this shift from fee-for-service to value-based payment.” 32:00 Looking for collective courage in industry – why don’t CEOs link arms in solidarity for value-based care? 32:45 “Change the payment model and we will make an impact on physician burnout by putting the meaning back into medicine.” 33:15 Continuation of fee-for-service will bankrupt the system at an accelerate pace 34:00 The need for a new type of collective leadership to reframe healthcare 38:00 Dr. Neuwirth explains the importance of the marketing mindset in reframing healthcare (“The essence of marketing is understanding your customer.”) 41:00 The importance of customer segmentation in optimizing care delivery for population health 43:30 Dr. Neuwirth provides an overview of the Reframe Roadmap 46:30 Dr. Neuwirth explains how creating a segmented rebranded primary-care ecosystem starts with complex chronic care 50:00 Complex Chronic Care clinics for seniors (Examples from ChenMed and Iora Health) 56:00 A Consumer-oriented care redesign example from Nicholas Archer of AdventHealth (Project Fulcrum) 62:45 An executive from a large multi-billion retailer tells Zeev the true meaning of “customer obsession”
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Sep 1, 2021 • 48min

Ep 66 – An Old-World Doctor’s Prescription for Health in a New World, with Dr. Tony Dale

We’re excited to share this special edition episode with Dr. Tony Dale, an “Old World” doctor from England who has since become a successful healthcare entrepreneur in the United States.  Despite practicing socialized medicine early in his medical career, Dr. Dale has become a champion for free market reforms to our nation’s healthcare system.  As the founder and Chairman of The Karis Group and Sedera, he has brought cost transparency and consumerism to the forefront.  Dr. Dale’s entrepreneurial vision has directly impacted the lives of millions of patients seeking the best possible care at fair and affordable prices. In this podcast conversation, we discussed his newest book “The Cure For Healthcare: An Old World Doctor’s Prescription for the New World Health System”. This episode was recorded in collaboration with the Point Health podcast and its hosts Steven Cutbirth. Episode Bookmarks: 01:20 Intro to Dr. Tony Dale — from practicing family medicine in London to his work as an American healthcare entrepreneur dedicated to affordable care 02:30 Early experiences with his father, a family doctor in Taiwan, who led him into a career in medicine 04:30 What Dr. Dale learned from his work as a physician in the UK’s NHS within a socialized model of medicine caring for the poor 06:30 Access to care in a socialized model does not necessarily mean access to quality 07:30 Seeing 40-60 patients per day, on top of doing home visits, led to bad medicine 08:15 Relocation to the United States with an inspiration to help doctors treat the “whole person” in a holistic way 10:00 How the British system prevented family medicine doctors from helping their patients who were hospitalized 10:45 Dr. Tony Dale’s new book, The Cure for Healthcare 11:10 Inspiration from “The Price We Pay” by Dr. Marty Makary 12:00 Fascinating examples of the “power of the free market” from his work with Sedera to provide medical cost sharing 12:45 Dr. Dale’s experience in influencing health policy and how that convinced him that a grassroots effort is really the true cure for healthcare 13:45 Albert Einstein’s famous maxim, “The thinking that got us to where we are is not the thinking that will get us to where we want to be” 14:30  The issues of waste, inefficiency, and outright fraud — how current health policies enrich the very few, at the expense of the “ordinary American” 16:30 “The answer to changing the system isn’t incremental.  It is dramatic.” 16:40 Parallels to the disruption of the transportation system from Uber/Lyft (ridesharing) and Priceline (airline and hotel booking) 17:40 How Cristen Dickerson (a radiologist in Houston) and her company Green Imaging is bringing “the Priceline model to Radiology” 19:30 Inspiration from radical change agents who bring a “stroke of genius” to fixing healthcare 20:30 President Obama and the passage of the Affordable Care Act that led to an exemption of Christian healthcare sharing ministries 22:45 Finding a way to make the medical sharing model (a non-insurance solution) mainstream through the founding of Sedera 25:00 The story of his founding of The Karis Group (now Point Health) to help patients shop for cash pay options for healthcare services 27:40 The exploitation of government regulations related to the Medical Loss Ratio in order to drive health insurance profits 28:30 “The system is working perfectly for what it is designed for.  It is designed to let the big hospitals consolidate and drive up prices.” 29:20 The “smoke and mirrors” tactic of  duping patients to pay more for urgent care by billing as an ER (paying 3X more for the same care!) 30:30 How a free market based on innovation and cash payment can improve the patient-provider relationship 31:40 Referencing the work of Dr. Keith Smith (Surgery Center of Oklahoma) in creating lower costs and transparent prices 32:30 The transformational potential of Direct Primary Care 34:00 Dr. Dale discusses the work of his son Matthew Dale (CEO, Point Health) 35:00 Unleashing the power of consumerism in healthcare by creating tools that enable cost-conscious shopping 37:00 Dr. Dale explains how figuring out how to get better care and easier access at a lower price will ultimately transfer wealth to the American people. 39:00 Mobilizing CEOs to “fire the healthcare system” with inspiration from Harris Rosen who saved $440M with his employer-sponsored plan 42:00 “Directing dollars into a free market ecosystem with open, fair, and transparent pricing will lead to easier access, higher quality, and dramatically lower costs.” 43:45 Single Payer vs. Free Market – Dr. Dale discusses the impact of health policy in the future 45:30 Searching for the American Dream – “The free market can show people how to thrive.”
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Aug 30, 2021 • 54min

Ep 65 – Developing Human-Centered Health Systems in Low and Middle Income Countries, with Dr. Chintan Maru

Historically, health systems in low- and middle-income countries (LMICs) have taken a volume-based approach to health rather than a value-based one. The public sector has focused on coverage rates or access, and the private sector profits when it drives quantity of expensive, hospital-based care. Adhering to this path will create long-lasting structural flaws that increase costs without delivering desired results, similar to what we see in the US and many other developed economies. Our guest this week is Dr. Chintan Maru, founder and executive director of Leapfrog to Value, a health initiative to advance value-based care in lower- and middle-income countries. Dr. Maru is a medical doctor and public health expert who has dedicated his career to maximizing the value of health systems. The race to value is not limited to fixing health care in the US – lessons learned and shared internationally will have world-wide impact, and will help lower- and middle-income countries leapfrog past hurdles and accelerate their own race-to-value. Join us as we learn from Dr. Maru about his efforts to leapfrog to value in Ghana, South Africa, Kenya and India! Episode Bookmarks: 01:45 Low- and middle- income countries (LMICs) are at-risk of replicating system flaws from higher-income countries 02:10 The Leapfrog to Value strategy: Building a robust ecosystem for VBC experimentation 04:00 How Dr. Maru’s father dealing with Parkinson’s Disease provided a personal perspective on the work he does in value-based care 06:00 “In low- and middle-incomes countries now, quality has eclipsed access as a prime driver of outcomes.” 08:30 “There is a big focus in low- and middle-incomes countries on primary care and community-based health delivery, often via community health workers.” 09:15 How Value-Based Care differs In LMICs: focus on how to spend more on health to achieve universal health coverage! 09:45 “Instead of volume versus value, you are trying to get both volume and value.” 11:00 Ensuring localization by directing donor-funded programs for health system development with local stakeholders 13:15 Dr. Maru explains how the definition for “value” differs in LMICs when implementing universal healthcare 14:00 “The phrase ‘value-based care’ hasn’t really shaped the dialogue for universal health coverage for places like India or Kenya yet. It’s just coming into the conversation.” 14:15 How can payment models in LMICs prioritize health over healthcare? 15:15 Feasibility versus point of path feasibility in creating value-based care systems 16:30 “There is a ‘leapfrog to value’ opportunity in low- and middle-income countries to build a value-based health care system somewhere between the point of feasibility and  the point of path dependency.” 17:00 Building new national health insurance models in Kenya, India, South Africa, and Ghana to experiment in value-based care 18:45 Dr. Maru cites mobile banking penetration in Nairobi as an example of how we can learn from the ingenuity of others when there isn’t already an entrenched ecosystem 20:15 Partnering with USAID Center for Innovation, the Gates Foundation, and the Rockefeller Foundation on the Leapfrog to Value flagship report 21:45 Getting buy-in from local stakeholders in LIMCs for value-based care experimentation and innovation 23:00 “Value-based care is partnership-driven.” 24:00 The role of global health donors in providing risk capital to cover the costs of value-based care pilots in LMICs. 25:00 Comparing climate change and the need for environmental sustainability to the value-based care movement 26:30 Determining appropriate hospital bed capacity in places like Mumbai, India, Lagos, and Nigeria 27:30 Sensitizing healthcare investors to take a bit of a civic-spirited point of view–perhaps even before any value-based payments really shape the market 28:45 Creating the right incentives for patients to be responsible for personal health outcomes when the health system is predominantly funded by the public sector 29:45 Implementing direct-to-consumer options in publicly-funded health systems 30:45 “The tip-of-the-spear opportunity might actually be a vertically-integrated system because the payer-provider context allows for value-based care.” 31:15 The example of Thailand as an exemplar country that pursued both value-based care and universal coverage 32:45 Finding homegrown, local examples of ingenuity in LMICs like India (e.g. eye care and cardiac surgery) 34:15 Developing a human-centered model for tuberculosis care in India 38:00 The role of technology in making the leapfrog to a value-based system 39:30 “Many of these countries are articulating their own national digital health roadmaps.” 40:00 How COVID-19 has demonstrated the potential for technology to enhance care delivery 42:00 Dr. Maru discusses the use of Patient Reported Outcome Measures (PROMs), e.g. HIV treatment 45:45 Dr. Maru discusses the elements of workforce development that are needed to make a shift towards value. 48:00 How COVID-19 has affected the movement to value-based care in countries like India where the pandemic is uncontrolled. 49:00 “Social determinants of health are the highest value levers.” 51:00 Dr. Maru makes a book recommendation: Reverse Innovation in Healthcare: How to Make Value-Based Delivery Work 52:00 “What motivates me most is this idea that health systems are really about human flourishing.”
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Aug 23, 2021 • 1h

Ep 64 – Creating Optimal Post Acute Care Networks in the New Value Paradigm, with Ian Juliano

The traditional definition of post-acute care (PAC) represents the legacy of a fragmented approach to healthcare that segments care into “silos” and finances institutions to care for a “slice” of the patient instead of incentivizing whole-person, coordinated care. As post-acute care is the largest driver of overall Medicare spending variation, establishing a coordinated, whole-person care network across the PAC continuum is essential for organizations to successfully operate under value-based payment models and to optimize patient outcomes. However, without transparent, market-wide data with longitudinal analytics, a comprehensive network, and relationships with hospitals, it seems like an  insurmountable challenge to overcome. Our guest this week is Ian Juliano, founder and CEO of Trella Health. Trella Health, is dedicated to creating optimal care networks that yield superior outcomes and greater efficiencies. Employing sophisticated longitudinal analytics on its massive, proprietary database, Trella enables providers and payers to compete and thrive in the new world of Value Based Care. For Ian, value-based care and PAC network optimization is a personal calling. His individual commitment provides a clear path to follow in the race to value! Episode Bookmarks: 05:00  Advocating the benefit of data democratization in VBC to Andy Slavitt 06:00 Working with Niall Brennan, the Chief Data Officer of CMS from 2010-2017 07:00 Building one of the largest proprietary databases of CMS claims data through a partnership with the CMS Virtual Research Data Center (VRDC) 08:40 “Transparency in data can lead to better treatment decisions that result in improved outcomes and lower costs” 09:40 How Trella’s massive database is helping hospital systems, post-acute providers, and ACOs make better decisions 11:30 The challenge of ineffective transitions of care post-discharge and the cost differentials between different PAC settings 13:00 Ian speaks about how hospital ownership of home health agencies or IRFs leads to inappropriate referrals post-discharge 14:40 “As a nation, we have been overly, myopically focused on the cost of a post-acute care setting versus the impact and cost trajectory of the patient.” 16:00 Ian provides an eye-opening example of how $1million in costs were saved (along with better outcomes) through appropriate transitions to home health instead of SNFs 18:30 Ian provides another example of a system saving $1-2M in spend by sending patients to on-time hospice at the  end-of-life 21:00 “In some academic medical centers, over two-thirds of inpatient discharges that meet high-acuity guidelines receive no post-acute care whatsoever! And one-third of those patients are back in the hospital within two days, leading to higher costs.” 23:00  Ian speaks about how ACOs and DCEs can ensure access to outstanding SNF and home health agencies by aligning incentives 25:00 “Developing the right post-acute care provider network is not all about narrowing.  It’s about finding the right network that meets all of the specialized needs, to get best-in-class care for all of the different categories of patients.” 25:50 The importance of physician training in building an optimized PAC network 26:20 Using data to look at patient flows, identify gaps in care, and monitor cost performance KPIs over time 28:40 Ian speaks about the future of the skilled nursing industry in relationship to value-based care 30:30 “If I were an ACO, I would be quite mindful anytime a hospital recommends a hospital IRF. I would make sure to see whether a SNF is more appropriate.” 31:30 How did occupancy rates in long-term care impact SNFs during COVID-19? 32:00 How do increased referral rates to home health instead of SNFs lead to lower adherence rates? How can home health agencies ensure that patients actually receive care? 34:40 Primary PAC Optimization Strategies: 1) Sending appropriate patients to SNF instead of IRF. 2) Sending home health appropriate patients who are at risk of non-compliance to SNF anyways (in order to ensure care) 36:00 The episodic mentality of the current fee-for-service home health model and how inadequate nurse staffing leads to patient stacking  38:40 “To survive in this new era, home health needs to start thinking about how to demonstrate value and fight with hospitals for the rewards of that value capture.” 42:30 Leveraging Telehealth in the home health setting – not every visit needs to be in person. 44:00 Ian speaks about the issue of fraud in the home health industry and why more consolidation is needed. 46:00 Referencing the ACLC Whitepaper on the Coordinated Care Model for patients with post-acute needs 47:00 A really well-managed ACO will have made a huge investment in data to understand network performance and developing optimal partnerships with post-acute providers.” 51:00 The advantage of DCEs over ACOs in creating the right incentives to ensure optimal PAC network performance 55:00 Ian provides his parting thoughts on the moral imperative for value-based care and how that drives him as a leader
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Aug 20, 2021 • 53min

Ep 63 – COVID-19 & SARS-CoV-2 Delta Variant: Scientific Insights from a Leading Virologist, with Dr. Rodney E. Rohde

We are pleased to release a special bonus episode and do our part to address the nation’s concerns around the pandemic and the COVID vaccine. As it stands right now, around 164 million people, or 50% of the total U.S. population, have now been fully vaccinated. Ultimately, with a large portion of the U.S. population still unvaccinated, it seems that COVID-19 is not going to disappear soon. The U.S. will continue to see outbreaks of the virus in communities with low vaccine uptake. Our guest is Dr. Rodney Rohde, a virologist and clinical laboratory expert with 30 years of experience in Public health, virology, and zoonotic disease, and is a Professor in the College of Health Professions and Associate Director for the Texas State University Translational Health Research Center. This episode is for anyone who wants to hear a scientific discussion about SARS-CoV-2/COVID-19 to combat misinformation that is out there about the pandemic. Episode Bookmarks: 04:30 Dr. Rohde shares a brief overview of the medical laboratory profession and the Clinical Laboratory Science degree programs 08:30  The impact of the pandemic on the medical laboratory staffing crisis 09:50 Dr. Rohde speaks about the importance of laboratory medicine in improving value-based care and health equity 13:00 Did SARS-CoV-2 originate from a laboratory leak at the Wuhan Institute of Virology?  Or did the virus originate from a zoonotic spillover event? 18:15 Referencing Dr. Rohde’s recent article discussing how the US is split between the vaccinated and unvaccinated – and how the deaths and hospitalizations reflect this divide 20:00 Dr. Rohde discusses how “99.5% of all the people dying from COVID-19 in the U.S. are unvaccinated” and how to understand breakthrough infections happening with the vaccinated 22:30 How to eradicate a virus and why current immunization rates will not support disease eradication 24:50 “Viruses, especially RNA viruses, are the most diabolical microbes on the planet.” 25:30 Viral mutations that create infectious variants and the opportunism of infection 28:20 The global achievement of smallpox eradication 28:50 Dr. Rohde explains vaccine efficacy and what people should ask their physicians if debating whether or not to receive the vaccine 31:00 The low of mRNA vaccines 34:00 Dr. Rohde explains what the Delta variant is and provides a scientific overview of viral mutations 37:00 The changing pathology of the virus and how younger, unvaccinated people are now being affected by the Delta variant 38:00 Booster shots for immunocompromised individuals and the likelihood of boosters for the general population 39:20 The transmissibility of the Delta variant. what the R-naught number means in understanding viral contagion, and how Delta variant compares to Ebola transmission 45:00 Referencing the COVID-19 thought leadership and insights from Scott Gottlieb, Tom Frieden, and Peter Hotez 46:20 The three-year cycle of unchecked pandemics, the development of herd immunity, and the potential for an endemic transition in 2022 47:50 The significance of the landmark scientific achievement of developing a mRNA vaccine technology (the first time in history!) 50:00 Viewing public health as part of our public defense and why we need to learn that one lesson from this pandemic!
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Aug 16, 2021 • 1h 4min

Ep 62 – The Role of Direct Primary Care in the Value Movement, with Dr. Gaurov Dayal

Employers are on the frontlines in the battle against rising healthcare costs. Legendary investor Warren Buffett said that rising health care costs, not the tax system, are the number one problem that American businesses face. “If you go back to 1960, or thereabouts, corporate taxes were about 4% of GDP. And now, they’re about 2% of GDP,” “At that time, health care was 5% of GDP, and now it’s about 17% of GDP.” In Buffett’s view, this says a lot of what’s playing a bigger role in hindering business activity in the economy. He is famously quoted as saying that “medical costs are the tapeworm of American economic competitiveness.” Direct Primary Care (DPC) is a unique solution for employers to win the “race to value.” Our guest this week is Dr. Gaurov Dayal, the President and COO for Everside Health and a nationally recognized physician leader, who, in 2019, was selected as a finalist as the Director for CMMI to replace Adam Boehler. Everside Health is tackling employer healthcare costs head on by offering direct primary care services to employers. Their DPC model redirects health care from fragmented care sites such as inpatient and outpatient settings, specialists’ offices, ER and urgent care clinics into the optimized primary care setting. In the longer term, Everside works to deliver cost savings by diagnosing, treating efficiently, and managing the health of a covered population across 32 states with 350 health clinics located at or near the facilities of its employers, unions, and other benefit sponsor clients. Episode Bookmarks: 02:25 Dr. Dayal shares his recent “once-in-a-lifetime” experience traveling to Iceland! 03:30 Recent APM delays and pullbacks from CMMI – what does this mean for the value movement? 05:05 “The progression to Value-Based Care is a fairly bipartisan issue.” 05:45 Is the COVID-19 pandemic detracting from the current health policy focus on value? 06:45 The deficiencies of the healthcare system highlighted by COVID-19 08:30 Dr. Dayal reflects on his experience interviewing for the Director of CMMI position in 2019to replace Adam Boehler 09:45 “There is a lot of passion at the federal level to push ideas that can improve care for the US population.” 10:40 The challenges of balancing stakeholder interests in the political process and the need for more clinical leadership and influence 13:45 Is capitation truly needed to have value-based care?  Or can you pay for outcomes in a FFS model? 14:45 “The linkage of the payment to the delivery system creates value-based care.” 15:30 Dr. Dayal discusses the capitalistic model of healthcare and how FFS domination prevents large scale change 17:00 “In the history of companies, very few companies are able to successfully transform themselves from one business to another.” 17:30 “We are entering an era of new providers disintermediating in value-based care, rather than old incumbents successfully bridging the gap.” 18:00 Dr. Dayal discusses disruption in the Medicare Advantage space (e.g. ChenMed, Oak Street Health), employers collaborations (e.g. Everside) 19:00 The germination of specialty-focused companies in VBC (e.g. renal care, oncology, orthopedics) 19:30 Dr. Dayal compares the “race to value” to the automobile industry transitioning from combustion engines to electrical power 21:00 Referencing legendary investor Warren Buffett’s position on rising health care costs as the number one problem that American businesses face 22:00 Everside Health’s Direct Primary Care (DPC) model operating in 32 states with 350 health clinics located at or near the facilities of its employers 22:45 The average family spends $20k on healthcare at a time when working Americans are facing wage stagnation and looming inflation 23:00 The rising costs of healthcare benefits provided by employers and how the lack of transparency contributes to the problem 24:30 “Overutilization of healthcare services is as dangerous as underutilization” 25:20 “Everybody in this country needs better access to good primary care.” 26:00 Dr. Dayal explains how Everside serves employers with ongoing access to primary care, including onsite clinics and telehealth. 27:00 Goals of Everside Health: 1) Higher employee engagement with primary care, 2) Healthier Employees, 3) Lower Total Cost of Care 28:00 Foregone employee compensation due to the high costs of healthcare benefits 28:30 How DPC works (no out-of pocket costs for employees, no FFS, aligned physician compensation structure, limited patient panel size) 31:00 The employer-sponsored health insurance marketplace and the shot across the bow from Amazon, Berkshire Hathaway, and JPMorgan Chase 33:00 Dr. Dayal reflects on the failure of Haven and why it happened 34:00 How working with lower-income industries creates more of a “burning platform” for value-based care because of price sensitivity 34:30 Dr. Dayal shares optimism for the future based on a grassroots consumer movement from employees demanding change 36:00 The growth of Medicare Advantage over the last decade as a precursor for what we are about to see in the employer-sponsored insurance market 37:00 A ceiling has been reached with High Deductible Health Plans 37:30 Primary care as the best (and cheapest) solution for healthcare reform 38:30 The challenges of the virtual care/digital health boom related to lack of point-solutions and consolidation 39:20 How Everside is creating a platform company that aggregates the best-of-breed digital solutions with Direct Primary Care 41:00 Referencing the recent Milliman report on Direct Primary Care studying employer ROI 42:30 Dr. Dayal discusses how employers can achieve ROI with long-term investments in Direct Primary Care 43:30 “These models only work when engagement is very strong.” 44:30 Employers will see the highest ROI with DPC will be seen by avoidance of chronic conditions. 49:00 “It is interesting that we have the most expensive healthcare system in the world, but no one seems to be happy with it.” 49:30 The frustration of Primary Care Physicians with Fee-For-Service 50:30 PCPs have better opportunities in the future because of the emphasis on VBC and consumerism 51:30 The limitations of virtual care and urgent care and why more convenience in primary care is the best option 53:30 Addressing Social Determinants of Health and in the primary care setting and the importance of care navigation 56:30 Dr. Dayal discusses the explosion of telemedicine and virtual care during the pandemic and what we should expect in the future 63:00 Parting thoughts of optimism for the future of value-based care
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Aug 9, 2021 • 57min

Ep 61 – The Convergence of Physician Independence and Prospective Payment, with Dr. Jim Walton

Our guest this week is Dr. Jim Walton, President and CEO of Genesis Physicians Group. Dr. Walton was drawn into medicine at an early age – he followed his dad making house calls, going to nursing homes, and forging deep ties in the community. His clinical work throughout his medical career was focused in poor communities, coordinating care for complex patients from diverse backgrounds. As an experienced and innovative physician leader, Dr. Walton provides executive leadership to more than 1,700 physician and allied health members in a North Texas independent practice association. He also established and leads the group’s ACO which is focused on creating physician-led risk-based solutions. Dr. Walton’s passion is engaging physicians to stay independent by providing them with a population health infrastructure for succeeding in risk. Add that to his passion for treating the underserved and caring for those living on the extreme fringe of vulnerability, it’s easy to see why he is an ideal leader in the race to value. Episode Bookmarks: 05:05 Dr. Walton shares his prior experiences in treating marginalized populations 06:30 A personal patient story that had a profound impact on Dr. Walton’s career in service to the underserved 08:20 Establishing rural clinics to care for the uninsured and AIDS patients in the early nineties 10:00 Developing community medicine strategies to mitigate racial disparities in care 11:40 “The role of the profession of medicine is to design solutions to improve community health.” 14:00 Starting a value journey with a legacy model, fee-for-service physician IPA 15:40 Succeeding in a Medicare ACO provided confidence to take risk with Medicaid 18:20 The importance of solving community-based social issues and lessons learned fromMedical Home Network 19:30 Integrating both clinical and social determinants of health data to develop an AI-based predictive analysis 20:00 Building an infrastructure for social interventions to better care for Medicaid patients 22:00 Value-based care as an enabler of physician independence 23:00 Physician leadership involvement in the structure of financial rewards to incentivize practice transformation 25:00 Dr. Walton discusses how his physician-led risk-bearing entity is competing with PE-backed firms and hospital systems 25:30 “The joy of practicing medicine can be found in a team-based, physician-led model that promotes independent practices.” 27:30 Dr. Walton on how managed care contributes to physician burnout and why value-based care is different when built by physicians 30:30 Tapping in to both the intrinsic and extrinsic motivations of physicians to improve patient care 33:30 How diminishing fee-for-service rates creates a deleterious treadmill effect with doctors (unless they adopt value-based care) 36:00 Developing a compelling value proposition for payers 39:30 COVID-19 as the ultimate crucible for testing the resiliency of physicians 41:00 The siphoning of patients by urgent care facilities and retail primary care models 42:00 Primary care redesign of patient panels leading to specialization in chronic disease 43:00 Responding to emergent physician needs during the pandemic 43:45 “Prospective payment is the destination” 45:00 Dr. Walton discusses how the ACO Provider Relations team engages physicians 47:00 Tapping into the clinical intuition when stratifying risk in a patient population 48:30 Dr. Walton speaks about how younger physicians will find purpose in their practice of medicine 53:20 Parting thoughts about the inspiration of Dr. Don Berwick and the Triple Aim 55:00 “Value-based care allows us to reimagine our professional duty to improve quality, reduce unnecessary suffering, and eliminate health disparities.”
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Aug 2, 2021 • 58min

Ep 60 – Cultivating Reverence Through Value-Based Payment, with Akil McClay

This is one of the most health challenging times in modern history. Healthcare systems and practitioners face dire circumstances in delivery of care to scores of citizens. A reverential ethic in healthcare leadership that promotes an informed and respectful approach towards life is key to health system success in population health. This core value is how Trinity Health, one of the largest integrated care delivery systems in the nation that serves more than 30 million people across 22 states, approaches their transition to value-based payment.  They believe the “race to value” is a moral imperative to improve community outcomes and ensure health equity, instead of just a business opportunity. Our guest this week is Akil McClay, System Director of APM Operations at Trinity Health. Akil is responsible for the implementation, deployment and operational CIN/ACO/APM activities across four states (Delaware, Pennsylvania, Indiana and New York) with approximately 290,000 covered lives. Additionally, Akil serves as the Executive Director for the Trinity Health Integrated Care MSSP Enhanced ACO and successfully led Trinity Health Integrated Care to achieve $45M in shared savings for performance years 2017−2019. Most importantly, Akil lives the value of reverence, and his insights spark a similar passion in each of us.   Episode Bookmarks: 04:00 Akil’s formative years that led him to understand the need for minority health and health equity 05:30 How charity care hospitals impact the health of vulnerable communities 06:30 How an educational path in neurosciences led to a healthcare administrative career 07:45 “When you are a healthcare leader, you have the opportunity to impact millions of lives across the country.” 10:00 “It starts with us.  You need to have leaders that are reflective of the communities that we serve.” 10:30 Akil reflects on the presence of institutional racism in our country’s healthcare system and how Mike Slubowski is committed to DEI in leadership 11:15 Akil discusses the inequitable distribution of vaccines in the Philadelphia market and how Trinity was able to operationalize equity through a rapid-cycle innovation approach 15:35 How the VA system is an exemplar of value-based care innovation and why the private sector should learn from them as it moves to fully-capitated payment 17:40 A fully-capitated, total cost of care model gives us the best ability to care for our patients.” 18:05 How Trinity is moving to a fully-integrated EHR system across all of its markets 19:20 Engaging patients in healthcare by creating a community-based center (a lesson learned from the VA) 21:40 Akil discusses how Trinity Health has been able to navigate the COVID-19 pandemic 24:00 Trinity Health’s deployment of a unified telehealth platform 25:00 High-speed internet access as a social determinant of health 27:40 Trinity Health’s early beginnings in value-based care led by Rick Gilfillan and the aspirational goal of having 75% of revenue derived from the APM portfolio 29:00 The future of VBC is in risk-based payment and how early adoption of CMMI programs allowed for innovation 30:00 “We want to have the majority of our revenues come from value-based contracts because we believe that is what’s best for the patient.” 31:20 Do we need as many hospitals as we currently have in the United States?  What is the impact of COVID-19 on the movement to VBC? 33:00 Akil discusses how Trinity Health is building out capabilities for risk coding and documentation to better reflect burden of illness in their patient population 37:40 Trinity Health’s approach to building an integrated EHR and digital health platform for patient engagement 42:00 EHR optimization through provider-led workgroups and use of internal teams to build a homegrown analytics platform 44:35 Overcoming the limitations of digital tools by listening to patients 45:40 Streamlining provider EHR workflows at an enterprise level 48:00 The formation of Truveta, a consortium of health systems pooling patient data to glean insights into medical conditions for more personalized medicine 51:00 Trinity Health’s advocacy for value-based payment and applying lessons learned from participation in the Next Generation ACO (NGACO) Model 52:30 The importance of reinstating the application process for the CMS Direct Contracting Model (or extending participation in the NGACO Model) 54:10 Parting thoughts from Akil on how moving to VBC is “fighting against tradition” and how organizations should look to build sustainable non-FFS revenue streams 56:00 “This is hard. We have to think differently about how we get paid as we move into this value-based economy.”

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