The Race to Value Podcast

Our guest this week, Matt Miclette, is military veteran and a psychiatric and mental health board certified registered nurse. He is the Senior Director of Clinical Operations at NeuroFlow – a digital health company that provides an industry-leading solution for Technology-Enabled Psychiatric Collaborative Care.  Matt is also the Co-Founder and Executive Director of a nonprofit organization called Action Tank.  As a recipient of the prestigious Pat Tillman military scholarship, Matt is living with the passion that Pat Tillman spoke of, “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits … A passion for life is contagious and uplifting.” Matt’s passion is bright and shines through in his service for people with mental health needs. In value-based care, it is clear that primary care is at the tip of the spear in dealing with Ambulatory Care Sensitive Conditions like CHF, COPD, and diabetes that drive up costs. In that model for managing chronic disease, the position of primary care providers being upstream to specialists allows them to curb 80-90% of healthcare costs by preventing unnecessary specialist visits and avoidable inpatient stays and ED visits.  With behavior health, it is a little bit different though.  Behavioral health conditions (for the most part) can’t be addressed by specialists because there aren’t any access points for them to even be seen! Although 70% of primary care appointments include problems with significant psychosocial issues, less than half of those receive any mental health treatment at all, because there is a such a shortage of specialists. To put this in context, the Substance Abuse and Mental Health Services Administration estimates that by 2025, the U.S. will have a shortage of over 15k psychiatrists and 26k mental health counselors! Research shows that a Psychiatric Collaborative Care Model (CoCM) is an effective and efficient way of delivering integrated care for more complex patient behavioral health needs – CoCM is a model that enhances “usual” primary care by adding two key services: care management support for patients receiving behavioral health treatment and regular psychiatric inter-specialty consultation to the primary care team. Join us as we consider this and other important solutions with Matt in this week’s race to value! Episode Bookmarks: 04:45 “Passion is what makes life interesting, what ignites our soul, fuels our love and carries our friendships, stimulates our intellect, and pushes our limits.” – Pat Tillman 05:40 Matt discusses the inspiration of Pat Tillman and his passion into lifelong learning 06:00 How caring for wounded warriors recovering from combat trauma drove Matt’s future work in treating the “indivisible injuries” impacting behavior health 07:00 Realizing the stigma associated with behavior health from his time leading a military psych unit in Fort Hood 07:50 Making an impact through facility-level hospital policy, e.g. 75% reduction in restraint use 08:10 Matt discusses his experience working in public health policy related to substance use disorder 08:30 A shared passion for “changing the world” with Christopher Molaro, CEO/Co-Founder of Neuroflow 09:30 Alarming stats about behavioral health and SUD in our country! 11:10 Matt on the recent CDC report showing that the U.S. hit the highest level of annual overdose deaths ever recorded (93,000) – a 30% increase from prior year! 11:45 “The shortage of mental health providers is most acutely seen in rural communities. Over 50% of the counties in the U.S. don’t have a single psychiatrist.” 12:05 Understanding the population and identifying which individuals have the most acute behavioral health needs through upfront screening and measurement-based care 13:00 Matt explains how we can more effectively use primary care and interdisciplinary teams to treat behavior health issues 15:30 The Psychiatric Collaborative Care Model (CoCM) as an approach to enhancing primary care to deliver integrated care for patients with complex behavioral health needs 16:30 Implementation of integrated behavioral health and the importance of physician champions and C-Suite buy-in 18:00 “Psychiatric Collaborative Care is a stepped care model which means we get the right patient to the right level of care.” 18:55 Matt discusses the advantages of the CoCM in providing team-based care, outcomes measurement, goal setting, and behavioral health activation 22:00 The importance of structural measures like program enrollment and caseload size to assess the performance of integrated behavioral health models 23:30 Screening for social determinants (e.g. food insecurity, housing insecurity, loneliness) during the intake process for collaborative care 25:30 The cost savings impacts of effective integration of medical and behavioral services 27:20 The policy window for addressing behavioral health is open, and the time is now to lower healthcare costs (those with BH issues are 2-3X more expensive) 27:50 Referencing the IMPACT Trial (one of the most famous Collaborative Care studies) showing a six-fold ROI in CoCM implementation 28:30 Success stories in healthcare cost savings with behavior health integration 29:30 Leveraging FFS in the short-term as an incentive to stand up a CoCM program 29:50 Matt discusses how Health First is using universal screening and cloud-based registry solutions to ensure more effective delivery of Collaborative Care 32:00 Matt discusses the perceived risks of remote suicide screening and how technology can be used to link resources to patients in need 34:30 Setting yourself up for success in CoCM implementation through rapid deployment and a full patient registry 34:50 Remote screening for PHQ-9 assessments (Care Manager-led vs. Tech-enabled) 36:00 The importance of integrated BH technology to provide a hub for documentation, planned interventions, risk stratification, time tracking, and digital homework for patients 36:30 PCP workflow integration through EHR integration 38:40 Matt discusses important Neuroflow partnerships with Prudential, US Air Force, and Stop Soldier Suicide as examples of technology-enabled behavioral health integration 42:25 Matt reflects on his own experience with provider burnout while working at the Walter Reed National Military Medical Center 43:00 The need to care for the mental health of providers and how team-based care and technology can help 45:30 Matt provides his parting thoughts with involving the care team in the development of consumer technologies in the healthcare setting

Our guest this week is driven by an inner purpose to alleviate suffering for those in the poorest of communities, recognizing that health care can only truly be transformative in providing superior health outcomes if it advances health equity.  Over the years, he has used his voice to advocate for underserved communities in the belief that the equitable attainment to health is a human right. Dr. Derek J. Robinson is Vice President and Chief Medical Officer for Blue Cross and Blue Shield of Illinois (BCBSIL) and is responsible for care management operations, clinical leadership and strategic oversight in providing high value health care to more than 8 million members. Dr. Robinson is also the founding chair of the Health Equity Steering Committee, which was established to develop health equity strategies across markets and lines of business. For nearly two decades, Dr. Robinson has led community efforts to promote diversity and inclusion in undergraduate and post-graduate education at the local, state, and national level. He is a member of the Office of Diversity and Inclusion advisory committee at the Accreditation Council for Graduate Medical Education. Additionally, Dr. Robinson is vice-chairman of the board of trustees at Xavier University of Louisiana. His deep experience in health care and education give him a unique and meaningful perspective, one that we will all do well to regard as we endeavor to advance in the race to value!   Episode Bookmarks: 04:30 Dr. Robinson discusses his journey in emergency medicine and what now drives him as a value-based care leader 06:15 Creating “impact at scale” in his work in clinical leadership and strategy at the health plan level 07:30 In 5 years, life expectancy fell for everyone except for non-Hispanic white Chicagoans (3,500 excess deaths for Black people in Chicago every year) 09:00 The impact of COVID-19 on highlighting disparities among racial lines and national trends in life expectancy amongst African Americans 09:30 Dr. Robinson discusses the root causes of social determinants of health (e.g. housing policies, racial segregation) that lead to racial disparities in care 10:45 Chicago has ~30-year life expectancy gap between neighboring communities (larger than any other American city) 11:00 Housing policies also impact infant and maternal mortality, elevated lead in children, etc. 11:15 “Your zip code is more important than your genetic code.” 11:45 Dr. Robinson explains how investments in community infrastructure and resultant economic development creates public health 13:30 Referencing landmark reports confirming the presence of racial and ethnic disparities within the care delivery system 14:00 “Opportunities for focus” by governments, corporations, philanthropic partners, and the healthcare community 16:30 Dr. Robinson describes the Blue Door Neighborhood Center to provide a community-based hub for health and wellness 18:00 Creating a social impact fund to help small businesses impact health in communities 18:30 Providing housing stability for those dealing with chronic conditions 19:00 BCBSIL investments in community benefit organizations and social services to improve health equity and SDOH in Chicago 22:10 Health disparities persisted prior to COVID-19, but the spotlight from the pandemic has served as an accelerant to addressing them 23:00 That health equity journey that BCBSIL is focused on through partnerships with 24 provider-led ACOs and 44 IPAs/PHOs 23:30 Dr. Robinson explains the $100M investment by BCBSIL in the Health Equity Hospital Quality Incentive Pilot 24:30 The importance of hospitals collecting data on race, ethnicity, language, sexual orientation, and gender identity to assess disparities 26:00 Expanding telehealth and bridging the digital divide amongst underserved patients 26:30 Addressing the underrepresentation of diversity in the physician workforce 29:00 Partnering with institutions in physician workforce diversity and implicit bias training 30:30 Creating an annual report on Health Equity to ensure visibility of information by key stakeholders 31:00 Worsening under-representation of minorities in tenured clinical faculty positions at academic institutions 32:30 “Having a more racially and ethnically diverse physician workforce will lead to increased access of care for the underserved.” 34:30 KFF survey reporting that only 35% of African Americans stated they definitely or probably would not get the vaccine 35:00 Generational trauma and current distrust of African Americans in the healthcare system 36:30 Building trust in African American communities in vaccine efforts to ensure a more equitable distribution 41:30 Partnership with the American Hospital Association’s Institute for Diversity and Health Equity to support hospitals in eliminating disparities with specific conditions 43:30 Referencing the groundbreaking report, titled Missing Persons: Minorities in the Health Professions that stated physician workforce DEI is more important than access to care 45:00 Dr. Robinson discusses the moral imperative to systemic change and how racially segregated hospitals were eliminated by Medicare payment policy 46:00 Dr. Robinson reaffirms the importance of high quality, culturally competent, linguistically concordant care to eliminate health disparities 50:00 Dr. Robinson on how bridging the digital divide in communities to address connectivity to the internet will improve health and wellbeing in communities

                While the health care system has been gradually transitioning to a more tech-enabled industry for several years, in a matter of months, the global pandemic has fast-tracked digital health care trends that have been primed and ready for greater investment and implementation. The increased investment in and use of technology-enabled care protocols like telehealth and remote patient monitoring during the crisis has accelerated the acceptance and adoption of digital solutions for both health care professionals and their patients. As a greater number of payers and providers adopt value-based payment arrangements and innovative data management and analytic solutions emerge, digital tools will enable the collection and analysis of robust patient data to inform population health management strategies and equip providers to creatively inform and transform their approach to care delivery. In this episode, we share the audio from a recent webinar where we discuss the digital health landscape with two foremost experts, Dr. David Nace, Chief Medical Officer of Innovaccer, and Ed Marx, Chief Digital Officer of The HCI Group.  Additionally, we offer the recent ACLC Intelligence Brief, Overview of the Digital Health Landscape. The brief offers a detailed review of the digital health landscape, analyzing major trends and recent merger and acquisition activity, and outlines expectations for the future. The intelligence brief, combined with this episode, will give you valuable insights to inform your own race to value!   https://www.accountablecarelc.org/publications/overview-digital-health-landscape

Only 25% of health is in the control of the healthcare system. So why does our country continue to pump the majority of its health care spending into a deficit-based health care model that focuses solely on the science of doing something to the individual? Aspirational Healthcare is a better answer, spending 75% on supporting the individual in the ownership and management of their own health. And employer-driven reform is the key that will unlock aspirational healthcare for millions nationwide. Our guest this week is Darrell Moon, CEO of Orriant, a company that changes the dynamics of health care and gives employers control over the ever-increasing costs of the health care benefits they offer their employees. Join us as we discuss the Nuka System of Care in Alaska, employer-driven reform, and the principles of Aspirational Healthcare – all are important milestones on the race to value!   Episode Bookmarks: 1:45 What is an Aspirational Healthcare System? 2:50 Background on Darrell Moon, CEO of Orriant 3:20 Background on Nuka System of Care (the role model for Aspirational Healthcare) 4:30 The Aspirational Healthcare Conference (July 14-15, 2021) 5:20 Darrell talks about his recent discovery of Nuka System of Care and how it inspired him 6:00 Southcentral Foundation instituted a total system-wide transformation of care with Nuka 7:30 Referencing Dr. Doug Eby of Nuka and the requirements of an ideal health system 8:45 Training workers to be “partnering influencers” rather than just diagnosticians and treatment planners 9:40 The current healthcare system has an improperly skilled workforce (Aspirational Healthcare addresses this first!) 11:55 CQI drives us to meet the needs of the customer, but it doesn’t work in FFS 12:45 Business Leaders and the Federal Government are really the true customer in the American healthcare system (not the patient!) 14:00 Darrell talks about why employers are a transformational force to a more customer-centric health ecosystem 16:00 Employers need to create incentives in their healthcare purchasing model to empower change 17:00 Why would the system ever change on its own?  Employers must take the lead! 18:00 Darrell explains an Aspirational Healthcare investment strategy for employers to follow 19:00 Creating a “massively powerful” primary care system 19:30 The importance of influencers in improving patient outcomes 20:30 Investing in Health Savings Accounts (HSAs) for employees to pay deductibles and copays 21:50 ‘Poor health’ costing employers $530B on top of the $880B they already spend in premium dollars! 23:30 Southcentral Foundation demanded “perfect healthcare” in creating Nuka twenty years ago (and it worked!) 24:30 Lessons learned from Haven’s failure being applied with Amazon Care and Walmart Health 24:50 The founding of employer-sponsored group health insurance in WWII 25:50 The leadership of Regina Herzlinger in creating Health Reimbursement Accounts 27:20 Darrell discusses what Amazon Care will look like when it completes its’ healthcare strategy! 28:30 Employers will move away from Employer-Sponsored Group Health Insurance in the next ten years! 30:00 Nuka’s relationship-based healthcare system is centered around “massively powerful primary care” 31:00 Building a Direct Primary Care practice based on a prescription model 32:45 Primary Care Quarterbacking to reduce medical errors associated with lack of specialty care coordination 33:30 Direct Primary Care is doing what Nuka did by creating a “massively powerful primary care” model. 35:30 Darrell discusses the impact of behavioral health integration on improving cost and clinical outcomes 37:30 Implementing strategies to address Complex Behavioral Change to improve population health 39:00 Creating relationships based on trust is key to helping patients 39:45 Balancing the amygdala (emotion) and prefrontal cortex (reasoning) functions of the human brain 41:20 The need to destigmatize mental health and create earlier interventions through surveying and health coaching 43:00 Managing catastrophic mental health issues through innovation 45:00 Apps and digital solutions are only part of the answer.  Relationships are the most important thing! 47:30 Nuka’s Results (40% reduction in ER visits, 36% reduction in hospital admits, etc.) 48:30 How Nuka builds trusting relationships from effective storytelling! 50:00 Nuka as the best organization (in any industry) that has implemented CQI! 51:30 Darrell discusses how Edward Deming’s focus on customers relates to servant leadership 53:00 “The solvency of your organization is your customer.” 54:00 Register for the Aspirational Healthcare conference at https://aspirationalhealthcare.com/

There is an immediate opportunity for value-minded medical practices and health systems in joining a Direct Contracting Entity (DCE) that is already established.  Many of these DCEs (typically existing health care delivery organizations or newly-organized physician aggregators) are now seeking formal partnerships with providers in their area. These partnerships may facilitate an entry point for organizations who have not participated in prior CMMI models or those organizations more advanced in risk who wish to increase their value profile in a model that emphasizes beneficiary engagement and improved patient outcomes. If you have been approached to join a DCE, the ACLC wants to support you in the consideration of this opportunity. To that end, we are pleased to share this bonus episode, with our guest Dr. Tom Davis. 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 helps simplify the decision process for the independent physician who wants to know whether they should consider participating in the GPDC model. Independent physicians now is an important time to consider your participation in value – whether you join the GPDC model or do something different, this episode will accelerate your move to value! In addition to listening to this episode, make sure to read our blog post with additional details: https://www.accountablecarelc.org/publications/global-and-professional-direct-contracting-starter-checklist-prepare-dce-partnerships Episode Bookmarks: 03:00 What are Direct Contracting Entities (DCEs) and how did they come about? 04:15 What types of DCEs are currently recognized by CMS and should I consider joining one? 06:45 What are the potential benefits to medical practices that are considering joining a DCE? 12:00 How is Value-Based Care innovation better addressed by DCEs than other payment models? 13:15 Is there a competitive disadvantage to not participating in a DCE? 14:30 How should an organization evaluate a prospective DCE suitor when approached to join one? 17:30 Why is joining a DCE such a rare and historic opportunity? 18:30 Parting comments and contact information for Dr. Tom Davis

Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region or community. In 2009, Congress attempted to modernize HIE processes by passing the HITECH Act, offering grants and incentives to states and municipalities for developing regional HIE initiatives. Although there has been some progress toward effective mechanisms for data exchange, in many regions of the country it is no easier to share medical information than it was over a decade ago. That is not the case in the State of Nebraska and neighboring states where CyncHealth has achieved health care transformation through data democratization and community betterment collaboration.  They have done this by becoming more than a HIE; instead they have become a true “population health utility” by building the roads and the infrastructure for better workflows and better patient care (not just improved data exchange). This week, we are pleased to welcome three important guests from CyncHealth, Dr. Jaime Bland, President and CEO , Dr. Larra Petersen-Lukenda, Vice President of Population Health, and Dr. Joy Doll, Vice President of Community and Academic Programs. Their vision for a ‘population health utility’ builds upon the ONC’s vision for interoperability through data democratization and cross-sector collaboration. In this episode, we interview these leaders to better understand how to leverage data to create the greater good in societal health outcomes. You will hear from them how health care transformation can be realized through community partnerships and data sharing across the continuum of care, collaborative research in population health, and an empowered “health data competent workforce” to meet clinical and social needs in a more holistic way.   Episode Bookmarks: 03:45The purpose of a ‘population health utility’ is to create better workflows and improved patient care, not just improved data exchange 04:45 Fewer than half of office-based physicians can exchange patient health information outside their organization electronically 05:30 The HIE market is projected to double from $1 billion in 2020 to $2 billion in only 5 years 06:00 Jaime discusses how CyncHealth’s 15-year journey to build a HIE infrastructure to support population health in Nebraska 07:20 Jaime and Larra’s vision for leveraging a HIE as the basis for a clinically integrated network/ACO 08:00 Improving upon the cumbersome query-based exchange model to deliver better patient outcomes in complex care scenarios 09:00 Jaime explains how they have reframed the HIE into a “population health utility” 09:40 Joy describes the application of the population health utility to address the Quadruple Aim and improve patient outcomes 10:25 Larra on reaching the ONC’s 10-year vision for interoperability can improve clinical decision support and patient engagement 11:55 Larra on how “The ability to influence the future of healthcare through data is an amazing responsibility to benefit the greater good of the community.” 12:30 Jaime on the Nebraska Prescription Drug Monitoring Program (PDMP) — a stand-alone medication query platform integrated into the CyncHealth HIE 16:15 Larra on the benefits of the PDMP in improving completeness of the overall medical record, with impact on patient safety and care interventions 18:30 The Opioid Crisis and SUD (23.4 million have SUD causing 81,000 drug overdose deathsannually — two-thirds of which are related to opioids) 20:00 Jaime on how CyncHealth has responded to the Support for Patients and Communities Actin order to address the Opioid Crisis 21:15 Larra emphasizes the importance of the Support Act as a way to leverage technology in response to the national opioid epidemic 24:30 Joy on the opportunities for health policy and public sector funding to address disparities in care 27:30 Jaime on how transforming an HIE into a “Population Health Utility” is helping Nebraska fight COVID-19 30:00 Larra on how COVID-19 dashboards were used to drive population health interventions and resource allocations at the state-level 33:40 Joy on how CyncHealth formed a partnership with a local university to support data science research on COVID-19 and population health 34:30 Jaime on how Don Rucker (National Coordinator for HIT at the ONC) immediately recognized the value of the CyncHealth population health utility 35:30 The recent IMPACT Act report to Congress addressing the need for improved data sharing at the local level to improve Social Determinants of Health (SDOH) 37:00 The Gravity Project – collaboration with SMEs to develop national standards for SDOH data collected and exchanged in electronic record systems 37:50 Jaime comments on the CyncHealth SDOH platform that supports cross-sector collaborations in communities between providers and CBOs 39:30 Joy discusses the passion of CyncHealth to address health inequities associated with SDOH (e.g. meeting the health needs of the homeless) 40:30 Joy on how connecting health systems and CBOs together as a continuum of care will better address health inequities 41:30  Joy explains why structural racism cannot be addressed without improving data collection 42:30 Developing a closed-loop referral system to provide patients with assistance for social needs 43:00 Larra on the complexities of leveraging technology for SDOH when it disrupts workflows and how data standardization can lessen the burden 46:00 Joy discusses how social risk scoring and risk stratification can improve population health 47:00 The need for a holistic, multi-layered approach in addressing social needs and health inequities 48:00 Racial biases in predictive algorithms that lead to discriminatory treatment of minority populations 49:00 Joy on how data democratization and community-driven approaches will provide the best solutioning around health inequities 50:00 Understanding health literacy in our society will help providers better assess root causes for individualized behavioral decisions impacting utilization 52:00 Jaime on how the lack of infrastructure for the sharing of health information leads to data siloes and why that creates inequities in our communities 52:45 Larra reflects further on the distributional inequities that lead to unfair resource allocations and how CyncHealth is solving for this 53:30 Reducing structural inequities through partnerships to create more effective data governance models 54:00 Over-reliance on heuristics that assume data is representative of the entire population and how that leads to distributional inequities 55:00 Joy on why listening to partners and collaborating on research together can bring a voice to the underserved 56:00 Why education of the workforce is needed to transform data into information and how that can empower provider teams to improve population health 57:30 Joy discusses CyncHealth’s strategy to build a “health data competent workforce” 58:30 Bridging the knowledge gaps between Data Scientists and Healthcare Providers will mobilize a workforce to address population health 59:00 Joy provides an overview of several of CyncHealth’s population health research projects (e.g. opioid exposure in infants) 60:00 How population health research will drive health policy and community action for the pubic good and create a “health data competent workforce” 62:00 Larra explains the importance of data scientists and clinical teams coming together to improve data models in population health 63:00 How meaningful data visualizations can facilitate better understanding across a broader audience 63:30 Jaime on how research generated from a population health utility can be translated to clinical peers and why that is the differentiator for CyncHealth 64:30 Joy on how CyncHealth’s specialized approach to community-based partnerships and co-learning is transforming health outcomes

We are discussing “Price Transparency and Free Market Healthcare” with Dr. Keith Smith, co-founder of Surgery Center of Oklahoma and Sean Kelley, Founder & Managing Partner of Texas Medical Management. Keith and Sean are the forefathers of price transparency as they have been providing upfront, transparent prices to patients for decades. This is one of our more controversial episodes to date, as we cover with brutal honesty, the systemically broken healthcare system that allows patient fleecing, price gouging, excessive profiteering, and limited competition to establish a market clearing price.  This provocative interview will raise important concepts such as the needs of the buyer, the importance of price transparency, and why free market principles and bundled pricing for surgical procedures are necessary.  Is there any difference between the healthcare industry and a Mexican drug cartel?  Is the value-based care movement flawed? Should the government recuse itself from any conversation having to do with health value? Tune in to find out! This is a special joint episode between Race to Value and Point Health, released alongside the ACLC Intelligence Brief entitled “Revealing Value? Hospital Price Transparency”.  This brief can be downloaded here. Episode Bookmarks: 02:00 Download the ACLC and Point Health Intelligence Brief entitled, “Revealing Value? Hospital Price Transparency” 02:30 Introduction to Keith Smith and Sean Kelley – the forefathers of price transparency 05:00 Dr. Smith shares the story of his founding of Surgery Center of Oklahoma – a free market ASC with fully transparent, bundled procedure pricing 06:00 The “rising terminator class of Administrators” and why Dr. Smith started seeing Medicare patients for free! 07:00 “We were accomplices to financial crimes that were devasting to patients.” (The fleecing of patients by profiteering hospitals) 09:00 Sean discusses the founding of Texas Medical Management (formerly Texas Free Market Surgery) 10:30 85% of all surgical dollars go to facilities! (Motivation to move cases out of the hospital that should be done in a surgery center) 12:00 “Really good doctors are not paid more than bad doctors.  In fact, it is often the opposite.” 13:45 Sean reflects back on the early leadership and inspiration of Dr. Keith Smith in starting TMM 14:50 “The only reason I stayed in medicine is to be a part of a solution that brings doctors and patients back into relationship models that eliminate all the BS.” 15:30 Only 25% of all healthcare dollars spent actually go to people providing care! 17:00 “Changing the way that healthcare is purchased by employers and TPAs is the most critical part of the survival of free market providers.” 18:30 Medical Tourism and how patients are travelling from all over the country (and the world) for free market surgeries! 22:30 “The healthcare system is working as it is designed – it is a cartel; there is no mistaking that.” 24:30 Dr. Smith expresses his frustration with influencing peddling in health policy and how industry consolidation is driving up prices 26:20 Self-funded buyers are demanding transparent pricing and a stop to price gouging. 27:00 “The DC regulatory machine, brokers, and consultants needed a good thumping.” 29:00 Helping other surgery center disruptors with price transparency models to build critical mass across the country 33:00 The challenge of industry insiders and lobbyists to fight price transparency (“Washington is not the solution.”) 34:40 Sean discusses how a local employer challenged the “cartel” which led to Direct Primary Care and Free Market Surgeries 36:00 Referencing Rick Scott (former HCA CEO) on why hospitals are not going to fix the problem of high healthcare costs 37:30 Dr. Smith on why the new Hospital Price Transparency regulations won’t work…but it will change the narrative 39:30 Correcting the definition of price transparency so it includes total costs (not just patient out-of-pocket costs) 41:30 How hospitals are blocking search engine results for price transparency 42:30 The best patient advocate is an independent primary care doctor that doesn’t work for the hospital! 43:30 The entrepreneurial response to disrupt a broken system (ex: Atlas and Sesame) 44:30 Direct Primary Care that are rebelling against the insurance system 47:00 Why health insurance companies actually want more spending 48:00 Dr. Smith on how is constantly creating new bundles for episodes of care (and he is willing to share his knowledge!) 50:30 Transparency does not create an increase in prices!  And why “the race to the bottom” is a myth as well. 52:30 Innovation is needed drive down cost structures (ex: 30% of revenues of surgical practices are spent on billing and collections for bad debt!) 53:00 “There is no such thing as a race to the bottom.  That is flawed economic thinking. What you have is a race to a market clearing price.” 55:00 “The only concern should be the needs of the buyer…and the buyer is sovereign.” 56:00 Providing value to the purchaser is key.  There needs to be competition in the market. 61:00 How the value-based care movement impacts a free market surgery center based on price transparency 62:00 Should the government recuse itself from any conversation having to do with health value? 64:00 Dr. Marty Makary and “The Price We Pay” 67:00 The dichotomy of value-based care and hospitals and how ACOs can used to minimize system leakage and increase profits 71:00 Reflecting on the price transparency movement and how that has changed patient lives for the better

The movement to value-based care will necessitate a major paradigm shift in how physicians practice medicine. They can no longer be “cowboys” in the wild west of fragmented, uncoordinated care delivery where information technology is focused on fee-for-service. Instead of cowboys, we need “quarterbacks”, communicating with an interdisciplinary care team and facilitating hand offs across the care ecosystem. In this environment, information technology is like the offensive line, protecting the physician and creating the opening for a meaningful play. Our guest this week is Dr. Matt Lambert, Chief Medical Officer of Curation Health, an advanced clinical decision support platform for value-based care that drives more accurate risk adjustment and improved quality program performance by curating relevant insights from disparate sources and delivering them in real time to clinicians and care teams. Author of two books, and with more than 20 years of experience as a clinician, CMIO, and change leader in value-based care, Matt’s insights will expand your vision of health value! Episode Bookmarks: 4:00 Physician Workflow Optimization in the movement to Value-Based Care (Cowboys vs. Quarterbacks) 6:30 VBC is requiring providers to optimize workflow to support team-based care (the Quarterback role) 7:00 APIs will enable EHR systems to evolve over time to better support value-based care 7:30 Curating meaningful information (and minimizing noise) to providers at the point-of-care 8:00 Using AI to decrease cognitive load for providers 8:20 “Healthcare doesn’t have a data problem. It has a clinical workflow problem.” 9:00 Physician Burnout (“a public health crisis that urgently demands action“) 10:30 How VBC is changing regulations and documentation standards for electronic health records 12:00 “The CMIO role is the bridge, it’s the translator between the clinical world and the technical world.” 12:25 NLP models often overwhelm providers with data that is not meaningful 12:45 Reducing disruptions and hard stops in provider workflow with technology-enablement 13:00 Dr. Lambert discusses his own personal experience with physician burnout 14:45 Simplicity as the ultimate form of sophistication and the artful design of clinical documentation solutions 17:00 How healthcare technology companies come short when they don’t have strong clinical leadership 18:00 Expanding focus beyond point-of-care to clinical documentation integrity teams 18:30 HCC recapture for risk adjustment and how algorithms can help capture new HCCs 19:30 Using NLP to identify new diagnoses from discharge summaries 20:30 Dr. Lambert discusses a use case for HCC coding optimization with RAF lift to improve ACO performance 21:45 How HCC coding optimization can improve patient engagement and better address SDOH 24:20 Referencing Trenor Williams, MD and his work in SDOH and social risk intelligence 24:45 Social applications of the risk adjustment model 25:45 The impact of COVID-19 on the future of value-based care 26:00 Referencing his recent HIStalk article on subscription revenue models 26:15 Post-pandemic interest from providers in subscription models and VBC 27:00 Deferred care during the pandemic and how that will affect population health 27:50 Risk adjustment over FaceTime and over the telephone 28:30 The similarities between post-COVID healthcare in US and the National Insurance Act of 1911 in the UK 29:30 Post-viral syndrome and long-term sequelae related to COVID-19 33:00 Eric Neil (Chief Information Officer, UW Medicine):  “There are no old and bold CIOs!” 33:45 Providers have the best technology at home but are averse to new HIT solutions in the ambulatory care setting 34:00 A design flaw of the EHR Meaningful Use program that encouraged only platform adoption 34:30 How the Pareto Principle applies to Health Information Technology and workflow automation 36:00 The evolution of technology to develop superior products that are by a CDI prior to the physician. 36:20 Referencing the Microsoft acquisition of Nuance to deliver new cloud and AI capabilities across healthcare 36:50 Alexa use cases in healthcare and the thoughtful design of a use case for voice recognition and AI 38:00 Being thoughtful about investing in an IT infrastructure for population health in the ambulatory care environment 39:20 Referencing Dr. Lambert’s book, Unrest Insured 41:00 Comparing COVID-19 with the 1918 Influenza pandemic 41:45 The early origins of health insurance in 1929 and how that compares to current subscription models 44:00 Responding to the pandemic with deregulation of healthcare and the future of Medicare Advantage 47:30 Provider exhaustion and fatigue with COVID-19 49:00 The importance of team-based care to revitalize the PCP landscape 50:15 Home-based primary care and the shifting of incentives to full-risk models 53:00 Leading physician behavior change through alignment of incentives 55:00 Implementing new models of care and retraining the workforce for VBC 56:00 Sustainable provider compensation models related to Medicare Advantage

When Billy Beane decided to employ a recent Harvard graduate to use advanced statistical analysis to build a championship major league baseball team, he changed the game forever. While Beane’s famous early 2000s team never won a World Series, multiple 100-win seasons and a new record for the longest winning streak got the attention of teams across the MLB, all while on one of the league’s lowest payrolls. Most people know Beane’s story as it was popularized in the book—and later in the movie—Moneyball. In healthcare, we are overdue for a “Moneyball” revolution. The shift towards value-based payment has made it clear that our system needs to do a better job generating outcomes that matter to patients — a positive health-care experience, improved health, and good quality of life. The machine learning techniques that were used to algorithmically determine a player’s value were light-years ahead of the archaic methods that had been used in baseball up to that point. Similarly, many of our conventions in delivering care come from an era when healthcare was delivered primarily by doctors and nurses with elite training whose success depended mostly on content expertise. A key component to value-based transformation in healthcare will be artificial intelligence. Without AI, medicine will never advance to a state where the totality of a patient’s data can be used to find predictive signals that will lead to enhanced treatment and population health interventions that improve outcomes. Our guest this week is Andrew Eye, the founder and CEO of ClosedLoop.ai, the recently announced winner of the CMS Artificial Intelligence Health Outcomes Challenge. Listen and find out why Andrew and ClosedLoop are exemplars in the race to value!   Episide Bookmarks: 02:00 The Billy Beane story and how, in healthcare, we are overdue for a “Moneyball” revolution 03:00 A key component to value-based transformation in healthcare is artificial intelligence 04:00 Andrew Eye – a national leader in AI in Value-Based Care – and his company ClosedLoop.ai 06:45 Partnership with Dave DeCaprio following his work with the Human Genome Project 07:30 How Andrew’s daughter’s medical condition provided “WHY” inspiration to build a next-gen predictive analytics platform 09:20 How ClosedLoop.ai beat out the world’s leading technology and healthcare organizations to win the CMS AI Health Outcomes Challenge! 11:25 “Physician trust in AI is crucial.  Algorithms never saved anybody’s life. We predict the future so that you can change it.” 12:50 Creating an open source, AI-based predictive model for predicting COVID-19 Vulnerability 13:00 Andrew discusses what it was like to submit the winning submission for the CMS AI Challenge without electricity in the Texas Snowpocalypse! 14:00 CMS’ focus on AI Explainability and how ClosedLoop was “born to win” 17:00 “Explainable AI” (XAI) versus “Black Box” machine learning algorithms 19:00 Early AI firms were reluctant to share “secret sauce” of proprietary algorithms and the impact on physician trust and external validation of bias 20:00 “We’re not building models.  We are building a machine that builds models.” 20:20 “The idea that there is one algorithm that is best for every healthcare organization in the country is a total fallacy.” 21:00 “Explainability in AI is absolutely critical to helping care teams have more effective interventions in population health.” 22:30 Physician paranoia about “machines taking over” where there work will be eventually outsourced to algorithms and other artificial tools of clinical reasoning 23:45 The impact of AI on Radiology and how that scenario differs from other instances in medicine where AI is applied to population health 25:20 The opportunity to augment clinician pattern recognition with AI that goes far beyond manual chart review for surface insights 26:15  “There is going to be a point in time where patients choose a doctor based on whether or not they are using all of the available information.” 27:00 The challenges of algorithmic bias and fairness in ensuring health equity and references to recent research (article here and here) 30:30 Label choice in ML algorithms where costs are used as a proxy for health 31:30 Differentiation between algorithmic bias (based on math) and algorithmic policy (based on policy) 33:30 The inferiority complex that healthcare organizations have with “data shaming” and AI can pull predictive signals out of messy data 34:30 The Medical Home Network AI case study that focuses on Social Determinants of Health 35:30 Augmenting claims data with ADTs, Rx data, and Health Risk Assessments 37:00 “Until you squeeze all of the predictive signal from the data that you have, you shouldn’t be shopping for data that you don’t have.” 38:50 Andrew explains (in layman’s terms) the Receiver Operating Characteristic (ROC) curve used in statistical validation 39:50 Why a really accurate model for the entire population is not as important as the accuracy within the 3-5% of patients that actually drive up costs 40:45 Focusing on “percent capture” is more important that ROC curves 42:00 Building the right population health AI model by asking the right questions 42:30 Ensuring successful integration of predictive modeling in the workflow of the provider and pop health team 44:45 Feature drift that occurs in algorithms when datasets change and input values are affected 46:00 MLOps as a process of taking an experimental Machine Learning model into a production system 48:20 Andrew explains the FDA regulatory environment for AI in healthcare and its impact on health equity 51:10 Andrew shares his thoughts on Big Data futurism and the future of AI as “the next Moneyball” opportunity 52:30 The need for lowering cost to predictive models in prediction of rare diseases 53:00 How CMS is leading the charge in data liquidity with Blue Button 2.0 APIs 54:00 Organizations leading in value-based care are the ones investing in AI/ML

Sixty years ago, May 1961, President John F. Kennedy challenged the American nation in a speech to Congress, asking them to commit to “landing a man on the Moon and returning him safely to the Earth.” Eight years later, that bold goal was realized – in July 1969 Apollo 11 landed and returned safely with a crew. President Kennedy’s moonshot goal is an important reminder of courageous leadership that sets an inspiring goal that pushes us to think and achieve boldly.  That is not unlike the 10-year vision of Ochsner Health to transform the health of Louisiana, taking it from 49th out of 50 in America’s Health Rankings to a ranking of 40 by 2030. As a native Louisianan, Dr. David Carmouche is committed to transforming the health outcomes of his state.  Dr. Carmouche serves as President of the Ochsner Health Network, the accountable care network of the massive Ochsner Health System. The health system is committed to a value-based strategy and its CIN has generated returns north of $100M in its value-based contract portfolio over the last few years.  In this episode, Dr. Carmouche shares meaningful lessons from his value journey covering such topics as physician leadership in the value movement, partnerships with employers, community resilience, precision medicine and social determinants of health, and Ochsner’s 40 by 30 vision to transform health in the state. Episode Bookmarks: 04:00 Dr. Carmouche’s leadership purview (and reflections from his glory days on the gridiron???) 07:20 Dr. Carmouche speaks to the national pursuit to value-based payment and looming Medicare insolvency 09:10 The experimentation phase of value-based care and the next-level commitment to pursue the most viable APMs 10:10 Subsidizing government contracts (Medicare, Medicaid) with commercial payers to spot margin and why that is no longer tenable 12:00 Dr. Carmouche discusses the financial results of Ochsner’s value-based contract portfolio 13:00 Board-level and CEO commitment to value as a strategy for population health and long-term economic success 13:25 Investment in care capabilities and realignment of incentives within large employed physician group as keys to success 14:10 The ‘muscle memory’ of owning a health plan and how that created orientation to risk at Ochsner 14:40 The importance of leadership in driving success in value-based payment with improved outcomes in patient communities 15:45 The three verticals of Ochsner Health’s business:  Care Delivery, Risk Operations and Insurance, and Digital Services 16:30 How Ochsner Health manages fee-for-service dependency in its legacy business model with its commitment to value 19:10 Building partnerships with insurance brokers and fully-insured employers to support appropriate steerage and drive cost savings 21:15 Creating economic alignment with self-funded employers and the challenges of creating meaning gainshare opportunities 22:50 Negotiating care management fees with self-funded employers as in interim step to full-risk 23:30 Dr. Carmouche discusses the network agreement they reached with Wal-Mart to provide high value care for employees across Louisiana. 26:45 “From Competition to Collaboration” – Dr. Carmouche’s contribution to a book that outlines the Health Ecosystem Leadership Model (HELM) 27:00 Dr. Carmouche reflects on the diverse experiences in his career that allowed him to learn about the different sectors of the healthcare ecosystem 28:15 “No one sector of the healthcare ecosystem can create significant value alone” 29:15 How an interaction with Dr. Paul Grundy inspired Dr. Carmouche to make the biggest impact possible in improving the health of Louisianans 31:00 Blending physician leadership with the business understanding of different sectors in the healthcare economy to drive value creation 34:00 How Ochsner worked to ameliorate the scourge of COVID-19 in New Orleans and lessons of community resilience from Hurricane Katrina 36:00 Rapid deployment of a virtual care model to deliver primary care and behavioral health services (going from 3,000 visits to 100,000 visits in one year) 36:40 Digital medicine program to provide full-service virtual remote monitoring and management of hypertension and diabetes 37:40 The disparate impact of COVID-19 on disadvantaged minority populations 38:20 Louisiana is next to last in health status of all 50 states and why it is so difficult to solve for social factors like poverty, education, and health literacy 39:40 The endless opportunities for population health and why Ochsner will have failed if Louisiana’s health rankings do not improve over time 39:50 Coordinating with state government, private investment, and communities through the 40 by 30 initiative 40:20 $100 million investment to address Louisiana’s most critical health needs 43:20 The physician culture of Ochsner Health that emphasizes teamwork 44:30 Dr. Carmouche discusses the moral injury that is happening to physicians because of administrative bureaucracy 45:30 Revising physician compensation so that it focuses less on RVU production and more on value-based care performance 46:30 Eliminating burdens in physician workflow through automation and point-of-care alerts 47:30 Growth in primary care that is attributable to compensation alignment and optimized care delivery model 49:30 Dr. Carmouche speaks to the connection between evidence-based care and precision medicine 50:20 Collecting social determinants data from health risk assessments to drive care processes and community-based interventions 51:30 Developing AI and machine learning algorithms to have more precision in predictive models 52:00 The application of population health-based genomics testing and genetics counseling to improve care outcomes 53:20 Leveraging digital medicine tools and wearables for chronic disease management 56:30 “Personalized care within a population health agenda is the way of the future.” 58:30 How moving to “asset-light” hospital models with fewer beds would have made us ill-prepared for pandemic response 59:30 “We can’t afford the fixed cost, asset-heavy healthcare delivery system that has been the hallmark of U.S. healthcare in the last 100 years.” 63:00 This vision of Warner Thomas, President and CEO of Ochsner Health 64:30 How improving health equity and transforming the workforce will deliver the promise of value in Louisiana 66:20 “We didn’t make it to the moon in ten years without someone putting a stake in the ground.”