The Race to Value Podcast

It was Thanksgiving 2016 and Sugandan (Su) Barathy was a normal college student in Texas, with finals and graduation in the weeks ahead. His future was bright with a comfortable job already secured, but a car accident changed his life. Though seriously injured, the medical professionals sent him home twice as a result of negligent care. Consequently, Su experienced avoidable complications and needless pain – but the blatant errors and deficiencies of the health care system are distant followers to the foremost lessons of Su’s healing journey. During a nearly month-long ordeal in the ICU, Su experienced mental and spiritual pain and suffering, as well as loneliness and neglect. Only kindness, love, and gratitude brought him from the brink of complete despair to a place of joy. As health care professionals we each have an obligation to develop a holistic, patient-centered mindset that goes beyond repairing a broken body. We must practice healing the broken spirit. True healing power comes from kindness, love, and gratitude. These are the healers of the soul.   “At times, our own light goes out and is rekindled by a spark from another person. Each of us has to think with deep gratitude of those things that have lighted the flame within us.” – Albert Schweitzer “When we are no longer able to change a situation, we are challenged to change ourselves.”― Viktor E. Frankl “Gratitude turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity…it makes sense of our past, brings peace for today, and creates a vision for tomorrow.” —  Melody Beattie “Thankfulness is the beginning of gratitude. Gratitude is the completion of thankfulness. Thankfulness may consist merely of words. Gratitude is shown in acts.” Henri Frederic Amiel   Episode bookmarks: 1:47 Introduction to the episode – A Message of Love and Healing for this Season of Thanksgiving 3:04 The Car Accident that happened one day before Thanksgiving and a Health System that Failed 4:55 “I don’t feel like I was acknowledged.” 6:00 Nurses shopping online for Black Friday deals when leaving the ER with an untreated ruptured spleen and broken ribs 6:45 Ten days of immense pain and suffering after leaving the ER with negligent care 7:10 Su goes to the student clinic and sent to the ER…on his own accord, without an ambulance 8:05 The “horrific walk” to the ER after ten days of suffering with pneumonia, pulmonary edema, ruptured spleen, and broken ribs 9:00 The ER doctor is shocked that Su was able to walk to the hospital in his condition without being transported by an ambulance 9:20 Emergency surgery! 10:00 The poorly designed environment of care is not conducive to Su’s healing post-surgery 11:11 “I felt like the care that was given to me was transactional and check-the-box medicine” 12:05 “My body was being taken care of, but there was no one to listen to me and care for my needs beyond the physical level.” 13:05 “A very dark place where no one was listening to me” 13:20 “It was me alone in this battle to heal rather than a team that can help me heal through this.” 13:40 All alone in the hospital and finding out his grandmother just died 14:20 The care team was detached from Su’s emotional wellbeing and is not at all patient-centered 15:20 The power of human relationships and its effect on healing of the soul 16:00 “Without emotional support, you are broken.” 16:30 “The extra ounce of courage from within” that comes from the expressed love of others 18:00 Pain recognition as part of the healing 19:00 Culturally relevant care from one nurse that prevented an opioid addiction 23:00 “Feeling the pain made me feel alive again, gave me the courage to fight, and gave me the connection to the present to truly heal.” 24:15 The darkest nights of the soul in the ICU 25:00 “At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” (Albert Schweitzer) 25:15 The healing begins due to the selfless act of kindness and love from a stranger 26:40 “A powerful gesture of the universe….the love and affection of a kind stranger healed me also.” 28:07 “I am the person that I am today because of that prayer.” 29:32 The healthcare industry heals the body, but often fails the soul. 30:20 “A holistic approach to healing is what I feel is truly needed in healthcare.” 31:34 Value-based care is about reimaging the healthcare system 33:20 Being discharged from the hospital on Christmas Day – the Greatest Gift 34:20 Gratitude from an horrendous healthcare ordeal, “I was brought back to the spirit of Christmas and joy.” 35:30 “I have so much gratitude for the team that took care of me and the stranger that prayed over me.” 36:14 “I was given the gift of spirit, joy, thankfulness, and gratitude that I will take with me for the rest of my life.” 36:34 “Had I not gone through the negligence of the health system, I wouldn’t have experienced the kindness of that stranger”. 37:20 Su’s new life:  a new life in San Francisco, playing soccer at a higher level, spreading the joy of soccer and love in San Quentin prison (“A Boy named Su”) 38:55 Su’s recommendation to healthcare executives – Take Care of the Nurses! 40:55 The healing continues through the sharing of this story 41:50 Su shares the story of his grandmother who passed away during his hospitalization 43:03 “There is light at the end of the tunnel.  If I can be that person that bring you out of the darkness, I am here for you.”

Welcome back for part 2! This episode further explores Klasko’s vision of health assurance, an industry that focuses on consumer’s health, and that is enabled through innovative partnerships between health care and technology organizations. Patient’s expectations are shifting toward a system of care that is empathetic, communicative, creative, and responsive – those providers, policy-makers, payers, and other partners who align with these principles will be the winners in the race to value! Dr. Stephen Klasko is the President and CEO of Thomas Jefferson University and Jefferson Health. His newest book, co-authored with venture-capitalist Hemant Teneja, is a manifesto that advocates for bringing consumerism, affordability, and rational economic behavior to the healthcare sector. UnHealthcare: A Manifesto for Health Assurance is a declaration to usher in a new age of digital and mobile consumerism in the healthcare industry, and introduces the concept of “health assurance” – a gamechanger that would force a redesign of the system. His vision is for a consumer-centric, data-driven, cloud-based healthcare system designed to help us stay well: we would need as little “sick care” as possible. Episode bookmarks: 03:18 The FHIR Interoperability Standard and Blue Button are “necessary but not sufficient” to bring about widespread consumerism and democratization of health data 03:30 Consumers will eventually wake up when they “no longer feel like patients” 04:00 Consumers have way too much respect for the healthcare system because they are too forgiving when it fails 04:40 Patients always assume their doctor is the best, and doctors can take advantage of this by not being patient-centered 04:54 Dr. Klasko shares a personal story of a friend who always chooses the best service option in every transaction, but then naively chooses to have his heart surgery wherever the PCP tells him 06:10 Dr. Klasko shares an anecdote on how patients will not often heed the advice of a second opinion because of fear that their primary physician will judge them 06:40 How the younger generation will be more demanding as a health care consumer and how the younger physicians are embracing thus 08:05 Data interoperability is an issue where health policymakers have been “asleep at the wheel” 08:15 The World Economic Forum tells Dr. Klasko, “There were two industries that escaped the consumer revolution – banking and healthcare.  Now you are alone.” 09:20 Dr. Klasko describes how nonsensical telehealth medical licensure restrictions are 09:45 Data and interoperability are unnecessarily limited by ridiculous and overly strict laws, including HIPAA. 09:59 “Data needs to be interoperable. It is just absolutely crazy that we have to get most of the data we need from insurance companies.” 10:21 “My view of the future is that the patient owns their own health data.” 10:30 Getting permission from doctors to share their own data is straight out of the 1970s 11:20 “Interoperability challenges between different EHR systems is another absurd reality.” 11:25 Commure is an example of an SSO, FHIR-layer, health assurance company which “overcomes the tyranny of the traditional EMR” 12:13 “Health assurance will require consumers demanding it, open interoperability standards, enlightened health policy, and entrepreneurs working with the healthcare system in a way they haven’t before.” 13:20 Moral injury and suicide rates among doctors due to a monolithic, rigid and impersonal system of care 14:14 “Med schools choose doctors based on science GPA, MCATs, and organic chemistry grades…and then we wonder why doctors aren’t more empathetic, communicative, and creative.” 14:45 Med Schools are based on an antiquated 1970’s model that emphasizes memorization in an era before digital computing, iPhones, and AI 14:55 “When you select doctors on self-awareness, empathy, communication skills, and cultural competence, you triple the diversity of your workforce and make much more happier doctors.” 15:10 The non-creativity bias in the medical profession and how that limits blue sky innovation in healthcare 16:10  Jefferson’s Onboarding and Leadership Transformation (JOLT) program that aims to change the traditional thinking of leaders 17:40 “The use of continuous, real-time data in the provision of medical care will allow providers to use their time more effectively to address the human needs of patients and address SDOH.” 18:50 Dr. Klasko condemns the design of the traditional patient physical and how it ignores overall brain health, emotional, social, and spiritual needs 19:35 Dr. Klasko’s business thesis regarding the “economies of unscale” and how his manifesto relates to the movie “Jerry Maguire” 20:04 Klasko’s Conundrum:  How will Dr. Klasko will take one of the fastest-growing academic medical centers in the nation and completely unscale it so Jefferson can turn into “healthcare with no address”? 21:50 Starting the move to value and health assurance with Jefferson’s employees, using more virtualized care and shifting more procedures into the ambulatory setting 22:34 Jefferson’s early-stage implementation of Livongo 23:06 How doing the right thing will often eat into operating margin in the short-term 23:40 Jefferson’s collaboration with Aramark 24:00 There are only two choices: Be like Sears, Penney’s, Macy’s and live in the short-term or live in the “Amazon moment” 26:36 Dr. Klasko shares how bewildering healthcare news headlines are where health systems are reporting significant losses during COVID and health plans are reporting record profits 27:27 “The concept of medical loss ratios is antithetical to any kind of efficient system.” 29:00 The model of the middle man is fundamentally wrong 29:20 UHC’s Optum and its work in digital transformation, primary care, and changing consumer behavior as an example of moving from “dog wagging the tail, to the tail wagging the dog, to the tail that ate the dog” 29:50 Strategically-aligned payer-provider partnerships (ex: UPMC, Kaiser, Intermountain) 30:00 Partnership with Blues plans (ex: Ochsner and Louisiana Blue) 30:20 “The only way we avoid Medicare-For-All is to have strategically-aligned payer-provider alliances.” 31:13 The 4th Industrial Revolution:  how medical science will be disrupted by AI, internet of things, 5G, 3D printing, robotics, CRISPR, and gene editing 32:21 “We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run”. – Roy Amara 32:40 The Jefferson Institute for Bioprocessing (specialized education and training institute for biopharmaceutical processing) and the Jefferson Vaccine Center (vaccine research for infectious diseases and cancer) 33:12 Genetic testing for cancer diagnosis (e.g. Thrive, Grail) 34:40 Jefferson’s partnership with Color Genomics for genetic subtyping of newborn babies to diagnose underlying conditions and propensity for disease development 35:50 “We do a lot of things in healthcare that are just turning things around 360o.  I’m excited about working with innovators and disrupters like Hemant Teneja and others in the traditional healthcare ecosystem to truly start that true transformation.”

Dr. Stephen Klasko is the President and CEO of Thomas Jefferson University and Jefferson Health. His newest book, co-authored with venture-capitalist Hemant Teneja, is a manifesto that advocates for bringing consumerism, affordability, and rational economic behavior to the healthcare sector.UnHealthcare: A Manifesto for Health Assurance is a declaration to usher in a new age of digital of mobile consumerism in the healthcare industry and introduces the concept of “health assurance” – a gamechanger that would force a redesign of the system. His vision is for a consumer-centric, data-driven, cloud-based healthcare system designed to help us stay well: we would need as little “sick care” as possible. This episode explores the principles behind the manifesto and health assurance. Built on open technology standards, empathetic user design, and responsible AI, the vision for health assurance will only be realized through creative partnership between professionals in traditional healthcare and technology companies.  As these two worlds of healthcare and technology innovation merge, we can transform our fragmented, expensive, and inequitable healthcare system into one of improved health and decreased cost. Join us as we explore the role of health assurance in the race to value!   Bookmarks: 05:37 “Health care has not only escaped the consumer revolution –we’ve lost touch with what patients really need.” 06:12 Dr. Klasko discusses what he learned from Steve Jobs and how he “changed the world” in 3 years 08:00 Jefferson Health and the “new math” of innovation and strategic partnerships 08:55 Partnership with Silicon Valley entrepreneur Hemant Teneja 09:12 “Mass production and economies of scale is giving way to mass personalization at scale” 09:36 Livongo and how it “treats people with diabetes, not as patients, but as people who that want to thrive without diabetes getting in the way”. 10:00 “Costly sick care will give way to affordable, personalized, and preemptive care with genomic sensors and AI-based digital therapies.  That will be the true revolution in healthcare.” 10:40 Health Assurance as an emerging movement towards consumer-centric, data-driven healthcare 11:12 How the Presidential election cycle only seemed to focus on how we pay for the expensive, fragmented, and inequitable system – not how we fundamentally disrupt and transform it 13:12 Dr. Klasko tells the story of the future pandemic of October 2030 and how Health Assurance stopped it in its tracks 15:25 The “Amazon moment” of healthcare and how it redefines competition (future competitors are those who can bring health to home) 16:03 Dr. Klasko discusses JeffConnect (the telemedicine platform used by Jefferson Health) 16:37 Current business models for providers, insurance companies, and pharma are dead! 17:37 The 4th Industrial Revolution of AI and its impact on the future of care delivery 18:43 The use of wearables in cardiology care 19:53 Moving away from the current sick care model and making the health system easier 20:25 “The secret sauce at Jefferson Health is that getting to people while they are people, and not patients.” 21:24 Consumer segmentation needed for patient-centeredness 22:32 The real revolution will take place when patients reach the “mad as hell, not going to take it anymore” moment 25:58 The consumer mistrust in FAANG (Facebook, Amazon, Apple, Netflix and Google) to manage personal health data 26:23 Dr. Klasko provides his take on Haven Healthcare (the JV between Amazon, Berkshire Hathaway and JPMorgan Chase) 27:07 Healthcare disruption by startups should not be about moving fast and breaking things 27:40 Jefferson is moving entire digital innovation and consumer experience team to General Catalyst, a multi-billion dollar venture capital firm 28:25 “The future for the traditional healthcare ecosystem is going to be creative and strategic partnerships.” 29:00 Traditional vendor-customer relationships will not solve most of the problems large health systems are trying to solve 29:45 Health systems co-developing products with startups should share in both the risks and the rewards 30:20 Partnerships with startups will allow health systems to share in the trillions of dollars that will be spent on the digital transformation 32:33 Racial disparities in care outcomes with COVID-19 33:30 Bernie Sanders on fixing the “Sick care, hospital-driven, insurance-driven, pharma-driven, corporate-driven, fragmented, expensive, and inequitable healthcare system” 34:10 Frustration with Presidential election when it comes to self-congratulatory political talking points for a job well done 34:30 Referencing the work of Dr. William Kissick and the Iron Triangle of Health Economics 35:10 Disruption to increase access, increase quality, and decrease cost will be painful! 35:36 “Nobody has the courage to do anything other to question how to pay for a fragmented, expensive, and inequitable system…and then hope the system will transform” 36:16 The failure of the ACA because it expanded the middleman. Disruption means doing something different with insurers and pharma. 38:10 Reforming how much we pay specialty physicians (ortho, derm, neuros should not make 8-12X times more than primary care) 38:35 Considering “dark and dangerous” aspects of the 4th Industrial Revolution (AI, drones, robotics, genomics, etc.) 39:55 Responsible innovation must make sure not to codify biases (e.g. AI and policing) 40:42 Social determinants of health must stop being an academic thought exercise.  We must put money to this if SDOH equates to 80% of health! 41:49 How to eliminate food deserts by aligning incentives with public welfare and implementing drone delivery 43:33 Implementing remote monitoring to lower costs associated with pregnancy (and also improve outcomes) 44:40 Enlightened health policy must meet with payment models in order to allow entrepreneurial disruption of the health system. 44:57 Upton Sinclair quote as a hallmark for what is wrong with healthcare (“It is difficult to get a man to understand something, when his salary depends on his not understanding it.”)

North Carolina seems like an unlikely laboratory for value-based care. It refused to expand Medicaid coverage under the Affordable Care Act and ranks in the bottom third among states in measures of overall health. North Carolinians are experiencing stagnant or worsening population mortality rates and substantial health disparities, with 15% percent of residents living below the poverty line, and over one million (10% – 9th highest in the US) North Carolinians uninsured. Health care costs are rising, crowding out other state budgetary priorities and limiting wage increases. But the state has embarked on one of the country’s most ambitious efforts to transform how health care is defined and paid for. Accountable Care Learning Collaborative co-founder Dr. Mark McClellan, CMS Administrator during the George W. Bush administration, has publicly stated the “No state is moving as far and as fast as North Carolina.” UNC Health is leading that charge. Mark Gwynne, DO, is the President and Executive Medical Director of UNC Health Alliance (statewide CIN) and UNC Senior Alliance (NextGen ACO): his leadership, results, and vision for the future provide Race to Value listeners a rich viewpoint for value. The physician-led CIN unites independent and employed providers in a program that drives collaboration and communication across the health care continuum to improve quality of care, control health care costs, and work in partnership to provide coordinated care  Their recent performance has reduced the cost of care for 140,000 Blue Cross NC members, earned $17.5 million in quality and shared savings payments, and achieved a 100% quality score. The NextGen ACO is one of only a few academic organizations participating in the highest-risk alternative payment model and ranks #1 nationally for quality. Bookmarks: 3:55 The state of Value-Based Care transformation in North Carolina in juxtaposition with the state’s health outcome challenges 4:49 “North Carolina: The New Frontier For Health Care Transformation” (Dr. Mark McClellan: “No state is moving as far as fast as North Carolina.”) 7:03 “We’ve created a pretty good substrate for our payer partners across market segments where we are really starting to see the scale that we need to catalyze this kind of work.” 7:28 The tipping point for value-based care transformation of 35-40% needed to capitalize on investments and leverage the altruism of providers 8:00 The key to value-based success in NC is based on Partnership (e.g. partnering with forward-thinking payers) 8:35 UNC Health Alliance and its recent outstanding performance of $17.5M in shared savings and 100% quality score in the Blue Premier program 11:13 Dr. Gwynne discusses how Blue Cross NC is approaching its collaboration with his CIN and what the national payer community can learn about partnership with providers to transform care delivery 12:01 Transparency in calculating benchmarks and MLR and making quality targets achievable 13:54 Investing in a robust infrastructure around clinical quality improvement and establishing improvement collaboratives among primary care practices 14:23 Pivoting an internal infrastructure to focus on outcomes with appropriate patient outreach, provider education, facilitating improvement efforts in practices, and making EMR adjustments to support the work 16:25 The economic effects of COVID-19 on the PCP community and the Blue Cross NC “Accelerate to Value” stabilization program 21:17 Dr. Gwynne discusses how primary care practices should be looking at capitation in the years to come 23:15 Dr. Gwynne shares his perspective in balancing shared savings distribution to providers with capital re-investment (UNC Health Alliance distributes 80% of Shared Savings to its providers across all contracts) 23:47  Making key investments in data analytics, systems to support health equity, intensive case management services, point-of-care interventions, provider engagement, and the financial infrastructure to manage risk contracts 27:50 Dr. Gwynne discusses the importance of behavioral health integration in the primary care setting, along with a population health focus on behavioral health 30:03 Strategies for BH Integration: embedding behavioral health providers in primary care, partnering with psychiatrists in managing medications and doing case reviews, and leveraging data from screenings and patient registries 32:58 Access to remote clinical social workers to address behavioral health issues in seniors living in rural communities 33:30 Partnering with Blue Cross NC and Quartet Health for proactive risk identification of behavioral health issues along with a referral system to facilitate access to services 34:45 Substance use disorder, pain management and opiate use, and the use of Medication-Assisted Treatment (MAT) therapy 37:50 Dr. Gwynne discusses how UNC Senior Alliance (a Next Generation ACO in its 4th year) first entered into the “ACO World” by diving right in to CMS’ highest-risk payment model! 39:07 The performance results of UNC Senior Alliance over the years showing persistently high clinical quality across populations and market reductions in total cost of care compared to benchmarks 40:05 3-day SNF waiver, telemedicine, and transportation programs as keys drivers to improve health outcomes in the NextGen ACO 41:15 “Redesigning care to improve clinical quality and decrease total cost of care are actually two sides of the same coin.  Both of those often lead to better health outcomes.” 42:08 The future of UNC Senior Alliance as it ponders continuation as a NextGen ACO versus moving into the Direct Contracting model where capitation can be paired with other contracts 43:26 Partnership with Medicare Advantage plans and moving away from P4P to ACO models 44:44 The need for clinical integration and the NEJM study that found that the average Medicare patient saw a median of two PCPs and five specialist physicians per year. 46:00 “The core principle of clinical integration, and a clinically integrated network, is coordinating care.” 47:16 Addressing high ED utilization amongst COPD patients through enhance coordinated care that resulted in a 40% reduction in ED visits! 50:00 The importance of a clinically integrated network being physician-led to build out the value business across hospitals 51:32 Dr. Gwynne puts perspective on the Medicare ACO results that show physician-led ACOs perform better (compared to than hospital-led ACOs) by explaining that integrated health systems are really in the best position to reduce unnecessary utilization and address total cost of care 53:41 Dr. Gwynne discusses patient-centered care and the implementation of a Patient Advisory Councilto empower the patient, give them a voice to influence and direct their own care, and drive improvements in the primary care setting 58:39 The need for the Quadruple Aim and how to overcome a “siege mentality” described by Dr. Robert Pearl 1:00:22  “I fundamentally believe that primary care is the foundation of the health care system… One of our most important jobs is to ensure that providers on the frontlines can focus on patient needs, and we can relieve as much the non-essential burden as possible.” 1:02:00 The importance of the interdisciplinary care team to assuage the burden on primary care providers 1:03:00 The example of unmet social drivers of health and the need for partnership between primary care and the broader community (e.g. food insecurity) 1:04:00 “The future of value-based care is allowing our doctors to provide the comprehensive care that they know what they want to provide – and sometimes can’t – because lack of resources.” 1:05:00 The importance of learning organizations and peer learning to make health care better across America

The concept of “accountable care in the safety net” was introduced in a Dartmouth Study published by the Commonwealth Fund back in 2013.  In that study, there were 4 critical success factors outlined for a coalition-based Medicaid ACO: 1) aligned leadership through a shared vision, 2) strong governance, 3) a unified strategy for using data, and 4) a sophisticated care coordination infrastructure.  MHN ACO has exhibited excellence in all four of those areas. Since 2009, Medical Home Network has served as a beacon for healthcare transformation and collaboration. Established as a formal provider collaborative working to improve healthcare delivery and access for individuals most in need, today MHN leverages a suite of innovative technologies, healthcare expertise, and a passion for improving the provider and patient experience to create practice-based programming that integrates Chicago’s delivery system, transforms on the ground delivery and achieves real results. Cheryl Lulias launched and serves as CEO of the 1st Medicaid ACO in Illinois. The MHN ACO is provider owned and governed by leaders from 12 health care organizations, representing nine federally qualified health centers and three hospital systems. In an ever-changing healthcare landscape, MHN ACO has established itself as a beacon high value, high impact integrated delivery system in the safety net ensuring patients receive better care where and when they need it. Bookmarks: 4:01 “History of Accountable Care in the Safety Net”  (Reference to Commonwealth study on FQHC coalitions forming ACOs) 5:38 Cheryl shares the history of Medical Home Network and its journey in health value 7:42 Creating a standardized, whole-person model of care centered within a digitally connected, clinically integrated delivery system 8:35 Cheryl discusses MHN ACO’s results ($50 million in savings, 24% reduction in inpatient hospital days, 25% reduction in readmissions, 8% reduction in ED visits) 9:51 FQHC resiliency during the COVID-19 pandemic crisis and scaling up of telehealth and virtual care 13:46 Adjusting MHN’s AI-powered risk stratification model to identify community members at high-risk for hospitalizations from a COVID infection 16:15 The devastating impact of COVID and the scourge of violent crime, drug overdoses, and suicides impacting Cook County 17:40 Establishing ADT connectivity and real-time alerting with 30 hospitals through MHN Connect Health Information Network 18:21 Data liquidity, supercharged AI predictive models, and the creation of a 360o patient view by integrating data from claims, pharmacy, and health risk assessments 21:04 How prediction of “rising risk” informs MHN’s whole approach to care management 26:10 Cheryl explains MHN’s collaborative care program that utilizes a decentralized, team-based approach where interdisciplinary care teams are embedded at the practice level 28:26 Cheryl shares a patient success story 31:17 Cheryl counters the skepticism of artificial intelligence by sharing the results of her collaboration with Closed Loop AI 35:22 MHN’s commitment to advance health equity and reduce disparities of care through the Racial Equity Rapid Response Team 36:41 The impact of systemic racism and threat it poses on the health of our communities 43:03 Holistic integration of primary care and behavioral health at Medical Home Network 45:43 Cheryl’s strategy in forming a Board that decoupled ownership and governance and created a balance of power between the health centers and the hospitals 49:37 MHN’s commitment to workforce development for care coordinators and community outreach workers 51:23 The challenges associated with provider and care team burnout in developing the workforce 53:48 MHN’s launch of a MoreCare, a Medicare Advantage Special Needs Plan in partnership with Cook County Health 57:09 Cheryl describes the future of medicine and what we need to do to fix a broken healthcare system

Today’s episode follows Austin Regional Clinic (ARC), a large multi-specialty medical group that serves over 500,000 patients in Austin, Texas. Founded in 1980 as an HMO, ARC is coming full-circle on their journey in value-based care as they now serve more than half of their population in value-based contracts. Tyler Willson, VP of Population Health and Clinical Quality talks with us about the tipping point for value, ARC’s strategy during and post-COVID, as well as partnerships with payers. We also explore Austin’s unique market where corporate giants like Apple, Tesla, Amazon, and IBM are turning the area into a hub for innovation, which offers a unique opportunity for ARC. Find out what will happen with Medicare Advantage plans in the market, how analytics and automation are enhancing care, and how an important partner is making it all possible for ARC to be a leader in the race to value.   Bookmarks: 4:01 Reaching the financial tipping point in health value 5:24 Austin Regional Clinic’s value-based care journey 8:28 Tyler describes ARC’s current population health infrastructure 9:08 The shift of payment environment towards full- and delegated-risk models 10:25 Sourcing capital and investments to build infrastructure 10:45 JV with Agilon Health (a PE-backed company that supports ARC in taking fully delegated, capitated risk in Medicare Advantage) 11:35 Evaluating the landscape to determine strategic planning horizon, scope, and scale for VBC portfolio 12:00 How the increased level of involuntary risk will necessitate strategic investments in enhanced care models 12:35 Lessons from COVID-19 in determining the “true” risk in ARC’s revenue portfolio 13:40 Shared Savings are critical lifelines in the COVID era 14:40 Austin, TX as an emerging national innovation hub 16:04 “so much of an organization’s capacity for innovation comes from what it believes” 17:00 Competition for workforce talent in Austin 17:30 How to design and implement patient satisfaction surveys to collect meaningful data 18:53 Austin as an “innovate or die” type market 19:35 An outline of poor public health measures in the state of Texas 21:04 ARC’s commitment to patient access as a bedrock principle 24:05 ARC’s holding true to its value proposition during the pandemic crisis 25:11 Ensuring patient access to telehealth 26:00 Creating a patient-centered care medical home by focusing on patient access 27:10 An overview of ARC’s quality measure performance 29:00 ARC’s focus on automation, predictive analytics, and extensive outreach to ensure successful closure of care gaps 33:45 The use of ML and NLP in algorithms to drive automation in burden of illness documentation 36:22 Predictive analytics as the “unicorn of our industry” 38:00 Development of a Medicare Advantage strategy in partnership with Agilon 41:30 Incubating the types of infrastructure to test innovation viability for managing full-risk MA 42:31 The importance of an investment partner in ARC’s expansion of its full-risk MA portfolio 43:00 Market growth of Medicare Advantage being driven by consumer price sensitivity 45:00 Capturing accurate documentation in the burden of illness to the highest level of specificity 46:30 Advocating for CMS to include audio-only visits as a means to document and revalidate HCC codes 49:30 An overview of ARC’s participation in Medicare ACO program with Ascension Seton 50:58 Evaluation of the Direct Contracting ACO model 53:50 Employer-physician collaboration to deliver quality care

There are over 1,300 Federally Qualified Health Centers (FQHCs) in our country providing a healthcare lifeline for more than 28 million Americans living in underserved areas of the country. The vast majority of these are living with significant health concerns and are extremely vulnerable to economic fluctuations. Community Care Cooperative, C3, epitomizes what the research shows, that despite the inherent challenges of serving as a safety net, FQHCs perform better in caring for the Medicaid population. C3 is Massachusetts’ largest ACO taking on full global risk, and the only state ACO that is governed exclusively by FQHCs. Under the guidance of Christina Severin, the organization has been raising the bar in ramping up and utilizing telemedicine, integrating and prioritizing behavioral health, identifying and rooting out racism, and fighting for health equity and social justice. Christina has been in CEO roles in Boston-area health care organizations for 20-plus years, at Codman Square Health Center in Dorchester, at the Medicaid managed care organization called Network Health, and at Beth Israel Deaconess Hospital’s new ACO. Her passion and effectiveness are evidenced in this riveting episode – get ready to be elevated to another level on your race to value! Bookmarks: 3:37 The transformation of MassHealth, the state’s Medicaid program 4:15 18 FQHCs coming together to form their own physician-led ACO 7:47 Research from the American Journal of Public Health showing that FQHCs have better outcomes and lower costs 8:00 Research from the American Journal of Preventative Medicine showing that FQHCs have better performance on select quality measures 9:00 Christina discusses how FQHCs have lower medical loss ratios than their counterparts 10:00 The “incredible paradox” of the US healthcare system 10:55 The unique cultural characteristics of FQHCs 11:55 “Necessity is the mother of invention” and the magic of Federally Qualified Health Centers 12:45 Deciding to take two-sided risk for total cost of care when undercapitalized 15:45 How the largest FQHC-based ACO in the country developed operational programs for early success in downside risk 17:45 Setting up an effective governance structure as a key to success 21:22 Leading and managing the COVID-19 pandemic in the state of Massachusetts 22:50 Bridging the “digital divide” by providing patients with laptops and broadband access to support telehealth visits during the pandemic 24:00 Working with the community to raise $5M to scale up telehealth capacity, training, and infrastructure 25:20 The early collaborative success of the Massachusetts FQHC Telehealth Consortium 27:01 The murder of George Floyd and the calling for racial justice as a driving force 29:38 Advancing alternative telehealth modalities as a way to ensure health equity and access to care 32:00 Health centers are on the vanguard of developing the most effective models of care that includes behavioral health services 34:24 Delivering behavioral health services during the pandemic 35:55 The impact of the pandemic on mental health (depression, loneliness, isolation, and trauma) 36:45 Higher prevalence of COVID-19 illness with low-income workers and communities of color 40:20 Recognition of institutionalized racism and how white supremacy been the key driver of adversity for African Americans 42:00 What C3 is doing to support and advance diversity, equity, and racial justice 44:00 A 30-year difference in life expectancy between white and black communities in the Boston area 45:10 The difference between health-related social needs and Social Determinants of Health 46:50 The MassHealth ACO flexible spending program that provides cash assistance to individuals with complex needs and are experiencing impediments with food nutrition and housing 49:54 Referencing Health Affairs article, “Value-Based Health Care Must Value Black Lives” that proposes a framework to incorporate racial justice into value-based care 50:45 Christina shares her thoughts about reorienting value-based care policies around racial and health justice 52:38 We spend so much of GDP on healthcare that it takes money out of things that are critically important to communities of color, like public education 53:00 Shrinking capital costs in healthcare so tax revenues can be redistributed to support policies that promote health equity and social justice 54:30 Christina shares a personal family story about a pen pal relationship with Ruth Bader Ginsburg 56:05 How we can honor the legacy of Ruth Bader Ginsburg by giving voice, even when in dissent, to advocate for a more just and equitable world 58:00 The need for community impact investments by highly profitable health plans and health systems 59:53 Adopting prospective primary care capitation to improve the health and wellness of Americans 1:01:00 Advice for FQHCs debating whether or not to take two-sided risk

In this virtual panel discussion, Dr. Ernest Grant (President of the American Nurses Association), Dr. Jan Jones-Schenk (Senior Vice President – College of Health Professions, WGU), and Jason Thompson (Vice President – Diversity, Equity and Inclusion, WGU) will discuss how we must eliminate barriers to equity in access and learning in order to reduce racial disparities in care. Progress in advancing diversity in the US health care workforce has been slow. This is evidenced by the low numbers of people from historically underrepresented populations joining the health professions workforce, ongoing reports of bias and discrimination in health professions learning environments, and a continuing dearth of proven and replicable best practices to advance diversity. Many of our health professions schools and clinical practice sites are taking some action on diversity and the more contemporary concepts of equity and inclusion, but without making the necessary commitment to comprehensive, system-wide approaches that create meaningful culture change. As a result, addressing harmful bias and eliminating discrimination remain critical challenges to achieving excellence in health care and health professions education. Within the registered nurse (RN) workforce, according to the National Council of State Boards of Nursing (NCSBN), 81% are White/Caucasian (vs 60% of the US population), while 19% of nurses are from underrepresented racial/ethnic populations. The Accountable Care Learning Collaborative believes that nursing programs must address bias and reduce discrimination in health professions learning environments because, in not doing so, racial disparities in care will persist. In our Accountable Care Atlas, we identified a specific competency to “understand the unique cultural characteristics of the population served to implement changes in the organization to provide high-value care”. This cultural competency failure is reinforced by research that shows that care. If you would like to watch a video recording of this webinar, you can do so here. Bookmarks: 1:40 ACLC Leadership takes a stance on institutional racism and how BLM movement is a public health issue 4:00 Introduction to panelists: Dr. Ernest Grant, Dr. Jan Jones-Schenk, and Jason Thompson 4:50 Reference to population health research that shows us that the American health care system is not immune to institutional racial discrimination 8:05 Jason Thompson on how we can engage in a societal conversation to foster a better understanding about the presence of racism 8:26 “I can’t make you racist in 45-minutes…and I can’t undo it in 45-minutes.  It takes multiple conversations and constant engagement.” 9:51 “There has never been any period in American history where the health of blacks was equal to that of whites. Disparity is built into the system.” 10:19  “Advancing health equity will require a justice-oriented framework that identifies structural racism’s manifestation in medical care.” 10:50 Reference to Don Berwick’s recent article, “The Moral Determinants of Health“ 12:05 Dr. Ernest Grant on how our country can reorient value-based care and public health policies around racial and health justice 13:30 Dr. Ernest Grant on how the nursing profession can mobilize around the issue of institutional racism and health inequity 13:50 Dr. Ernest Grant references his testimony to the House Ways and Means Committee on the disparate impact of COVID-19 in the African American community 14:37 “As nurses we have the responsibility to use our voice to call for change.  Our code of ethics obligates us as nurses to be allies and to speak up against racism, discrimination, and injustice.” 16:00 Dr. Jones-Schenk speaks to how we need to “go upstream to the source” to address seek solutions in reforming society 17:05 “As a profession, we make a promise to society that we will address the health needs of society. We have a responsibility for outcomes in diverse populations – not just caring for illness.” 17:45 Reference to recent article, “Value-Based Health Care must Value Black Lives” and its suggestion to reorient value-based care policies around racial and health justice 19:30 Dr. Ernest Grant on how we can hardwire conformance to social justice within the nursing profession by leading by example 20:43 Dr. Ernest Grant on nurse role modeling and the eradication of stereotypes 21:21 Dr. Ernest Grant on advancing equity in health care by reforming education, having diversity in the workforce, and offering mentorship in the profession 24:47 Dr. Jones-Schenk on how to lead a social movement in health equity with data (“Historically tyranny of the aggregate” and the need to stratify data by populations) 27:09 Dr. Jones-Schenk on the need for faculty diversity in nursing programs and how this perpetuates the problem 28:33 This month is the 10th anniversary of Institute of Medicine’s landmark report, “The Future of Nursing: Leading Change, Advancing Health” (Has anything changed?) 29:51 Jason Thompson addresses how intentionality and direct action is needed to address under-representation of women, minorities, and nurses on corporate boards and senior leadership roles 31:37 “If we are really about saving money and being efficient, and providing better care, let’s call it out for what it is. Let’s not call it health disparities…this is racism.” 33:25 Dr. Jones-Schenk reflects on the IOM “moonshot” goal of 10,000 nurses on Boards, and the progress we have made over the last decade in the leadership and empowerment of nurses 35:18 “Language matters.  Sometimes we used softened language because we don’t want to hurt people’s feelings. We’re hurting more than people’s feelings right now by using overly nuanced language to describe this problem.” 36:14 Dr. Ernest Grant expounds on the “Nurses on Boards” initiative and the need for community involvement to drive change, including the type of food accessible in communities 39:10 Dr. Jones-Schenk shares a personal story about a nursing student becoming personally involved in the public health of his community by running for mayor 41:47 “The fact that the nation’s health professions have not kept pace with changing demographics may be an even greater cause of disparities in health access and outcomes than the persistent lack of health insurance for tens of millions of Americans.” (referencing the groundbreaking report, Missing Persons: Minorities in the Health Professions) 43:35 Jason Thompson discusses institutional barriers in Higher Education that disadvantage students of color 45:16 “We haven’t thought about a systematic solution…we all work in our own silos…If you have a systematic problem, you need a systematic solution.”   47:42 Dr. Ernest Grant discusses the implicit bias in the NCLEX-RN exam for nurses and other barriers in nursing education 52:00 Dr. Jones-Schenk on how to reinvigorate the promise of education for people of color and what institutions of higher learning can do to provide equity in access and learning 53:55 “We have to declare our commitment through action.  This means empowering groups who can identify structural issues that support racism and then resourcing their recommendations.” 58:13 Dr. Jones-Schenk on implicit bias and micro-inequities and how to eliminate bias in teaching and learning 59:33 “We are trying to correct longstanding errors in our culture. We have to be bold and stand up to detractors that say this is just political correctness and not a big deal.” 1:00:43 “Are psychometrics considering population-specific differential analysis?” 1:01:02 “Until you see it, you can’t change it. And once you see it, hopefully you can’t unsee it. Higher Education doesn’t have a choice!” 1:01:16 Dr. Jones-Schenk refers to the recent statement from 40 health systems that racism is a public health crisis 1:02:00 Dr. Jones-Schenk refers to Macy Foundation recommendations (Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments report) 1:04:48 Dr. Ernest Grant discusses what ANA is doing to empower nurses — both socially and economically – to create meaningful change in communities and within the political arena 1:09:00 Jason Thompson discusses how health disparities are created by the summation of all of our individual behaviors, and how the individual commitment makes a difference 1:10:00 Jason Thompson on how “mandatory” training doesn’t work! Only “consistent and regular” training works. 1:11:15 Drs. Ernest Grant and Jones-Schenk on how the word “mandatory” creates apprehension in the workforce and how we need to reframe the dialogue

Most people know that 3M as a massive industrial conglomerate, a Fortune 500 company with 60,000 products that include Post-It notes, Scotch tape, sandpaper, hanging hooks, band-aids and more. A lesser-known division, but the one that is paramount to our focus on value-based care, is their Health Information Systems division: a $1billion+ dollar enterprise built over the last 35 years and focused on healthcare data aggregation and analysis. 3M’s Health Information Systems business works with more than 8,000 healthcare organizations worldwide, including 250,000 physicians, health plans, and 80% of US hospitals, as well as local and national governments in the US and 25 other countries. They deliver software and services across the continuum of care and combine clinical documentation systems and risk assessment methodologies to capture, analyze, and advance patient information in value-based care. Dan McMaster is our guest for this episode. He is the Director of Strategy and Business Development for 3M Health Information Systems. Dan’s leadership and vision have served 3M for over 16 years – his in-depth knowledge of the organization reveals a compelling origin story and unfolds a future of innovation that ensures 3M will be a winner the race to value. http://www.3mhis.com/ http://www.3mhiscer.com/ https://www.3mhisinsideangle.com/podcast/   5:46 The need for analytics and business intelligence in the transition from volume to value 6:12 Potentially Preventable Readmissions (PPR) – identifying acute care hospital readmissions to improve the quality of care 6:37 Clinical Risk Groups (CRG) – “a FICO score for your health” 7:27 Providing key population measures to health plans all over the country and CMS for improving health outcomes 8:26 Using AI to surface real-time insights when completing the medical record 11:00 3M’s journey in health information technology from when the healthcare company first started 35 years ago 13:40 Clinical and Economic Research at 3M HIS and the development of DRGs related to Rich Averill’s health-related research at Yale University 15:10 Collaboration with payers to develop capitation models 15:30 3M’s and M*Modal launch of AI and natural language understanding CDI tool for real-time alerts at the point-of-care 17:00 The story of the challenging new product development of the Post-It note and how this experience shaped the current culture of innovation at 3M 20:23 Developing innovation for HCC coding for Medicare Advantage risk adjustment 22:08 Partnership with payers, providers, government, and EHR companies is key for innovative solutions in healthcare 26:18 How to sift through all of the noise, buzzwords, and rhetoric when evaluating new and emerging technologies 26:53 The potential for AI and NLP to enhance the capabilities of providers in order to improve health outcomes 29:27 AI can reduce the intense documentation burden that contributes to physician depression, anxiety, and suicidality 31:40 Innovation with Medicare Advantage and how advancement in health informatics systems for this population can be leveraged for the bigger whole 37:10 Dan speaks to 3M’s involvement in the ACLC and how Michael Leavitt has led with the need for collaboration in value-based care 39:30 Leveraging technology appropriately can free up time for physicians so they can better address patient care needs 41:48 The need for an “Infinite Game” mindset in healthcare innovation

The importance of Humana’s consumer focus, care in the home, technology, and other strategic imperatives related to value-based care have been amplified by the novel coronavirus (COVID-19) pandemic. As COVID-19 presses onward, this week Race to Value presents an industry perspective from Mike Funk, Vice President for the Office of Health Affairs and Advocacy.  Mike Funk believes that the transition to value-based care is inevitable. In his role with Humana, he leads the organization’s commitment to ensure that Humana providers are well equipped for the transition to value, especially during these unprecedented times. From stabilizing physician practices, increasing access to care, creating a high-touch primary care model, improving interoperability, and more, Humana has been a leader in the race to value. In this episode Mike reveals Humana’s efforts in value, including outlining impressive partnerships with the DaVinci project, OATS, Epic, Oak Street Health, Iora Health, Kindred Health, and the University of Houston, to name a few. Mike Funk is responsible for thought leadership at Humana in transforming the industry to value-based care, as well as serving as the voice of the provider, infusing clinical thinking and leadership across the enterprise. His prior experience includes; executive positions in hospital administration, physician practice management, managed care, insurance products, and health and wellness services. Mike most recently spent the last several years in the Provider Development Center of Excellence, where he focused on developing value-based programs, and assisting physicians with the tools, capabilities, and best practices for transitioning from fee for service to value. Mike is a fellow of the American College of Healthcare Executives and a Certified Medical Practice Executive. References for more information: https://www.humana.com/provider/news/value-based-care http://valuebasedcare.humana.com/ Bookmarks: 5:45 “Unprecedented times call for unprecedented actions” 6:24 Primary focus of Humana during the pandemic has been to improve access to healthcare services 6:45 Pandemic was the catalyst for jumpstarting and mainstreaming telehealth 8:01 5-10 years of technology adoption progress happening in 2-3 months 8:30 The “genie is out of the bottle” when it comes to telehealth 9:10 Limitations with technology and telehealth access in rural areas 9:30 Older Adults Technology Services (OATS) investment by Humana Foundation to launch national digital engagement consortium for older adults 10:11 Recognition by CMS of increased need for telehealth 10:20 Mike shares a story of a practice leveraging telehealth visits in an innovative way 12:40 Lack of interoperability held back the healthcare system in navigating the pandemic crisis 13:20 Need for interoperability COVID-19 test results 13:50 Humana’s participation in the HL7 Da Vinci Project to support increased data sharing by leveraging the FHIR Standard 14:20 Humana’s work with EMR companies to advance interoperability (Epic, eCW, AthenaHealth) 17:00 Humana’s goal to ensure stabilization of physician practices 18:00 Risk-based payment models providing stability in cash flow 21:00 Humana has evolved its value-based product portfolio to include specialty bundles (e.g. joint replacement, spine, maternity care) 21:10 Humana’s omni-channel approach to create a value-based care ecosystem that is “personalized, proactive, and predictive” 21:40 Increased demand in home care services and Humana’s recent investments in Kindred and Heal 22:00 Humana’s partnership with high-touch primary care practices (e.g. Iora, Oak Street) and their own practice (Partners in Primary Care) 22:20 Moving from a health insurance company to a health company with elements of insurance 23:45 Humana’s Bold Goal initiative and other strategies to address social determinants of health and support whole-person care 24:35 CMS’ work to assess COVID-19 impact on Medicare beneficiaries 24:45 Humana’s work with MGMA to better understand the impact of diverted care during pandemic 25:05 Humana’s work to support medication adherence 27:20 Addressing racial disparities within a whole-person care model 28:15 Humana’s collaboration with local government in San Antonio to address diabetes which contributed to overall improvement in population health 29:30 Humana’s recent pilot with Oschner Health to launch a value-based program to address social determinants of health 30:10 Humana delivering meals to patients in need during pandemic 30:40 Humana’s commitment to health equity and recent investment in Humana Foundation to address racial inequities in population health 33:00 How the pandemic will rapidly shift the healthcare industry to value-based care due to mounting debt levels 36:40 The need for workforce development in preparing for value-based care and the new partnership with the University of Houston College of Medicine