The Race to Value Podcast

Many industry insiders believe that health system-led ACOs are inherently disadvantaged to demonstrate value-based care in an environment where most revenue is still generated in fee-for-service. In moving to value, hospitals must contend with demand destruction on their fee-for-service lines of business as they reduce admissions, emergency department visits, and procedures. Physician-led ACOs, they argue, simply do not have this dichotomy; therefore, they have a clearer pathway to financial benefits from reducing hospital costs outside of the physician practice. This premise often appears correct as we often see “low-revenue” ACOs, typically led by physicians who mostly provide outpatient services, have better results than “high-revenue” ACOs, generally led by hospitals that provide both inpatient and outpatient services. Lisa M. Trumble, President and Chief Executive Officer at Southern New England Healthcare Organization (SOHO Health) respectfully disagrees. She believes that “Clinical Integration is the Answer” in this race to value, and she has the results to prove it!  As one of the leading CIN executives in the country, Lisa Trumble has shown how clinical integration can enhance communication between providers and improve on the outcomes and excessive costs that are commonly seen in an uncoordinated care delivery model. This week’s episode features Lisa M. Trumble, the President and CEO of SOHO Health, a new ACO and CIN that is a partnership between Saint Francis Healthcare Partners and Trinity Health of New England. With 30 years of experience in health care leadership, Lisa shares powerful insights on clinical integration and challenges healthcare executives to “buckle up” on this race to value. Bookmarks: 3:45 Lisa comments on what it was like to start a new job as CEO right when the pandemic started! 6:30 Leading change during an important inflection point in the industry as it shifts towards value 6:45 The fragility of the FFS model during the throes of a pandemic 7:08 Lisa reflects on prior work in value-based transformation in Massachusetts and how that state differs from Connecticut in its commitment to health value 7:42 SOHO Health and Trinity Health of New England are committed to (and invested in) this transition to value-based care 8:15 Remaining on a FFS chassis is not sustainable.  Negotiating increases in FFS will not be tolerated in the future. (“Buckle up and look out!”) 8:45 Direct-to-Employer contracting 9:03 Partnering with physicians and creating JVs for Centers of Excellence and Bundled Payments 10:50 Hospitals needing to evaluate core business and how to reduce infrastructure cost to create a “survive-able” margin 11:09 Reducing utilization for unnecessary services and preventing leakage within a CIN 12:00 Despite reductions in inpatient services in VBC models, utilization is still growing in ambulatory surgery 12:20 Developing a bundled payment model with physicians in ASCs where financial incentives are aligned 12:50 Employers will no longer tolerate paying for surgeries that cost twice as much when performed in an inpatient setting 13:15 Value-based care is a difficult situation for health systems. At the same time you are losing business, you also have to transform and make key investments. 13:25 “If you don’t commit to value-based care, you will slowly work your way out of the market and be uncompetitive. The market will find a way to figure it out with others.” 15:15 PHOs, IPAs, ACOs, and CINs all are struggling to figure out the best way pursue clinical integration 16:00 The beauty of a design of a Clinically Integrated Network is that it isn’t limiting you to only one area of care delivery — “Clinical Integration is the answer to how to perform well in a value-based environment.” 17:30 Multidisciplinary collaboration is important to providing the appropriate level of care 19:25 Lisa explains how SOHO is approaching collaboration with employers 20:40 Employers are finally willing to consider benefit redesign due to economic pressure 21:35 The challenge with payer partners developing chronic disease programs 25:00 Proven evidence of more standardization and higher repetition of procedures per provider creates better outcomes 25:50 Hysterectomy complications between neighboring states (Example to justify Center of Excellence strategy) 26:20 Delivering Value can’t be done in “every setting, everywhere, with every option available” (COEs for Episodes of Care needed) 28:00 Disengagement of specialists in a conventional value-based care model (Bundles and COEs can overcome this challenge) 30:20 Incentive Alignment for Providers and structuring a Physician Compensation Formula 35:14 Rewarding citizenship and physician engagement in a physician comp model 37:14 Minimum performance expectations for care delivery 41:01 Shared decision-making with patients (must understand the values and beliefs of the patients you are serving) 42:08 Measuring success for transitions of care 45:50 Strategies for making capital allocation decisions for value-based transformation 47:20 Payers should step up in the provision of capital to fund infrastructure 48:45 Budget-based risk models are not viable in the long-term because of diminishing returns 52:30 The challenges of EHR fragmentation in delivering a longitudinal health record 55:39 Demonstrating ROI for EHR investments are difficult 58:15 The impact of the pandemic on telehealth implementation 1:02 Other digital health strategies and creating a virtual home ICU 1:04 Development of workforce skills within a clinically integrated network 1:11 The future state of hospitals as care is shifted to ambulatory settings

MaineHealth Accountable Care Organization (MHACO) serves a uniquely heterogeneous population that is spread across coastal, rural, and urban communities with multiple different cultural components. And they serve the oldest population of all states in the Union! The organization’s ED utilization in its early years was historically around 775 visits per thousand – a significantly high number when compared to other ACOs in the country which were well below 700. At the same time, the ACO was about 10% lower than other ACOs in providing primary care services. Find out how MaineHealth was able to implement a Value Oversight Committee, leverage technology, improve processes, and engage their workforce to achieve nearly $20 million dollars in savings in its first year of contracting with CMS in the Medicare Shared Savings Plan.   In this episode we speak with Jennifer Moore, MBA is the president of MHACO, whose membership includes 10 acute care hospitals and over 1,600 private practice and employed physicians, and manages numerous commercial ACO value-based contracts. These ACO contracts cover approximately 230,000 Medicare and commercial lives. Jen has significant expertise in value-based contracting, ambulatory quality measurement and performance, data analytics, and provider relations activities.  Jen is a board member of the National Association of Accountable Care Organizations (NAACOS) and serves as chair of the NAACOS governance committee. Listen to MHACO’s BACON podcast: https://mainehealth.org/mainehealth-accountable-care-organization/provider-resources/bacon-podcast Bookmarks: 4:24 Introducing an extreme ED Utilization scenario and how the ACO initiated an historic turnaround! 5:57 Jen discusses how critical the Value Oversight Committee (VOC) is pivotal to the success of the ACO 6:48 Diagnosing a Patient Access issue in the ACO with key metrics (ED visits/K and PCP visits/K) 7:30 “Houston, we have a problem” (the ACO was higher than the market in 16 of 17 contracts!) 8:00 Performing a root cause analysis of high ED utilizers 8:41 Loneliness is a major driver of ED use 9:05 Getting stakeholder buy-in for the ED Problem: showing physicians there was actually a failure in the care model by using data 9:44 Finding actionable data and knowing what steps to take to solve a problem 11:28 The importance of flexibility in ACO operations: solving challenges at the local level in each of MHACO’s regions 12:12 Leveraging population health management data, SMEs, and Value Oversight Committee to develop a focused operational tactics 12:30 Selecting tactics for the ED Playbook:  1) Patient Education campaign and 2) Actionable Care Planning 12:50 Implementing the “Where to Go for Care” Patient Education Campaign 14:44 Implementing ED Actionable Care Planning 16:45 Risk Stratification and Predictive Modeling (Johns Hopkins ACG) 19:30 ED Propensity Scoring (Urgent Risk, Impactability, Frequent ED Utilizers, Recent ED Utilizers) 20:00 Capturing Social Determinants of Health Data 21:15 Transitioning from a Centralized to an Embedded Care Management Model 23:50 The “a-ha moment” during the pandemic:  the need for more primary care capitation 24:10 Telehealth deployment during COVID-19 26:50 The importance of Clinical Documentation as a driver of ACO contract performance 28:45 Engaging specialists in clinical documentation 30:35 MHACO’s “heat map” report for Top 10 ACO quality measures 33:30 MHACO’s practice incentive report for other ACO quality measures 34:00 Payer collaboration 36:00 Joint venture between MaineHealth and Anthem Blue Cross and Blue Shield 36:35 Forming a Provider Advisory Council to make recommendations to payers 39:35 The leadership domains that are most relevant and impactful for ACOs 42:00 Designing a compensation formula for distribution of P4P and Shared Savings to physicians 45:40 Hardwiring a consistent culture of improvement and innovation within the ACO

Primary care is especially compromised in the ongoing pandemic crisis. PCPs are uniquely vulnerable to the deleterious economic effects of COVID-19, since most of their revenue still comes from in-person visits which have plummeted since March amid widespread stay-at-home orders and fears about in-office virus transmission. The pain has been particularly acute for PCPs who are not backed financially by health systems, private equity or other entities. Roughly half of U.S. doctors still own their own practices, and those independents were already operating on razor-thin margins after years of reimbursement cuts, unfavorable payment structures, and expensive EHR and tech implementations. Add a pandemic to the mix, and it’s a recipe for disaster. We are pleased to welcome Dr. Jed Constantz as our guest this week. As a primary care finance and delivery reform strategy consultant, he has worked with payers, employers, and providers, all the way from independent primary care physicians to large health systems. Over his 30 plus years in healthcare, he has developed tools and resources for primary care providers and employers seeking to reduce costs, drive greater efficiency and quality outcomes, and thereby create a “featured-and-favored” network in their regions and community. This process includes a deep focus on the selection of the right community of primary care physicians and specialists, a thorough audit of existing patient and population data, commitment to accountable care standards, and improved compensation for the physician. Jed comes with wisdom and critical counsel for sustaining PCPs as the foundation of our health care system. Bookmarks: 5:50 The lack of a payment strategy for primary care prevents trusting relationships. 6:50 COVID-19 has provided a deeper understanding of why primary care needs to be purchased differently. 8:00 Payment reform will allow primary care to live up to the expectations of true patient-centered care and population health. 10:30 Primary Care must retain the agency to care for patients when underlying financial arrangements and equity positions change. 11:30 Terms and conditions of primary care business arrangements must allow physicians to continue to have a high level of accountability to the patient. 14:30 Primary care physicians must pursue business models that allow them to practice independent clinical decision-making. 16:00 The VillageMD and Walgreens partnership is a perfect example of a corporate model that retains primary care independence. 16:45 Blue Cross North Carolina as an example of how to calculate the future value of primary care so money in health care can be spent more intelligently. 21:55 Innovation must be focused on meeting the needs of the patients, and F2F encounters are not as important as we once thought. 22:40 Dr. Constantz explains how the FFS economic model makes it impossible to spend quality time with patients. 23:17 The innovation of telemedicine is a great example of how primary care was able to make a pivot towards improved population health during COVID-19. 24:00 The Primary Care Innovators Network (PCIN) and its contribution to innovating care delivery through payment reform. 24:42 The Triple Aim as a foundation for patient activation to improve health outcomes (Dr. Constantz cites the research of Judith Hibbard.) 25:08 Payment reform in primary care gives you the opportunity to imagine a different relationship between the primary care team and the patient. 26:50 The disruption of the employer-sponsored health insurance marketplace 27:52 Rosen Hotels as an example of what employers can do to take charge of healthcare costs and funnel savings back into the community. 31:15 Dr. Constantz shares his perspective on how self-funded employers are planning their health benefits strategy for 2021. 33:54 Partnership between The National Alliance of Healthcare Purchaser Coalitions (National Alliance) and the American Academy of Family Physicians (AAFP). 35:21 Collaboration between employers and community-based primary care to rebuild healthcare 37:53 Practice-level technologies are a core element of an advanced primary care model practice 39:00 AthenaHealth and Navina collaboration as an example of a technology enablement that drives clinical decision-making 40:20 The coupling of payment reform and a strong practice-level technologies program allows the care team to be redeployed more effectively 41:41 More effective ICD-10 documentation and capture is an opportunity to improve care in the “New World” of primary care 43:05 Dr. Constantz addresses the various factions of the primary care community that are still resistant to change 46:30 Not all primary care is created equal – focus on the most exceptional segment of advanced primary care first as a source of inspiration for the laggards. 48:57 The repositioning of the primary care industry to make it the predominant force of reshaping the future healthcare 50:00 Dr. Constantz questions the notion of a national primary care shortage and proposes that we instead consider more effective deployment of existing resources 50:51 Care team innovation will address the “shortage” of primary care by allowing for more effective execution of care plans (references the work of Dr. Peter Anderson) 53:20 Dr. Constantz posits that we should zero in on the sincere interest in succeeding in the care of an individual (instead of defaulting to financial risk arrangements) 56:20 The PCMH laid the foundation for primary care transformation but didn’t meet expectations because the money didn’t follow 58:30 True patient-centered care can improve outcomes and lower costs and is an important part of the ongoing evolution of primary care 59:45 The important of the ACLC in creating a catalog of resources for primary care and disseminating that knowledge to the entire industry 60:00 “The ACLC is the kind of organization that strengthens the ability to design a best-in-class primary care capability that is ultimately able to deliver the goods.”

Quality in health care has been a hot topic for over 20 years, ever since the landmark report, To Err is Human, which declared that up to 100,000 people die each year from preventable medical errors. Since that time, the industry has increased its efforts to incorporate quality principles from Lean, Six Sigma and other models, but only one organization has raised a quality standard for health care organizations and their workforce. The National Association of Healthcare Quality (NAHQ) is leading the quality revolution with its framework of essential qualities for the health care professional. Join the conversation as we speak with Stephanie Mercado, CEO of NAHQ. Stephanie is a leader in healthcare association management, advancing healthcare professions, and workforce development. Since joining NAHQ in December 2013, NAHQ membership has increased by more than 70%. Stephanie has raised NAHQ’s prominence and value in the healthcare quality space, with the introduction of industry elevating initiatives such as the award-winning HQ Essential Competencies and the National Healthcare Quality Summit. In partnership with NAHQ’s Board of Directors, and an outstanding staff and volunteer team, Stephanie led the development of the profession’s first-ever Comprehensive Competency Framework, and the profession’s first-ever Workforce Study, offering critical insights to workforce development opportunities for healthcare quality and safety professionals. In addition to her work with NAHQ, she currently serves on the Institute for Healthcare Improvement’s National Steering Committee for Patient Safety, the Association Forum Healthcare Collaborative Steering Committee, and is a board member of the Commission on Accreditation for Healthcare Management Education (CAHME), and more. In 2018, Stephanie was selected as a recipient of the Outstanding Nonprofit Leader Award from .orgCommunity. We are grateful for Stephanie’s leadership in the race to value!   Bookmarks: 6:00 Workforce Empowerment and Culture Alignment to support Quality Improvement6:55 Healthcare Quality Competencies needed to improve patient safety and health outcomes 8:45 The acceleration of Value-Based Care and the recognition of codependent relationships across the care continuum 9:45 A coordinated and competent workforce is a ‘must have’ to thrive in health value 10:15 Breaking down the barriers to coordinate care across the continuum 12:00  The NAHQ Healthcare Quality Competency Framework 12:55 The juxtaposition of Quality Training and Medical Training 14:00 Setting a standard to serve as a roadmap for the industry 14:40 Governor Leavitt providing thought leadership in the creation of national standards 15:00 NAHQ’s support of individual contributors 15:45 NAHQ’s partnerships with healthcare organizations to find opportunities for improvement 16:15 Healthcare leaders sometimes don’t know who is doing the work of quality in their organization 17:00 NAHQ’s partnerships with academic organizations to hardwire competencies into curriculum 18:05 WGU as a leading national example of hardwiring quality competencies into nursing education 22:35 Leveraging the synergies between health value and quality in partnership with the ACLC 25:30 The Quality competencies that are underperforming the lowest are ones that are underpinnings to Health Value 29:00 Data that shows a correlation between quality training and a higher level of work performance 32:20 Stephanie speaks about the administrative burden of quality measures and the need for standardization 33:10 Looking at other industries with similar challenges in alignment and harmonization of standards, e.g. the history of railroads 35:56 How healthcare can have its own “intercontinental connectedness” with outcome measures, systems, and competencies 38:46 How consumer focus on service reliability and customer service can align with clinical performance and process improvement 42:44 Priority #1 – focusing on individual contributors (training leads to higher performance) 43:30 Priority #2 – supporting corporations (you can’t “abracadabra” yourself of workforce competency gaps) 44:30 Priority #3 – academic partnerships (students need a common vocabulary, toolset, and competencies when entering the workforce)

Palliative care, and the role it plays in health value, is difficult for many people to understand because it runs so contra to the linear algorithm that is allopathic medicine. Curative care – played out in the form of surgeries, procedures, therapies, and various other medical interventions – is focused on doing something TO the patient. This becomes problematic when the patient has a terminal illness – eventually the illness will win. Nature always wins. Palliative care shifts the caregiver’s paradigm from one of asking, “How can I help prevent death?” to the more appropriate question, “How do you want to live?”   When caregivers ask the right question, treatment activities naturally move away from an escalation of clinical interventions that can shorten life and worsen quality of life, and move toward supportive medicine and therapy in the form of symptom-controlling medication, rehabilitation, and counseling that focuses on a patient’s quality of life, symptoms, and emotional wellbeing. – things they do FOR the patient. That’s not to say that curative treatments aren’t appropriate or indicated – palliative care works in partnership with other specialists – but the palliative care provider plays an important role in truly helping the patient understand the nature of the disease, the treatment options, and the patient’s physical ability to respond to the treatments. Inevitably, patients choose less treatment: costs decrease while quality of life increases.   In this episode we speak with Dr. Tim Ihrig, Chief Medical Officer at Crossroads Hospice and Palliative Care. Dr. Ihrig is a nationally recognized thought leader in palliative care, with 1.5 million hits on his Ted Talk “What We Can Do To Die Well” and author of the important book, Palliative Care and Symptom Management. His work in multiple organizations has proven that effective palliative care aligns with the objectives of the Triple-Aim – it is a key organizational and individual competency required to make value-based care a reality.   5:50 Dr. Ihrig explaining his early involvement in the ACLC and his journey in health value 8:00 Reverse engineering the individualized care of a patient into programs, training, policy, and reimbursement 10:45 The linear algorithmic model of treatment that leads to an escalation of clinical interventions 11:05 The need to reform medical education so that death is not always viewed as a failure of the physician 12:30 Asking the question, ‘how do I want to live?’ shifts the narrative to loving, learning, and growing through every breath 13:00 Informed Consent as one of the core tenets of true palliative care 14:10 Physicians must ask the question: what is sacred to you as an individual? That doesn’t change over time, cancer or not. 14:45 Understanding the appropriateness of treatment against the backdrop of where somebody’s at on their physiologic journey 14:53 True palliative care going beyond the limits of allopathic reductionism and looking at the whole human being 16:04 Aligning therapies with the clinical reality of where patients are physiologically and what their goals of care are 16:45 Palliative care needs a concise, unified definition of what it is to overcome current misperceptions 18:31 The present medical paradigm sets up fighting to beat Mother Nature, which means we all fail. 19:56 The inflection period – the moment in our health journey when our bodies no longer have the capacity to recover or restore 22:50 Using the inflection period as a tool to prevent iatrogenic causality which potentiates decline secondary to physiologic stress. 23:45 The diminishing ROI of medical interventions at the inflection period 24:18 Dr. Ihrig describes a personal example of iatrogenic causality that brought about death 25:07 Patients becoming victims when we don’t understand the reality of death and the limitations of medicine 27:00 Shifting the focus of control away from where the healthcare provider and the prescribed treatment is at the center 30:00 Overcoming a patient’s fear of the unknown by asking the right questions 33:10 Transcending medicine by translating the voice of the patient 34:35 The effect of the COVID-19 pandemic on ICU bed utilization and ventilators 36:10 The opportunity of the pandemic experience to rethink health care and how we embrace death 39:15 Dr. Ihrig discusses what is necessary for the acceleration of adoption of palliative care in value-based care 40:40 The misunderstanding that palliative care operatives with a negative financial margin 43:05 Getting ACOs to understand what true palliative care is 45:23 Advice for ACOs looking to start a palliative care program 50:35 The need to educate clinicians on the effective implementation of palliative care delivery models 53:05 Healthcare iatrogenically potentiates the greatest series of atrocities the world has ever known.

In health care, we excel in addressing problems in the human body that are fixable.  However, with regard to the two main un-fixables in life — aging and dying— we often inflict therapies on patients that shorten lives or increase suffering before death. These heroic measures result in wasteful costs in the healthcare system: of $700 billion a year spent in Medicare, it’s estimated that about one-quarter of that spending goes to the 5% of Medicare beneficiaries who are in their final year of life, without knowing which of those dollars are actually adding value to the patient. While many healthcare organizations are struggling to develop risk-based population health management strategies, geriatric care models, focused on high-risk, high-need patients, can be valuable resources for healthcare organizations hoping to improve care and reduce costs. In this episode, Carrie Coumbs, an expert in geriatric care models, shares valuable insights in caring for seniors, covering topics of senior housing, rehabilitation, home health, home-based care, hospice care, re-hospitalization avoidance, home care collaboration, as well as Alzheimer’s and Dementia care. Carrie is an exemplar in building a legacy of care for seniors.   5:07       How Carrie found her calling to care for seniors by hearing their life stories 8:38       An administrator telling a nurse that there is not enough time for a patient that is running out of time 11:45     The importance of communication and empathic listening in the healing journey 13:00     Honoring the preferences and values of a patient defines health care quality 17:30     The importance of educating our youth on “real” life expectancy 19:13     Incorporating assisted living, independent living, and memory care into the medical school curriculum 21:33     Learning from other countries how to educate our society about aging 28:24     The influence of Dr. Bill Thomas on geriatric medicine and eldercare 27:15     Providing home care to a patient makes someone whole again, just like providing a prosthetic to an amputee 29:02     A patient that fell one mile short of receiving palliative care support due to a benefit coverage limitation 29:28     Current hospital landscape prevent physicians from being a part of their community (referencing Charles Martin) 33:21     How ACOs can improve transitions of care from hospital to PAC 35:25     Just achieving ACO Shared Savings is not the true measure of success 39:00     Senior housing and assisted living 41:40      An example of a senior housing community-saving Medicare nearly $4M (Juniper Communities’ Connect4Life) 46:40     The ever-increasing shift to ambulatory care and newly-emerging home-based care models 48:00     The growth of telemedicine and remote patient monitoring 49:23     The growth of community medicine, senior housing, and in-home care support 52:37    Ideas about getting seniors to embrace technology as a way to improve health and wellbeing 57:34    Vision for a coordinated care network (CCN) model (referencing ACLC whitepaper) 1:02:36       It’s not OK for seniors to accept being invisible.  Society needs to change.  We can learn from seniors, and they should walk proud. 1:06:04       The importance of the ACLC in expanding the conversation on aging

How does an organization have a banner year in 2019, start 2020 with additional momentum, and then continue to grow despite COVID-19 making them change their whole approach? Because they have something the market needs, because they are able to adapt, because they care about solving their customer’s needs – and the list goes on.   Earlier this year, Innovaccer released survey results showing that more than 45 percent of healthcare executives understand value-based care; however, most of those are still in the pilot phase of their value-based performance or risk-based transition. About 30% said all patient data is not in one place, and many organizations are not using artificial intelligence. The inadequate progress towards true democratization of data and widespread interoperability confirms we have much to do as an industry in creating a more workable approach to health value. Innovaccer is leading an important movement towards data activation and the creation of a unified, longitudinal patient record, including in part, their InCare solution: an artificial Intelligence-enabled care management platform that automates workflows and creates point-of-care alerts.   In this podcast episode, we are speaking with Dr. David Nace, Chief Medical Officer for Innovaccer. His experience as a family physician, an executive in the insurance industry, an advisor on a government task force, a chair for the Primary Care Collaborative, and a host of other experiences make Dr. Nace a perfect guest to help health care professionals understand better approaches to data. In the race to make value work, Dr. Nace and Innovaccer are showing the industry how to care as one.   05:27     Fee-for-service as the “wild west” of healthcare motivating his journey in value 09:40     Data activation required to effectively manage a patient population 12:27     The effect of the pandemic as a contributor to even more innovation 16:30     Education and workforce development needed for value-based care transformation 19:05     Transcending the vendor-customer relationship by forging collaborative partnerships 23:05     ACLC as a vehicle to expand learning through industry collaboration 26:21     Leveraging large employers to drive patient-centered, primary care empowerment 28:10     PCMH principles as building blocks of whole-person care 30:45     The birth of the ACOs as an outgrowth of the PCMH movement 36:18     Using machine learning and AI to provide insights and create efficiencies 37:24     Overcoming inertia and using COVID-19 as a source of technological innovation 40:22     The three stages of AI: real-time data insights, insight-driven action, and automation 43:55     Unified patient records allow for automated chart reviews and AI-driven clinician workflows 47:05     How the pandemic will allow us to overcome inertia in health value 49:06     Medicare Advantage as a potential scenario for payment reform 51:25     SDOH and how to understand the true drivers of patient health outcomes 54:23     Zipcodes and credit scores are the two most important data points to understand vulnerability

The Rio Grande Valley, located in the southernmost tip of Texas along the US-Mexico border, has become a new epicenter for COVID-19 over the last month.  Death rates are also over five times higher than the rest of Texas because more than 60-percent of residents are diabetic or prediabetic and more than 90-percent of the population is Latino. To compound the situation, the Valley was also impacted by the landfall of Hurricane Hanna on July 25th creating mass flooding, infrastructure stress, and home displacement in the local community. The Valley needs our prayers and support.  In this bonus episode to the Race to Value podcast, Edwin Estevez provides an update on how the RGV community is dealing with this current public health crisis.  If interested in helping out the Rio Grande Valley community, please contact Edwin at eestevez@rgvacollc.com.  Resources to community benefits organizations provide relief to the Valley are also listed below.   http://www.foodbankrgv.com/ https://www.redcross.org/local/texas/central-and-south-texas/volunteer.html https://www.salvationarmytexas.org/mcallen/

Physician groups are becoming the dominant type of new entrant into the ACO space and have been most successful in achieving savings to date.  Many in our industry think that physician-led ACOs are at a disadvantage in comparison to hospital-led ACOs because they lack the capital and the administrative firepower to spin up a population health infrastructure. RGV ACO, one of the leading Accountable Care Organizations in the country, has proven that physician leadership is actually the key ingredient to success in health value. Located in the southernmost tip of Texas along the US-Mexico border in the Rio Grande Valley, RGV ACO has achieved its success with some of the most insurmountable odds imaginable.  In the Rio Grande Valley, more than a third of families live in poverty. Nearly half of the residents have no health insurance, and obesity, diabetes, and heart disease are widespread. This region, made infamous by Dr. Atul Gawande over a decade ago in the New Yorker article “The Cost Conundrum” was once the most expensive healthcare market in the country.  In response to the problems of its local community, RGV ACO was formed and took the charge to lead a revolution in health value.  Their success story shows that something truly magical can happen when physician leadership, innovation, and aligned incentives converge in a way to solve important problems in our health care system. In this podcast episode, we are speaking with Edwin Estevez, the Chief Executive Officer of RGV ACO.  Edwin is a remarkable leader in our health care industry and will share his journey in health value.  Anyone interested in how leadership can transform the care outcomes in a community should listen to the story of RGV ACO.  We are in a race to make health value work in our country, and RGV ACO is a true success story of how to beat the odds and transform the lives of many.   06:45  Creating a competency-based framework for value-based care 07:40  Implementation of the ACLC Accountable Care Atlas 10:00  The Success of Physician-Led ACOs 13:00  When “something magical happens in value-based care” 15:20  Community engagement with high-risk populations 18:10  Tapping into the altruism inherent in the practice of medicine 19:30  Creating “interdependence” for independent physicians 22:14  Capital requirements for startup ACOs 25:15  Creative thinking and capital support from payers 28:17  Incentivizing for physician leadership and process transformation 32:40  Overcoming the “The Cost Conundrum” by refusing to fail 35:00  Engaging the community in a culturally appropriate way 36:00  Home Health Partnerships 38:42  Addressing Racial Disparities in Care and Health Equity 43:00  Developing a Patient-Centered Diabetes Care Playbook 48:55  Partnering with local grocery stores to improve population health 54:00  Edwin shares his passion for health care and education 58:00  Workforce Development for independent practices within an ACO 1:02    Next-level risk contracts and multi-payer strategies 1:07    Direct Contracting must be “physician-led” to be successful