The Race to Value Podcast

Now is the time to embark on a journey towards a brighter and more resilient future. As the U.S. healthcare system grapples with the aftermath of a global pandemic, we find ourselves at a pivotal crossroads. This episode delves deep into the profound changes brought about by the pandemic, examining how it has exposed vulnerabilities in our existing systems and ignited conversations about the need for transformative change. Join us as we navigate this critical juncture, exploring the shifts in healthcare, economy, and societal values that could ultimately lead us to a high-value system that prioritizes well-being and sustainability for all. Get ready to be inspired and informed as we embark on this enlightening exploration of the post-pandemic world. Joining us in the Race to Value this week is David B. Nash — an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. His accolades and achievements in healthcare transformation are innumerable. (The week before this interview was recorded he had received the Lifetime Achievement Award from the American Association for Physician Leadership.) Dr. Nash is also a bestselling author with his new book, “How COVID Crashed This System: A Guide to Fixing American Health Care.”  In this episode, we discuss insights from Dr. Nash’s research on COVID-19’s impact on the healthcare system and how this post-pandemic era can help us transition to a high value health care system.   Episode Bookmarks: 01:30 Introduction to Dr. David Nash, an American physician, world renowned scholar and public health expert, and Founding Dean Emeritus of the Jefferson College of Population Health. 03:30 Have we learned our lessons from the COVID disaster? 05:00 Dr. Nash reflects on his recent experience with Dr. Ashish Jha on the last day of service to our country as the White House COVID-19 Response Coordinator. 05:30 “The office of the presidential response to COVID is now a janitorial closet somewhere in the West Wing of the White House…it is sad.” 06:00 “1.2 million dead from COVID-19 is more than the total of all combat casualties of every war since the Revolutionary War of the United States!” 06:30 “Sadly in the history of our country, when the dying stops, the forgetting begins.” 07:00 PTSD from the pandemic with physicians and healthcare professionals, coupled with societal apathy towards COVID-19 and surging cases in China. 08:00 Medicaid Redetermination as the consequence of the end of the Public Health Emergency and how lost coverage will impact marginalized populations. 09:00 3,000+ people died from 9/11, and we are still taking our shoes off at the airport.  1.2M died from COVID-19, and it is back to business as usual. 09:30 Societal issues (e.g. structural racism, inequality) persist in our country. 10:00 What is the True North for American Healthcare really?  ($4 Trillion in spend with significant amount of low value care, declining life expectancy, low ranking in world health rankings) 10:30 Additional societal measures of a poor performing health system (alcoholism, depression, suicide, opioid abuse). 11:30 How Philadelphia is suffering an exacerbation of  pre-pandemic problems (lack of access, redlining, crime, homelessness, educational disparities). 11:45 There is a 20-year disparity in life expectancy between rich and poor communities in Philadelphia. 13:00 The persistence of health inequities and social injustice since the transatlantic slave trade. 13:30 COVID-19 blasted a searing light on social determinants of health! 14:30 “You can’t have value-based care without equity.” – the costs of health inequities are in the hundreds of billions (see recent JAMA article). 15:00 Employer engagement in health equity transformation. 15:30 “The emergence of the payvider model has given value-based care additional energy.” 17:00 The evolution of medical and nursing education to improve health equity. 18:00 Testing of innovations at scale during the pandemic (e.g. telehealth, hospital-at-home, physical infrastructure changes, novel medical devices). 18:30 The extension of Medicare telehealth flexibilities and the extension of the Acute Hospital Care at Home Program through 2024. 19:00 Bridging the digital divide in Philadelphia through the provision of telehealth services at Jefferson Health. 20:00 The economic incentives that led to the rapid adoption and diffusion of innovation.  What is next for digital health post-pandemic? 20:45 The opportunities for applying precision medicine in cancer care and generative AI in healthcare. 22:00 “Amazon, Walgreens, Walmart, and CVS are the Big 4 disruptors of technology innovation in healthcare. This is where the action is.” 24:00 The existential threat of Artificial Intelligence and the forthcoming technological singularity. 25:00 Personal reflections on the disruption of ChatGPT in healthcare and medical education. 26:00 The need for clinical rotations of medical residents in retail-based healthcare settings (e.g. Walmart, Oak Street, Walgreens, Iora Health). 27:30 AI should not need to be a threat to physician autonomy. 28:00 The collision of moral and fiduciary responsibility in healthcare. 28:45 Referencing Dr. Nash’s article, “Population Health is the New Public Health” – “The virus exposed a truth that the public health paradigm is outdated and insufficient.” 30:00 Public health spending is $400 per person in the U.S. (compare that to healthcare spending at a rate of $10k per capita). 31:00 Dr. Leana Wen – “Public health saved your life today. You just didn’t know it.” 31:30 The structural, financial, and cultural challenges of public health and why it is not an attractive career trajectory for physicians. 32:30 The leadership needed to fix public health. 33:00 Dr. Nash expresses his concerns about the not-for-profit governance of health systems that overemphasis profit motives. 34:00 Putting C-Suite leaders at personal financial risk for improving population health and health equity. (a controversial idea to find our True North!) 36:30 Reference Don Berwick’s article: “Salve Lucrum: The Existential Threat of Greed in US Health Care” 38:30 Addressing the challenges of pharmaceutical drug shortages. 41:30 The emerging focus on SDOH tools and measures for optimization of provider EHR workflows. 46:30 The Four Horsemen of the Mental Health Apocalypse (e.g. Opioid, Alcoholism, Depression, Suicide) – how COVID-19 and social isolation exacerbated the crisis. 47:30 The PTSD of the younger generation due to their pandemic experiences. 48:00 How life expectancy in Blue Zones is impacted by community relationships and the need to overcome tribalism in the U.S. 48:45 The incontrovertible evidence of how one’s health is affected by the political party of a state’s governor. 49:30 Putting mental health training, research, and payment on par with traditional health services delivery. 51:30 Realigning economic incentives for physicians as the be all, end all starting point for healthcare transformation. 53:00 Dr. Nash provides his perspective on Risant Health (the value-based care merger between Kaiser Permanente and Geisinger). 55:00 Parting thoughts from Dr. Nash on what it will take to heal our country in the post-pandemic era.

In value-based care, true leadership emerges from the depths of the heart, where empathy, compassion, and authenticity converge to illuminate the path of positive change. Purpose-driven leadership can not only revolutionize community health but also create a ripple effect that reaches every corner of society. At the intersection of purpose, compassion, and community lies a transformation of our healthcare system with a tangible impact on the well-being of individuals, families, and neighborhoods. Now is the time for healthcare leaders to harness the power of the heart to shape a healthier and more harmonious world for all.  The heart’s power of purpose knows no boundaries, for it holds the strength to heal, inspire, and connect the threads of humanity. Joining us this week on the Race to Value is Mikelle Moore, a nationally recognized health executive with more than 25 years of experience impacting communities through forward-thinking, collaboration, and leadership. Mikelle has payer, provider, business and start-up experience in healthcare having served in executive leadership at Intermountain Health, an integrated system serving an 8-state region. During her tenure at Intermountain, she served as Chief Community Health Officer and as the first female CEO of the system’s flagship hospital. In addition, Mikelle has worked in contracting for a provider-owned health plan and in strategy for Mayo Clinic Arizona. As a thought leader in the space, Mikelle knows the value in moving from healthcare to health. In this week’s episode, prepare to be inspired and enlightened by Mikelle’s heartfelt exploration of “The Power of Purpose:  Transforming Community Health Through Leadership of the Heart.”   Episode Bookmarks: 01:30 Introduction to Mikelle Moore, a nationally-recognized VBC executive leading system change to improve population health outcomes. 03:15 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Broadening the scope of care delivery in health systems to address the determinants of health through equity, impact investments, and ESG factors. 06:00 Mikelle discusses her leadership journey as an expression of authenticity and purpose to right the wrongs of a broken system. 08:00 Intermountain Health as a leading health system that is designed for a consumer-provider approach to improving health care. 09:00 Advocating for improvements in the variability of care and the reduction of wasteful healthcare utilization. 09:30 Listening to the community in the strategic planning of a hospital. 10:00 Pivoting from “sick care” to “health care.” 10:45 The realization that health disparities were far reaching beyond just the care delivered, e.g. poverty, homelessness. 11:00 “If we want to be health leaders that are making healthcare better, we have to be champions for addressing disparities in underserved and marginalized communities.” 13:00 Finding common ground with Community Benefit Organizations (CBOs). 14:00 Mikelle shares his insights on the importance of relationship-building in community partnerships. 16:00 How the principles of collective impact forged new community partnerships to address behavior health and SDOH. 17:00 Defining success by really understanding the problem and what issues get in the way (e.g. how nonmedical issues such as homeless and social isolation impact health outcomes) 19:00 Developing a system of communication and data sharing between the CBO and health system that is centered on patient needs. 20:00 The Alliance for the Determinants of Health as a vehicle to address social needs to improve health. 21:00 The impact of institutional racism on health equity. 24:00 Viewing social factors in society as a lens to view and understand racism. 25:00 “Inequities are often delivered at a subconscious level. It is our accountability to identify those disparities and build systems of care to prevent them from occurring.” 25:30 The need to include minority populations in clinical research trials. 26:00 The importance of literacy in the messaging of prevention strategies. 26:45 Conscious vs. Subconscious Racial Bias and the accountability for health leaders to address both. 29:00 The critical need to have a well-trained, qualified, and more culturally-competent health workforce that mirrors the diverse population it serves. 30:45 An opportunity for health systems to overcome division in communities through staffing and training models. 31:30 How Circles USA gathers middle-income and high-income volunteers to support families in poverty. 32:30 Health leader participation on nonprofit CBO boards can enhance understanding of lived experiences in a community to advance health equity. 33:30 Empowering the clinical workforce to understand why outcomes are different in minority cultures. 35:00 “Listening to others without judgement improves our ability to be a colleague, parent, healthcare worker, or problem solver when we realize a disparity exists.” 36:00 The epidemic of behavioral health and Substance Use Disorder. 37:00 “ As healthcare leaders, our goal is to make behavioral healthcare a convenient, routine, everyday part of one’s life so that people can reach their fullest potential and, more importantly, find — hope.” 38:00 Solving complex problems in community health through multi-level thinking. 39:00 How COVID-19 made mental health challenges more visible. 39:45 Social connection, health and wellness, and access to support services as an access point for improved societal wellbeing. 41:00 The failures of the criminal justice system in recognizing mental health issues. 41:45 Increasing access to outpatient therapy and acute response to behavioral health conditions. 42:15 Creating a continuum of access to behavioral health services by normalizing conversations in the workplace. 43:30 How the flawed economics of fee-for-service create inequities in maternal health outcomes. 45:30 The implications for improved maternity services and patient engagement in a community health model. 47:30 Creating the right incentives for improved maternal health with value-based payment. 48:45 The need for employees to emphasize person-centered maternal health care. 49:30 Innovative employers as a template for redesigning Medicaid within a state. 50:30 The potential for hospitals and health systems to become an anchor institution for community health. 52:30 How an anchor institution can contribute to both economic and community health. 54:45 Investment allocations and staffing decisions that can support a “do both mindset” as an anchor institution. 57:00 The impact of consumerism on the improvement of community health. 58:00 Looking to other industries for a consumer-centric view of what healthcare could be. 59:00 Transforming to a more consumer-centric definition that values “health” and “wellness” over “healthcare.” 59:45 Partnerships and listening to what people need as a catalyst to system transformation.

Peering into the horizon of healthcare, we unveil the vanguard of value-based care research and innovation, where data-driven insights and daring ideas converge to shape a healthier tomorrow. In the ever-evolving landscape of healthcare, trailblazing research serves as the guiding light that illuminates the path toward a value-based care revolution. By delving into the intricate dynamics of accountable care, dissecting payment models, and exploring innovative strategies, research on healthcare transformation provides the foundation upon which healthcare stakeholders can build a more equitable, efficient, and patient-centered future. This work not only dismantles traditional barriers but also empowers policymakers, providers, and patients to collectively navigate the complex journey toward a value-driven healthcare paradigm. Our guest this week on the Race to Value is none other than the esteemed David Muhlestein, PhD, JD a true trailblazer in the field of value-based care research and innovation! With a passion for accelerating the adoption of accountable care and driving meaningful change, David has dedicated his career to unraveling the complexities of the value movement by telling a story with data.  As the chief research and innovation officer at Health Management Associates (HMA), David Muhlestein’s research and expertise centers on health care payment and delivery transformation, understanding health care markets, and evaluating how the broader health care system is changing. In this interview, we cover topics such as the value-based care movement and the goal of speeding the uptake of accountable care; the current growth trajectory of ACOs; payment model reforms that are taking place to advance health equity; the positioning of Medicare Advantage in the accountable care landscape; the inclusion of specialists in value-based care; multi-payer alignment to reduce administrative burdens and increase the impact of accountable care reforms; hospital and health insurer price transparency; and the new Primary Care Alternative Payment Model (“Making Care Primary”).   Episode Bookmarks: 01:30 Introduction to David Muhlestein, PhD, JD – one of the nation’s leading value-based care research executives. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:30 The glacial pace of scaling payment model transformation and CMS’ goal of speeding the uptake of accountable care. 05:30 Industry challenges (e.g. supply chain disruptions, labor shortages, inflation, financial distress) that complicate value-focused investments. 07:30 The plateau of accountable care growth over the last three years in terms of total number of participating ACOs and lives covered. 08:30 The business model for value is supported by payment mechanisms, unique population health capabilities, and playbook approaches. 09:30 Who is really the customer of a health system?  (Is it the patient, the health plan, or physician practices that drive referrals?) 10:30 The capacity-focused world view of a FFS model – creating capacity for well-reimbursed services and then driving transactional patient volume. 11:00 The population health focus of VBC and how that creates conflicts within health systems optimized for fee-for-service capacity. 14:00 Changing the reality of an organizational culture dominated by FFS is increasingly more difficult in a post-pandemic economy. 15:30 Has anyone else noticed that the VBC solutions vendors at healthcare conferences are less predominant in recent years? 16:00 “When times are tough, organizations revert to the lowest common denominator that is their underlying business model.  That is the current challenge for value transformation.” 17:00 Recent stats on the growth trajectory and overall savings of Medicare ACOs over the last few years. 19:00 Average savings in the MSSP (after bonus payments) is about 1% relative to the projected benchmark. 20:00 The spending growth of the Medicare program surpassing the net savings of the Medicare Shared Savings Program. 20:30 Health policy challenges in making ACOs more transformative in bending the cost curve for Medicare Trust Fund sustainability. 22:00 VBC Policy Lever #1: Low-risk APM design (to encourage participation) with the progression to increased risk and mandatory participation. 22:45 VBC Policy Lever #2: Expand the definition of what it means to be in a value-based arrangement in the Medicare program. 24:30 How health equity is now gaining traction in the value movement (as highlighted by ACO REACH and private payer equity-focused reforms). 25:30 A safety-net deficit in accountable care and the need for upfront investments in accountable care adoption that can address social drivers of health. 26:30 Reading between the lines to understand what CMS is really working on. 27:45 Despite other priorities, it is clear that the primary concern for CMS is to advance health equity! 29:00 Improving the measurement of health equity as a starting point for transformation. 30:30 Recent research from David Muhlestein: “Medicare Advantage is now chosen by the majority of Minority And Low-Income Beneficiaries” 32:45 How will CMS address health equity with Medicare Advantage? 33:30 Why are minorities and dual eligibles increasingly enrolling more in Medicare Advantage? 34:30 The debate that MA has better clinical and cost outcomes than Traditional Medicare. 35:30 The supplemental benefits and lower out-of-pockets costs that incentivize MA enrollment. 37:00 The lack of inclusivity for specialists in accountable care models and how bundles and COEs do not support engagement in chronic disease management. 38:00 CMS has announced a strategy to better engage specialty care in longitudinal, coordinated accountable care models, but many in industry are skeptical. 39:00 Three Categories of Specialty Care: 1) Chronic Care, 2) Urgent or Emergency Care, 3) Scheduled or Elective Care 40:00 Proceduralists that focus on elective care are the most difficult to engage in a value-based model. 41:00 How bundled payment arrangements can align incentives to engage specialists. 42:00 Improving the bridge between a diagnosis and a specialty procedure (proceduralists should not have ultimate diagnosis and referral responsibility in a VBC model). 44:00 The opportunity for Multi-Payer Alignment in Value-Based Care to reduce administrative burdens and increase the impact of accountable care reforms. 46:00 “If all of your payers are operating under different paradigms and payment models, it will be difficult to transform your business.” 46:30 The lack of common incentives to drive multi-payer alignment (full indemnity vs. TPA, limited ROI for younger populations in advanced primary care models). 48:30 The Core Quality Measures Collaborative (CQMC) as a broad-based coalition to facilitate cross-payer quality measure alignment. 49:30 Mandatory multi-payer alignment from Congress? 50:00 Competitors in the private pay sector as a driver of alignment in common patient populations? 51:00 Recent research from David Muhlestein:  “Commercial Insurer Price Transparency: A Comparison Of Four National Payers” 53:00 The lack of quality and cost improvements in healthcare due to a lack of transparency. 54:00 New regulations mandate disclosures of hospital charges, shoppable services, and insurer disclosure of negotiated rates. 55:30 Hospital And Insurer Price Transparency Rule Challenges (e.g. messy data, massive size of datasets, misalignment of providers with actual services provided). 57:30 A 1% larger market share is associated with $100 more payment on a hospital admission! 58:30 Will informed negotiations between payers and providers lead to lower prices over time?  Will transparency also drive steerage to higher quality providers? 60:00 The new Making Care Primary (MCP) Model that helps Medicare and Medicaid providers transition to value-based care. 61:00 MCP is a 10-year transformation model of participation with different tracks depending on risk tolerance.

In this thought-provoking episode, we delve into the transformative world of value-based care, exploring the multifaceted facets that are reshaping the future of healthcare. Join us as we dissect the vital components of this paradigm shift, from tackling social determinants of health and championing health equity, to seamlessly integrating behavioral health into patient care.  Discover how population health enablement is empowering communities, while bundled payments revolutionize the healthcare landscape. We’ll also uncover the incredible role of technology and patient outreach, enabling unprecedented levels of personalized care and accessibility. And lastly, we navigate the critical importance of physician engagement, a driving force behind the success of value-based care. As we peer into the crystal ball, we envision the future role of hospitals, embracing change and embracing innovation. Joining us in the discussion this week are three important thought leaders in value-based care transformation: Dr. Caroline Goldzweig, Chief Medical Officer – Cedars-Sinai Medical Care Foundation Cynthia Deculus, Vice President and Chief Population Health Officer, Cedars-Sinai Dr. Michael Conseulos, Vice President Strategy, Growth, and Innovation Consulting at OptumInsight Get ready to be inspired as we illuminate the path toward a healthier, fairer, and more compassionate healthcare system. The journey starts now! This week’s episode is brought to you by Edifecs – an EMR-agnostic, interoperable, and AI-enabled technology helps providers unify and utilize data for a more complete digital portrait of patient populations. The result: better clinical, financial, and compliance outcomes.  To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit edifecs.com today.   This audio was re-purposed from a discussion that took place at the Pinnacle Value Based Care Symposium on April 24th, 2023.     Episode Bookmarks: 01:30 To learn how Edifecs’ applications can enhance prospective risk adjustment and value-based contract performance, visit www.edifecs.com  today! 02:30 This we ek’s episode is all about the VBC paradigm shift –from tackling SDOH and championing health equity, to seamlessly integrating behavioral health into patient care. 03:30 This week’s guests are Dr. Caroline Goldzweig (Cedars Sinai Medical Foundation), Cynthia Deculus (Cedars Sinai) and Dr. Michael Consuelos (OptumInsight) 04:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:15 “The true measure of any society can be found in how it treats its most vulnerable members.”  – Mahatma Ghandi 06:45 “We are finally seeing major movement in the direction of healthcare providers addressing social determinants of health.” 09:00 “There is so much more to making people healthy than just writing a prescription.  We must begin to impact how patients are living.” 11:00 Cynthia discusses how Cedars Sinai is helping patients navigate the totality of health and social needs, especially dual eligible Medicare patients. 14:00 Patients who have a chronic disease have a three to four times higher frequency of behavioral health comorbidities. 14:30 Cedars Sinai Collaborative Care Model – an overview of how Cedars Sinai is integrating behavioral health in the primary care setting. 16:45 How Care Teams at Cedars Sinai coordinate transitions of care and prevent ED overuse for patients dealing with a behavioral health condition. 18:00 Behavioral health provider workforce challenges and the role of technology and education to fill the void in providing whole-person care. 20:00 Depression screenings in primary care and the need for more inpatient psychiatry beds in the acute care setting. 22:00 34% of all deaths from cancer could be prevented if disparities in access to care were eliminated! 22:30 Cedars Sinai identified an opportunity to improve health equity in their treatment of cancer patients. 23:30 The need for personalized screenings and treatment for cancer. 24:45 Ensuring access to clinical trials for underserved patients with cancer. 25:30 The recruitment of peer champions to overcome cancer screening disparities in Cedars Sinai employee population. 27:00 The need to improve healthcare access to cancer screenings and treatment for underserved populations. 29:00 Offering screenings at low or no-cost to underserved patients prior to accessing Medicare! (An absolute imperative!) 30:00 Population Health Enablement (e.g. interoperability, registries, staffing, EMR automation, PAC partnerships, workflow optimization, AI, patent outreach tools, RPM) 31:00 Dr. Consuelos on the importance of balancing VBC maturity and risk tolerance with the development of a population health infrastructure. 33:00 Developing a value-based care roadmap that includes both enablement and partnership strategies to drive growth and margin. 34:00 Identifying and understanding your population (and providers) before developing a population health enablement infrastructure. 36:00 The reality of technology deployment and workflow optimization. 37:30 Obtaining buy-in for a standardization effort is a critical change management process. 38:00 Understanding your value proposition for success in accountable care. 40:30 Engaging clinical champions for success in bundled payments for clinical-defined episodes of care. 42:00 Establishing a CHF post-discharge clinic with interdisciplinary care teams as a model to improve clinical outcomes. 43:00 “When value becomes more about doing the right thing for patients, you can catch the attention of every physician (including specialists).” 44:00 How bundled payments requires a population health perspective (instead of individualized patent transactions). 45:30 Advice for provider organizations that are slow to move to value-based care. 46:30 Specialists are increasingly becoming more and more activated in VBC through the launch and/or redesign of CMS Alternative Payment Models. 49:30 “Addressing healthcare workforce burnout is about reconnecting with purpose at the organizational level.” 52:00 Value-based care as an opportunity to address burnout in primary care. 53:00 Transparency and inclusivity as vital components to an organizational culture. 53:30 The power of storytelling in value-based care transformation.

Dr. Jason Spangler, a specialist in health economics, patient-centricity, and value assessment, joins the podcast to discuss the intersection of these fields in improving health outcomes and creating sustainable healthcare systems. The episode explores the challenges and progress in incorporating the patient perspective into value assessment models, innovative approaches to healthcare model development, the concepts of value flower and value spillover in healthcare, and the importance of collaboration in healthcare policy change. The podcast also discusses the difficulties patients face in accessing treatment centers and emphasizes the need for government intervention.

In this week’s episode, we embark on a journey into the realm of transforming rheumatology care with tech-driven value-based care. Autoimmune conditions affect millions of people worldwide, causing chronic inflammation, pain, and a host of complex challenges.  These patients often receive substandard care, as it takes almost 2.5 years to receive a diagnosis and patients often wait six months to receive an appointment with a rheumatologist!  This is often a neglected patient population in the movement to value-based care, but what if there was a new frontier of care that leveraged technology and a value-based approach to transform the lives of those living with autoimmune conditions? This podcast explores how a virtual specialty practice, centered on improving patient outcomes and reducing healthcare costs, is driving the transformation of rheumatology care.  We are joined today by Anuj Patel (Founder) and Dr. Elizabeth Ortiz, the CEO (Chief Medical Officer) from a new startup company called Motto Health. Anuj is a seasoned digital health innovator and operator with over 15 years of experience in the healthcare industry. And Dr. Elizabeth Ortiz is a board-certified rheumatologist with patient care experience ranging from large public medical centers to concierge practices.   Episode Bookmarks: 01:30 Where does rheumatology care intersect with the world of value transformation? 02:45 Introduction to Anuj Patel and Dr. Elizabeth Ortiz, the Founder and Chief Medical Officer respectively for Motto Health. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:00 The rheumatology workforce faces a deficit of physicians trained to provide high-quality care to patients with rheumatic diseases (only 0.5 rheumatologists per 100,000 people). 06:00 Chronic inflammatory conditions are very expensive to treat (e.g. the average healthcare cost for a patient with Rheumatoid Arthritis is $32k per year). 06:30 Why aren’t ACOs and other Risk Bearing Entities actively addressing this patient segment like they do patients with diabetes, CHF, COPD, or even kidney disease? 06:45 The epidemiological fragmentation of chronic diseases across the care delivery landscape. 07:30 Lack of overall marketplace adaptation in rheumatology care and treatment (e.g. specialty pharmacy injectables) to the shift in value-based care. 09:00 The wide breadth of conditions in the specialty of rheumatology and how that creates a “black box” for other physicians to understand. 10:15 Patients waiting so long to see a rheumatologist that it takes, on average, 2.5 years for a patient to receive a confirmatory diagnosis! 10:30 Rheumatology provider shortage worsening (50% of adult and 32% of pediatric rheumatologists projected to retire over the next 10 years). 11:30 The window of opportunity for clinical outcomes improvement if chronic autoimmune and inflammatory diseases are diagnosed early. 12:30 Limited capacity for rheumatologists to see new patients due to long persistence of disease and the shortage of providers. 13:00 How virtual care can increase access by offloading the maintenance burden of managing a large patient panel. 13:30 Enablement of expanded geographic access through a virtual care model. 13:45 “Virtual care delivery can democratize access for patients in need of rheumatological care.” 14:00 In Texas, 213 of 254 counties in the state do not have a practicing rheumatologist leading to 5M people without access to care. 14:45 A huge opportunity in value-based rheumatological care is to tackle the exorbitant specialty drug costs for drugs like Remicaid or Humira that have an annual cost of $70k. 15:00 Mark Cuban’s online pharmacy announced that it will be selling a biosimiliar of Humira for a steep discount. 15:30 Since 2016, AbbVie has raised the price of Humira 30X from $522 per syringe to $2,984 per syringe. 17:30 Biosimiliar adoption should not be over-indexed in value-based care. We must first prioritize site of care and treatment plan adherence. 18:30 Inpatient hospital settings cost much more for drug infusions. (VBC opportunity to shift infusions to the practice setting.) 19:15 The importance of an integrated Lifestyle Medicine model in managing chronic inflammatory conditions. 20:00 Dr. Ortiz explains how biologics have changed the landscape of rheumatology care. 21:00 The factors to consider when safely titrating a patient off of an expensive biologic drug. 22:00 Sleep and stress management are more important than diet when controlling an autoimmune condition. 23:00 The prevalence of Rheumatoid Arthritis among employees can lead to a substantial burden on employers in terms of productivity loss, absenteeism, and healthcare costs. 25:00 Providing better access to rheumatology care for employers providing health benefits to their workers. 26:30 Treating patients sooner leads to lower healthcare costs and improved workforce productivity for employers. 27:00 Rheumatological care requires more than just the specialist – the need for physical therapy and diet and health coaching. 28:00 Allostatic load (the cumulative physiological wear and tear on the body that occurs in response to chronic stressors) impacts inflammation. 28:30 The connection between allostatic load and inflammation as a contributing factor to health inequities in underserved populations. 29:30 Dr. Ortiz discusses the relationship between stress and autoimmune conditions; however, stress management is underutilized as a treatment tool. 30:00 Allostatic load over time can actually lead to the development of an overactive immune system which then, in turn, leads to an autoimmune disease. 30:30 Adverse childhood events, PTSD, and the stress of discrimination leading to more severe chronic diseases in African American population. 31:00 How do stressful social structures lead to devastating outcomes with Lupus in African American populations? 33:00 “The data shows that diet, stress management, sleep, exercise, and a sense of community all favorably impact clinical outcomes with Rheumatoid Arthritis.” 34:00 The benefits of an anti-inflammatory Mediterranean diet and exercise in managing inflammatory conditions. 34:45 The importance of health coaching in implementing lifestyle programs to improve patient engagement and accountability. 36:00 Longer life expectancy in Blue Zone regions due to improve connection with community. 36:45 The psychological impact of social isolation during COVID-19. 37:00 Research shows how chronic inflammation can significantly impact mental health and increase the risk of developing depression and anxiety disorders. 38:30 Dr. Ortiz discusses the bidirectional relationship between inflammation and mental health and how mental health issues complicate patient outcomes. 40:30 How Motto Health’s virtual care platform brings additional benefits of team-based care and scalability in rheumatology care and mental health support. 41:30 Combining collaborative and longitudinal care to reach an inflection point in the virtual delivery of behavioral health care. 43:00 Dr. Ortiz on the essential role of rheumatology care and other specialties in understanding and addressing Long COVID. 45:00 Challenges to expand rheumatological capacity – no increases in fellowships in practice and over half of the rheumatologists in practice are experiencing burnout. 45:30 Enhanced partnership between rheumatology and primary care to alleviate lack of rheumatological capacity. 46:00 The need for more integrated services that are reimbursable to improve care of autoimmune patients. 47:00 Medical education costs and high student loan debt burden causes a shortage of rheumatologists. 47:45 Anuj shares his vision for the value-based future for rheumatology care. 48:45 How capitation arrangements and incentives alignment creates a long-lasting, longitudinal care model in rheumatology. 50:45 What is Motto Health and how does it bring VBC and consumerism to rheumatological specialty care?

We need to change the calculus of self-interest in health care. If the trend of unfettered greed in fee-for-service medicine continues, we will have a bleak future ahead of us. Our industry is on a ventilator, demanding another cigarette. Yet despite its moribund appearance, a few critical vital signs do offer hope. There is an opportunity to find optimism with unifying language and shared virtues to guide health care transformation. By developing a shared vernacular for value-based care, we will be able to have the meaningful conversations to reimagine care delivery. And this new language will be shaped by the evidence from leading exemplars in the value movement.  Amidst the vast wilderness of the healthcare landscape, we can find hope in these green shoots, sprouting with resilience and the promise of a brighter future. This post-pandemic era is a tremendous opportunity for value creation. Now is the time to have the conversation and be the change we want to be. The elevation of social consciousness related to health equity, transparency, and financial accountability—coupled with industry challenges related to escalating inflationary pressures, workforce shortages, lack of patient access, supply chain disruption, and weaknesses in our public health infrastructure—will provide the catalyst for a new modus operandi in American healthcare. Joining Eric Weaver on the Race to Value this week are Craig Solid and Andrew Kopolow. Together they recently co-wrote an article published by the American Journal of Medical Quality entitled, “Changing the Calculus of Self-Interest in Health Care.”  In this podcast discussion, they discuss their views about greed in healthcare and what it will take to transform our industry to a more sustainable, value-based model. “Greed has poisoned men’s souls, has barricaded the world with hate, has goose-stepped us into misery and bloodshed. We have developed speed, but we have shut ourselves in. Machinery that gives abundance has left us in want. Our knowledge has made us cynical. Our cleverness, hard and unkind. We think too much and feel too little. More than machinery we need humanity. More than cleverness we need kindness and gentleness. Without these qualities, life will be violent and all will be lost…”  — The Final Speech from “The Great Dictator” (Charlie Chaplin) Episode Bookmarks: 01:30 Referencing the recently published article, “Changing the Calculus of Self-Interest in Health Care” written by Eric, Craig, and Andrew. 01:45 Eric reads an excerpt from The Final Speech from “The Great Dictator” by Charlie Chaplin. 02:45 How is the greed of fee-for-service healthcare holding us back from our human potential? 03:00 Introduction to Craig Solid, PhD and Andrew Kopolow, MPA MSW CPHQ PMP CLSSMBB FNAHQ. 05:30 Don Berwick’s JAMA article entitled, “Salve Lucrum: The Existential Threat of Greed in US Health Care” which called out our industry for the glorification of profit (Salve Lucrum) 07:30 The difficulty in addressing profit motive through value transformation when “none of us speak the same language” through a shared vernacular in healthcare. 08:30 The emotionality of Dr. Berwick’s article as a recognition of the existential threat of greed in healthcare. 09:15 Hospital closures across the healthcare landscape are seen as just the normal course of business. 09:45 How can we even talk about the quality of care when people can’t even access the care they need? 10:00 The oversimplification of “quality” and “value” is holding us back. 10:45 What is the solution to price gouging of prescription drugs, exploitive market consolidation, upcoding, overpaid executives, lack of transparency, and patient medical bankruptcies? 11:30 The need to align incentives in healthcare so that it does not personify greed as a primary virtue. 12:00 Optimism for socially-conscious healthcare based on Bright Spots and Green Shoots! 12:45 The exemplars of value-based health care (i.e. the Green Shoots) shows us that transformation is NOT mission impossible. 13:15 “Amidst this vast wilderness, hope in healthcare really does take root in the form of green shoots, sprouting with resilience and the promise of a brighter future.” 13:45 High Reliability Organizations are an example of the positive. We need to understand how they operate and maintain solvency. 14:45 Leveraging Green Shoots in the creation of a national playbook strategy for healthcare transformation. 15:00 Acknowledging the complexity of healthcare in recognizing that transformation in not a linear transition. 16:00 “Value and patient-centered care is our North Star. Leading exemplars provide us with an opportunity to cumulatively get to where we need to be.” 16:30 “There is a duality in the future of healthcare. We can stay on our current path or choose one that can actually give us hope through value-based care.” 17:00 ChenMed as a leading example to provide hope in value-based care. 18:00 Other examples of leading innovation include Geisinger, Intermountain, AbsoluteCare, and other leaders in the Race to Value! 18:30 Oak Street Health as another value exemplar, yet Don Berwick questions their level of executive compensation. 19:30 Is there a way to have a capitalist model in healthcare where you can do well by serving the public good? 19:45 Aledade recently purchased the medical debt of their patients to eliminate the friction of healthcare profiteering that leads to poor health outcomes. 20:30 The community benefit of non-profit hospitals is questionable.  Do nonprofit hospitals put profits over patients? 21:00 How do we find our voice for value when most patients have never heard of value-based care and do not know what it means? 23:00 We need to teach people how to think about (and measure) “value” in particular situations. 25:00 The importance of identifying the destination for value (“We are racing ahead to value without really knowing where we are going.”) 27:00 Applying a lens to help us see the hidden opportunities for value (e.g. executive compensation, staff wages, the costs of quality metric reporting). 28:00 We cannot engage in meaningful dialogue until we have a consensus-based and specific definition for value. 29:45 Toxic tribalism in our society hinders progress on major issues (e.g. healthcare reform, mass shootings, climate change, abortion rights, gender-affirming care). 31:30 Understanding the long-term impacts of our actions.  Consensus-based prioritization on sustainability will change the calculus of self-interest. 32:30 There is no path forward without having a better understanding of value. 33:30 High risk for insolvency and diminished care access as key challenges for our value-based future. 34:00 We must be comfortable with subjectivity in defining value and not have that hold us back from having meaningful conversation. 35:00 Starting the conversation with what is in our collective self-interest. 36:30 The importance of shared virtues. 37:30 Optimism for a unifying language to guide healthcare transformation. 38:00 Don’t let the complexity of value prevent us from having the conversation.

Since diabetes is one of the few chronic conditions that can be very effectively managed by an individual, why are there so many people with poorly managed diabetes? Despite conventional logic, it’s not that most people aren’t willfully noncompliant with their diabetes care. Instead, many have extenuating socioeconomic or other circumstances that can lead to drifting away from their care plans. There is an opportunity in value-based care to engage diabetic patients more effectively through data-driven personalized care interventions.  By merging rich, non-traditional data sources such as purchase trends with foundational elements like claims and clinical services, trusted care team members can develop one-of-a-kind insights into individuals’ risks and behaviors. Translating broad, extensive multiple data sets into actionable information specific to an individual holds the potential to better manage populations while simultaneously changing the trajectory for each patient living with a chronic disease. On this week’s episode, we have: Richard Mackey, Chief Technology Officer at CCS, a company that transforms chronic care management by combining equipment and products with comprehensive education, monitoring, and coaching…serving more than 400 employers and more than 1,800 managed care plans nationally to support patients with diabetes.  Joining Richard on the podcast is Jean-Claude Saghbini, Chief Technology Officer at Lumeris who also serves on the advisory board for CCS. Richard and Jean-Claude address how technology-assisted disease management makes the patient experience less arduous. They also discuss how devices and digital tools such as continuous glucose monitors, insulin pumps, chatbots and smartphones can generate an enormous amount of new and unique data. The information from these additional data feeds can be used to derive valuable insights into both the individual and population levels to drive the future of personalized care. Episode Bookmarks: 01:30 Data-driven, personalized care interventions are key to effective chronic disease management. 02:00 Introduction to Richard Mackey and Jean-Claude Saghbini. 02:45 An overview of technology-assisted disease management. 04:00 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:00 Diabetes is such a significant problem in the United States, affecting over 37 million people, and it leads to numerous health complications. 07:00 Richard provides his perspective on the potential for aggregating disparate data sources and applying advanced analytics to transform diabetes outcomes. 08:30 How technology solutions can enhance the relationship between the care provider and the patient. 09:00 An overarching data interoperability framework is not necessarily required to leverage the power of data and technical solutions. 09:30 Jean-Claude on balancing the aims of interoperability, data normalization, and predictability in data flows with current day realities. 12:00 The importance of partnerships in driving scale in population health management through combined data feeds and biometric capabilities. 13:00 Richard expounds on the importance of partnerships in data-driven solutioning and medical device optimization for effective delivery of VBC. 14:30 Jean-Claude on how healthcare organizations can extract insights from technology to change the trajectory of disease in their patient population. 16:00 Predictive analytics can accelerate progress in understanding relationships between external factors and human biology.   17:30 Richard discusses the impact of predictive analytics to enhance the reengineering of clinical pathways to deliver personalized care to patients. 18:15 The unique opportunity to customize patient segmentation at the individual-level (versus relying just on profiling patients at the population-level). 19:45 Jean-Claude on how SDOH predictive models focused on housing instability or transportation access can be combined with clinical data. 21:00 “We are at the intersection of both AI and enhanced accessibility of data.  This will ultimately change the trajectory of chronic disease in our country.” 22:00 Diabetes supply ordering patterns can be an early indicator that there’s a problem with a person’s self-care routines. 22:45 How consumption-focused data can be used to support more effective chronic disease management for diabetes. 25:00 The correlation between medical cost savings and lower Hemoglobin A1c scores in diabetic populations (e.g. a 1% reduction in HbA1c is associated with a 9.8% reduction in TCOC). 25:45 In general, on average, a patient with an A1c > 9% costs $10,000 dollars per year more than a patient with an A1c < 7%. 26:30 “We certainly see that better care and lower cost care go hand in hand.  The shift from FFS to value-based care will give us the outcomes we want in terms of cost and quality.” 27:00 “The keys to value-based care success are alignment of incentives, technology enablement, and effective change management.” 29:00 Adherence to continuous glucose monitoring (CGM) therapy results in a 20% reduction in excess healthcare utilization for diabetic patients. 30:00 “Technology-assisted disease management and health coaching is not just a transaction.  It is an important relationship with the patient that reinforces the provision of primary care.” 31:00 A digital front door can improve communication, care coordination, and population health management, ultimately leading to better patient outcomes and more efficient healthcare delivery. 31:45 “It is important for us to have a holistic, 360-degree view of the patient to drive and fuel care management interactions.” 32:00 The importance of self-managed care options in diabetes to empower the healthcare consumer to maintaining their care plan. 33:30 How successful technology to improve healthcare consumerism is not always front-facing and often runs behind the scenes. 34:45 The inevitable shift away from inpatient hospitalizations and procedures to care being delivered more in the home. 36:30 Richard shares the story of how his father was burdened with a fragmented and complicated diabetes care experience. 37:45 The opportunity to improve outcomes in value-based care by creating an integrated, seamless experience for patients suffering with diabetes. 39:00 Even the most sophisticated data-driven intervention runs the risk of failure if it is not backed by an established, trusted bond between patients and a provider. 40:30 The power of data to empower care for diabetes by interdisciplinary teams. 42:00 “Data can only be effective to drive population health outcomes if there is trust between the provider and the patient.” 42:30 Data consistency, predictive analytics, workflow integration of recommendations, and provider centricity as keys to success in developing trust. 44:30 “Healthcare data is the lifeblood of modern medicine, but it’s value is limited with patient trust. Trust is the currency that enables the exchange of health information and empowers patients to take control of their health.” – Karen DeSalvo 46:00 Everyone is touched by diabetes.  Now is the opportunity to make a difference!

We are on an enlightening journey to transform American healthcare in the race to value. Medicare Advantage increasingly stands out as a superior vehicle for value transformation due to its ability to catalyze care delivery innovation through full-risk capitation. By promoting coordinated care and integration among healthcare providers, MA plans foster a patient-centric approach that improves overall care quality and health equity. Additionally, these plans prioritize preventive care and wellness initiatives and enable early identification and management of chronic disease, ultimately reducing healthcare costs. By incentivizing providers to prioritize outcomes over volume, Medicare Advantage is our path forward to a uniquely American healthcare system that we can be proud of. Joining us this week on the podcast is Don Crane, former CEO of America’s Physicians Groups. In this episode, he shares his valuable insights and expertise on Medicare Advantage and how it will shape our future in healthcare transformation. Join us as we explore the challenges and opportunities that lie ahead for Medicare Advantage and discuss the potential impact on the healthcare landscape! Episode Bookmarks: 01:30 Introduction to Don Crane (Former President and CEO of APG) and the potential for Medicare Advantage to transform American healthcare. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Don Crane joins the Race to Value again as returning guest. (Check out his prior episode on Primary Care Transformation!) 05:00 The explosive growth of MA and the evidence showing that MA plans deliver better economic and clinical outcomes. 06:30 How a capitation in Medicare Advantage enables population health outcomes through effective SDOH interventions. 08:00 The criticisms of Medicare Advantage from notable thought leaders Richard Gilfillan and Don Berwick. 09:30 Protection of the Medicare Trust Fund is the common point of agreement between MA proponents and opponents. 10:00 Don addresses the criticisms of risk adjustment gaming and the program’s overall spend. 10:45 Is it necessarily a bad thing if MA costs more than Traditional Medicare if it provides better care outcomes and supplemental benefits? 11:30 “Spending more on Medicare Advantage makes all the sense in the world to me if it provides better outcomes and value for seniors.” 12:00 The perspective from seniors enrolled in Medicare Advantage on the appropriateness of spending for supplemental benefits. 12:30 “The astronomical growth of Medicare Advantage should be celebrated.” 13:00 The V28 HCC changes to the Risk Adjustment model for payment year 2024 will decrease the number of codes by more than 2,000 from the HCC model. 14:00 The adverse impacts of risk adjustment coding changes will increase administrative complexity and hurt seniors by reducing MA funding to the tune of $10B. 15:45 The need to evaluate both Traditional Medicare and MA to determine the best path forward. 16:30 Risk adjustment is grounded on the premise of fairness to both the payer and provider and should prevent both over- and under-payment. 17:30 “Risk adjustment is such an important ingredient in capitated payment models and provides a business case for addressing inequities in underserved communities.” 18:30 Concerns about the elimination of risk adjustment and how that will adversely affect sicker patent populations through “cherry picking” during MA enrollment. 19:30 Don compares the bad actors in MA who perform upcoding to the overpayments and overutilization that occurs in Traditional Medicare. 20:00 Is the potential for upcoding exaggerated by detractors of Medicare Advantage? 20:30 Eliminated risk adjustment in Medicare Advantage is an example of throwing out the baby with the bathwater. 21:00 How Star Ratings work in Medicare Advantage to unlock bonuses and rebates when improving care quality. 23:00 Don discusses the importance of performance quality measurement and why Stars Rating program is so effective. 25:00 Overall MA spending is 2-5% higher than Traditional Medicare –does that additional investment spawn care delivery innovation and improved patient outcomes? 26:30 Sachin Jain’s Op-Ed discussing how MA plans perform better on several key quality measures, with annual beneficiary costs that are about 40% lower than traditional Medicare. 28:00 The flawed thinking in comparing overall spending between Traditional Medicare and MA programs and why MA is the better vehicle for value-based care. 29:00 The positive impact that the provision of MA Supplemental benefits has on social determinants of health. 30:00 The new science of studying the ROI of SDOH investments to improve overall population health. 31:00 The silver lining of the MA debate in creating the opportunity to save American healthcare. 32:30 We are moving in the direction of 70-80% MA enrollment over the next decade, whereby making it an attractive vehicle for healthcare reform. 34:00 The blunt force instrument of Medicare fee schedule cuts and the need for a different tool in the health policy toolbox. 35:30 The double whammy of Medicare FFS spending cuts and the V28 Coding policy changes on the value movement. 37:00 Transitioning Risk Adjustment from Version 24 to Version 28 – how code eliminations impact Medicare Advantage? 38:45 MA Risk Adjustment coding changes will ultimately inure to the detriment of seniors, especially those in underserved populations. 40:00 The glacial pace of value transformation coupled with depletion of the Medicare Trust Fund is causing further FFS cuts to the Medicare Fee Schedule. 41:00 The need for the entire nation to rally behind value-based care to bring scale to the movement! (reimbursement cuts are not the long-term answer) 43:00 The “Meaningful Use” program as a perfect example of how “carrots and sticks” can scale the value movement. 45:00 The critical intersection between private equity capital investment and Medicare Advantage. 47:00 The advantages and disadvantages of capitalization and profit incentives from PE and VC investment communities. 50:00 The unshakable presence of health plans in the value-based care ecosystem. 51:00 Advocating for a mandate for health plans to offer capitation and why “Medicare For All” is not a realistic option. 52:00 Getting over the knee jerk hatred of health plans and instead turn them into a vehicle for value transformation. 55:00 A vision for the future of Medicare Advantage and as a moonshot opportunity to create a healthcare system we can be proud of. 56:45 The universal consensus that value-based care models are the way to go (and why we fail to adopt them at scale!) 58:00 Acceleration of capitation is our only hope. 59:00 Can Medicare Advantage transformation catalyze the attainment of the Quintuple Aim? 63:00 The problem of physician burnout and how it can be ameliorated by a value-based payment model. 64:00 The need for AI and scribing support to eliminate the burdens of EHR workflow. 64:30 How advanced Primary care models are more effectively in addressing societal challenges with chronic disease. 68:00 Parting thoughts of optimism for a brighter future in value-based care.

We have Dr. Omolara Thomas Uwemedimo as a guest on this week’s Race to Value! She is a healthcare social entrepreneur, board-certified pediatrician, community health equity consultant, career transition and business coach, public health researcher, and health justice advocate. She is currently the CEO and Co-Founder of Strong Children Wellness, a multi-award winning healthcare practice in New York City, providing integrated, physical, mental, and social health services for low-income communities of color. Back in 2019, Omolara lost her ability to walk. She was diagnosed with Multiple Sclerosis, a chronic autoimmune condition. During her recovery, she became a staunch wellness advocate for women of color who in healthcare often experience disproportionally higher rates of chronic disease due to weathering – the deterioration of one’s health due to medical racism and toxic environmental stress in the workplace and in society.  In response, she founded “Melanin and Medicine”, a community health equity consulting and social entrepreneurship company that helps women of color thrive by building purposeful careers within healthcare enterprises.  She also has a weekly podcast called “Funding Your Healthcare Vision” that helps visionary leaders of health centers & practices to secure grants, contracts and other funding to strengthen, scale & sustain their vision, mission & impact to support under-resourced communities of color. With her leadership insights, you too can break the barriers to health justice by building a healthcare social enterprise built on CBO partnerships and social impact innovation! Episode Bookmarks: 01:30 Introduction to Dr. Omolara Thomas Uwemedimo (CEO and Co-Founder of Strong Children Wellness, founder of Melanin and Medicine, and host of Funding Your Healthcare Vision). 04:00 The intersection of Social Entrepreneurialism and Value-Based Care, where private profit creates public good. 06:30 The difference between “health equity” and “health justice”. 07:00 Creating health justice for a psychosocially complex Medicaid patient population dealing with social and mental health challenges. 07:30 Working with grant partners and Community Benefit Organizations (CBOs). 08:30 Closing the loop between physical health and social determinants of health (SDOH). 09:00 Overcoming a flawed business model by moving physical health care delivery into the CBO setting. 09:30 Aligning the public health interest in patient outcomes with economic incentives. 09:45 How healthcare capitation (PMPM reimbursement) merges with philanthropy dollars to drive holistic care delivery. 10:00 “The collective impact of capitation and philanthropy is the precipice of an integration model that makes an impact with payers and patients.” 11:00 The majority of healthcare organizations are not conducting place-based interventions to improve health equity and create health justice. 12:30 The fatigue of healthcare providers dealing with under-resourced communities. 13:30 Starting with the patient first by addressing the referral process in addressing social health needs. 14:00 Developing a social navigation workforce as a baseline to deliver primary care to Medicaid populations. 15:00 Funding a healthcare social enterprise through embedded CBO partnerships (“reverse integration”). 16:00 “We thought we were dealing with psychosocially complex patients until we integrated our care model with CBOs.  This in where the impact can be made in VBC.” 16:30 Identifying the right community organizations (e.g. homeless shelters) in creating a holistic care model. 17:30 Securing over $2 million in grant funding within a community health network and working with other BIPOC, women-led healthcare practices to create sustainable health justice. 19:45 “Human social organizations are an essential leader in health.  We must think beyond the delivery of care when building a mission-driven healthcare social enterprise.” 20:00 What is in your arsenal beyond just clinical care? (e.g. community health education, training staff in patient counseling). 21:30 Making the math “work” with your targeted patient population (e.g. underserved youth, undocumented immigrants). 22:30 Using your innovative advance primary care model to pitch potential funders. 24:00 An example of the largest Medicaid payer in New York offering a PMPM for patient navigation services. 26:30 The “interrogation phase” of a healthcare business model to identify strengths, values, virtues, vulnerabilities, and threats. 27:45 Finding operational gaps in the social and cultural responsiveness of staffing to address community needs. 28:45 Evaluation of profit margin and financial burn rate to best understand scale and impact in population health. 29:00 Leveraging technology for virtual care efficiency. 29:30 Progression to the “innovation phase” with verifiable frameworks developed in due diligence. 30:00 Focusing on optimizing one service line at a time (e.g. outsourced clinical delivery, consulting, provider training, decentralizing information). 31:00 The importance of an evidence-basis in developing a fundable community vision. 31:30 The “identification phase” within a community needs assessment to identify the right partners. 32:00 The Five M’s:  Market Buy-in, Mission Alignment, Money, Management focused on justice, and Missing services?. 33:00 Connecting with key stakeholders to make an elevator pitch for funding. 33:45 Co-creating a collaborative partnership and implementation of an integrated model. 34:00 Setting up a legal structure and the necessary agreements for a successful CBO partnership. 36:30 Conducting pre-visit screenings and risk assessments for social and behavioral needs to help families navigate the services enrollment process. 38:00 The ethical balance of conducting comprehensive screenings with the capability to actually implement the necessary SDOH interventions. 38:45 Supporting nurse educators and patient navigators in seeing SDOH in the same way as they see vitals. 39:30 “Knowing a BP is just as important as knowing that a patient is positive for a Food Insecurity screen. The navigators are the linchpin, and the care coordinators are the glue.” 41:00 Not a single CBO partner can handle everything for a patient. (The importance of having both a referral and a follow-up process.) 43:00 The Medicaid Health Home program in New York as a laboratory to pursue social impact innovation. 45:00 Negotiating a Medicaid PMPM model to deliver population health and subsidize navigation in FFS. 46:30 The New York 1115 Medicaid Waiver to provide subsidies to Regional Health Information Organizations (RHIOs). 47:00 An inflection point in VBC:  The people in clinical care are not always the ones to ensure population health justice. 48:45 Cultural competence as the bedrock of a great patient-provider relationship. 50:00 Referencing a recent study that shows that black patients receiving care from black residents had lower all-cause mortality rates and longer life expectancy. 51:00 How can white-owned or white-led healthcare organizations become more culturally responsive? 52:00 Diversity, Equity, and Inclusion (DEI) to best support patients and families in medical decision-making. 53:00 Preventing burnout with BIPOC Founders as a key to save Primary Care and build Health Justice. 54:00 The recent suicide of Dr. Nakita Mortimer, a black female Anesthesiologist, as a cautionary tale for BIPOC physician burnout. 55:45 A personal patient story that illustrates how social impact funding transformed the life of a child and his family. 60:00 How to reach out to Dr. Omolara to learn more about how to build a healthcare social enterprise.