The Race to Value Podcast

It is Black Maternal Health Week, and this week’s episode provides context and value-based solutioning on how to address the alarming rise of maternal mortality in the U.S. We have horrifically poor maternal health outcomes in the African American population of our country, and it is directly attributable to a flawed design of our healthcare system juxtaposed with the presence of longstanding and systemic institutional racism. If there ever was an opportunity for improving health equity through value-based care, it is with this moral imperative to ensure the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival. On this week’s podcast, you are going to hear from one of the leading voices in health equity, reproductive justice, and value-based maternal health. Our guest is Dr. Neel Shah, the Chief Medical Officer of Maven Clinic, the world’s largest virtual clinic for family health care. He is also a visiting scientist at Harvard Medical School where he previously served as a professor of obstetrics, gynecology and reproductive biology. Dr. Shah has been recognized with the Franklin Delano Roosevelt Humanitarian of the Year Award from the March of Dimes for his impact on maternal health in the United States. He is featured in the films Aftershock, which won the Special Jury Prize for Impact at the 2022 Sundance Film Festival, and The Color of Care from the Smithsonian Channel and Executive Producer Oprah Winfrey. As a physician-scientist, Dr. Shah has written landmark academic papers on maternal health and health care policy, and contributed to four books, including as senior author of Understanding Value-Based Healthcare. He is listed among the “40 smartest people in health care” by the Becker’s Hospital Review, and he currently serves on the advisory board of the National Institutes of Health, Office of Women’s Health Research. In this podcast, we discuss a special documentary that Dr. Shah contributed to called “Aftershock”. This inspiring film on black maternal health equity turns pain into power and should be watched by all who strive to make a positive change in American healthcare.  Join us on April 12th, for a screening of the Aftershock documentary and a discussion with other attendees.   This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system. Bookmarks: 01:30 Black Maternal Health Week and the fundamental human right to have a safe and evidence-based childbirth that optimizes the chance of survival. 02:15 Introduction to Dr. Neel Shah, one of the leading voices in health equity, reproductive justice, and value-based maternal health. 03:30 AFTERSHOCK, is an original documentary on black maternal health equity.  (Watch Trailer and attend special free virtual screening on April 12th). 04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:15 This podcast is dedicated to Shamony Gibson, Amber Rose Isaac, Kira Johnson, Maria Corona, Sha-Asia Semple, Cordielle Street, and the thousands of women who have lost their lives in the United States maternal health system. 05:30 Since 1970, we have seen a 500% increase in C-Section procedures over vaginal deliveries, with the rate of C-sections among black birthing persons being much higher than the general population. 06:00 C-sections bring in an average of $10k per procedure, compared to an average reimbursement of $4,500 for a vaginal delivery. 07:30 “Childbirth is the most utilized healthcare service in the United States of America and accounts for 25% of all hospitalizations.” 08:30 The opportunity to extract more “value” in the maternal health system. 08:45 “In childbirth, we predominantly have a “too much too soon” problem. One in three receive a major surgery to give birth, and one in ten babies go to ICU.” 09:00 Profit margin of 50% per case has normalized C-sections, despite the overwhelming adverse outcomes and contra-indications for most C-sections performed. 09:30 How the surgical apparatus for childbirth creates flawed financial incentives. 09:45 The institutionalization of both birth and death in the American healthcare system. 10:30 Pregnancies are the easiest episodes of care to define and that lends itself readily to bundled payments. 11:00 The need to pay less for C-sections and the need to pay more for vaginal deliveries. 11:30 The maternal mortality rate for black women is 43 per 100,000 which shows that they have a pregnancy-related death risk that is 3-4X greater than that of white women. 12:45 “The wellbeing of Moms is a bellwether for society in general. Every injustice in society shows up in maternal health and maternal health outcomes.” 13:30 The high degree of racial inequity across outcomes, which include death, morbidity, undertreated illness, economic disempowerment, and social isolation. 14:00 The data shows that anti-black racism contributes to the most severe forms of health inequities. 14:30 How public health data has conflated race and racism in interpreting evidence-based practices in medicine. 15:30 The flawed maternal health outcomes calculator that erroneously downgrades patients for being black as a physiologic indicator. 16:15 “Redlining in healthcare” – how historical racism in urban planning decisions creates social barriers and leads to systemic health inequities. 16:45 The 1921 Tulsa Race Massacre as an example of how the legacy of racism contributed to the worst maternal health outcomes in the country (still persisting to this day). 17:45 Black moms often aren’t dying of the medical condition like what is stated on their death certificate…what they are really dying of is failure of communication. 18:30 Disparities in health literacy can have serious consequences for the health outcomes of Black individuals. 19:45 Joint Commission: 80-90% of sentinel events (near misses, deaths) are due to failures of communication and teamwork. 20:00 Communication and teamwork are the ultimate artisanal crafts in medicine, but medical schools traditionally do not teach this. 21:00 Childbirth is the ultimate team sport, but “the team” only forms for the first time upon the onset of delivery. 22:00 Dr. Shah discusses how a communication whiteboard in the maternal health setting can improve both teamwork and patient outcomes. 23:30 The importance of collaboration in an interdisciplinary care team. 24:00 The longstanding racism in the medical establishment that leads to multigenerational distrust of the health system. 25:00 “The existential challenge for the healthcare system in 2023 is trustworthiness. The job is not for patients to be more trusting of us; we need to be more trustworthy.” 26:00 How the legacy of the institution of slavery commoditized the reproductive potential of people and contributed to anti-black racism. 26:45 The insidious nature of adequately responding to pain reported by African American patients in the healthcare setting. 27:00 Racism in healthcare is systemically embedded and irrespective of status or income. (Examples include Serena Williams, Beyonce, Meghan Markle.) 27:15 How racism is embedded in medical textbooks. 27:45 Horrendous racist medical experiments (e.g. Tuskegee Experiment, Henrietta Lacks, “welfare queens”) 28:00 The three criteria of trustworthiness:  Competence, Affirm Dignity for People’s Lived Experience, Reliability. 28:30 The competency of reliability is what we furthest from in the healthcare system. 30:00 J. Marian Sims, the father of gynecology, developed the C-section procedure so slaves could avoid fistulas from vaginal births to produce more slave labor. 31:00 Despite the longstanding track record of racism in maternal health, journalists didn’t really start telling the telling the story of back women dying in childbirth until 2018. 32:30 Injustices in society comprise gender inequity, racial inequity, geographic inequity, and generational inequity. 32:45 The pervasiveness of generational inequity in our politics, e.g. MAGA, Build Back Better. 33:00 “Hope, opportunity, and progress in our country are eroding in our country. There is empirical evidence that this is true. We see it in policing, educational attainment, and maternal health.” 33:30 The danger of leaving African Americans behind in the pursuit of generational equity. 33:45 The most convincing evidence that racism still exists in America in 2023 (comparing risk of wealthiest black woman to poorest white woman). 34:00 Dr. Shah speaks about his personal experiences traveling across the country to better understand maternal health inequities. 35:00 How George Floyd and BLM movement changed awareness for the presence of racism in healthcare. 35:30 Maternal mortality is the lagging indicator and recent increases are discouraging (despite that leading indicators are strong). 36:00 Avoidance of preventable deaths are an improving leading indicator. 36:30 Maven Clinic is the world’s largest virtual clinic for family health care that offers continuous holistic care for fertility and family building. 39:00 Loretta Ross as an inspiration for optimism in reproductive justice (“making sure the chain doesn’t break at your link”) 40:00 Dr. Shah provides an overview of the Maven Clinic and how it “thinks differently” in providing a model for health. 41:00 Providing a model for care, support, and access by meeting people where they are. 42:30 Earning trust through the provision of virtual, cultural-affirming care. 43:45 Developing economies of scale through technology. 44:00 “Social determinants of health need a hyper-local response, especially when it comes to material needs like food and housing.” 44:30 How Maven Clinic employs a short-form digital SDOH screening tool that reduces barriers to identifying addressing social needs. 45:00 Defining loneliness and why community partnerships are so important in the birthing process. 45:45 “The birth equity movement is in a similar place that the HIV/AIDS movement was in the late 1980’s. There are a proliferations of CBOs galvanizing on behalf of their community.” 47:30 Identity shift from academic physician to technology executive and CMO (WSJ: “Obstetrician Neel Shah Joined the Telehealth Revolution”) 49:30 How COVID-19 caused an awakening within Dr. Shah to make a more outsized impact on maternal health equity at a national level. 50:45 Building a Car Instead of a “Faster Horse” – seizing the disruptive opportunity for innovation in maternal health. 51:30 “Correctly deployed science gives you confidence in what you think you are observing is true. It then allows you to create products that can fit into markets and drive scale.” 54:30 Parting thoughts of inspiration from Dr. Shah’s experience as a contributor to the Aftershock documentary. 56:00 “Historically, the healthcare system has treated people’s experience as a secondary luxury after you made them safe. We got it backwards – the way you make people safe is by attending to their lived experience.”

A large wooden ship encased in glass sits prominently in the lobby of Humana’s Louisville headquarters. Its placement seems out of the ordinary, until you understand its symbolic purpose. The ship symbolizes the collaboration necessary from all of those focused on member/patient well-being. We must all row together to make progress and help those we serve live their healthiest lives. Physicians. Nurses. Health coaches. Pharmacists. Health plans. And many others. Collaboration and teamwork are critical to now and in the future of value-based care. The annual Humana Value-based Care Report spotlights the progress value-based care physicians make in achieving better outcomes for their patients with Humana individual Medicare Advantage. It details four key areas—prevention, outcomes and utilization, patient-physician experience and costs and payments. Humana shares these results annually to highlight how the company supports physicians in helping their patients achieve their best health.  In this special episode, we are joined by Kate Goodrich, MD, MHS, the Chief Medical Officer for Humana.  Dr. Goodrich discusses the annual Humana VBC report and strengthens the care for value-based care as the future of healthcare! Episode Bookmarks: 01:30 Download the ninth annual Humana Value-Based Care Report 02:15 Introduction to Kate Goodrich, MD, MHS, is Chief Medical Officer for Humana 04:00 How a large wooden ship in the lobby of Humana’s Louisville headquarters symbolizes collaboration in Value-Based Care. 04:45 Collaboration within the care team. (“Financial incentives matter in optimizing the care of patients.”) 07:00 Collaboration within communities. (“It takes a village to take care of patients and their social determinants of health.”) 09:00 Collaboration at the national level across entities and within the federal government. 11:00 The Institute for Advancing Health Value as a leading example of national collaboration in VBC transformation. 13:30 Humana has over 74,000 primary care physicians in value-based relationships, caring for over 3 million Humana MA members. 14:30 How value-based Humana Medicare Advantage achieved better outcomes than FFS (e.g. hospitalizations, ED utilization, diabetic control). 16:15 “Control of blood sugar is a critical leading indicator of value-based care success.” 17:00 Avoiding low value care services that provide little or no clinical benefit (e.g. MRIs and CTs for routine low back pain). 18:00 Humana MA members receive 9.2% fewer low value services than those that are enrolled in fee-for-service. 19:00 Dr. Goodrich on the importance of VBC in addressing the healthcare cost problem in our country. 19:45 50% of Humana value-based programs earned shared savings (compared to original Medicare at 20.1%). 20:00 Humana value-based care physicians earn almost three times as much of Medicare’s fee schedule. 21:00 “If you’re a primary care physician, frankly, you will make more money in value-based care arrangements.” 22:30 Humana MA members average $500 in annual additional health plan benefits (e.g. home care, prescription delivery, healthy food cards) when associated with a value-based physician. 23:30 How screening for social barriers aligns with the provision of additional health plan benefits that improve care outcomes. 25:00 Examples of preventive care and CCM programs that close care gaps and increase Stars Ratings. 26:00 “Our outreach campaigns have closed more than 350,000 gaps in care per year. That’s paved the way for 10% of members who were previously non-compliant with the screening to identify a particular condition and then have the opportunity to seek more focused care.” 27:00 The success Humana is having in improving medication adherence in value-based arrangements. 28:00 “Non-adherence to medications is traditionally seen as a patient non-compliance issue. And I would argue that that it is rarely true that patients “don’t want to take their medications.” 31:00 Humana’s senior-focused primary care model as a holistic approach to healthcare that empowers patients. 33:00 Examples of Humana’s primary care model include CenterWell, Conviva, and alliance partnerships with Cano Health, Oak Street Health, and ChenMed. 35:00 Clinical Integration within senior-focused primary care teams (e.g. behavioral therapy, social work, pharmacy, nutritional counseling) 37:00 The positive correlation between value-based financial incentives and improved utilization outcomes. 37:30 Ambulatory-sensitive chronic conditions (e.g. CHF, COPD, asthma) that can be better managed in primary care setting. 39:00 Compared to traditional Medicare beneficiaries, Humana MA members had lower rates of hospital stays, emergency department visits, and 30 day readmissions (Referencing research article: “Comparison of Health Care Utilization by Medicare Advantage and Traditional Medicare Beneficiaries with Complex Care Needs”) 41:00 Dr. Goodrich discusses how Star Ratings are reflective of member experience (90.6% of Humana members are in contracts rated four star or above, and 66% are in contracts rated 4.5 stars or higher.) 43:00 How value-based care arrangements can address the plight of physician and nurse burnout. 45:00 Dr. Goodrich discusses Humana’s strategy to reinvest value-based savings in future innovation. 49:30 The future growth of Humana’s portfolio. 50:30 Continued investment in closing health equity gaps. 51:00 The importance of the annual Humana Value-Based Care Report – showing progress and sharing data of value-based success!

This week we have the honor of being joined by a world-renowned family physician and health equity expert, with deep experience in value-based care transformation, technology and innovation, and health disparities improvement.  You are going to hear from the one and only Dr. Nwando Olayiwola, a leader in this Race to Value who is committed to ensuring that everyone has access to fair, high quality and equitable health and health care, no matter their background. To achieve this, she has committed her career to health system reform, practice transformation, primary care redesign and leveraging technology and other innovations to mitigate health disparities. Dr. Olayiwola is Nigerian American physician, professor, author, speaker, consultant, and health equity leader. She was named the American Telemedicine Associate’s Woman of the Year in 2019, she was named one of the most influential minority executives in healthcare by Fierce Healthcare in 2021. Dr. O is a tireless advocate for healthcare of underserved populations, women and girls, and community and social determinants of health and innovations in technology, and the intersection of social justice and healthcare. As the inaugural Chief Health Equity Officer and senior VP of Humana, a role that she started in 2021, and she’s responsible for setting equity agenda and strategy for Humana. In this episode, you will learn about the enablement of an equitable healthcare ecosystem through actionable data, performance measurement and quality improvement, health equity innovation, and relationship-based care. Episode Bookmarks:  01:30 Introduction to Dr. J. Nwando Olayiwola, a Nigerian American physician, professor, author, speaker, consultant, and health equity leader. 02:30 Dr. O is the inaugural Chief Health Equity Officer and senior VP of Humana. 04:00 Personal background and formative experiences that has led Dr. O towards a career path in healthcare equity transformation. 05:30 The Health Equity Journey at Humana. (“Making Health Equity Part of the Value of Value-Based Care”) 06:45 Humana became a pioneer of health justice and health equity in rebuilding and uniting Louisville after the murder of Breonna Taylor. 07:00 Humana’s Bold Goal Population Health Initiative to enable an equitable healthcare ecosystem. 07:45 “We need to innovate constantly in the way that we deliver and finance healthcare. It must fit within the lives of people’s own lived experience.” 08:00 Optimism for the evolution of our healthcare ecosystem to better prioritize health equity. 09:00 “We must do everything we can to eliminate barriers to healthcare that are unnecessary, that are avoidable, and that are unjust.” 09:45 Imagining a world where healthcare is more than just having an insurance card – it actually becomes an equitable ecosystem of liberation and authenticity. 10:30 Dr. O provides specifics on the various types of health disparities that we encounter in our country and how those impact minoritized and marginalized populations. 12:00 Dr. O’s TED Talk: “Combating Racism and Place-ism in Medicine” 13:00 How is Humana positioning itself as a catalyst for equity innovation by leveraging it health plan and provider assets collectively? 15:00 How the Health Equity movement mirrors the path of the Health Quality movement following the “To Err is Human” report. 16:30 Referencing landmark National Academy of Medicine paper: “An Equity Agenda for the Field of Health Care Quality Improvement” 17:00 Measuring health equity on dashboards measuring organizational performance. 18:00 “We must get the right data to validate we are providing culturally affirming, culturally sensitive, and culturally humble care to people we’re caring for.” 18:00 Referencing NEJM Catalyst article on how Humana developed a health disparities impact measure:  “Building the Foundation for Reducing Disparities in Medicare Advantage” 19:30 The need for committed leadership to support health equity work. 20:45 The importance of equity-focused executive hiring practices and actionable SDOH data capture. 22:00 Preventive care measures as a component of a health equity action plan. 22:45 Social Barriers preventing Equitable Care: Financial Strain, Food Insecurity, Housing Instability, Loneliness, Lack of Transportation. 23:00 Positive correlation between social risk and high medical loss ratio. 24:00 Building a more relationship-based delivery model of care that engenders trust between patients and providers. 25:30 The importance of continuous learning in health equity through performance measurement, testing, and validation. 26:30     Building partnerships with Community Benefit Organizations (CBOs) across the country. 27:00 Leveraging insights from acquired data intelligence on underserved communities to improve patient health literacy and economic empowerment. 29:00 “Our vision is that every person will have a fair, just, and dignified opportunity to reach their full health potential.” 30:45 Inspiration from Oprah Winfrey: “I firmly believe that none of us in this world have made it until the least among us have made it.” 31:45 How structural racism limits the positive impact of education as an ultimate opportunity equalizer. 32:30 Learning from Serena Williams’ challenge in accessing equitable health care. 34:00 Working at the “speed of trust” to overcome generational traumas from racism and inequities in healthcare. 35:30 “Trust is earned – it is not given.”

As the healthcare industry moves towards achieving CMS’s goal of having every Medicare beneficiary in an ACO or ACO-like model by 2030, we must focus on patients in institutional settings. For long-term care patients, better care and better health means ensuring patients receive advanced care planning and regular wellness visits. And it also requires providers and facilities to work together in preventing avoidable hospitalizations and unnecessary SNF and hospice utilization. Unfortunately, the needs of geriatric patients in an institutional setting are often overlooked as compared to other populations in the vast environment that falls within the influence of value-based care. LTC ACO — the first ACO in the country focused specifically on the special needs of Medicare beneficiaries residing in long-term care facilities — is changing that narrative. The mission of LTC ACO is to dramatically improve the quality and cost of healthcare delivered to these Medicare beneficiaries, rewarding participating providers for achieving these outcomes. Using this approach, it is their vision to revolutionize the way healthcare is provided to Medicare beneficiaries residing in long-term care facilities. Joining us this week in the Race to Value is Jason Feuerman, the President and Chief Executive Officer of LTC ACO. In addition to leading one of the only ACOs that is dedicated exclusively to management of long-term care facility residents, Jason supports managed care and strategic value-based initiatives for Genesis HealthCare, the biggest post-acute care operator in the country. In this episode, you will learn about LTC ACO implemented a program in the traditional Medicare population that mirrors Institutional Special Needs Plans (I-SNPs). He discusses how the ACO engages and incentivizes providers and facilities and has operationalized a data infrastructure to drive care interventions. They have woken up an entire ecosystem with their approach to value-based care and have generated well over $40M in Shared Savings throughout their lifespan. By focusing on improving care outcomes and engaging providers, they have become the industry-leading exemplar for improving patient outcomes in long-term care!   Episode Bookmarks: 01:30 Introduction to Jason Feuerman and LTC ACO, the first ACO focused specifically on the special needs of Medicare Beneficiaries residing in long-term care facilities. 03:00 LTC ACO was launched by Genesis Healthcare, the biggest post-acute care operator in the country, with significant experience in MA risk and bundled payment models. 06:00 Lessons Learned from MA: How Institutional Special Needs Plans (I-SNPs)provided an operational thesis for LTC ACO in the Medicare Shared Savings Program. 07:00 By improving quality and driving down unnecessary costs, LTC ACO returns the Shared Savings earned to LTC facilities and the physicians who support them. 08:00 “Waking up the ecosystem” by providing outcomes data to long-term care providers. 10:00 Achieving capital efficiency in a model where there is no downside risk. 12:00 How capital requirements for delegated Medicare Advantage differ from the MSSP model. 13:00 Less than 15% of residents in long-term care facilities are in a MA plan. (Limited business opportunities in Medicare Advantage) 15:30 Applying the same tenets of I-SNPs to a Medicare ACO (e.g. aligning providers and providing rewards with surpluses) 16:00 “Waking up an Ecosystem”:  Most LTC providers do not know what happens to their patients once they leave the long-term care institutional setting. 17:00 How data can be used to inform long-term care providers how their patients are doing across the continuum. 18:30 The use of AI for population-based predictive analytics to identify potential health risk (see recent Press Release regarding ClosedLoop AI partnership) 19:00 “Long-term care providers gravitate towards population health data and how they can contribute to bending the cost curve.” 21:00 Alzheimer’s dementia is the only top-10 cause of death that cannot be prevented, cured or slowed.  We spend $200B on Alzheimer’s and Dementia care (more than Cardiology and cancer care combined!) 22:00 Jason discusses the potential implications of Alzheimer’s/Dementia in value-based care. 25:30 The impact of hospitalization on a LTC patient can include more time in bed, which can result in increased blood clots, pressure ulcers, muscle atrophy and loss of function. 26:30 Using data from EHRs and pharmacy utilization (Medicare Part D) to predict the risk of hospitalization. 28:00 “Our goal is to reduce hospitalizations and the need for skilled care using predictive analytics.” 29:00 How primary care physicians can become the “true quarterbacks of care” by empowering them with data. 29:30 How LTC ACO is approaching pharmacy utilization to better care for their patients. 32:00 LTC ACO has achieved well over $40M in Shared Savings during its lifespan. 34:00 Jason provides an industry-leading example of how to align providers and facilities in the ACO’s value-based care strategy. 35:30 Most ACOs incentivize SNFs by just providing them with them the promise of referrals. 36:30 LTC ACO recently distributed $1.5M to providers and facilities from its most recent Shared Savings event. 37:00 Balancing both cost and quality initiatives of the CMS program to achieve Shared Savings. 37:30 The “feel good” aspect of independent providers working with the ACO beyond bonuses earned (e.g. lowering unnecessary SNF and hospice utilization to improve care). 38:30 “Our goal is to get as much money into the hands of providers as possible. This is not about holding back dollars so the ACO can make money.” 41:30 Jason describes the impact of COVID-19 on LTC ACO and the overall long-term care segment of the industry. 43:00 How social isolation with the pandemic created a high increase for inpatient rehabilitation needs. 44:00 The trauma of the pandemic on the healthcare workforce that comprises the LTC ACO network. 44:45 How hospitals learned a lesson to “care in place” during the pandemic (instead of referring patients to a long-term care facility). 47:00 The number of Americans aged 65 and older will more than double over the next 40 years —  reaching 80 million in 2040. 47:30 Did CMS contemplate the institutional population when developing its goal to have all patients in an accountable care relationship by 2030? 49:00 Jason describes the importance of the value-based movement in improving care for the geriatric population. 50:00 ACO REACH focuses on communities (not institutions!) 51:00 “Most people not being addressed in value-based care are in institutional settings.” 52:00 How CMS will continue to move the needle on VBC, in partnership with private industry innovation, will benefit the entire geriatric population. 53:00 LTC ACO, with six years of experience as an ACO, is driving industry-leading results in improving care outcomes!

The healthcare system in the United States is ailing and in need of a massive value-based transformation. While we are increasingly polarized in our politics, there is one issue on which most Americans agree: our health care system is broken. Despite spending more per capita on health care than any other country, Americans are in worse health, with lower life expectancies, higher hospital admissions, and at greater risk of suicide and maternal mortality compared to peer nations. This is largely because our health care model has been focused on “sick care” aimed at addressing acute or chronic conditions rather than preventive health maintenance. We have increasingly placed greater value on specialty care over primary care. If we are to right the course and seize this historic opportunity to deliver care that is patient-centered and financially accountable for outcomes, we must unleash the potential of massively powerful primary care! This week on the Race to Value, you are going to learn about Southeast Primary Care Partners (SPCP) – an independent primary care MSO committed to upholding the independence, innovation and collaboration of Primary Care Physicians, with the ultimate goal of transforming healthcare and achieving true value-based care everywhere. Eric Lisle is the CEO, President and Co-Founder of Southeast Primary Care Partners. And joining him is Craig Worland, the Chief Development Officer for SPCP. These two industry leaders paving the way for a revitalization of primary care in the Southeast and are leading a value journey that we are excited to share with you on the podcast this week! Episode Bookmarks: 01:30 Our ailing healthcare system and the need to unleash the potential of massively powerful primary care. 02:30 Introduction to Southeast Primary Care Partners (SPCP) and our guests Eric Lisleand Craig Worland. 03:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 05:30 Eric Lisle shares his “Personal Why” and how that informs his leadership in value transformation at SPCP. 06:30 “Our passion is bringing the love of medicine back to primary care physicians.” 07:30 Craig Worland describes personal challenges navigating the healthcare system and how that inspired him to create meaningful change. 08:45 “The fee-for-service economic system is not designed to streamline care delivery in a way that keeps the patient well.” 09:30 How pivoting to a new economic model creates enablement for primary care transformation. 12:00 Value transformation in primary care is often limited by regional dynamics in the payment landscape. 13:30 How primary care enablement improves patient care outcomes. 14:30 Primary care is the only specialty in medicine that increases life expectancy when community access is enhanced. 16:00 Only 32% of primary care physicians work in a private practice outside of corporatized care delivery business model. 17:00 How independent physician-enablement strategy at SPCP creates whole-person care and improves health equity in underserved communities. 19:30 “The culture, leadership, and long-term strategy of a primary care practice must be oriented towards robust Total Cost of Care revenue models.” 20:00 Can hospital-owned and PE-backed primary care groups effectively pursue a value transformation agenda? 23:00 Investing in FTEs to enhance the population health capabilities of a primary care MSO. 24:45 Creating EHR interoperability and data aggregation to empower population health insights. 25:30 How the SPCP MSO leverages capital to invest in a PCP-led, patient-centered care environment. 26:30 Forming effective payer-provider partnerships through spirited collaboration and demonstration of risk capability. 28:00 The SPCP MSO is differentiated through provider empowerment, payer agnosticism, and commitment to both rural and urban communities. 31:45 Creating a holistic patient view by combining data analytics from aggregated claims with an integrated electronic health records system. 33:30 Displaying actionable insights at the point-of-care to close care gaps. 36:00 Prospective payment models in primary care are a “gamechanger” because they allow for investment in critical infrastructure to drive value. 37:30 Is the CMS goal to move all Medicare patients in accountable care relationships by 2030 realistic? 38:00 ACO REACH is an encouraging sign of risk progression and prospective payment. 40:00 Health inequities in Georgia and Alabama (e.g. cardiovascular disease, diabetes, CKD, cancer, strokes, HIV/AIDS, maternal deaths). 41:00 “The beauty of prospective payment is that it allows providers to do what makes the most sense to improve the health of patients.” 42:30 Getting the economic right – how the dollars provided through prospective payment are agnostic to minority and underprivileged populations. 44:00 The true path to health equity is driven by economic incentives just as much as moral imperatives. 44:45 Hospital closures in rural areas are compounding health inequities.  (How can VBC transform care outcomes in these areas?) 47:00 Eric Lisle discusses how SPCP will be able to replicate their MSO model at scale to succeed in new markets in the southeast. 49:30 Craig Worland on the importance of “leadership with empathy” in a successful primary care model. 51:30 The importance of the Institute for Advancing Health Value in supporting organizations like SPCP.

Are you ready to climb the mountain and reach new heights for a transformative future? In the “race to value”, the mountain climber must not be intimidated by the steep terrain of a broken healthcare system. Instead we must look within ourselves, while also finding inspiration from others, to keep climbing! The ultimate summit of value transformation is what drives us, but the climb itself is what matters.  If you are looking for inspiration in your value journey, look no further than our guest this week, Debbie Welle-Powell. Debbie is a healthcare thought leader, educator, national speaker, and content expert in delivery systems, clinical models of care, population health, and digital care. She is also an avid mountain climber, having attempted three of the Seven Summits while also reaching the summit of all 58 of Colorado’s 14,000 peaks. She has also climbed Mt. Rainer in in Washington and Grand Teton in Wyoming and, she has climbed peaks in Bolivia, Mexico, France, Argentina, and Mt. McKinley in Alaska.  In this podcast, you will learn how taking the path least travelled is when you learn the most about yourself and why value transformation is a most noble journey to undertake in healthcare. As the former Chief Population Health Officer at Essentia Health – an integrated delivery system with 14 hospitals, and 1,500 provider health system spanning the states of Minnesota, North Dakota, and Wisconsin – Debbie Welle-Powell designed, built, and operationalized Essentia’s $2.5 billion dollar transition from a primarily fee-for-service model of care to one that focused on value.  She oversaw risk-based contracting with payers and care delivery transformation, resulting in forty-five percent of the system’s fee-for-service revenue tied to financial and clinical performance which produced record earnings on shared savings. Debbie’s exceptional experience and background in multi-state, large integrated delivery systems, coupled with industry involvement and insights into emerging opportunities, trends, and challenges, have been valuable to health systems and purchasers seeking to grow, diversity, and promote expertise in the development and implementation of data-driven strategies and solutions in population health and value-based care. Episode Bookmarks: 01:30 Introduction to Debbie Welle-Powell, a nationally-recognized leader in value-based care transformation. 03:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 The grim statistics of American healthcare and the moral and economic imperative to reform it! 05:00 Recent article from Don Berwick about the excess profiteering and greed in healthcare: “Salve Lucrum: The Existential Threat of Greed in US Health Care” 06:30 Debbie discusses the current state of the healthcare industry and how she spent her career moving healthcare delivery to full-risk and globally capitated payments. 07:30 A leadership commitment to test models of care that address the moral imperative for improved outcomes. 08:30 Reflections on Dr. Berwick’s article and the need to expand the conversation by focusing on solutions. 11:00 The Innovation Center Strategy Refresh is a stake in the ground for 100% of Medicare beneficiaries to be in an accountable care relationship. 12:00 The need for innovation in specialty care and new risk models that improve health equity. 13:00 “Medicare is a laboratory for change.” (e.g. alignment of quality measures, multi-payer approaches to improvement, expansion of access in rural areas) 13:45 Two-thirds of those in Medicare Shared Savings contracts are now taking risk. 14:00 Balancing the need to move fast while not being too aggressive (“people are exhausted!”) 15:00 In the last year, hospitals have seen their operating costs increase upwards of 10%, and their bottom lines are now hemorrhaging to the tune of billions of dollars. 16:00 Pay inequity with nonprofit hospital CEOs making on average 8X the rate of hospital workers without advanced degrees (while the highest paid receiving 60X the hourly pay of general workers). 17:30 How do we better align hospitals and health systems with VBC? How should they be rethinking their approach to investment in delivery assets and organizational culture? 18:00 “Value-based care and the ACO movement has significant opportunities to create more affordability and better outcomes for our patients.” 18:15 The need for a federal framework that provides a groundswell of support to move in the direction of value. 18:30 Leveraging the CMMI Strategic Framework to move 150 million Americans into value-based payment models. 19:30 Debbie describes how she led her health system towards the acceptance of downside risk in 2015. (Learn more about Essentia’s Population Health Strategy) 20:30 When Debbie left Essentia Health, 42% of health system revenue was flowing through value-based contracts (upside and downside). 21:30 The importance of leadership, organizational culture, and data in a health system’s value journey. 22:30 Referencing Debbie’s recent article on “The Future of Integrated Virtual Care.” 23:30 Essentia Health’s integrated virtual care generated higher patient satisfaction scores, eliminated many SDOH barriers, prevented ED visits, and saved approximately $2.5M in healthcare costs. 24:00 Debbie discusses the Essentia Health integrated virtual care journey and how they navigated the challenges of COVID-19. 26:00 How remote patient monitoring and a Personal Health Record (Epic MyChart) lowered healthcare costs and utilization for specific chronic conditions. 27:00 Implementing a Hospital-at-Home program – lessons learned in testing a different model of care. 28:00 What is the permanent nature of virtual care in the post-pandemic era? 29:00 The need for Telehealth ROI and the demands of younger patients for virtual care. 31:00 Unlike in a fee-for-service model, payer contract negotiations in value do not always have to be a zero-sum game. 32:30 Debbie explains how to cultivate meaningful payer-provider partnerships to improve population health outcomes and reduce health disparities. 34:00 Strategies for engaging payers to get “must have” value-based contract terms and meaningful data to deliver on care model transformation. 37:00 “The willingness to solve problems in partnership with payers is the true test of the commitment to deliver better care for communities.” 38:45 The importance of data, governance, and strategy to guide the fluidity of ever-evolving payer-provider relationships. 41:00 Debbie elaborates on her success in planning targeted SDOH interventions to eliminate health disparities using the ADKAR® Model for change. 42:00 Recognizing the health divide between North and South Minnesota and how Essentia Health addressed gaps in care and health inequities. 43:30 Conducting health risk assessment screenings on all patients and how that data drove community-based interventions. 44:30 Using community benefit funding within the health system to support CBOs taking care of patients’ social needs (e.g. food, transportation, housing). 47:00 In 2023, 10.9 million beneficiaries are being cared for in MSSP ACOs, while 2.1 million are being cared for by REACH ACOs. 48:30 Debbie provides her leadership perspective on CMS payment model innovation. 49:30 Improving alignment and consistency between MSSP, REACH, MA, and Medicaid payment models. 50:30 “If you are not in risk, take the first step in an upside-only value-based arrangement.  The benefit is knowing your performance against your peer groups.” 51:00 The inevitability of mandated bundled payments. 52:00 The lack of payer alignment in the commercial market creates a challenge for them to lead in value transformation. 52:45 Expect to see significant growth in the value movement by 2025. 54:00 How important is it that we teach emerging healthcare leaders about value-based care? Do we need a new kind of leader to disrupt legacy thinking in healthcare? 56:00 “Be involved and willing to take risks. That is what it is going to take to challenge the status quo and push our stakeholders to be better.” 57:30 As an avid mountain climber, Debbie has attempted three of the Seven Summits and climbed all 58 of Colorado’s 14,000 peaks, as well as Mt. Rainer in in Washington and Grand Teton in Wyoming. Additionally, she has climbed peaks in Bolivia, Mexico, France, Argentina, and Mt. McKinley in Alaska. 58:00 Parting thoughts of inspiration on what it means to reach the summit and how mountain climbing relates to the value journey. 58:45 “When you take the path least travelled, that is when you learn the most about yourself. People deserve this race to value.”

One of the most widely known and influential thinkers on management, Peter Drucker, once said, “The entrepreneur always searches for change, responds to it, and exploits it as an opportunity.”  In this movement to value, it’s seems that the new players – innovators and disrupters with unbridled passion for entrepreneurialism – are going to be in the best position to be at the headwaters of a transformation in American healthcare. The financial incentives in the current model of healthcare are simply too entrenched to be overcome by most legacy incumbents worried about how value transformation will create demand destruction in their fee-for-service lines of business. We need a better way forward.  Now is the time to  throw away traditional economic principles to reshape healthcare in our country! Our promise to build a uniquely new American healthcare system that is patient-centered and economically viable will be realized by innovators like the one you will hear on this week’s episode. We are joined this week by Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare. Thompson has the mindset that if it’s broken, you fix it…we as industry leaders shouldn’t wait for someone else to figure out how we are going to win in this Race to Value!  Thompson is a health economist and entrepreneur that you should be listening to.  As the co-founder and CEO of Nice Healthcare, he has created a technology-enabled primary care clinic that delivers all care in the comfort of the patient’s home and contracts directly with small employers. Thompson built this company in response to the economic dysfunction and lack of cost accountability that he observed in our broken healthcare system. According to Thompson, it will be necessary for innovators to lead the way since the legacy model is too entrenched to reform itself.  Listen to this incredible interview to find out why Thompson believes that value-based care (if done right) will ultimately lead to the bankruptcy of legacy companies!   Episode Bookmarks: 01:30 Introduction to Thompson Aderinkomi, the Co-Founder and CEO of Nice Healthcare. 02:30 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts! 03:30 In 2017, Thompson co-founded Nice Healthcare – an on-demand, in-home technology-enabled clinic that delivers comprehensive healthcare to employees of small and medium-sized businesses. 04:30 Thompson shares the horrific story of the poor healthcare his one-year old son received and how that shaped his entrepreneurial vision to start his company! 06:45 How the lack of consumer-centric innovation in healthcare harms the spirit and hurts patients financially. 08:00 Thompson’s privilege allowed him and his family to overcome their poor healthcare experience unscathed…how many people do not have that fortune? (The inspiration for Nice Healthcare) 09:00 Referencing the famous article, “It’s the Prices, Stupid,” by the late health economist Uwe Reinhardt where he argued that high prices explain most of why U.S. healthcare costs are so much higher than those in other advanced countries. 09:45 The problem with supplier-induced demand, where a  physician (i.e. the “supplier”) also serves the economic role as a consumer by generating their own demand. 10:15 Nice Healthcare is fully capitated (no fee-for-serve whatsoever) which allows it to offer unlimited virtual care and home visits, along with lab tests, drugs, xrays, and EKGs conducted in the home. 10:45 “The problem with healthcare is the unit price.” 12:00 Thompson explains the pricing inelasticity demand in healthcare and why that creates flawed incentives for consumer price gouging. 13:00 Profit maximization by increasing market share is not necessarily the modus operandi in healthcare when you can get away by charging whatever you want. 14:45 “Unless you create a completely new business model in healthcare, you are not going to change the price.” 15:00 How Nice Healthcare has changed the pricing model through a disruptive business model. 17:00 Receiving delegated risk from payers in the form of capitation. 18:30 “Our technology and processes allows us to operate at a lower unit price point that we, in turn, pass on to the consumers of care.” 19:00 Referencing prior Race to Value episode with Dr. Farzad Mostashari 21:30 “The very notion that a legacy model for-profit entity would deliberately engage in activities (like value-based care) that lower their revenues or profit is ludicrous.  Innovators and upstart companies must solve this problem.” 23:00 “If none of the incumbent healthcare players are going out of business, you don’t have value-based care. The ultimate result of true value-based care should be bankruptcy of legacy companies.” 24:30 A new innovator can be profitable and create value for shareholders and communities with much lower revenues than incumbents. 26:00 True innovators in healthcare do not grow fast because they are creating value. 26:45 Referencing “The Innovator’s Prescription’ by Clayton Christensen (the wasteful spending in healthcare that can be addressed by innovators) 28:30 “Simplicity doesn’t start with Technology.  Technology only makes simplicity elegant.” 29:00 The simplicity of the Nice Healthcare care delivery model. 31:00 The surge of venture capital and private equity investment going into virtual care and high-touch primary care models and the move to asset-light hospitals.” 32:45 “Hospitals should not be for-profit and should not even be private organizations. They should serve as a utility offering a public good.” 34:30 Removing the profit motives from hospitals will make them a public utility (just like police and fire departments). 35:30 “Everyday primary care should be as easy to access as air. That is where free market principles, competition, and true innovation come into play.” 38:00 Employer-sponsored health plans have gone up 54% in the last decade.  Are employers the “sleeping giants” that will awaken to force the change needed in our healthcare system? 39:30 Thompson explains how Medicare and commercial insurance plans are inextricably linked together. (Lower wages because increased healthcare costs creates less tax revenue to fund Medicare program.) 42:00 “Any solution we want for Medicare has to involve the commercial population.” 42:30 “The federal government needs to wake up to the fact that the healthcare industry is making it impossible to fund Medicare.” 43:30 “The most expensive and complex care should be provided by the government. The lowest risk pool has everyone in it.” 44:00 “Funding Medicare through income taxes harms employees. We have to be free from that paradigm so employers can affect change in healthcare with true innovation.” 45:30 How the high barriers to entry in the healthcare marketplace prevent new entrants from coming in to impact real change. 45:45 The need to create national provider licensure, loosen telehealth regulations, and lower the debt burden for students in medical schools. 47:45 The healthcare economic model must change to better serve society – healthcare should be a “right” instead of a privilege. 49:00 Will increased patient expectations become a formidable agent of change to hold the healthcare industry accountable for consumer-centric innovation? 50:00 Consumer demands will not lead change in healthcare because they lack agency and ultimately succumb to pricing inelasticity. 51:30 Thompson explains how Nice Healthcare provides patient-centered care by pulling up a random patient review on Google (and compares it to a random competitor clinic in Minnesota). 55:30 Nice Healthcare Results: 98% of patients rate care as better than their previous clinic,  $453 net yearly savings per employee, and the company has a 93.2 Net Promoter Score. 56:30 Saying “no” to insurance and partnering with innovative, forward-thinking brokers led to product distribution at a low price point with minimal friction. 58:00 Combining virtual care with in-home visits to replicate the clinic experience. 62:00 Thompson provides a contrarian view of Population Health by stating that it has nothing to do with predictive modeling and algorithms (we should instead focus on changing our food industry, educational system, and policing to improve health.) 63:00 “The sole purpose of population health management is to improve patient experience and lower the cost of care to improve quality and outcomes. You don’t need data to do that. All you need is to provide access to primary care at a lower unit price.” 66:00 Thompson provides parting thoughts about what it takes to be a healthcare innovator (and provides criticism for those incumbents who are lying about the value they are creating.)

Disclaimer: The information provided in this podcast is purely for educational purposes and should not be interpreted as a recommendation for a specific treatment plan, medicinal plant, or course of action for medical treatment. None of the statements or ethnobotanical information in this episode have been evaluated by the Food and Drug Administration (FDA). The purpose of the information conveyed in this podcast is simply to explore the ancient healing practices of indigenous cultures. Please consult a professional if you are considering the use of plant-based medicines.      In many ways people have become disconnected, dislocated, and dislodged from their place in the world as a result of trauma.  Trauma due to physical, emotional, and sexual abuse, neglect, household dysfunction, or just everyday unmanaged stress as an important social determinant of health. These traumas can actually change the chemical makeup of the brain and increase the risk for developing certain physical ailments, including digestive problems, diabetes, chronic pain, and heart disease. Unfortunately, the American healthcare system is not effective in addressing the root causes of the chronic issues we face at a psycho-emotional level. Western culture is now looking for alternative ways to stem the epidemic of anxiety, depression, and stress we see in the modern world.  Is there an opportunity in health transformation to seek alternative and ancient sources of healing medicine that finds coherence between the mind and heart and the body and the spirit?      This week we are offering our listeners with a Bonus episode to discuss the healing potential of ayahuasca. Our guest is Kevin Johnson (also known by the Q’ero people of Peru as Puma Blanco). He is a shamanic healer who has become a popular public speaker, giving presentations on consciousness, shamanism, plant medicines and psychedelics. He’s been featured in several magazines and periodicals, and has appeared on many popular podcasts including; “Tangentially Speaking” with Christopher Ryan, “The Duncan Trussell Family Hour”, “The Warrior Poet” with Aubrey Marcus, “Not Just Paleo” with Evan Brand, “Fat Burning Man” with Abel James, and “The Truth Junkie Podcast” with Kevin Bates…just to name a few. This won’t be your typical Race to Value episode.  Not only are we exploring the congruency between ayahuasca and healing and the parallels between shamanism and Western medicine, but we will also be learning about the Q’ero people of Peru who have a special relationship with the planet and an approach to energy balancing that maybe we could all learn from.      If you have an open mind and an open heart, you will find this conversation to be quite enlightening and informative as people around the world are retracing the ancient pathways of shamanism, the oldest spiritual practice of healing on the planet. So let’s now hear from Kevin Johnson, who is joining us for this special bonus episode of the Race to Value! Episode Bookmarks: 01:30 Trauma as an overlooked social determinant of health that leads to chronic disease. 02:30 Introduction to Kevin (Puma Blanco) Johnson – a shamanic healer and popular public speaker on the topics of consciousness, shamanism, plant medicines, and psychedelics. 03:00 The healing potential of ayahuasca, parallels between shamanism and Western medicine, and the Q’ero people of Peru. 05:45 Referencing prior episode with Dr. Charles Nemeroff, the Co-Director for the Center for Psychedelic Research & Therapy. 06:00 Inspiration from Hippocrates: “The greatest medicine of all is teaching people how not to need it.” “Foolish the doctor who despises the knowledge acquired by the ancients.” 06:30 Ayahuasca is a very ancient medicine, with archaeological evidence for the consumption of ayahuasca going back at least a thousand years. 07:30 An overview of ayahuasca as a plant medicine and how it can provide healing, alleviate suffering, and enhance spirituality. 09:45 Is cultural appropriation of ayahuasca in the West necessarily a bad thing according to indigenous healers? 11:00 Celebrities like Prince Harry and Aaron Rodgers are touting the benefits of ayahuasca. 11:45 Dr. Rick Strassman was the first person in the U.S. to undertake human research with DMT (the psychoactive component of ayahuasca) and called it “The Spirit Molecule.” 12:45 Research shows that most ritualistic ayahuasca users have a shared experience with something that is deeply spiritual and mystical in nature. 13:30 “There is an intelligence behind the medicine that is directing the experience.” 14:00 “A hygienic process for psychology” — the universe has an energetic impact on human beings (positive and negative), and ayahuasca can help people purge negative energies. 15:30 Is there a potential physical healing component to ayahuasca? 16:45 The psychological healing of a ceremonial ayahuasca experience. 17:45 The “mother” can provide clarity, insight, discernment, and wisdom. 18:30 The ancient culture of the Q’ero – a Quechua-speaking community that live in one of the most remote places in the Peruvian Andes. 19:30 The Q’ero have kept their ancient teachings, secret codes and Andean cosmovision intact and alive for centuries. 20:00 The destructive nature of Western Culture that leads to domestication and conditioning that is incongruent with living as a spiritual being in Nature. 21:00 A pilgrimage to the Q’ero Nation in the Peruvian Andes and the ancient wisdom ofDon Gino Chaka-Runa. 22:00 How the Q’ero people experience happiness by living in close connection with the earth and their community. 22:45 The Mystical World of the Q’ero as “Masters of the Living Energy” 23:00 “The game is energy, and you play it through acquisition, maintenance, and investment.” 23:45 Living in reverence and harmony to the spirit of nature (Pachamama) and managing a system of living energy. 24:45 How Western culture creates physical, psychological, emotional, and spiritual sickness due to living incongruently with the natural world. 27:30 The ancient Q’ero healing principles and approach to energetics (the balance of “Sami and Hucha” – light refined energy vs. heavy dense energy). 30:00 The domestication of Western culture that leads to an atrophy of the energy system (“Poq’po”), resulting in trauma and sickness. 32:00 “We must always be in Ayni – living in sacred reciprocity.” 33:00 The Q’ero as “wisdom keepers” and their prophecy to restore ancient wisdom for the healing of the world. 33:45 The Ancient Prophecy of the Eagle and Condor and why the Q’ero moved to South America to preserve their wisdom. 36:30 A planetary realignment that shifted Earth into a new epoch and signaled the restoration of wisdom to people in the West (the people of the Eagle). 37:30 How the release of condors in California is emblematic of the fulfillment of a prophecy! 38:30 “Thoughts, words, and actions are energy.  We need to control of the ways we are using our energy so that it benefits us, the people around us, and the world as a whole.” 39:45 The energetic concept of sympathetic resonance (like energy attracts like energy). 41:00 Changing the energy we address the world with to determine the outcomes of the situations in our lives. 42:00 How shamans engage with plant medicines on an energetic level to curate vibrational energies in ceremony that facilitate healing. 45:00 Are their similarities between Q’ero energy practices and other cultural practices of shamanism, mindfulness, yoga, meditation, etc.? 47:00 The optimism of ancient wisdom spreading in the West to provide more holistic healing. 48:30 Plant medicines are not a panacea.  Ayahuasca is for everyone, but not everyone should drink ayahuasca or take other psychedelics. 49:30 Other ways to alter consciousness for profound transformation (e.g. floatation therapy, yoga, meditation) 50:30 A warning about bad acting shamans that can weaponize ayahuasca. 51:30 How ayahuasca tourism in South America has created a dangerous environment for healing with plant medicine. 52:30 The importance of music in ayahuasca ceremonies. Medicine songs known as Icaros can create waves of frequency to move blocked energies and repel negative energies. 53:30 “There is a lot of potential with plant medicines and psychedelics, but we must approach with wisdom and discernment. We must always keep safety in mind.” 54:00 Find out more about Kevin (Puma Blanco) and his work in the ancient practices of shamanism through Vida Brilliante. 55:00 Kevin (Puma Blanco) closes the podcast by singing an Ayahuasca Icarosthat calls the spirit of a tree.

Implementing value-based care can help providers improve patient health and reduce care costs, but it also presents the opportunity to explore new and emerging areas of research in breakthrough treatments that can revolutionize healthcare as we know it today. Embracing such a paradigm shift is for the mindful, who acknowledge that certain aspects of medicine are not working as intended.  If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine. On this week’s podcast, you will learn about some of the research being done to further scientific rigor and expertise in the study of psychedelic therapy. In clinical research settings around the world, renewed investigations are taking place on the use of psychedelic substances for treating illnesses such as addiction, depression, anxiety and posttraumatic stress disorder. Psychedelics fell from medical grace nearly half a century ago, their reputation mired by associations with counterculture drug excesses and Cold War era enhanced interrogation, but now a new wave of research has returned to psychedelics as potential candidates to treat mental health disorders. We are joined this week by Charles B. Nemeroff, M.D., Ph.D the Co-Director of The Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin. Dr. Nemeroff is one of the nation’s most influential psychiatrists and has published more than 1100 research studies, and his research is currently supported by grants by groups such as the Multidisciplinary Association of Psychedelic Studies (MAPS).  His research is focused on the pathophysiology of mood and anxiety disorders with a focus on the role of child abuse and neglect as a major risk factor. He has also conducted research on the role of mood disorders as a risk factor for major medical disorders including heart disease, diabetes and cancer. At the Center for Psychedelic Research and Therapy, he aims to advance the application of psychedelics for the treatment of mental health disorders through impactful clinical research.  Additionally, the center looks to improve the health of those suffering from severe depression, anxiety and PTSD through psychedelic-assisted psychotherapy and research focused heavily on military veterans and adults affected by early childhood trauma. Episode Bookmarks: 01:30 “If we are to truly attain better patient outcomes at a lower cost, we must consider emerging areas of research that can create new knowledge in the practice of medicine.” 02:45 Introduction to Charles B. Nemeroff, M.D., Ph.D the Co-Director of the Center for Psychedelic Research and Therapy at Dell Medical School at The University of Texas at Austin. 04:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts! 05:00 The field of human-based research into psychedelic drugs has in the last ten years become a legitimate field of study, after decades of repression by governments around the world. 05:30 The renaissance of psychedelic research with renewed media and medical interest in LSD, psilocybin, MDMA, ayahuasca, DMT, and ketamine. 05:45 From the Woodstock generation to present day – Dr. Nemeroff provides an overview on this history of psychedelic research. 06:30 Early psychedelic research conducted by Timothy Leary and Ram Dass (formerly Richard Alpert) that created a spiritual awakening and captured a generation. 07:30 A research moratorium that persisted for decades until the Dr. Rick Strassmanundertook human research on N,N-dimethyltryptamine, also known as DMT. 08:00 Distinguishing recreational use for spiritual awakening vs. psychedelic-assisted treatment for serious psychiatric disorders. 08:30 How psychedelics can rip away defense mechanisms in the mind that prevent people from facing the certainty of death and other unpleasant realities. 09:30 Dr. Nemeroff discusses his medical practice specialty in the psychiatric treatment of severe PTSD and treatment-resistant depression. 10:00 Military veterans, victims of sexual trauma, victims of childhood abuse, and others with severe depression often do not respond to conventional FDA-approved treatments. 11:30 The Public Health Problem of Suicide: There are approximately 50,000 suicides each year in the United States (the only leading cause of death that is increasing in number!) 12:00 The Next Big Addiction Treatment: Substance Use Disorder (SUD) can also be effectively treated with psychedelic-assisted therapy. 13:30 The economic burden of major depressive disorder among U.S. adults is an estimated $236 billion, an increase of more than 35% since 2010! 15:00 Lack of access to care for patients with depression leads to under-treatment, whereby increasing ED utilization and driving up overall healthcare costs. 15:30 Depression is a risk factor for the development of heart disease and stroke (and is a major risk factor for poor treatment outcomes). 16:00 Carving out psychiatric treatment from most commercial health plans exacerbates access challenges. 16:30 Further access challenges posed by cash-only mental health practitioners (i.e. psychologists, psychiatrists). 18:00 Most mental health practitioners do not offer Cognitive Behavioral Therapy (CBT)(“rent a friend” mental health support is not evidence-based treatment!) 18:30 Two-thirds of patients with depression are treated in the primary care setting – lack of specialization in treatment leads to over-reliance of pharmacological interventions. 19:30 The lack of medical concordance in behavioral health therapy due to lack of familiarity with the current evidence base. 21:30 Dr. Nemeroff discusses his research in psychedelic-assisted therapy for treating military veterans and their families dealing with PTSD (see Heroic Hearts Project and The Mission Within). 23:30 How psychedelics have fundamentally changed the lives of military veterans. 24:45 The promising research from Multidisciplinary Association of Psychedelic Studies (MAPS) on MDMA treatment of PTSD. 25:00 Recent study on MDMA-assisted therapy for severe PTSD (“the largest magnitude effect benefit of the psychedelic in any psychiatric condition studied so far”). 27:00 The National Institutes of Health recently awarded a grant to scientists at Johns Hopkins University to study whether psilocybin can help people quit smoking tobacco. 27:15 Dr. Nemeroff discusses his interest in studying the use of psilocybin to treat alcohol use disorder. 28:30 Private foundation funding of study to evaluate treatment of severe depression using both psilocybin and transcranial magnetic stimulation (TMS). 30:00 The vast majority of those receiving moderate high doses of psilocybin have mystical experiences that are forever life-altering. 80-90% of people often report their psychedelic journey as one of the top 5 most meaningful and spiritual experiences in their entire life, comparing it to the birth of their first child or the death of a parent! 30:30 The classic psychedelics like mescaline, LSD, psilocybin, and DMT have effects that emerge from a particular type of serotonin receptor in the brain. 31:00 “Although psychedelics share a common pharmacological property, it is still unclear what the real mechanism of action of psychedelics actually are. We need to better understand this through research.” 31:45 “The psychedelic experience is not for the faint-hearted.  It is pretty intense.” 32:30 Can non-hallucinogenic psychedelic analogs be created that block the psychedelic experience but still provide the same therapeutic benefits? 33:00 Dr. Nemeroff discusses the effects of psychedelic neuroplasticity where the brain can actually become rewired to overcome incessant fear-based thinking associated with mental health conditions. 35:30 “Psychedelics can help those suffering from PTSD and depression overcome the ‘circle of hell’ associated obsessive thought storms and irrational fear generalization.” 37:00 Given the overlapping experiences of ego dissolution and expanded consciousness between meditation and psychedelics, should we consider meditation as a core component of psychedelic therapy? 39:00 The need for medical supervision in the administration of psychedelic medicines and the importance of identifying ideal candidates for treatment. 40:00 The adverse consequences of allowing the widespread use of psychedelics to proliferate without regulation. 40:30 The US psychedelic drugs market is projected to grow from $2 billion in 2020 to $10.75 billion due to research innovation and the increasing prevalence of treatment-resistant depression and mental health disorders. 41:30 Dr. Nemeroff discusses recent psychedelic company IPO activity and the drive to commercialization. 43:00 Most promising research that will lead to immediate commercialization opportunities are MAPS (MDMA for PTSD) and Compass Pathways (psilocybin for TRD). 44:00 How much will companies charge for these new psychedelic therapies once they are approved to make them commercially viable? 45:45 How will the FDA handle the approval of psychedelic therapy in conjunction with psychotherapy? 47:15 How will Psilocybin or LSD microdosing be treated in the context of approved therapies? 48:30 Mescaline, psilocybin, and ayahuasca have be used for thousands of years, administered in cultural contexts that are ritualized with use limited to religious or healing purposes. 50:00 The ethical concern for quality assurance to provide dosing consistency of psychedelic medicines. 51:30 Personality contraindications to taking psychedelics. 52:00 Psychedelics are not drugs of abuse – no one takes them every day. 52:30 Tragic outcomes will quickly change the dialogue on the treatment potential of psychedelics. We must be careful! 53:45 The potential to provide psychedelic medicines in a controlled palliative care setting to help cancer patients deal with end of life.

The healthcare industry is facing immense financial pressure. Staffing shortages, skyrocketing labor costs, continuing supply chain disruptions, inflation, rising interest rates, and volatile markets are pressuring both revenue and expenses for provider organizations. These economic challenges, however, are an opportunity to catalyze value-based care.  The promise of value in health can lift up communities through improved clinical outcomes, reduced disparities, financial rewards associated with population health, and emerging opportunities for upskilling the workforce.  Now is the time to prioritize value-based care as a key strategic priority for long-term success and sustainability. There are few other health systems in the country that have demonstrated more of a longstanding commitment to transformation than Ochsner Health through its population health enterprise. A leader in innovative healthcare delivery, Ochsner Health Network (OHN) is the accountable care network of the massive Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana (and one of the largest health systems in the Southeastern region of the US). Ochsner has 47 hospitals and more than 370 health and urgent care centers across Louisiana, Mississippi, Alabama, and the Gulf South. Ochsner Health Network – the value-based care arm of the health system –has 277 affiliated physician practices with nearly 3,500+ physicians spanning 625 locations. They are responsible for managing 406,000 lives across six risk-based, accountable care contracts in their value-based care portfolio. Through its collaborative efforts, OHN is making a difference for the nearly 1 million patients throughout Gulf South communities each year. In this week’s episode of the Race to Value, we are engaging two incredible leaders from Ochsner Health Network (OHN). As Chief Executive Officer for OHN, Eric Gallagher is responsible for directing network and population health strategy and operations, including oversight of value-based performance management operations, population health services and care management programs, post-acute and home care strategies, value-based analytics, and OHN network development and administration.  Joining him is Dr. Sidney “Beau” Raymond, the Chief Medical Officer for OHN who is board-certified by the American Board of Internal Medicine and has been on staff at Ochsner since 2016 and practicing medicine since 2000.  These two leaders discuss what it takes to transform a health system in the “race to value” and how to ultimately improve the health for an entire state in the process!   Episode Bookmarks: 01:30 Ochsner Health Network (OHN) is the value-based care arm of the Ochsner Health system – the largest nonprofit, academic healthcare system in Louisiana. 02:30 Through its collaborative efforts with patients, communities and employers, OHN is caring for nearly 1 million patients in Gulf South communities. 04:00 Introduction to Eric Gallagher (CEO, OHN) and Dr. Sidney “Beau”Raymond (Chief Medical Officer, OHN) 05:00 Support Race to  Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts! 06:00 A recent Kaufman Hall report on the mounting pressures facing providers (e.g. staffing shortages, labor costs, supply chain disruptions, inflation, rising interest rates, volatile markets). 07:30 Eric Gallagher discusses the critical challenges of staffing shortages and the skyrocketing cost of labor. 08:30 “Staffing shortages and rising costs of labor is a critical challenge. It serves as a catalyzing environment for value-based care.” 09:30 Investments in value-based infrastructure has forged collaborative relationships within the entire system. 11:00 Dr. Raymond on how post-pandemic workforce pressures have impacted primary care access and care delivery innovation. 13:00 The number of Americans ages 65 and older is expected to more than double over the next 40 years. 14:00 Approximately 10,000 Americans are aging into Medicare each day. 15:00 The Ochsner value journey in caring for seniors — from global capitation risk in Medicare Advantage to the Ochsner Accountable Care Network (OACN) ACO. 15:30 OCN/OACN have saved CMS over $100 million in the last 5 years! (recent press release on OACN Shared Savings Results) 16:30 Ochsner Health Plan – the only Medicare Advantage plan sponsored by and fully integrated with Ochsner Health. 17:30 Oschsner 65 Plus – a new initiative consisting of freestanding, PCP value-focused clinics delivering high touch, team-based primary care for seniors. 20:00 In the last three years, OACN MSSP ACO has doubled in size to 63,000 attributed beneficiaries. 21:30 How Ochsner has improved quality results performance in the ACO and is scaling it through continued growth. 23:00 The importance of value-focused leadership in building infrastructure and culture to drive performance outcomes. 23:45 “You can’t undervalue the importance of having the talent, leadership-buy-in, and investment to drive value-based outcomes.” 26:00 How senior-level engagement and alignment creates an environment for care delivery innovation. 27:45 The elevation of value-based care to one of four pillars of success for Ochsner Health. 28:00 Hardwiring VBC success into the compensation model for both system executives and physicians in the Ochsner Health enterprise. 28:30 How primary care engagement has led to next-level partnerships with specialists in the network. 30:00 How compensation plans and bonus incentives have driven provider engagement in value-based performance. 33:00 Ochsner’s partnership with Walmart to provide integrated, coordinated, high value care for employees across Louisiana. 34:30 The importance of employer-provider partnerships in improving the health and wellness of a workforce. 35:30 Sharing of financial-risk with self-funded employer-sponsored health plans. 37:00 Negotiating PMPM prospective payment with employers for a care management team model that improves clinical outcomes. 40:00 How Ochsner has been very intentional in building a population health data infrastructure to support its partner physicians. 41:00 Using claims groupers and population-based analytics to evaluate the totality of care spend for specific patient populations. 41:45 Collaborating with partner hospitals and community physicians to democratize population health data analytics at the point-of-care. 43:00 “HIT infrastructure capability and democratization of data at the point-of-care are the dual challenges in reaching greater depths of analytical precision.” 43:45 Ochsner’s patient population: 14-percent have diabetes and 40-percent have hypertension. 44:00 Improving outcomes for patients through enrollment in the Ochsner Digital Medicine program. 46:30 The use of algorithms for personalized care interventions to better engage chronically ill patients. 47:00 Overcoming physician concerns that the use of digital medicine is competitive to in-person E&M encounters. 47:30 The digital medicine program has improved outcomes (e.g. screenings, care gap closures, patient engagement) without diminishing office-based RVUs. 48:30 Piloting digital medicine for Medicaid populations and how that has increased care access and engagement. 50:00 Digital Health as a core component of Ochsner Health’s strategy (along with value-based payment). 51:00 The role of innovationOchsner (iO) as an important think tank and lab for digital health innovation. 52:00 Piloting the Ochsner Connected Stability Fall Prevention digital health program for MA members who are the highest risk of falls. 56:30 How the Ochsner population health enterprise delivers integrated behavioral health in the primary care setting. 58:00 Virtual behavioral health integration as the next big opportunity for care delivery innovation. 59:00 The Office of Professional Well-Being at Ochsner that has been established to improve the well-being of the workforce. 60:00 The growing concern of burnout and moral injury with physicians, APPs, and other clinicians. 61:30 A conscious effort to minimize inbox messaging for providers as a way to eliminate administrative burdens that contribute to provider burnout. 62:30 Integration of pharmacists in primary care setting to help manage prescription refills. 63:30 Team-based care (e.g. social workers, nurses, care coordinators, dieticians, patient engagement specialists) as an opportunity to improve overall workforce outcomes. 66:30 Partnering with Higher Education for interprofessional upskilling opportunities (e.g. Delgado Community College partnership in training nurses and CHWs). 69:00 The Healthy State by 2030 initiative as a catalyst to improve health equity in marginalized and underserved communities in Louisiana. 71:00 Community partnerships that recognize the impact of education as an opportunity equalizer. 74:00 Parting comments on the importance of health equity as a societal priority that is a shared responsibility in communities.