The Race to Value Podcast

The message from state and federal regulators, healthcare leaders, and our society-at-large is being heard loud and clear:  Health equity is a moral imperative. A cultural zeitgeist for health equity has been awakened in the collective consciousness of all ethnicities in the context of COVID-19 health disparities and the ongoing fight for civil rights and social justice. The economic imperative for equity is also too big to ignore, given that inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed.  The future of equitable health is important to the future of our country, and we must address this moral imperative with business solutions. Joining us this week in the Race to Value is Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator. Dr. Bhatt is the Executive Director of the Deloitte Center for Health Solutions (DCHS) and the Deloitte Health Equity Institute (DHEI), Dr. Bhatt directs the research, insights, and eminence agenda across the life sciences and health care industry while driving high-impact collaborations to advance health equity. He is a prominent thought leader around the issues of health equity, health care transformation, public health, and innovation. Do you want to learn more about how we can create a catalytic engine for equitable health? Tune in to this podcast to learn from one of the nation’s leading minds on how to advance health equity through business solutions.  In this episode, we discuss collaboration with life sciences and health care industry to advance health equity, digital transformation, ACO REACH, and climate-related strategies.   Episode Bookmarks: 01:30 Introduction to Jay Bhatt, D.O., MPH, MPA – a leading physician executive, internist, geriatrician, and public health innovator. 03:00 Subscribe to the Race to Value weekly newsletter and leave us a review and rating on Apple podcasts! 04:30 The three root causes of health equity:  1) socioeconomic, gender, racism and other biases, 2) disparate circumstances in the drivers of health, and 3) inadequately designed healthcare systems. 06:15 Creating a catalytic engine for the future of equitable health and why the Deloitte Center for Health Solutions and The Deloitte Health Equity Institute (DHEI) are so critical to the health of this country. 06:30 “There is a workforce imperative, a market imperative, and a moral imperative for health equity. We must address the moral imperative through business solutions.” 07:00 Deloitte Report: “Inequities in the US health system cost approximately $320 billion today and could eclipse $1 trillion in annual spending by 2040 if left unaddressed.” 07:30 Collaboration with life sciences and health care industry to advance health equity, digital transformation, and climate-related strategies. 08:30 Engaging key decision makers and global leaders in health equity through Deloitte’s involvement in the World Economic Forum. 09:00 Activating Boards and C-Suite leaders in health equity and implementing place-based change through community outreach and population health interventions. 09:40 Health equity innovation through an accelerator that supports minority-led non-profit organizations and social entrepreneurs. 10:00 Addressing access to maternity care deserts that contribute to inequities throughcollaboration with the March of Dimes. 10:45 A recent research report conducted by the Deloitte’s Health Equity Institute and other partners entitled, “Collection of Race and Ethnicity Data for Use by Health Plans to Advance Health Equity.” 11:45 “Continuing to analyze the delivery of care and examine patient outcomes across demographics, including race and ethnicity but also sexual orientation, gender identities, and language is critical to administering more equitable and inclusive care, and building trust with communities across America.” 12:45 “Building and sustaining trust is critical to improve the availability of high quality race and ethnicity data to advance the journey of health equity.” 13:30 The importance of proximity and lived experience, community partnerships, transparency, and assurance of patient privacy in the collection of race and ethnicity data. 14:30 Federal agencies are advancing more inclusive standards for self-reported, voluntary identification of race and ethnicity data. 14:45 “Health Equity by Design” through interoperability standards developed by the Office of the National Coordinator (ONC). 15:30 “Transparency, trust, and partnership can improve the collection and use of race and ethnicity data. If we want better results, we have to create better systems.” 16:30 Medical Home Network (MHN)  – a FQHC that is one of the nation’s foremost clinically integrated and digitally connected delivery networks to improve the health of Medicaid beneficiaries in safety net communities in the Greater Chicago area. 17:45 Chicago is a city facing immense challenge in health equity. In the last decade, life expectancy has fallen for everyone except for non-Hispanic white Chicagoans. 18:30 ACO REACH explicitly identifies Equity – not just Value – as a central goal. Have other payment models perpetuated racism and structural inequities? 19:30 REACH ACOs now being required to develop a Health Equity Plan. 20:00 Dr. Bhatt speaks to the MHN FQHC model and how it contributes to improved community health outcomes. 21:00 Health Risk Assessments (HRAs) that drive the advanced application of AI and predictive analytics for targeting population health interventions in underserved communities. 21:45 Individuals with unstable housing have a life expectancy that is 27-years less than others with a stable housing situation. 22:30 “Industry collaboration is an ecosystem. The alliances we make support trust, collaboration in alternative care sites, and reduce friction to care access.” 23:00 The importance of the “Digital Front Door” and Virtual Care Delivery Transformation in value-based care. 24:00 How SCAN Health Plan educed disparities in medication adherence for cholesterol medications by 35%. 26:30 The ACO REACH payment model and a data-driven strategy will be key to designing a more equitable model for care delivery. 27:30 Translating key learnings in equity improvement through rapid cycle evaluation and improvement in action. 28:00 An example of a SDOH intervention to find improved housing for someone dealing with allergen exposure. 29:00 Seizing the moment for industry to galvanize around the advancement of health equity. 30:00 The seminal IOM Report, Unequal Treatment, that determined Black and Hispanic Americans typically receive lower quality of care—across a range of diseases—when compared to white Americans. 31:00 Referencing the recent actuarial analysis from Deloitte entitled, “Breaking the Cost Curve” 32:00 Dr. Bhatt explains why our country can no longer afford to endure systemic health inequities. 32:30 COVID-19 awakened a national consciousness for health equity. 33:00 How nonprofits, CBOs, governments, and the private sector can collaborate to overcome the challenges of the past, heal the present, and build a more resilient healthcare system for the future. 33:30 Gender equity and how placed-based change can help to identify, understand, and address social issues. 34:00 Diversity, Equity, and Inclusion (DEI) in the workforce as a key lens and driver of health equity. 34:45 Creating an ecosystem for equity through community partnerships and collaboration. 37:30 How digital tools (e.g. SMS texting, virtual care, remote patient monitoring, VR) can empower healthcare consumerism. 38:45 Creating digital literacy and improved access to broadband connectivity in underserved communities. 40:30 Designing clinical workflows and implementing training programs to avoid provider burden. 41:00 The impact of life sciences and research & development to improve diversity in clinical trials and address issues with pricing and affordability. 41:30 Referencing the 2022 Deloitte Global Life Sciences Outlook focused on health equity innovation in the life sciences sector. 42:00 Dr. Bhatt speaks about the need to improve diversity in clinical trials. 43:30 Establishing relationships with community leaders in black colleges and minority-serving institutions. 45:00 Dr. Bhatt discusses the future of Public Health and how it will overcome extreme challenges such as a decades-long backlog of funding needs and a global pandemic. 48:00  The complex relationship between climate change and health equity (climate change is now the “greatest threat” to global public health) 49:30 Dr. Bhatt on how climate change exacerbates health inequities and increases the total cost of care. 51:00 “Climate change stands out as a key force multiplier that amplifies the effects of health inequities in an exponential, non-linear way.” 53:00 Parting thoughts from Dr. Bhatt on rebuilding trust between minoritized communities and the health care sector.

Dr. Keith Fernandez, Chief Clinical Officer of Privia Health, discusses physician enablement and the potential for success in value-based care. Topics covered include leveraging healthcare technology, gathering important data, improving efficiency with technology, exploring revenue streams and clinical research, and the future of healthcare.

Dr. Jamy Ard, an expert in patient engagement and obesity management, discusses virtual weight loss management in value-based care with Rich Steinle. They explore the destructive effects of obesity on the healthcare system, the comprehensive approach to weight management, the role of behavior change in a weight loss program, the importance of trust and relationships in patient-centered care, and addressing health disparities and bridging the digital divide.

This week on the Race to Value you will hear from Dr. Neil Wagle, the Chief Medical Officer at Devoted Health. This is a company we have been wanting to profile on the podcast for quite some time! Devoted Health is a healthcare company that designs Medicare Advantage plans for seniors; however, they are so much more than just a MA plan. Devoted Health has built a different model of care that starts with knowing their members on a personal level and earning their trust. By focusing on each member as a person and not as a chart, they are able to provide the best quality care for older Americans through an all-in-one healthcare solution combining the MA plan, access to high quality local providers alongside virtual and in-home care, and full-service guides—with world-class proprietary technology powering it all. This company is a leading innovator in value-based care. Dr. Neil Wagle knows a thing or two about transforming healthcare. He is an internal-medicine physician by training, spent six years at Partners Healthcare (now Mass General Brigham) leading the health system’s efforts to improve the quality of care for patients. In 2017, he joined Devoted Health, a $12.7 billion health-insurance startup. As its chief medical officer, he’s spearheading the development of a model of care aimed at improving the health of older Americans by getting them the right care at the right time while saving costs for the US healthcare system. In this episode, we discuss clinician burnout and moral injury, post-pandemic recalibration of the healthcare system, virtual care delivery, the benefits of a fully-integrated technology platform, health equity transformation, creating a virtual “Blue Zone”, patient-reported outcome measures, activation of chronically ill patients, and the importance of company culture in delivering relationship-based care. Episode Bookmarks: 01:30 Introduction to Dr. Neil Wagle, the Chief Medical Officer at Devoted Health. 03:45 Dr. Wagle provides his background as a “synthesizer between medical-scientific world and the business world.” 04:15 Inspiration and mentorship from Dr. Tom Lee and being a part of Mass General Brigham’s first value-based contract. 04:45 “We’ll probably lose $70m in the first year, but we’re moving to value-based care because it is the right thing for patients.” 05:45 A chance coffee meeting with Ed Park led to the “ridiculously challenging” quest to build a system that could radically transform healthcare! 07:00 Provider burnout and moral injury is one of the major crises in healthcare (along with rising costs and inadequate care for aging Americans). 08:45 Dr. Wagle on how the pandemic has exacerbated moral injury and why we need to return to the altruistic underpinnings of medicine. 09:30 “The ability for physicians to connect with others has been decimated by overbooked 15-minute visits.” 09:45 How documentation requirements in fee-for-service medicine robs providers of “pajama time” with their families. 10:00 The Great Resignation in healthcare is being driven by the perpetuation of the fee-for-service business model. 10:30 Resolving the three crises of healthcare (i.e. Provider burnout, aging population, and rising healthcare costs) through care delivery transformation. 11:00 The good news in VBC: providers want to practice medicine in this way and patients actually have better outcomes with lower costs! 11:45 “You have to be able to monetize fewer hospitalizations. If you can’t, the value-based model of care won’t work financially.” 12:30 The emotional fuel of seeing better patient outcomes in VBC drives continual value-based care transformation. 13:00 The new wave of healthcare consumerism from the pandemic is causing a much-needed recalibration of care delivery. 14:00 “COVID exposed cracks in our fee-for-service model…” 15:45 “Value-based care is actually the ideal home for virtual care services because you don’t have to worry about over-utilization.” 16:00 Dr. Wagle describes how Devoted Health dramatically improves the health and wellbeing of Americans through person-centered care. 16:30 The “all-in-one healthcare” offering of Devoted Health as a virtual in-home medical group and MA plan, enabled by full-service guides and integrated technology. 17:30 Medicare Advantage patients receive this “all-in-one” care for free as part of their enrollment in the health plan. 17:45 Scaling a virtual care model further enhanced Devoted Health’s mission to treat members like family. 19:15 Overcoming the challenges of loss aversion in the perception of patients when adopting a virtual-first care delivery model. 20:00 The benefits of a virtual-first mentality when it comes to organizational scalability and culture. 21:30 Devoted Health has developed an end-to-end data and technology system that choreographs care delivery in a single, vertically integrated, tech-enabled model. 22:00 Dr. Wagle on the well-deserved skepticism of technology as a panacea…but how that is balanced with the practical vision of Ed and Todd Park. 22:45 Building a full-stack technology platform from the ground up was necessary (market-based solutions are based on FFS medicine and are incredibly fragmented). 23:00 Full-stack tech platform at Devoted does everything! (e.g. sales, enrollment, pharmacy, medical claims, prior authorizations, customer service, full EHR) 23:30 “Having a full-stack technology platform with all information in a single place allows us to deliver on the promise of complete, coordinated, and customized care.” 24:00 How human-centered technology design drives targeted population health interventions and personalized care delivery. 27:00 Human connection (relationship-based care) can be fostered with a full-stack technology platform because people don’t have to remember minute details. 28:00 Enabling tech-enabled rapid cycle innovation to deliver improved population health outcomes. 29:00 The challenges of defining “value-based care” and how health equity is changing how we understand value. 30:30 The historical debate about the adjustment of outcome measures to account for demographic factors. 31:00 “The world has moved to a different place where we have put a spotlight on health equity itself, rather than burying it in adjustment methodologies.” 31:45 How “Community Guides” at Devoted Health correlate the overcoming of SDOH with the Maslow Hierarchy of Needs to help members achieve full potential. 32:30 An example of how helping a member successfully enroll for public benefits can give them an extra $ 325/mo. 33:00 The development of a Health Equity Dashboard to measure their impact in closing equity gaps. 34:00 The product goal of Devoted Health is to be the world’s first virtual “blue zone” where people enjoy much longer, healthier lives than average. 35:00 “Longevity is not the ultimate goal. The first task of a health system is to make sure we treat people like family so they are happy and fulfilled.” 36:30 Dr. Wagle on what it really means to create a virtual Blue Zone at Devoted Health. 37:45 Creating the “Devoted Social Club” to help members overcome loneliness and social isolation through human connectedness and resilience tools. 39:30 Dr. Wagle on why the people and the culture is the foundation of Devoted Health. 41:30 “As we go out and look for new team members we look for experience, clinical acumen, and love in your heart.” 43:00 Caring for the clinician workforce so they can cultivate the love in their heart for the caring of others – it is a self-perpetuating phenomenon. 45:00 Keeping the mission as a “prime directive” by closing your eyes and imagining someone you love…than take action. 46:45 How Community Guides cultivate trusting relationships with members and help people overcome their mistrust of the healthcare system. 47:30 Spending time with members as an enabler of trust and empathy (e.g. a 90-minute phone call). 49:00 Trusting relationships are why Devoted Health has such a high net promoter score of 79 (higher than Apple, Netflix, and Amazon). 50:30 Starting with “Patient Priorities Care” in member engagement first…and then moving to data-enabled, rapid-cycle deployment of interventions. 51:30 Dr. Wagle discusses the importance of Patient-Reported Outcome Measures in value-based care. 54:00 6 in 10 adults have a chronic disease, and it is the leading driver of the nation’s $3.8T healthcare spend. 54:30 Dr. Wagle provides examples of how Devoted Health is making an impact in medication adherence and Hgb A1c reduction. 56:00 85% of diabetic members have their blood sugar under control, with an average A1c reduction of 2.3 within 100 days. 56:30 77% of hypertensive members now have their blood pressure under control, with an average reduction in systolic BP of 15.2 within 40 days. 57:00 Reduction of acute events related to Congestive Heart Failure by 50%. 57:45 Dr. Wagle shares an a research example of “learned helplessness” in dogs and how that behavioral pattern relates to most chronically ill patients managing their disease. 60:00 “We must relate clinical outcomes back to patient priorities. Those cycles are what capture momentum.” 61:30 Dr. Wagle discusses company growth and expansion and how Devoted Health is entering eight new states in 2023. 62:15 How will Devoted Health consistently replicate and scale as it enters into new markets at a national level? 64:00 Parting thoughts of appreciation from Dr. Wagle and how gratitude makes dreams come true in value-based care! 64:45 “Value-based care is more than possible…it is coming.  The arc of history is bending towards progress, and I am grateful to be a part of that journey.”

Did you know that an estimated 80 million Americans currently lack access to dental care? As oral health is essential to the overall health and well-being of an individual, the high volume of those without access can have potentially devastating health consequences such as an increased risk of developing cardiovascular disease, respiratory disease, diabetes, and adverse pregnancy outcomes.  Oral health can also influence eating habits and sleep patterns, which in turn can adversely impact both physical and mental health. And tragically, research shows that poor oral health is more common among individuals with lower income and educational attainment. And in value-based care, the growing number of emergency department visits for conditions related to poor oral health clearly shows the relationship between oral health and physical health. (There are approximately 1.8 million hospital ED visits annually for non-traumatic dental conditions which cost $3.4 billion to treat!) We need to establish a more integrated, accessible, and equitable oral health landscape in our country. In this special episode, you will hear from a leader in the field of oral health who is working to reduce disparities in access to and quality of care. Kaz Rafia is the Chief Health Equity Officer for the CareQuest Institute for Oral Health — a leading national nonprofit focused on creating a more accessible, equitable, and integrated oral health system. At CareQuest, he leads strategic initiatives to advance access to integrated oral health care for ethnically and socially diverse communities. He is someone definitely leading us in this Race to Value! If you like what you hear, you can also access a companion blog to this episode entitled, “Why Oral Health is Critical in a Value-Based System” brought to you by the Institute for Advancing Health Value and the CareQuest Institute for Oral Health!   Episode Bookmarks: 01:30 An estimated 80 million Americans currently lack access to dental care. 01:45 Lack of dental care can lead to devastating health consequences and an increased risk of developing chronic disease. 02:30 Introduction to Kaz Rafia and the CareQuest Institute for Oral Health 03:30 Companion blog to this episode: “Why Oral Health is Critical in a Value-Based System” 04:30 The link between oral health and community health. 06:30 Kaz speaks about the work that CareQuest is doing in building alliances to create a more accessible, equitable, and integrated oral health system. 07:00 “The inability of a person to receive oral health care is a clear threat to their overall health far beyond the mouth.” 07:30 Chronic periodontitis results in a higher risk of developing Alzheimer’s disease. 07:45 Oral care is a key intervention for reducing the risk of aspiration pneumonia. 08:00 The link between poor oral health and adverse birth outcomes. 08:30 CareQuest has developed MORE Care to integrate oral health capabilities into a person-centered primary care model. 09:30 Community Oral Health Transformation (COrHT) initiative and framework for safety net dental clinics to transform oral health care delivery. 11:00 Health disparities data showing that oral health varies across racial and socioeconomic lines. 12:00 Drivers for lack of access to dental care include geographic isolation, lack of transportation, and poverty. 13:00 How poor Medicaid reimbursement and “provider clustering” due to compensation economics contributes to oral health disparities. 14:00 Black adults are 68% more likely than white adults to have unmet dental care needs. 14:30 Dental coverage gaps contributing to oral health disparities in rural communities. 15:30 Alabama is now the only state currently lacking adult dental care benefits in Medicaid. 16:00 “The work done to evangelize value-based care models in dental care are reducing barriers to access nationally.” 17:30 World Health Organization recognition of dental care as a fundamental human right and their landmark global strategy on oral health. 18:30 Kaz discusses the importance of value-based care in oral health and how we define it. 19:00 Examples from Sweden and other countries on how to provide universal access to dental care. 19:45 The use of dental therapists to expand access to dental care and the recent legislative win for dental therapists to practice in Oregon. 22:00 The importance of clinical integration and how the “100 Million Mouths” campaign is integrating oral health into primary care. 23:30 Complications associated with lack of oral health, e.g. high blood pressure, diabetes, Alzheimer’s, poor pregnancy outcomes, behavioral health issues. 24:00 Research showing that medical-dental integration can enhance closure of medical care gaps. 24:30 Value-based opportunities to lower costs and improve clinical outcomes, e.g. checking Hemoglobin A1cs at dental appointments for diabetic patients. 25:30 Kaz discusses how the 100 Million Mouths campaign is integrating dental health into medical school curriculum. 26:45 There are 1.8 million hospital ED visits for non-traumatic dental conditions (NTDCs), which cost $3.4 billion to treat. 28:00 Kaz discusses the financial impact of non-traumatic dental conditions and how trends in ED utilization for NTDCs relate to social determinants of health. 29:00 Out-of-pocket expenditures are 40% of overall dental care spending and how this contributes to lack of optimal oral health outcomes. 30:30 “Accrued interest” that occurs when delays in front-end dental care treatment and prevention results in costly ED visits. 31:00 NTDC-related ED visits costs 3X what a regular dental visit would cost. 31:45 90% of NTDC-related visits are only given treatment for pain and then referred back to the dentist! 33:00 The mouth horror scene in Cast Away and how that relates to the millions of people facing access challenges to dental care! 33:30 6 million adults lost their dental insurance during the COVID-19 pandemic! 35:00 Kaz discusses the impact of the pandemic on dental care delivery and the potential for telehealth innovation in the long-term. 37:00 Teledentistry as a successful modality for triaging care needs to avoid unnecessary ED visits. 38:00 Investments to scale a value-based care infrastructure for oral health. 40:00 Kaz discusses the recent progress being made by CMS to include dental benefits coverage in the Medicare program. 42:00 “Oral health care is, in fact, health care.” – Kaz explains why preventive dental care coverage makes sense in value-based care transformation! 44:00 Anti-Racism in Dental Public Health: A Call to Action and the recent CareQuest collaboration to expand research in this area. 45:00 “Racism is a public health epidemic, and having difficult conversations is a key ingredient to change.” 46:30 “Being anti-racist is not a zero-sum game that takes away from anyone else. It is about the betterment of our society.” 49:00 Investing in Health Equity Innovation – how CareQuest Innovation Partners through a new initiative called SMILE Health will scale early-stage startups. 50:00 How do we effectively invest in health equity in a sustainable and meaningful way? 54:00 A recent CareQuest Institute survey revealed that more than half (51%) of oral health providers surveyed had never heard of APMs in dentistry. 55:30 Kaz on the importance of understanding the past to envision a more optimistic future for value-based care. 57:30 “The misnomer of dental insurance is that it seems more like a luxury than an absolute need and human right to ensure population health.” 59:00 nspiration from Michael Leavitt in the building of alliances to impact health inequities and low value care.

Paying it forward begins in the heart. Leaders who use their gifts in the service to others are those who understand that value given is value added. By every measure of success, Dr. Shawn Griffin has become one of the most impactful physician executives in value-based care transformation. And his story is all about how he recognized his unique gifts and built amazing teams to improve population health outcomes. Additionally, his sharing of best practices and key learnings with others across the country – through peer learning and mentorship – has amplified impact in improving the lives of others. The host of this podcast, Eric Weaver, was one of the people impacted by the mentorship of Dr. Shawn Griffin. His mentorship inspired Eric to make a difference as an evangelist for a better way of delivering care in this country. In this episode, you will gain access to an in-depth conversation with Dr. Shawn Griffin, the President and CEO of URAC. You will be inspired by his servant leadership in the pursuit of value-based medicine, and you will learn of his career path from rural physician to one of the leading physician executives in the country. We discuss the important of team-based care delivery and primary care transformation.  We also cover such important topics as healthcare accreditation, quality improvement, rural health care, pharmacy integration, technology innovation, and genomics-based care. The truest measure of a leader is whether they are generous, have a big heart, and pay it forward. Dr. Shawn Griffin is the quintessence of this type of servant leadership in the race to value!   Episode Bookmarks: 01:30 Introduction to Dr. Shawn Griffin, the President and CEO at URAC 04:00 Eric shares a personal extension of gratitude to Dr. Griffin for the mentorship he provided years ago. 06:45 Dr. Griffin describes his journey in value-based care, beginning in the early days of practicing rural family medicine. 08:00 The United States is an outlier in that Primary Care is not at the center of medical care delivery. 08:45 A decision to impact more lives by taking on leadership roles in system design and care delivery transformation. 09:30 How love for family and others manifested into a commitment to patient care quality. 10:30 Building an effective Population Health Team at Memorial Hermann ACO during his leadership tenure. 11:00 The importance of effective storytelling and celebrating wins to drive value transformation. 12:00 “One has to decide in life if they are going to use their gifts to help themselves or help others.” (how VBC leadership is Dr. Griffin’s way of paying it forward) 12:45 The impact of constantly changing health policy on ACO success (and how frustration led Dr. Griffin to make a difference at a federal level). 13:30 How mentorship and teaching in value-based medicine can transform care delivery on a national scale. 17:00 Dr. Griffin explains the importance of accreditation programs and how URAC was founded to set standards in healthcare. 19:00 Specialty Pharmacy Services Accreditation as an example of standard setting to drive quality improvement. 20:00 Telehealth Accreditation and how “Telemedicine is more than just a good camera. It is good quality medical care using technology to do it.” 21:00 “Raising the bar and advancing the quality mission as things change is what accreditation should be doing.” (Reference video on revamping telehealth accreditation) 22:00 Why an accredited program (e.g. URAC Gold Star) provides a basis for a patient to validate their trust in the care provided. 23:00 Dr. Griffin discusses how URAC accreditation is driving care delivery redesign across the world (e.g. Egypt and Saudi Arabia). 25:00 The challenges of defining health care quality. 26:30 “Measuring quality is an ongoing unsolved problem in health care.” 27:30 The power of a trusting patient-provider relationship in care quality and how patient definitions differ. 28:30 The limitations of HEDIS measures. 29:30 Quality measurement data capture at the point-of-care is a major contributor to provider burnout (“checking the boxes”) 32:00 “Most of us have better information available on picking a hotel in Paris than we do selecting a high quality primary care provider.” 34:00 Realigning incentives to get more medical students to practice family medicine in rural communities. 35:00 The role of the federal government to ensure adequate access to primary care in rural areas. 36:00 The crushing economic pressures on rural hospitals. 36:30 “We talk about food deserts in cities. We have provider deserts in the country.” 37:30 “If we are concerned about providing electric charging options for someone’s Tesla crossing the country, perhaps a bigger concern is whether you can receive healthcare in rural parts of the country.” 40:00 Dr. Griffin on opportunity for pharmacy integration and team-based care. 41:00 “One of the good things about medicine in the last 40 years is the recognition that a ‘captain of the ship’ model is not sustainable for doctors or patients. Team-based care is the way to go.” 42:30 The role that URAC is playing in Pharmacy Accreditation and Rare Disease Certification. 45:30 Dr. Griffin on the importance of data liquidity and information sharing in value transformation. 47:00 How concerns about HIPAA compliance (a “HIPAA-chondriac”) can contribute to the problem of data siloing. 47:30 “More data is not always better for physicians. Technology will not always make health care better. A relationship will do more for a person’s health.” 49:00 Balancing Population Health Management with Targeted, Individualized Interventions (examples such as Kaiser Permanente, Intermountain, UPMC). 52:30 Dr. Griffin discusses how the pandemic shifted consumer demand for telemedicine and what we should expect for telehealth delivery in the future. 54:00 Behavioral health telemedicine visits are effective. Pre-surgical screening for heart transplants does not work with telemedicine. 55:00 The “Telemedicine Tug-of-War” going on nationally and why we must always consider the most appropriate application of technology. 56:00 Convenience doesn’t trump quality. 57:00 Telemedicine, Remote Patient Monitoring, Wearables, ML/AI – these will not suddenly make healthcare the “Garden of Eden” overnight. 58:30 Parting thoughts on genomics-driven care and individualized-care planning in a population health model. 59:00 A patient’s Walmart receipts are more valuable to a physician than genomic data. 60:00 Screening genomics for hereditary diseases are scaling as costs come down, but we still cannot discount the impact of lifestyle choices on health. 63:00 How to find out more about URAC and the importance of peer learning and sharing of best practices.

Did you know that musculoskeletal care is one of the biggest challenges facing the value transformation of healthcare?  Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade!  Many of these procedures (such as knee replacements and spinal fusions) contribute to overspending on care that is not even needed, as it has been estimated that only 50% of MSK procedures are evidence-based. The rising costs ofmusculoskeletal care is now a top cost driver for employers and health plans. Yet despite rising costs, MSK outcomes for members haven’t gotten better over the last ten years. Studies have shown that, despite a dramatic increase in health care expenditures for patients with back and neck problems over the last decade, there has not been a corresponding improvement in patient clinical outcomes. In short, spending more money has not correlated with better outcomes.  We are in dire need of a value-based revolution in the provision of musculoskeletal care. The current system is clearly broken. Studies have demonstrated that common approaches to MSK care (surgery, imaging, injections, opioids) do not effectively resolve back and joint pain. And the challenges of escalating costs associated with such low value are too big to ignore. There is a better way, and this week on the Race to Value, we interview two of the leading innovators in orthopedic value-based care! In this special episode, we will begin with an interview with Dr. Kevin Bozic, the chair of surgery and perioperative care at the Dell Medical School at The University of Texas at Austin. He is an internationally recognized leader in orthopedic surgery and value-based health care payment and delivery models and currently serves on the Board of Directors for the American Academy of Orthopaedic Surgeons – a clear signal from the AAOS that the specialty is moving into the value-based care arena. Our second interview on the podcast is with Dr. Kian Raiszadeh, the CEO and Co-Founder of Livara and SpineZone, an orthopedic surgeon who has created an innovative orthopedic care management system for payors, providers, and health systems to unify the patient experience and transition to orthopedic value-based care. Episode Bookmarks: 01:30 Musculoskeletal healthcare spending is rising at an unsustainable rate – having doubled in the last decade! 01:45 It has been estimated that only 50% of MSK procedures are evidence-based. 02:00 Increased MSK spending in healthcare not associated with a corresponding improvement in patient clinical outcomes. 03:00 Introduction to Kevin Bozic, M.D., MBA and Kian Raiszadeh, M.D. 03:45 Upcoming conference in value-based orthopedics – OVBC on January 26th-28th 05:00 At the Musculoskeletal Institute at UT Health Austin, Dr. Bozic has created a MSK Integrated Practice Unit. 06:30 Dr. Bozic provides an overview of the Musculoskeletal Institute and how it functions as an Integrated Practice Unit. 07:30 “The vast majority of patients with musculoskeletal conditions do not require or benefit from surgery.” 08:00 The role of the primary care in treating MSK disease within a “musculoskeletal medical home”. 08:45 Comorbid conditions with chronic MSK disease (e.g. anxiety, depression, obesity) are rarely treated in a non-integrated model. 09:45 Holistic integration of primary care-based orthopedic physicians, APPs, physical therapists, dieticians, and social workers. 12:30 Dr. Bozic discusses the potential for condition-based bundled payments in the treatment of MSK disease. 13:45 The role of bundled payment care pathways in lowering overall costs with better clinical outcomes. 14:00 How reduction of inpatient post-acute care can result in lower episode spend with “no detrimental impact on patient outcomes.” 15:00 The big value opportunity — addressing the continuum of care across the spectrum of disease (not just focusing on the surgery). 16:00 Redesigning MSK delivery for optimizing outcomes associated with pain, functional status, and quality of life. 16:30 “Value is all about improving health outcomes in ways that over time reduce the cost of health care. Health is inherently less expensive than disease.” 17:00 The Value Institute for Health and Care and its work in improving health outcomes. (Reference podcast with Elizabeth Teisberg). 19:00 Dr. Bozic discusses the important of patient-reported outcomes (PROs) and how they are used in his musculoskeletal IPU. 20:45 How PROs provide an understanding of a patient’s baseline for pain, functional status, quality of life, and mental health. 23:30 Dr. Bozic provides his parting thoughts on physician leadership in the progression of VBC and the role that AAOS will play in this movement. 26:45 Dr. Raiszadeh and his founding of SpineZone and Livara to reverse the trend of overutilization in orthopedic care through integrated care delivery. 29:30 Dr. Raiszadeh provides perspective on the lack of value-based care from his years of practicing as an orthopedic surgeon. 31:00 “We can create a radically new patient experience in orthopedics allows patients to heal without surgical intervention.” 33:30 Dr. Raiszadeh describes the concept of Orthopedic Whole Health and how it evaluates patients comprehensively from the top-down. 35:30 The impact of obesity, anxiety, and depression on hormonal physiology that affects how patient sense musculoskeletal pain. 36:30 “MSK pain is like the canary in the coalmine. It is giving us an indication of something that is deeper, and that is what Orthopedic Whole Health addresses.” 37:30 The life altering perspective of orthopedic whole health and how this model can be built to scale. 38:00 Transitioning orthopedic care from a biomedical to a biopsychosocial model. 39:00 In the 1990’s, doctors began to view pain as a fifth vital sign, and they over-prescribed opioids (without focusing on safer and more holistic interventions). 40:00 Dr. Raiszadeh discusses the Bio Psychosocial Model of Pain Management in value-based care. 41:30 60-70% of orthopedic patients experience some degree of anxiety, depression, or shame and anger associated with childhood trauma. 42:30 How 1:1 and group sessions, expressive writing, and meditation can be used in MSK treatment. 43:30 Opioid dependency and risks of addiction in orthopedic care. 45:00 “How you feel is the overall foundation of health. It changes our entire chemical environment.” 46:00 The rise of consumerism in orthopedic care and how SpineZone’s consumer-centric model boasts an industry-leading net promoter score of 94. 47:30 Dr. Raiszadeh provides his insights about orthopedic consumerism and how to change a patient’s mindset for MSK treatment. 49:30 How orthopedic consumerism and bio psychosocial care aligns with employer expectations for risk-based payment. 50:30 Creating a MSK model that is non-transactional and opens one up to all aspects of life. 51:45 The launch of Livara – an orthopedic care management system to transition to value-based care at scale. 53:00 Using cost and clinical outcomes data to build a scalable platform that applies to all of orthopedics. 54:30 Leveraging data-driven algorithms to drive diagnosis and value-based care interventions. 57:00 Parting thoughts on the movement to value-based orthopedic care.

For all of you leaders out there on a value-based care journey, it is not lost on any of you that health value has become synonymous with health equity. We are at an inflection point in our society in the recognition that everyone needs a fair and just opportunity to attain their highest level of health. Achieving this will require ongoing societal efforts to address injustice, overcoming socioeconomic barriers to health, and eliminating preventable health disparities. But we cannot do that as a healthcare industry without the proliferation and scale of payment models that align incentives so we can realize true change for the better. On the Race to Value this week, you will hear from one of the foremost leaders on the national scene who is shaping the landscape for accountable care delivery that can advances health equity. Dr. Dora Hughes is someone who has taken this charge to lead in service to the underserved so that we may realize the dream of a more equitable and healthy society. She is the chief medical officer at the CMS Innovation Center at the Centers for Medicare & Medicaid Services (otherwise known as CMMI). She leads the Center’s work on health equity, provides clinical leadership and input on models, serves as the Innovation Center’s primary liaison with medical and clinical stakeholders, and provides leadership to the Innovation Center’s clinician community. In addition, Dr. Hughes is part of the CMS Innovation Center’s Senior Leadership Team, helping to provide enterprise-level leadership and strategic direction to the Center.  In this interview, we discuss the elevated national consciousness to advance health equity, how ACOs and other risk bearing entities can succeed with a health equity strategy, and the work being done by the Innovation Center to redesign alternative payment models for equity.  We spend considerable time discussing ACO REACH and value-based Medicaid transformation as well.  This is certainly a conversation you should listen to as you plan for success in your Race to Value!   Episode Bookmarks: 01:30 Health Value has become synonymous with Health Equity — everyone needs a fair and just opportunity to attain their highest level of health. 02:30 Introduction to Dora Hughes, M.D., M.P.H., the chief medical officer at the CMS Innovation Center (CMMI) 04:30 If you control for all variables that may contribute to health disparities, African Americans still get the worst quality of healthcare of any demographic in the country. 05:30 The first pillar of CMS’ Strategy Plan is Health Equity 06:30 Cara James, Ph.D., president and CEO of Grantmakers in Health: “I’m someone who’s working on equity before it became cool to work on equity.” 07:00 Referencing the seminal findings of the Heckler Report in the 1980s that investigated racial and ethnic disparities in the United States. 08:00 Momentum has been building towards addressing health inequities, despite the historical lack of national prioritization. 08:30 “It really took the pandemic and police brutality to blast the issues of health inequities into the national consciousness.” 09:00 Disparities go beyond COVID (e.g. black disparities in maternal health, colorectal cancer, kidney disease) 09:45 “Executive pay is now being tied to reduction in disparities. You wouldn’t have heard that 10 years ago or even perhaps five years ago.” 10:00 Referencing CCSQ Deputy Jean Moody-Williams: “For those of us engaged in health equity, this is our moment, but it is only a moment.” 10:30 Actions Needed: collecting and analyzing demographic and health data,  knowing patients individually and at the population level, identifying disparities, implementing evidence-based interventions. 11:45 “It takes vibrancy, resiliency, and an indomitable spirit to tackle disparities and scale progress at a national level.” 13:00 CMMI’s work to address Social Determinants of Health (SDOH), e.g. ACOs, Accountable Health Communities (AHC) Model 14:30 80% of what contributes to health reflects non-medical or social determinants of health (e.g. healthy eating, stable housing, educational economic opportunity, jobs) 15:00 “To maximize our patients health, we as providers have to think about our role both inside and outside the health system.” 15:45 The revolutionary nature of the AHC model in fostering healthcare and community partnerships to plan SDOH interventions. 16:30 Results from the AHC Model showing a 9% reduction in emergency department use among participants. 17:00 “Our understanding of healthcare has evolved. We are not going to be able to achieve our health goals without addressing health related social needs.” 17:30 The flaw of Medicare FFS that does not allow providers to code for SDOH interventions. 18:00 The flexibility of MA benefit design and capitated payments in advanced Medicare APMs supports hiring of social workers and CHWs. 18:45 Dr. Hughes responds to criticism from providers that SDOH interventions are “out of my lane” when it comes to health care delivery. 19:30 The need for health policies to address food deserts, lack of affordable housing, weak transportation infrastructure, etc. at the community level. 20:00 Dr. Hughes describes how CMS and other agencies are working to support culturally-competent and linguistically-appropriate care. 20:45 Resources: “A Physician’s Practical Guide to Implementing Culturally Competent Care” (CMS), “Think Cultural Health” (OMH), and “Multicultural Health Care” (NCQA) 22:00 Is implicit bias within current payment models contributing to health inequities? 24:00 Referencing Dr. Hughes’ and Melissa Majerol’s recent blog in Health Affairs: “CMS Innovation Center Tackles Implicit Bias” 25:00 How the estimated glomerular filtration rate (eGFR) leads to erroneous results and findings of kidney disease in African Americans. 26:00 Another example of how a heart disease risk calculator may incorporate racial bias into diagnosis of disease. 27:30 Identifying potential sources of bias before the launch of new payment models. 29:30 The longstanding history of bipartisan support for the movement to VBC and accountable care. 30:00 The 2021 performance year marks the fifth consecutive year that the MSSP has generated net positive savings to CMS. (See recent Race to Value podcast and Institute Brief) 31:30 Dr. Hughes responds to concerns about the reduced growth and participation in the Medicare ACO program and how this challenge is addressed in the CMMI Strategy Refresh. 33:00 Addressing health equity and ACO growth through external partnerships like the Health Care Payment Learning & Action Network (LAN) and provider site visits. 35:00 Developing a CMS-wide vision for Accountable Care expansion (Referencing recent NEJM Article on “Expanding Accountable Care’s Reach among Medicare Beneficiaries”) 35:45 The ACO program is a chassis for testing innovation center models in achieving 2030 accountable care goals. 36:00 CMS has proposed scaling successful features of the ACO Investment Model (AIM)and will leverage ACO REACH more broadly in years to come. 37:30 The ACO REACH program unlike other APMs to date, has made health equity a bedrock of payment model design. 39:30 Dr. Hughes on healthcare complexity, PCP and specialist fragmentation, and the challenges of reforming the system to better care for underserved communities. 41:00 MSSP ACOs and ACO REACH models are helping providers coordinate care and improve health outcomes for Medicare beneficiaries. 42:30 How the ACO REACH model provides flexibility to healthcare providers in how they deliver and they coordinate care (e.g. telehealth, diabetes preventive care, dental care, pharmacy integration) 44:30 “ACO REACH is forging new ways to address the health inequities underserved communities experience.” 44:45 Health Equity Action Planning and Health Equity Benchmark Adjustments under ACO REACH. 46:00 Dr. Hughes addresses concerns expressed by critics of the ACO REACH model. 50:30 Dr. Hughes provides perspective on CMS’s newly refined eligibility criteria and design characteristics for ACO REACH and why it matters to advance health equity. 55:45 Dr. Hughes discusses the work that CMS is doing to advance accountable care to Medicaid beneficiaries and how they are engaging with safety-net providers. 62:00 Parting thoughts from Dr. Hughes on how CMMI is engaging beneficiaries and caregivers in conceptualizing, designing, and testing payment models.

The Quadruple Aim of physician satisfaction is such an important aspect of value-based care. In the predominant world of fee-for-service reimbursement, physicians are struggling and burned out. Consequently, over half of all doctors won’t even recommend medicine as a career.  This negative shift in wellbeing is important to understand because the attitudes and feelings of doctors bear directly on the way they treat patients. A recent Harvard report calls physician burnout “a public health crisis that urgently demands action.” Some physicians are even going as far as to say the profession is dealing with moral injury because the word “burnout” is insulting and insufficient in describing the pain they feel when the fee-for-service system prevents doctors from doing what’s right, thereby forcing them to inflict harm on patients – where physicians themselves experience a form of injury. The business of fee-for-service medicine continues to get in the way of physicians healing patients. It breaks the spirit and the heart of our physician workforce, and it is imperative that physicians become empowered to lead a system transformation.  Value-based care will be a losing effort if we do now cultivate physician wellbeing in the value journey. In this podcast, you will hear from three physician thought leaders about the plight of physician burnout and its impact in advancing the aims of the value-based care movement. Most importantly, you will learn the tools necessary to transform organizational culture to ameliorate this important workforce challenge. Speakers: – Dike Drummond, M.D., CEO, Physician Coach & Speaker, TheHappyMD.com – Moshe Cohn, M.D., Associate and Advisor, Moral Injury of Healthcare – Amadeo Cabral, M.D., President, Turning Point Healthcare Consultants Sponsored by: VBCExhibitHall.com (VBCEH) Episode Bookmarks: 01:30 The differentiation between physician burnout and moral injury. 02:15 “Physicians need to heal in order to provide their best care for patients.” 03:00 Moral injury is a symptom of something larger – our broken health care system. 04:00 Introduction to Drs. Drummond, Cohn, and Cabral 05:45 Physician burnout and moral injury is a leadership failure. 06:30 Dr. Drummond provides context for why the physician workforce is suffering. 07:30 “The business of fee-for-service medicine gets in the way of physicians healing patients. It breaks our spirit and breaks our heart.” 07:45 “Burnout is a symptom of overwhelm in a physician that cares about what they do, when their purest expression of healer, helper, and light worker is blocked.” 08:15 Burnout is a physician impairment when it comes to ensuring quality and patient satisfaction. 08:45 Dr. Cohn explains the concept of why “language really matters” in communicating the public health crisis of physician burnout. 10:00 How physician moral injury is related to a clinical diagnosis of PTSD. 11:00 The leadership need for healthcare executives to address the repeated moral injury of their physician workforce. 12:30 How physician burnout differs from burnout we observe in other facets of the non-healthcare workforce. 13:15 The repeated barriers imposed by a system that prevents physicians in getting patients what they need to get better. 14:00 Dr. Cabral explains how the “slow boiling” public health emergency of physician burnout differs from more explosive public health emergencies like COVID-19. 15:00 Referencing confirmatory research (e.g. New York Times, Advisory Board) on the incongruence between the business of medicine and relationship-based care. 15:30 “Healthcare is not a broken “business” model — it is a broken “health care” model.  It is imperative that physicians are at the table to lead a transformation.” 16:00 How do we get the incentives of business and medicine to merge into a congruent state? 17:30 The “canary in the coalmine” – physician suicides are signaling that something is wrong with the overall healthcare system. 18:00 An interesting dialogue about how Don Berwick posed an expansion to the Quadruple Aim as an apology for the Triple Aim. 19:00 Dr. Cabral on how true Value-Based Care (a wellness model) is a solution for physician wellbeing which can sometimes differ from the business model of VBC. 20:30 Dr. Cohn discusses the need a better definition for “Value” and why the Triple Aim does a disservice to the industry when the overall cost model is broken. 22:30 “As a physician, the only thing we really care about is patient outcomes. However, our outcomes are now mostly centered on checking boxes.” 24:20 Dr. Drummond reflects on the need for physicians to carve out a more rewarding practice in the reality of their business model. 24:45 Does capitation actually produce a healthier physician workplace with better patient outcomes? 26:30 The need for non-physician administrators to respect the healing encounter. (How many leaders regularly shadow their doctors?) 28:30 Dr. Cohn reflects on how investment levels prioritize societal importance (in relation to pediatrician compensation, mental health, education) 29:30 Dr. Cabral on how other countries are able to better align the incentives of their health care systems. 30:30 The physician burden of meeting end-of-life treatment expectations with heroic interventions that are costly (profitable) and result in poor quality of life. 31:45 The “classically American” problem of patients seeking low value care at end of life. (How does this factor into value-based care?) 32:45 “Eighty-percent of the hospital beds in our country are unnecessary if we granted our society the ability to determine what is a reasonable and unreasonable investment in quality of life.” 33:00 Dr. Cohn compares the current healthcare delivery system to a “fast food” model influenced by big money and advertising. 34:00 Advancements in technology and innovation in healthcare does not mean that we can fix everything that is wrong with patients. 36:15 Dr. Cabral discusses how patient satisfaction scores are being weaponized against providers. 37:30 The need for quality measures to translate into quality outcomes. (The misalignment leads to “check the box” medicine and weaponization against physicians.) 39:30 Dr. Cohn tells the painful story of a pediatric patient with a terminal brain bleed that led him to the realization of how administrators value documentation over human emotion. 41:30 Dr. Drummond explains how patient satisfaction should never be 100% (unless you are a criminal!) 42:00 “A true value journey requires a culture of provider support and a proactive burnout prevention strategy.” 42:30 The need for a super-majority value-based revenue tipping point in a contracting portfolio to bring about true cultural change. 43:45 Dr. Cabral on how the $4T American healthcare system spends 30% on administration (compared to 9-10% in other countries). 44:15 Healthcare Job Growth since 1970’s: 200% for providers and 3500% for non-clinical providers! 46:00 Drs. Cabral and Cohn speak about the monolithic structure of medical education that is over 100 years old and why that is a barrier to team-based care. 48:30 Dr. Drummond on how there are no leadership classes in medical school or residency (leadership is instead learned once practicing in a broken industry). 50:00 Dr. Drummond references Team Care Medicine, Dr. Jim Jerzak, and Dr. Corey Lyon as leading exemplars in team-based care models. 51:00 Dr. Cabral on how physicians “crossing the schism” into leadership often imposes unrealistic meeting expectations (unless the practice of medicine is completely abandoned). 52:45 Dr. Cohn on how healthcare leaders takes physicians for granted (referencing “The Daily Exploitation of Medical Staff” by Danielle Ofri) 54:00 Dr. Drummond – Should I go the extra mile for a patient if the organization gets in my way and it is unhealthy for me and my family? 55:30 Parting thoughts from our guests on implementing strategies to cultivate physician wellness.

Are you ready for the risk-based tsunami on the horizon?  If you are a frequent listener to this show, you understand just how seismic this shift to value-based care really is and why we need the right culture, people, processes — fueled by capital – to spawn care delivery innovation.  It is in reimagining care delivery that we can truly deliver on the aims of improved outcomes, lower cost, better patient experience, and equity for all populations. Joining us in this Race to Value this week are two outstanding leaders in the value movement, Drs. Brian Silverstein and Yates Lennon.  We discuss how organizations should be preparing for the risk-based tsunami on the horizon through care delivery innovation. Dr. Brian Silverstein is the Chief Population Health Officer for Innovaccer, a leading healthcare technology company committed to helping healthcare care as one. He is an expert in value-based care delivery and health system transformation with vast experience in helping providers improve population health initiatives.  And joining him in this interview is Dr. Yates Lennon, the President of CHESS Health Solutions – a population health MSO empowering physicians and health systems to make the transition to value-based care. Dr. Lennon has extensive experience in quality, practice transformation, and physician engagement and has been instrumental in teaching health systems and providers across the country how to transform patient care and shift to value-based payment. If you are looking to understand the state and science of value-based care, look no further than this conversation with two of the leading minds in industry transformation!   Episode Bookmarks: 01:30 The seismic shift towards value-based care and the risk-based tsunami on the horizon. 02:00 Introduction to Dr. Brian Silverstein and Dr. Yates Lennon 04:30 Progressing in the value journey by understanding the landscape 05:45 Dr. Lennon provides an overview of the value ecosystem with varying adoption of risk in provider organizations. 07:00 “The days of sitting on the sideline are running out.  It is time to get started with value-based care if you haven’t already.” 08:00 The State and Science of Digital Maturity at U.S. Healthcare Providers (a recent report from Frost & Sullivan, commissioned by Innovaccer) 09:30 Dr. Silverstein on the legitimacy of the value movement with perspective on how digital infrastructure impacts the pacing of adoption. 10:45 The differentiation of the technology stack utilized by providers accepting full risk-based payment. 12:00 Traversing the value landscape with emerging changes in payment model design focused on the reduction of health disparities. 13:30 Dr. Lennon on how VBP and population health technology tools are perfectly suited to address problems in health disparities. 14:00 Codifying the health equity design of the ACO REACH payment model into operational programs. 14:30 Ensuring access to care in a medical home – an example from Atrium Health Wake Forest Baptist 15:30 “Access is important in value-based care when attempting to address health equity.” 16:00 Focusing on the quality and performance improvement measures that can improve equity. 16:30 Clinical workflow optimization and the use of Community Health Workers to conduct patient outreach. 17:00 Leveraging community resources to address Social Determinants of Health (SDOH). 17:30 findhelp (formerly Aunt Bertha) and Unite Us as examples of technology platforms that can improve SDOH interventions and community partnerships. 18:15 Lifestyle coaching to improve health outcomes with dual eligible populations. 19:00 Dr. Silverstein explains how traditional healthcare will not able to improve population health outcomes in a silo. 20:00 The correlation between a patient’s zip code and their overall health and wellbeing. 20:30 Dr. Lennon provides perspective on how the creativity of value-based care will improve models for patient engagement and care delivery. 21:30 Organizations that are in a “payment straddle” trying to figure out where the fee-for-service curve and the value curves can intersect. 22:30 Capitalizing on both FFS and VBC through Annual Wellness Visits (AWVs), Advanced Care Planning (ACP), Chronic Care Management (CCM), and Transitional Care Management (TCM). 24:45 “I can’t emphasize enough how important providing patient access is for primary care physicians in value-based care.” 25:30 The importance of coding and documentation in risk stratification and compliance. 26:00 Making quality “second nature” by leveraging teams to close care gaps. 26:45 The challenges of finding a competent workforce and retaining physician independence to ensure care delivery innovation. 28:30 The plight of primary care and the struggle to retain independence. 29:00 Referencing recent article from Dr. Mai Pham on how a hybrid payment model will be a lifeline for primary care physicians. 30:00 Dr. Silverstein discusses the inherent complexity of value transformation and the importance of local market dynamics and the art of timing. 32:00 Dr. Lennon on the climate for value-based payment in the North Carolina market and PCP considerations to reach a critical mass in value. 33:00 Should independent PCPs consideration a physician aggregation model to pool lives and access capital? 34:00 Managing contract availability with available cash flow and the timing of investment decisions. 34:45 The difficulties of ensuring holistic patient care delivery while simultaneously maximizing fee-for-service revenue. 37:00 Dr. Lennon discusses the insufficiency of Risk Adjustment in truly understanding the needs of vulnerable populations. 38:00 Educating providers on risk adjustment coding on the connection between good patient care and financial accountability. 39:30 Optimizing an EHR workflow for risk adjustment data capture and clinical data visualizations at the point-of-care. 40:45 Dr. Silverstein on the importance of accurate risk adjustment coding to appropriately plan population health interventions. 42:00 Dr. Lennon discusses the need to importance of coding accuracy to eliminate compliance scrutiny. 42:30 The shift in changing the mindset of FQHCs to focus on diagnosis code specificity. 43:00 How point-of-care tools embedded in the EHR can improve risk adjustment data capture. 43:45 “EMRs and digitization in patient care is just the beginning – not the end state.” (referencing the use of transaction engines from other industries) 44:30 Focusing more on patient care than the sophistication of tech stacks will ensure long-term success. 45:30 Are mandated risk-based payment models the right thing to do in ensuring value-based care adoption? 47:00 Dr. Silverstein on the “multi-level complex Chess” of payment model innovation and provider adoption. 48:30 Dr. Lennon speaks against the mandating of APMs in the current healthcare delivery environment. 49:00 The beauty of the natural progression of value-based care innovation at the physician-level. 50:30 Dr. Lennon reflects on the inability of fee-for-service to create sustainable population health models. 52:30 Drs. Lennon and Silverstein speak about controversies associated with Medicare Advantage upcoding and potential abuses in value-related plans. 55:30 Why don’t we shift the industry coverage of Medicare Advantage to the benefits and opportunities of the program? 57:30 The burdensome regulations that hinder those providers who are not the bad actors. (ex: the SNF 3-Day rule, home-based infusions) 60:00 Referencing recent report from Morning Consult, commissioned by Innovaccer onThe State and Science of Value-Based Care. 61:45 Parting thoughts from Drs. Lennon and Silverstein on the moral imperative of value transformation.