The Race to Value Podcast

The Health Care Payment Learning & Action Network (HCP LAN or LAN) is an active group of public and private health care leaders dedicated to providing thought leadership, strategic direction, and ongoing support to accelerate our care system’s adoption of alternative payment models (APMs). The LAN mobilizes payers, providers, purchasers, patients, product manufacturers, policymakers, and others in a shared mission to lower care costs, improve patient experiences and outcomes, reduce the barriers to APM participation, and promote shared accountability. Last month the LAN held their 2022 Summit, and this year’s event featured appearances by CMS and CMS Innovation Center leadership, the release of the 2022 APM Measurement Effort results, a discussion on the HEAT’s Social Risk Adjustment Guidance for APMs, and the announcement of the LAN’s 2030 APM Adoption Goals for Medicare, Medicaid, and commercial plans.  Joining us this week in the Race to Value are LAN Executive Forum Co-Chairs, Dr. Judy Zerzan-Thul and Dr. Mark McClellan.  They discuss the overall goal of the LAN and the LAN Summit is to collaborate and act on strategies that will accelerate the transition to innovative, patient-centered payment models by focusing on equity, access to high-quality and affordable care, engagement of patients, and reduced provider burden. https://www.advancinghealthvalue.org/hpclan_summit_22/ Visit the Institute for Advancing Health Value’s website. Download their recently released Intelligence Brief summarizing the 2022 LAN Summit. Visit the LAN’s website: Learn more about 2020 & 2021 APM Measurement Efforts Consult the HEAT’s APM Design Guidance  –  Advancing Health Equity Through APMs   Episode Bookmarks: 01:30 The purpose of the Health Care Payment Learning & Action Network (HCP LAN) 03:00 Introduction to Dr. Mark McClellan and Dr. Judy Zerzan-Thul 05:45 Dr. Mark McClellan speaks to the impact of the pandemic on value-based health reforms 06:45 “Payment flexibilities are one of the unsung heroes in the pandemic when it comes to value transformation.” 07:15 How capitation enabled some to navigate the pandemic favorably, while others struggled with FFS revenue disruption, team-based care, and telehealth deployment. 08:45 CMS payment flexibilities will soon go away so prepare for continued focus on patient-longitudinal well-being and outcomes tracking. 09:45 The especially challenging times of high inflation and workforce resilience and how value transformation is a strategy for sustainability. 12:00 Dr. Zerzan-Thul speaks about the Accountable Care Commitment Curve and how that can guide organizations to advancements in Health Equity. 13:30 The LAN’s Health Equity Advisory Team (HEAT) and its recommendations for developing a Health Equity action plan. 14:30 Measuring equity outcomes through an enhanced data infrastructure and community partnerships. 15:45 Dr. McClellan speaks to how Social Risk Adjustment (SRA) can advance health equity through APMs (starting with ACO REACH) 17:30 The challenges of implicit biases in individual measures of social risk. 18:15 “Risk factors like food insecurity and transportation will eventually get more built in to our approach to health care.” 19:00 The additional considerations of community engagement, peer transformation, and other payment incentives to advance health equity. 20:30 The recent release of the APM Measurement Effort (survey data compiled the HCP LAN). 21:30 Dr. McClellan discusses the current status of 2022 APM adoption (see interactive graphic showing that nearly 20% of payments flowing through Category 3B-4 models.) 24:30 Dr. Zerzan-Thul comments on trajectory of APM adoption and current status of Medicaid transformation in population-based payment. 27:00 Dr. McClellan discusses the Accountable Care Commitment Curve more at length. 29:00 “You can’t get to a critical mass of value transformation in the U.S. healthcare system without multistakeholder alignment.” 30:00 Dr. Zerzan-Thul speaks to what state agencies like the Washington State Health Care Authority can do to move healthcare organizations along the Commitment Curve. 31:00 Examples of legislative tools in Washington State that are advancing value-based payment and collaboration. 33:00 Data and transparency – how do we measure progress in health equity and value transformation? 34:30 Dr. Zerzan-Thul speaks about the work LAN is doing with State Transformation Collaboratives (STCs) (see Summit video on State Transformation) 35:00 Primary care transformation and multi-payer alignment as the starting points to transform healthcare at the state-level. 36:00 The impact of the economic downturn and Medicaid transformation in states moving to value. 37:00 Dr. McClellan on the importance of state leaders (e.g. policymakers, employers) to reform healthcare. 38:30 The STC pilot states (Arkansas, Colorado, California, North Carolina) are working closely with CMS in reaching their value-based care goals. 39:30 Key directional alignment between CMS and states will reshape health policy at the federal level. 41:45 Dr. Zerzan-Thul discusses the importance of FQHCs as “safety net” providers and how they can transition to APMs. 42:45 Oregon, Colorado, and Washington are leading states in FQHC adoption of APMs. 43:30 Dr. McClellan on how Medicaid payment shifts in Washington State are bringing more affordable and accountable care to patients. 46:00 Dr. McClellan discusses the strategic importance of multi-payer alignment in the national movement to value-based care. 49:00 Reducing care variation and supporting more efficient processes in delivering care across disparate populations. 50:00 Dr. Zerzan-Thul on how multi-payer alignment of quality measures can lead state-level value transformation efforts. 51:00 “We are asking payers to align on paying primary care at a Level 4 level, and we have commitments from payers to do that.” 52:00 Data aggregation and exchange at the state-level. 52:30 Certifying advanced primary care at a centralized level as a means to direct payment transformation. 53:15 Engaging health plans in various states to adopt and scale APMs in the transition away from FFS. 55:00 How the LAN, in partnership with states, are engaging purchasers in the commercial market. 56:30 Dr. McClellan on how to get patients to understand “accountable care” or “value-based care” by delivering on our goals. 58:00 “Value-based care is not a privatization plot of Traditional Medicare.” 59:00 Paying for “health” can help with the reduction of chronic diseases. 59:30 The political pressures of disrupting the status quo in healthcare. 60:00 The importance of effective storytelling in value-based care success as a way to inform legislators. 61:30 Dr. Zerzan-Thul on how the U.S. is 4% of the world’s population but spends half of the $8T global spend on healthcare services. 62:30 How do we measure whether people are getting person-centered care? (We need patient-reported outcomes in addition to CAHPs.) 65:00 Dr. McClellan on the imbalances of healthcare worker supply and demand. 63:30 Capital investments in value-based care are going towards digital transformation and upskilling of the workforce. 65:30 “The biggest challenge in the movement to value-based care is the workforce.” 67:30 Dr. Zerzan-Thul speaks about the challenging demands of managing the workforce pipeline for behavioral health professionals. 68:00 The importance of team-based care (everyone) in guiding us to the health care that we want. 69:20 APMs and the work of the LAN is key to building a better workforce and improving health care!

Dr. Michael Barr, M. Shawn McFarland, and Katie Capps discuss the importance of Comprehensive Medication Management (CMM) in value-based care. They highlight the need to maximize medication benefits, challenges in implementation, health IT infrastructure, health equity, and payment reform. They emphasize the collaborative approach between doctors and pharmacists and the role of CMM in improving patient outcomes.

The fight over access to gender-affirming medical care for trans youths — like the fight over abortion rights and other issues at the intersection of health, politics, gender, culture and race — is impacting where Americans live, work and raise families. And it’s grown particularly acute over the past year, as conservative governors and legislators have restricted access to medical care for gender dysphoria, a condition that stems from one’s lived experience of gender being different from the sex assigned at birth. The rhetoric is leading to violence and hate, and it must be overcome through education and understanding if we are ever to regain civility in our country. This is a special bonus episode about authentic truth, love, and compassion demonstrated with a family’s journey in gender-affirming care.  Eric interviews Melissa McLaren and her transgender daughter Conner just a few days after the horrific mass shooting at a nightclub in Colorado that targeted LGBTQ individuals.  Conner is a 17-year-old transgender woman, and her mother Melissa has been supportive of her gender transition since Conner expressed her preference to be a girl as a toddler.  Through the support of loving parents and a health system that provided gender-affirming care, Conner was able to find her truest self and live a life of authenticity. Episode Bookmarks: 01:30 An introduction to Melissa and Conner and their family’s journey in seeking gender-affirming care 02:30 The recent mass shooting tragedy at Club Q targeting LGBTQ individuals on the same day as Transgender Day of Remembrance (Nov. 20) 02:45 The conservative rhetoric against gender-affirming care that engenders hate and violence. 04:00 An overview of Conner’s gender transition and how Conner “would be dead today” had she not received gender-affirming care in her childhood. 05:00 Conner discusses the challenges she faced during her transition (most of it was “smooth sailing except for politicians”) 05:15 Melissa describes Conner’s gender transition since the age of 4 (she is now 17). Conner began expressing her female identity as early as 18-months old. 08:30 How a babysitter traumatized Conner as a 4-year old, stating that changing her gender was “against the Will of God” and that she would be “sent to Hell.” 09:00 Melissa begins her search for medical support to help her child overcome the emotional distress of gender dysphoria. 10:30 Gender-affirming care began with a social transition related to clothing choices. 11:30 Conner’s insistence at the age of 4 that she be identified by She/Her pronouns. 14:00 The team of medical providers that helped the McLaren family navigate the journey in age-appropriate gender-affirming care. 16:00 How mainstream media misleads the public about gender-affirming care. 16:45 The use and efficacy of puberty-blockers in pediatric gender-affirming care. 18:00 Conner describes what it was like to receive her first puberty-blocker shot (a big needle with thick serum) 19:00 The constant clinical monitoring and lab testing that coincides with puberty suppression treatment. 20:00 The patient-centeredness and family support provided in gender-affirming care. (Isn’t this what value-based care is all about?) 21:00 Patient-centered gender-affirming care is not about corralling patients into choices. It is about collaboration between the family and the medical team. 22:00 “We feel so well protected, understand the goals and how to safely get there, and what the offramps are.” 23:00 Approximately 300,000 teenagers identify as transgender, which adds up to 1-2 percent of the nation’s population within that age. 23:30 Referencing the prior Race to Value podcast, “The Truth and Beauty of Gender-Affirming Care, with Dallas Ducar” 24:00 Conservative political opposition to gender-affirming care, especially for the pediatric population, with some states saying this constitutes child abuse. 24:30 There have been hundreds of anti-trans laws restricting gender-affirming care (340 anti-LGBTG bills filed in the last year alone!) 26:00 Conner on how “Gender-approving care doesn’t start at hospitals and doctor’s offices.  It starts at home and in classrooms.” 27:30 Conner discusses what it would be like if Ohio passes a stricter version of the “Don’t Say Gay or Trans” law (HB 616). 28:00 Melissa on how banning LGBTQ conversation creates shame and forces people like Conner to live in secret. 28:30 “Conner is amazing just as she is, as her authentic self.” 29:15 Conner discusses what will happen to her if Ohio bans gender-affirming care for people like her. (HB 454). 30:15 Banning gender-affirming care is bad for healthcare providers, especially for those specializing in pediatric primary care and mental health care. 31:30 Melissa and Conner met with the Congressional LGBTQ Equality Caucusadvocating for transgender rights (picture of them with Speaker Nancy Pelosi). 32:30 The opportunity to meet Admiral Rachel Levine, the Assistant Secretary of Health and one of the first openly transgender government officials in the U.S. 33:00 “It takes a lot to worry about school and grades…and also worry if you will be able to use the bathroom the same day.” 33:30 Conner on her bouts with depression resulting from the hateful LGBTQ rhetoric at the state and national levels. 34:00 The need for compassion, empathy, love, and acceptance and how we can learn (and become inspired) from the McLaren Family story. 35:00 The recent murders at Club Q and the orchestrated, increasingly violent, right-wing campaign led by those who believe LGBTQ community shouldn’t be allowed to exist. 36:30 Melissa reflects on the heartbreaking news that LGTBQ safe places are under attack. 37:45 Melissa has been called a “child abuser” and a “groomer” in recent times since hateful rhetoric has escalated. 38:00 Melissa on the escalation of violence, bomb threats, and death threats juxtaposed to the love she sees in the LGBTQ community. 38:45 “For those who think that gender-affirming care is the wrong decision.  I wish you could see the smile on my daughter’s face.” 39:15 Seeing children blossom and thrive when they receive love and access to mental health and healthcare services. 40:30 “Keep your mind open.  Don’t close yourself off to new ideas.”

The need for physician leaders has never been greater. As the healthcare industry continues to undergo significant change, there is a clear opportunity for physicians with extensive administrative experience to rise up. In order to drive value-based care, physicians will need to assume leadership positions that are all too often filled by executives who do not possess medical training.  In the emerging health value economy, a physician leader needs to have both medical expertise and a business acumen to succeed.  However, how can physician leadership thrive when the entire profession is beleaguered, burned out, and depressed? Fee-for-service medicine is causing moral injury in the medical profession and doctors suffer immensely when the system prevents them from doing what’s best in the care of their patients.  Consequently, 50% of physicians are considering a career change, and it will cost health systems upwards of $1 million to replace a physician who leaves profession.  A balanced value strategy to ensure future success will ultimately require effective cultivation of both physician leadership and workforce wellness. Joining us this week on the podcast is Dr. Peter Angood, the Chief Executive Officer and President of the American Association for Physician Leadership (AAPL). AAPL focuses on maximizing the potential of physician-led, inter-professional leadership to help create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally. Since inception nearly 50 years ago, AAPL remains the only healthcare organization solely focused on providing full-service professional development offerings, an array of information resources, leadership education, and management training oriented toward the physician workforce and the organizations where physicians work or represented. AAPL CEO Dr. Peter Angood is an industry leader, a researcher that has authored over 230 publications, and he is a well-recognized international speaker on the host of issues related to physician leadership. His recent book, “All Physicians Are Leaders: Reflections on Inspiring Change Together for Better Healthcare”, has been well received the medical profession. Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022) 03:00 Introduction to Dr. Peter Angood and the American Association for Physician Leadership (AAPL) 05:30 Defining Value-Based Care (the changing value equation and the Quintuple Aim) 07:00 Patients don’t understand the language we use to define value-based care! 08:00 Patient perspective is the most important in defining value creation in the health system. 09:00 The aspiration of person-centered care is not being realized because of system complexity. 09:30 The need for physicians to have both medical expertise and administrative experience for leadership effectiveness. 11:00 Patient-physician relationships drive the majority of care delivery. 11:30 “The medical profession does not provide physicians with adequate training or experience in leadership or management.” 12:15 Additive training beyond medical school and residency is necessary for physicians to become leaders. 13:00 Non-clinical administrators can be effective, but there is an added benefit of physician leadership. 13:45 Quality performance outcomes are 25-33% better in health systems with physician CEOs. 14:30 Health systems in the US News & World Report rankings are predominantly led by a physician CEO. 15:00 The length of the education track for physicians delays leadership impact potential. 16:15 Mutual respect between clinical and non-clinical administrators as a key to organizational success. 17:30 Value-based care experimentation (e.g. Medicare Innovation Center, employer-based risk contracts with providers) 18:00 The capitation engine is driving from groups like Oak Street Health, ChenMed, One Medical and Iora Health. 19:00 “The complexity of the healthcare system hinders the success and sustainability of value-based initiatives.” 20:30 Are leading companies in value-based care truly focused on what is best for patient care? 21:15 The unwieldly payment model portfolio for CMMI will not be effective unless streamlined. 21:45 “Non-profit hospitals have experienced a 20% drop in cash flow. How can you innovate if you are trying to keep the doors open?” 23:30 Value-based care exemplars have not yet proven they can scale at a national level. 25:30 “Burnout and suicidality impacts the entire healthcare workforce – not just physicians. The pandemic showed us that a wellness strategy is desperately needed.” 27:00 The altruistic idealism of medical students erodes once they formally enter the profession. 27:30 The average student debt load for medical school graduates is $250-300K. 28:30 Decreased physician compensation and productivity pressures are adversely impacting the morale of physicians. 29:30 “The real driver of a well-balanced value-based care strategy is the patient-physician relationship.” 30:00 Burnout Strategy #1: Provide support services for physicians dealing with burnout and moral injury. 30:45 Burnout Strategy #2: Process improvement to optimize provider workflow and how it will improve workforce morale. 31:30 Burnout Strategy #3: Engage physicians in the process of continuous quality improvement to drive value creation. 32:30 The benefit of peer-to-peer networking in a team-based work environment. 33:00 Since the pandemic, there has been an 8% increase in clinical labor cost per patient – an additional $17M in cost for average sized hospital! 34:00 50% are considering a career change, and it will cost upwards of $1 million to replace a physician who leaves profession. 36:00 Workforce wellness and retention is a top concern for healthcare CEOs. 37:00 Physician employment – what is needed to ensure mutual respect and a successful workforce strategy? 39:00 50-70% of physicians are currently employed – does physician employment create a better work-life balance? 40:30 Physician employment may lead to lack of respect and agency to influence change — will the resultant burnout swing the pendulum to physician independence? 42:00 The exodus of the healthcare workforce is a high risk that demands wellness strategy prioritization. 43:00 This loss of physician independence limits value-based care effectiveness and, in most situations, employing physicians is like putting fee-for-service on steroids! 43:30 Physician-led ACOs outperform their health system ACO counterparts by a significant margin. Provider consolidation drives up healthcare costs. 44:30 M&A, private equity, and corporatization of healthcare – will this trend truly create more value in the system? 46:00 Dr. Angood provides an example of how an independent practice model can support long-term success. 47:45 Physician-owned systems will become more predominant in next 5-10 years as care delivery shifts more to the ambulatory sector. 48:00 Will Amazon, Google, Facebook, and Apple “figure out” healthcare? 49:30 Telemedicine usage surged during the pandemic where it accounted for 69% of doctor-patient visits but has since resettled into more of a pre-pandemic norm. 50:30 Physician-led vs. non-physician-led innovation (the concern of low-value technology solutions from companies lacking medical expertise) 52:30 An example of a family accessing an innovative subscription-based urgent care service 54:00 Hospitals are reevaluating post-pandemic telehealth utilization due to reimbursement challenges. 55:00 Electronic health records are poorly designed and contributing to physician burnout. 56:00 Three generations of physicians are currently in the workforce – Baby Boomers born before 1965, Generation X born between 1965-1980 and Generation Y born between 1981-2000. 58:00 Respecting intergenerational differences between physicians – wisdom (older cohort) vs. innovation (younger cohorts). 59:00 Idealism and altruism is a strong driving force for all generations of practicing physicians; however, work-life balance is more important for younger physicians. 60:00 Societal shifts to work and live in different ways and how that will impact future models of care delivery. 63:30 Upskilling and reskilling the healthcare workforce and reforming medical education for the future of value-based care. 65:30 Medical schools training physicians on the importance of SDOH-based interventions. 67:00 The continued challenges of achieving diverse representation of minorities in the medical profession. 68:00 The importance of regulatory oversight to reform medical school curricula in support of population health. 70:00 Parting thoughts from Dr. Angood on physician leadership and the work of the AAPL.

Value-Based Care is at a tipping point.  But it’s not just about whether providers adopt alternative payment models (APMs) or ACOs. The real tipping point is whether traditional health systems can get on board fast enough to survive the corporate health care business that is poaching providers and patients. Corporate health care is not only unfazed by downside risk of APMs, but also have built their business models on population-based payments. The pendulum is clearly swinging away from fee-for-service and future success will be dependent on a transition strategy to APM success. Joining us this week on the Race to Value is Terry Hush, CEO and Co-Founder of Roji Health Intelligence. Terry is a health care strategist and change management expert with experience across the health care spectrum. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs. In this podcast episode, Terry discusses the impact of private equity on physician consolidation and how that landscape change will impact value-based care adoption.  She also provides strategic guidance on how to build a population health infrastructure and develop a successful APM adoption strategy.   Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022) 03:00 Introduction to Terry Hush (CEO and Co-Founder of Roji Health Intelligence) and Free E-Book (“Smart Guide to APM Success”) 06:00 The regulations behind value-based care – are they moving us fast enough to a tipping point? 06:30 “Private equity-backed physician medical groups, ACO enablement companies, and other corporate healthcare ventures are forcing legacy health systems to change.” 07:00 Population-based payments within APMs are predictable revenue streams for health systems. 07:30 “Going forward, the driver of VBC will be the competition between corporate interests and legacy health systems – not health policy.” 08:00 Major financial losses within national health systems are a wakeup call to reimagine care delivery as a strategy for survival. 09:00 “Health systems that do not adopt APMs will ultimately be in jeopardy and will need to start devolving unprofitable lines of services.” 10:00 The alignment of financial incentives in the overall health economy favoring value over volume are virtually non-existent. 11:30 Changing the care delivery system as a requirement for APM success with investment motivation predicated on reforming fee-for-service. 12:30 “Advanced EHR adoption is not the same as a value-based care technology adoption strategy.” 13:00 Preferred VBC technology functionalities (e.g. risk stratification, outcomes and cost driver analysis, episodes of care tracking, platform for managing patient-centric interventions) 13:30 Managing data (e.g. claims, patient-reported outcomes, biometrics, prescriptions) 14:30 Non-EHR technologies in value-based care (e.g. patient engagement, behavioral health, CRM and consumerism, virtual care and telehealth, AI, wearables) 15:30 APM adoption will often happen first before the technology infrastructure is built to adequately assess cost and risk. 16:30 Lack of connectivity between EHRs and VBC technology platforms due to data blocking and lack of advancement in FHIR interoperability. 17:00 Technology integration is the substrate of population health activities. 18:00 Unstructured EHR data that is unreportable and cannot be queried (e.g. diagnostics, cancer staging information, genomic risk data) 19:00 SDOH and health risk assessment data (how should this data be used and structured?) 19:30 Prescription drug usage and treatment plan adherence data (lack of data integration makes treatment plans ineffective) 20:45 Tracking data to determine the effects of clinical and non-clinical Interventions (e.g. community services, financial services, self-management plans) 21:45 Simon Sinek – “The value of experimentation is not the trying. It’s the trying again after the experiment fails.” 23:00 Assessing competitive positioning in local market as a precursor to APM adoption. 23:30 Medicare APMs are more forgiving than private payers in allowing time to transition to downside-risk. 24:30 Medicare APMs offer automatic access to claims data (not always possible with private payers). 26:00 Recent MSSP Performance Results – positive net gain of $1.6B to CMS (fifth consecutive year of positive gains) 27:00 The issue of ACOs not getting enough credit for savings because of lack of trust in government calculations and savings algorithms. 28:00 “The world is changing.  Value is where it’s at in planning for the future.” 29:00 The massive landgrab of physicians by private equity investors (only 32% of primary care practices remain independent). 30:00 Physicians are attracted to predictable reimbursement and capital support. Will PE investments in physicians succeed? 31:45 Specialty practice acquisitions are driven by technology advancement (e.g. ophthalmology and retinal scanning) 32:45 Will the future of value-based care be able to support advanced clinical technologies in specialty care? 34:00 Can government actually play a leadership role in value-based investment and innovation? 36:30 Patients are coasting because providers are not engaged in care planning. Data-driven value-based care interventions need to solve for this. 37:30 Combining cost and clinical outcomes data within episodes of care (condition-based or procedure-based). 38:45 Creating interdisciplinary team-based care support networks for physicians. 40:00 Download the Smart Guide to APM Success and learn more at Roji Health Intelligence.

How can primary care physicians retain their independence in planning for future success in value-based care?  A medical practice must have access to capital to optimize physician workflow and improve patient experience; however, if it chooses the wrong partner, physicians will lose autonomy and compromise their own personal wellbeing.  Privia Health is a technology-driven, national physician enablement company that is on a mission to enable doctors and their teams to focus on keeping people healthy. Their goal is to transform healthcare by enabling physicians, and they want to build the largest primary care-centric ambulatory delivery system in the country. With a healthcare provider partner base of over 3,500 providers managing 3.9 million patients across eight states and the District of Columbia, they are well on their way. And their results in value-based care are superlative, as recently demonstrated by their most recent 2021 Performance Year in the Medicare Shared Savings Program yielding $99.9 million in savings. Joining us in the Race to Value this week is Shawn Morris, the Chief Executive Officer of Privia Health. Shawn is a seasoned industry leader focused on building a platform that can transform the healthcare delivery experience for physicians and patients. He is driving initiatives to meet providers where they are on the transition to value, by building strategic partnerships with physicians, health plans, health systems, and employers to better align reimbursements to quality, affordability, patient satisfaction and provider wellbeing. In this podcast interview, you will hear from one of the leading voices in value transformation discussing such topics as risk-based contract progression, the importance of workflow optimization in supporting provider wellbeing, technology enablement based on the tenets of automation and consumer-centric innovation, effective governance and management of physician-led risk-bearing entities, bridging FFS to value through a multipayer contract portfolio, and the national movement to value-based care transformation. Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value” Virtual Event (December 1, 2022) 03:00 Privia Health — a technology-driven, national physician enablement company leading in value-based care transformation. 04:00 Introduction to Shawn Morris, Chief Executive Officer – Privia Health 06:30 Privia Health has expanded its healthcare provider partner base to over 3,500 providers managing 3.9 million patients across eight states and the District of Columbia. 08:30 “Our goal is to transform healthcare by enabling physicians. We want to build the largest primary care-centric ambulatory delivery system in the country.” 09:00 Shawn describes the value-based care contract portfolio held by Privia’s physician partners. 10:00 Average practice size of a Privia Health practice is 5 clinicians. 11:00 “If you are not focused on both patient experience and provider wellbeing, you cannot achieve success in value-based care.” 11:30 The importance of understanding medical risk to run a success physician practice. 13:00 The five key elements of the Privia Platform to optimize value-based care performance. 15:00 Shawn describes the opportunity for value transformation in a physician practice landscape that is unsophisticated in managing risk. 17:00 Building hubs of transformation within states, starting with Single TIN anchor groups that are enabled by a technology and MSO wraparound capabilities. 18:00 Creating enablement for physicians by embedding insights directly into a unified EMR workflow. 19:00 The challenges of an un-optimized EMR workflow when physicians are forced to click in and out of disparate information systems. 20:00 Enabling provider access through relationship-based care and a purpose-built platform (“digital front door”) built around the tenets of consumerism. 22:00 Workflow optimization to close care gaps, capture HCCs, and leverage specialty referrals within a high value network. 23:45 Post-visit, technology-enabled workflow optimization to ensure effective care management and improved outcomes. 24:30 Shawn provides an example of effective virtual care delivery. 25:30 Closing gaps through automated robotic processing that nudges patients and enhances data capture. 27:30 Consumer-centric innovations that can alleviate the administrative burdens of providers. 28:00 Search Engine Optimization can be used for service recovery and reputation management. 28:30 “Simplicity is the ultimate sophistication.” – Leonardo da Vinci 29:30 Privia’s ACOs (collectively known as the “Privia Quality Network”) achieved shared savings of $99.9 million in the MSSP, caring for more than 112, 000 Medicare beneficiaries in 2021. 32:00 Shawn provides his perspective of how value-based government programs (e.g. MSSP) are driving transformation through trial and error. 34:00 Most of Privia’s MSSP lives are in the Enhanced ACO track with the most financial risk. 34:30 Understanding provider maturity and value-based readiness across the continuum when calibrating an optimal risk profile in the MSSP. 35:30 Building the infrastructure for downside risk (e.g. escrow to insure the repayment on the downside, data science and analysis) 36:30 How Privia shares downside risk and financial upside with partner physicians (60/40 split with physicians receiving majority of payment on upside). 37:30 Building an effective governance model and pod structure that can manage risk-bearing entities and constituent physician practices. 39:30 Privia Health providers have high satisfaction with the platform (e.g. provider NPS of 54, 95% average provider retention over the past four years) 41:00 The CMS goal to have all Medicare beneficiaries in a value-based relationship by 2030 as evidence of continued risk progression in the industry. 42:00 Understanding provider needs, risk progression, and the importance of consumer-friendly doctor-focused technology. 43:00 “A value-based platform shouldn’t serve just Medicare Advantage or Commercial patients. Physicians need the autonomy to focus on whole-person care for everyone.” 43:30 The actuarial component of value-based care and how that leads to effective physician aggregation in risk-bearing entities at the state-level. 44:30 Privia Health customers are now the biggest source of new business referrals for the company. 45:00 How going public provided Privia with increased visibility and access to capital to support continued growth. 47:00 Privia Health is using FFS as a bridge to VBC success with practices realizing >90% practice collections predictability with a diversified revenue mix ($1.3B in total annual collections) 48:30 Shawn provides guidance on how to successfully navigate value transformation in fee-for-service given the slow progression of risk-based payment. 50:00 Most people don’t realize that Medicare Advantage is still pretty much all fee-for-service. 50:30 Access is the key to value-based care success. RCM is the key to fee-for-service success. 50:45 The limitations of payers to administer capitation-based payment to medical groups (varying payer capabilities across states/regions) 51:30 The progression of risk in a medical practice – starting with upside-only models – to ultimately develop profitability in a more mature value-based care portfolio. 53:00 Shawn provides an example of building a RBE in Montana where there are currently no capitated MA risk contracts available. 53:45 Even in fully-capitated models, the bulk of provider payments (80-85%) are still paid out on a FFS basis to providers. 54:30 The importance of understanding benefit design in a commercial risk arrangement (e.g corridors, employer participation) to ensure success. 56:00 Only 32% of primary care physicians work in a private practice outside of corporatized care delivery business model. 57:00 “Privia does not employ providers. We want our community physician partners to be wildly successful by remaining independent.” 58:30 Shawn provides examples of successful independent physician models with their clients in Georgia, Texas, Florida, California, and Montana. 59:45 “The tenets of our model are Single Tax ID, movement to VBC in a disciplined way, diverse income streams, and a focus on patient experience and provider wellbeing.” 61:15 Recent strategic partnership with OhioHealth Health system to launch a medical group for independent providers throughout the state of Ohio. 61:45 Same-Store versus New-Market growth strategies driving the future of Privia Health. 65:45 Parting thoughts from Shawn Morris on how health systems should develop a physician alignment strategy for the future.

Chronic Obstructive Pulmonary Disease (COPD) afflicts 24 million adult Americans and represents the 3rd leading cause of death. COPD is also the 5th most costly chronic disease in the US with attributable direct healthcare costs estimated at $49 billion! Given the edifice of fee-for-service payment in US healthcare, we have allowed the care of COPD patients to become fragmented and inconsistent.  We continue to see care of this chronically ill population wrought with poor clinical outcomes and a high economic burden. However, we are now seeing that value-based care is beginning to catalyze COPD care delivery innovation for a more promising future! Our guests this week are Geoff Matous and Dr. Abi Sundaramoorthy of Wellinks – a digital health company offering the first-ever integrated, virtual chronic obstructive pulmonary disease management solution.  These two leaders are connecting the dots on COPD to create a constellation of care that includes pulmonary rehabilitation, personalized coaching and monitoring, and connected devices. Disruption in payment incentives have spawned care delivery innovation at Wellinks, and they are poised for further success of their platform with the promise of global capitation in ACO REACH and MA plans. Don’t miss out on the important conversation to learn how partnership and innovation can transform your healthcare organization’s COPD population health playbook strategy! Episode Bookmarks: 01:30 Register today for the “Population Health Equity: The North Star for Value”(December 1, 2022) 03:00 COPD affects 24 million adults and represents the 3rd leading cause of death and the 5th most costly chronic disease in the US. 03:30 The direct healthcare costs of COPD is $49 billion (and growing!) with COPD-related hospital admissions costing upwards of $40k 04:00 Introduction to Geoff Matous and Dr. Abi Sundaramoorthy 05:00 November is National COPD Awareness Month 06:00 COPD is an Ambulatory Care Sensitive Condition (i.e. a chronic disease for which good outpatient care potentially prevent the need for hospitalization) 07:30 Balancing the population health management requirements for COPD (Coding and Documentation, Quality measures, and Cost Reduction) 08:30 Impacting patient behavioral change to impact COPD-related healthcare utilization 09:30 “COPD Total Cost of Care reduction is a significant opportunity in value-based care that has been left untouched for far too long.” 10:00 Why are we still in the early stages of COPD Care Delivery Innovation? 11:00 Employer-sponsored plans will not drive digital health innovation for improved COPD management – it must be driven by ACOs and MA plans. 12:00 Geoff speaks to the advantages of virtual-first COPD care in a risk-based payment model. 12:30 75% of the total direct COPD cost is tied to exacerbations — how can chronic care management programs work to more effectively manage COPD patients?   14:00 Dr. Abi speaks about the challenges of health systems and ACOs developing a robust infrastructure for COPD virtual care. 15:30 43% of patients with COPD exacerbation will die within one-year of being discharged from hospital! 16:00 How the Wellinks Virtual COPD Management Solution approaches patient behavioral change. 17:30 The difference in approaches between “Pulmonary Health” and “Pulmonary Rehab” and how SDOH-based interventions can improve COPD management. 19:00 Health system attempts to help COPD patients self-manage their disease will fail if it is a “hero project” tied to temporary grant funding. 20:00 “Our call to action is to explore what can be done beyond the standard COPD care management playbook to improve patient outcomes and experience.” 21:00 99% of COPD patients have 1 comorbid condition, 87% have 3+ comorbidities! 22:00 Dr. Abi explains why COPD is a complex disease to manage and why addressing comorbidities alone will not be enough to reduce COPD exacerbations. 23:00 Behavioral health challenges associated with COPD patient management. 24:00 Optimizing clinical workflows to support a personalized and scalable COPD virtual care platform. 25:00 Taiwan implemented a nationwide COPD pay-for-performance program to align financial incentives for health care providers. 26:00 The limited success of the Hospital Readmissions Reduction Program (HRRP) in the US to address the misalignment of financial incentives that results in COPD exacerbation. 26:30 The United Kingdom has improved access to pulmonary rehabilitation 27:00 Why is value-based payment only focusing on COPD readmissions?  We need to get in front of the ED visits and the index admission as well. 28:00 “Financial toxicity leads to clinical toxicity.” 28:30 The promise of global capitation in ACO REACH and MA plans to provide realigned incentives for COPD preventive care models. 30:00 Applying lessons learned from BPCI Advanced and Kidney Care Choices programs to develop a targeted COPD value-based payment model. 31:00 Approximately 40% of COPD patients in the US have limited access to pulmonary rehab programs. There are 18K patients for every 1 pulmonary rehab facility in the U.S. 33:00 “Having only 4% access to pulmonary rehabilitation post-hospitalization of COPD is unacceptable.” 33:30 Referencing recent JAMA study showing that pulmonary rehabilitation after a COPD hospitalization is $5,700 net cost effective and adds Quality-Adjusted Life Years. 34:30 The workforce shortage of respiratory therapists to work in outpatient pulmonary rehab centers. 35:00 The impact of Social Determinants of Health in COPD disease progression in underserved communities. 37:00 Geoff discusses the vision of the Wellinks clinical model to improve COPD patient outcomes. 39:00 Dr. Abi discusses the artful design of their comprehensive COPD virtual care management platform. 42:00 How home-based COPD care management interventions create opportunities for personalization and customization. 43:00 The need for a continuous provider interaction in the COPD care continuum (and why we must overcome current care delivery fragmentation) 45:00 The available evidence of the contribution that patient activation makes to health outcomes, costs, and patient experience is significant. 46:00 “The major driver of COPD is behavior.” – Dr. Abi speaks about the importance of patient behavioral change outcomes in health coaching programs. 47:30 Training programs for health coaches in motivational interviewing. 48:00 Creating metrics for patient activation performance. 49:00 Findings from recent survey of COPD patients utilizing the Wellinks virtual platform. 50:00 Overcoming medical mistrust in minoritized communities in order to reach an effective level of patient activation. 52:00 Geoff speaks about the need for free market competition in “virtual first” provider models. 54:00 Lessons learned from prior partnerships to envision a more optimal patient care journey and data enablement strategy. 56:00 Information asymmetry in the patient care journey due to lack of health literacy and an overly complex health system. 57:30 Developing trusting relationships with patients through a “hub and spoke” care design model. 59:00 Recent mortality estimates suggest a growing socioeconomic divide with environmental risk factors for developing COPD. 60:00 Cell phone engagement with patients may often be the best starting point in working with patients in rural and underserved communities. 62:00 “Let’s all commit to bring the $49B COPD expense trendline down!” 63:30 Learn more about Wellinks and register for upcoming webinar with AHIP on November 30th.

As we look around to see what is enduring in our society, it is the work that was accomplished through loving relationships and mutual understanding.  The power of love-driven leadership has the potential to change the world; and in healthcare, it can transform the lives of people undergoing immense suffering. Healthcare leaders must collaborate on solutions to overcome barriers in health equity through a deeply rooted commitment to social justice and love to improve the human condition. Leaders in population health must be willing to step forward – even if it is uncomfortable – to build a community of love that will last forever. On the Race to Value this week, we interview Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development.  This is a conversation that all healthcare leaders should hear. Geoffrey engaged this interview with utmost authenticity as leader with a willingness to get in “good trouble” for speaking about the issues that many would prefer to ignore or not accept as real.  In this podcast, you will learn about the power of community partnerships in improving health equity to overcome the “political determinants of health” that prevent societal progress. You will also learn about the paramount importance of workforce development and scalable educational solutions in catalyzing a transformation in care delivery and culture change that values the moral imperative of value-based care. The empowerment and education of our workforce holds the key to eliminating workforce burnout and moral injury! And lastly, you will gain perspective on love-driven leadership that can overcome toxic tribalism and hyper-polarization in our society. Geoffrey is a proponent of love-driven leadership and advocacy for our most vulnerable in society, and his leadership in health equity has been recognized at a national level.  If you need inspiration to overcome the inertia in your health system towards real and impactful change, don’t miss this very important conversation!   Episode Bookmarks: 01:30 Introduction to Geoffrey M. Roche – a leader in healthcare innovation, future-focused strategy, DE&I, and workforce development. 04:00 Collaborating on solutions to overcoming barriers in health equity is informed by a deeply rooted commitment to social justice. 05:30 Geoffrey speaks about his early leadership work at Lehigh Valley Hospital-Pocono taking sojourns into homeless encampments in East Stroudsburg, Pennsylvania. 07:00 Leadership from a Hospital CEO and social justice warrior – how that led to an authentic impact in the population health of underserved communities. 08:00 Serving as Chair of the Commission’s Advisory Board to deal with homelessness – how that taught Geoffrey the “power of partnerships” 08:30 Uniting community stakeholders to eliminate stigmas and facilitate a better understanding of homelessness. 09:30 As a population health leader, you’ve got to be willing to step forward – even if it is uncomfortable. The community of love that you is built will be something you treasure forever.” 10:30 “The Health Equity Tracker” – a tool that aims to give a detailed view of health outcomes by race, ethnicity, sex, socioeconomic status, and other critical factors. 12:00 Geoffrey’s service on The National Health Equity Task Force under the leadership of Dr. Rachel Levine. 12:30 Participating in a national advocacy effort to address the disproportionate health outcomes of the COVID-19 pandemic. 14:30 The Health Equity design sprint led by Karen DeSalvo and Google to examine COVID-19’s impact on vulnerable populations. 15:00 What would it look like if we lived in a society without health disparities? – Geoffrey speaks about the power of data to knock down silos in healthcare that prevent equity. 16:00 The Leadership of David Satcher and Daniel Dawes in addressing disparities through holistic approaches to data, community, intersectionality, policy, healthcare, and SDOH 17:00 “There are so many people that don’t understand why we talk about issues of inequity and health disparities. We have to look through every lens to address this issue systemically.” 18:00 “Speak up, speak out, get in the way. Get in good trouble, necessary trouble, and help redeem the soul of America.” – John Lewis 19:00 How the risk-averse nature of healthcare is a barrier to the adoption of innovative products, treatments, interventions, and technologies that could help transform thousands of lives. 20:30 Board members and trustees of hospitals and health systems need to be educated in value-based care and health equity. 21:30 “If there is one aspect of our U.S. healthcare system that we have not done well, it is the engagement of our governance structure in health equity and value-based care.” 23:00 Geoffrey explains how entrenched organizational inertia within functional departments of health systems stifles innovation to advance equity. 24:15 Overcoming the “Political Determinants of Health” by fostering public-private partnerships. 25:30 The reskilling and upskilling of the workforce to ensure a high-value system will require scalable educational solutions. 26:30 Geoffrey discusses the importance of certificate and microcredential programs to address future workforce needs in value-based care. 27:45 “We have to create a society in healthcare that values the importance of workforce education to advance health equity and population health.” 28:30 “Health systems that do not embrace Competency-Based Education are actually harming their workforce strategy.” 29:00 Overcoming the slow resistance to education to empower healthcare transformation. 30:30 “The education of the healthcare workforce should not be managed by Human Resources.  It should be managed by Strategy and Transformation.” 31:45 The World Economic Forum estimates that, by 2025, 50% of all employees will need reskilling due to the adoption of new technologies and innovations. 33:00 Geoffrey speaks about the need for health systems to partner with Higher Education to develop a collaborative ecosystem for upskilling/reskilling the workforce. 36:00 The intentionality required to think about pathways and pipelines to ensure a diverse healthcare workforce. 36:45 The moral imperative of culturally competent care empowered by an effective DE&I strategy. 37:30 How can Higher Education become an incubator for healthcare system workforce development? 38:00 We are not prepared for the “Baby Boomer tsunami” that will decimate the supply of workers. 39:00 Career mobility is a secret weapon in the ongoing struggle to retain talent.  How can value-based care support workforce strategies for attraction, retention, and mobility? 40:00 Geoffrey explains why talking about the resilience of the healthcare workforce is insufficient in addressing the root causes of burnout and moral injury. 41:00 Engaging the workforce in value-based care is critical in care delivery redesign and cultural transformation. 42:00 Provider and workforce experience is just as important as patient experience. 43:00 Creating a “safe space” where workers are empowered to speak up about issues impacting patient safety.  How workforce fears leads to patient deaths. 44:30 Addressing Health Worker Burnout (35-54% of nurses and physicians and 45-60% of medical students and residents are reporting symptoms of burnout!) 45:30 Researchers estimate that annual burnout-related turnover costs are $9 billion for nurses and $2.6 to $6.3 billion for physicians. 46:30 The need for healthcare leaders to addressing workforce burnout with systems-oriented, organizational-level solutions (not just pizzas, back massages, yoga, and mediation apps) 47:30 Governing Boards need to address workforce burnout as their fiduciary responsibility. 49:00 The need to change nursing shifts and provide opportunities for workforce debriefings to reflect on care processes. 50:00 Healthcare workers should be treated like athletes and given breaks (rest brings about higher performance). 51:45 Referencing Chris Lowney’s book “Heroic Leadership” 52:15 Geoffrey shares his insights on the importance of love-driven leadership and the importance of authenticity and mentorship. 53:30 The culture of bullying in the medical profession needs to be overcome with love-driven leadership. 54:00 Mentorship programs that provide love, guidance, and inspiration. 55:00 Leaders that do not proactively seek out opportunities as a mentor – “It is time for them to go!” 55:45 Cultural awareness of the need for belongingness and inclusion and why leadership is not about titles. 56:45 Toxic tribalism and hyper-polarization on major societal issues impacting public health…issues like mass shootings, climate change, abortion rights, and gender-affirming care models. 58:00 “If you don’t advocate on these issues, you will further exacerbate the trajectory of health disparities.” 59:00 Advocacy for marginalized populations goes back to the origins of our healthcare system. Getting into “good trouble” is the right thing to do.

In this episode, we are going to discuss the impact of diagnostic errors on health equity. For patients of color, the unequal medical care and quality of the diagnosis received isn’t due to just location, education, or income. It’s also at times due to healthcare professionals’ cognitive biases, along with decades of clinical studies that examined only white, male bodies, and a lack of understanding about the social determinants of biological illnesses. The causes of poor quality diagnosis for people of color is multifactorial and is not just related to explicit or implicit racial bias, however — lack of trust, missing data, and reduced data at the point-of-care are just a few of the other contributing factors. Although health inequities within communities of color have persisted for hundreds of years, many are just now waking up to the problem.  There is now an elevated sense of awareness of health inequities in our country due to the exacerbated health outcomes triggered by COVID-19 and preexisting disparities that have been magnified under the microscope of the pandemic. If one studies history, you can easily find preexisting health inequities that took form long before COVID. It is widely accepted that the first kidnapped Africans to reach European colonies in the Americas for the purposes of slavery did so in 1619 – meaning Black health was ignored from or country’s beginning with health disparities persisting through the next 400+ years. The very foundation of the transatlantic slave trade is false medical theories of black inferiority and physical differences between blacks and whites. To better how the patient safety movement aligns with health equity, healthcare professionals should listen to Dr. Ronald Wyatt.  Dr. Wyatt is one of the most renowned patient safety experts and health equity champions in this country.  He is Vice-President and Patient Safety Officer at MCIC Vermont, a risk-retention group, where he leads multiple patient safety initiatives for several leading academic health systems. He is an internationally known equity, safety and quality improvement/implementation expert. Dr. Wyatt was the first co-chair of the Institute for Healthcare Improvement (IHI) Equity Advisory Group and is faculty for the IHI Pursuing Equity Initiative. After serving as the Medical Director for the US Defense Health Agency/Military Health System Patient Safety Analysis Center, he became the first medical director of The Joint Commission (TJC) Office or Quality and Patient Safety and the first patient safety officer for The Joint Commission. While at TJC, Dr. Wyatt led the team that wrote the Patient Safety Systems Chapter, contributed to Sentinel Event Alerts and created the Quick Safety publication. He served as technical advisor on the RCA2 document that has been widely adopted as a guide to completing a root cause analysis. Dr. Wyatt is a member of the ACGME Clinical Learning Environment Review committee, as well as faculty on the ACGME Disparity Collaborative. He also serves on several boards including the IHI Certified Professional in Patient Safety, the Society to Prevent Diagnostic Error and the Consumers Advocating for Patient Safety. Currently, he is faculty/advisor/coach on multiple health equity collaboratives including BCBS Massachusetts/IHI, ACGME BCBS Illinois Equity Matters, KC Learning Action Network and the Providence health system equity collaboratives. Dr. Wyatt has written and published many articles, blog pieces and chapters on patient safety, health equity/disparity and process improvement. Episode Bookmarks: 01:30 Introduction to Dr. Ron Wyatt 04:30 The human cost of diagnostic error (patient deaths due to a diagnostic error are estimated at 40,000-80,000 per year!) 06:00 “To make the right diagnosis in a timely manner is a core quality component.” 06:30 Dr. Wyatt discusses how correct diagnoses are the link between patient safety and healthcare quality. 07:15 The patient safety goal in diagnostic accuracy is “Zero Preventable” harm, injury, and death. 08:00 Prioritizing a culture that values open lines of communication, teamwork, and patient engagement. 08:30 The authority gradient in medicine that makes individuals less likely to speak up or report a diagnostic error. 09:30 Poor leadership is the common denominator of healthcare organizations with high rates a sentinel events. 10:00 Dr. Wyatt discusses his patient safety work with The Joint Commission that identified root causes of sentinel events. 11:30 LEADERSHIP: The leadership behaviors required in hospitals and health systems to support high performance in Patient Safety. 12:30 The need for leaders to hold physicians accountable and apply systems thinking (going after the “unknown unknowns”) 13:30 CULTURE OF SAFETY: The institution of a Reporting Culture to mitigate risks of patient harm. 14:30 Establishing a system of transparency in a culture that creates a “psychologically safe environment.” 15:30 Implementing strong corrective actions is the responsibility of good healthcare leaders. 16:30 CONTINUOUS PROCESS IMPROVEMENT: using tools and methods to create a closed loop system to make the system safer. 17:15 “Leadership, a culture of safety, and continuous process improvement must all be strategically aligned, operationally robust, and tactically impactful.” 18:30 Health inequities have resulted from healthcare professionals’ cognitive biases and other issues of institutional racism leading to poor trust. 19:15 The origins of health disparities beginning with the transatlantic slave trade. 20:30 Defining health inequity – health outcomes that are avoidable, systematic and unjust. 21:30 Contributors to inequities — Institutional racism, stereotype bias, implicit bias, workforce capacity, resource allocation, ineffective DEI strategies 21:45 “The canary in the coalmine for health inequity existed long before COVID.” 22:30 Dr. Wyatt provides a comprehensive explanation of the history behind  slavery and how the resultant devaluing of black lives led to health inequity. 23:45 Social drivers of health as the manifestation of racism. 24:45 Food insecurity explains why Mondays are the most attended school day of the week. 25:30 Mortality rates of minority populations during COVID-19 pandemic should not have been a shock to anyone studying public health data. 25:45 Implicit and explicit bias and “trust decay” due to lack of empathy by the health system. 26:20 Dr. Wyatt describes why current DEI efforts are insufficient. 27:15 The cultural revolution for civil rights and social justice following the murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and others. 29:00 Dr. Wyatt discusses how over-policing is a public health issue and shares a personal story of how he was discriminated by police as a young man. 30:00 Slave patrols that led to a persistence of racism in law enforcement that carries on to the modern day. 30:20 Dr. Wyatt discusses “The New Jim Crow”, i.e. mass incarceration of African American males in the U.S. 32:00 “Weathering” in adulthood due to past childhood experiences of racism and over-policing that are carried over to the healthcare system. 32:30 Dr. Wyatt shares the story of police beating a patient inside of a hospital and how an African American physician was arrested for obstruction of justice. 33:15 The answer is not defunding the police, instead it is integrating them in the communities they serve. 34:30 The longstanding history of distrust with the healthcare system in African American communities (e.g. gruesome experiments on slaves, Tuskegee syphilis study) 35:40 “The historic erosion of trust in the healthcare system.” 36:30 The Philadelphia Negro – statistical differences in health between races is “a peculiar indifference” (1899) 37:00 Trust can be created by authentic displays of respect and compassion in the healthcare setting. 37:30 Dr. Wyatt describes how his son experienced distrust of the healthcare system based on a bad experience with a pediatrician. 39:00 The need for more African American physicians will increase trust in the healthcare system. 40:30 “Race is an independent risk factor for death, and the data bears that out.” – Dr. Don Berwick 41:00 Dr. Wyatt discusses the need for health equity transformation in our country at the training level. 41:30 Racist myths in the medical profession that have persisted since the 1800’s (e.g. race-based decisions in CHF, renal failure, transplant referrals, etc.) 43:30 Creating tele-equity to positively impact patient care and diagnostic accuracy. 44:15 14 million homes in urban settings and 4 million homes in rural communities lack broadband access (and 75% of them are people of color). 45:00 Dr. Wyatt describes his collaboration with the American Telemedicine Associationto create a framework for implementing telehealth to improve health equity. 47:20 Building structural competencies into the deployment of telemedicine (“closing the power gap”) 48:15 Aligning health literacy with digital literacy. 48:30 Payment reform of telemedicine services to make it more affordable. 49:30 Growing concerns that AI and machine learning algorithms reinforce existing biases. 51:00 Referencing the NEJM article “Hidden in Plain Sight – Reconsidering the Use of Race Correction in Clinical Algorithms” 51:45 Abolishing biased algorithms through community partnerships and the avoidance of “over the horizon” decisions in clinical treatment. 53:00 Understand the culture of a community before applying data to make algorithmic decisions in diagnosis (creating a social risk picture) 55:00 Starting with the ACO REACH program, CMS plans to be embed health equity into all payment models, with more focus on improving health outcomes in underserved populations. 56:00 Dr. Wyatt explains the 4 Domains of Value-Based Purchasing, i.e. clinical outcomes, community engagement, patient safety, efficiency and cost reduction. 56:30 Stratifying HCAHPS data by race, ethnicity, and language for health equity performance management. 58:00 CMS requirements for health equity strategic planning and leadership. 60:00 Allocating population health resources to highest need (not most wanted) once high-risk populations have been identified. 61:00 Developing an anti-racism action plan to reduce health disparities starting with The Joint Commission standards. 62:20 Dr. Wyatt provides a framework for developing a value-based care strategy for Health Equity. 64:00 Diagnostic error account for 17% of preventable errors in hospitalized patients. 64:45 The dearth of research in diagnostic error prevention despite the abundance of overwhelming data showing the severity. 66:00 Leaders confronting biases in diagnoses to overcome health inequities. (Those who won’t need to find another job!) 67:45 “With regard to health equity, a rising tide does not lift all boats.  We must put systems in place that adjust depending on those most in need.” 69:30 Be prepared not to get paid for poor outcomes in underserved populations.  Payment mandates for health equity are forthcoming. 70:00 Wisdom from the Dalai Lama on Compassionate Equality — having compassion for all sentient beings. 71:30 “The root of the word courage is Latin word for heart.  We must commit to “heart work.” Healthcare quality begins and ends love.” 73:00 Dr. Wyatt is optimistic for the future because of conversations like this podcast! 74:00 If you love people, you can change the world.

When you hear about value-based care, do you get tired of hearing about concepts without tangible best practices?  Do you ever wish you could just acquire insights from a leader who navigated a successful value journey?  If you want to learn from one of the best in the “value game”, look no further than Dr. Bill Wulf, the CEO of Central Ohio Primary Care (COPC). Dr. Wulf is a respected leader in the value movement and leads the largest physician-owned primary care group in the United States.  During his leadership tenure, COPC has grown to over 480 physicians and 83 locations in central Ohio. The growth of the practice has empowered a successful value journey, with COPC caring for 75,000 senior patients in full-risk arrangements with Medicare Advantage and ACO REACH in partnership with Agilon Health (and the current move to full-risk in commercial plans with employers in partnership with Vera Whole Health). Dr. Wulf describes a value journey that has been over two decades in the making.  It started with a merger in the late 90’s to create a fully-integrated primary care practice platform. And then in 2010, a Patient-Centered Medical Home (PCMH) transformation led to unprecedented success in full-risk Medicare Advantage.  COPC has built upon their MA success to now partner with large employers in full-risk programs, and they are also one of the new participants in the ACO REACH program. In this interview, Dr. Wulf goes into great depth on the care delivery innovations that were made possible by prospective payment and capital investment. He discusses hospitalist and ER care coordination programs, home-based care delivery, after-hours primary care access, telehealth, onsite clinics at employer locations, and the importance of data-driven insights from a unified EHR. You will also hear about how COPC has benefited from successful partnerships to build an even more effective infrastructure for population health outcomes. Most importantly, you will hear how COPC playing the “value game” helps their independent physicians take better care of patients! Episode Bookmarks: 03:30 The origin story of Central Ohio Primary Care (COPC) – the nation’s largest independent primary care practice that is leading in VBC 05:30 Dr. Wulf describes how a practice merger in the late 90’s led a successful hospitalist program, contracting strategy, and ancillary services model 07:00 Post-merger growth of practice because of better contracting rates and ancillary services revenue 07:30 “Our growth in the last 10 years has been a result of us playing the “value game” in helping physicians take better care of patients.” 08:00 This year COPC is integrating 3 practices (30 physicians) at a time when there aren’t as many independent PCPs available. 09:00 COPC’s commitment to physician independence, where physicians have the freedom to care for their patients without interference. 09:30 Beginning the value journey through the decision to transform into a Patient Centered Medical Home (PCMH) 11:00 How physician independence leads to freedom to make data-driven referrals that improve population health outcomes. 12:00 A unified Electronic Health Record (EHR) led to the identification of the “best” doctors in the practice. 13:00 “The best physicians in the practice were not the busiest ones…but these physicians (pre-value journey) were making the least income.” 13:45 “Our best physicians were creating value for the payer, employer, and the government, but they were not recognized for value in a FFS world.” 14:30 Dr. Wulf describes how Level 3 PCMH recognition led to value creation (“a stepping stone”) 16:00 PMPM payments from commercial and MA plans led to programs that improved outcomes with high-risk patients. 16:30 COPC’s Hospitalist Program (100 physicians) and ER Care Coordination Program 17:00 Nursing care coordination that leads to effective post-discharge planning and transitions of care from the hospital. 17:30 Home visits to patients from nurses and social workers that prevent a hospital readmission. 18:30 COPC’s VBP Portfolio Progression that shifted from FFS to shared savings arrangements and then risk-based, prospective payments. 20:00 COPC has 75,000 senior patients in a full-risk arrangement through Medicare Advantage and ACO REACH. 20:45 Deciding to focus on Medicare Advantage early on (instead of becoming a MSSP ACO) by leveraging PCMH relationships in local market 21:30 The recognition that partnership was needed to advance practice to full-risk Medicare Advantage 22:30 Dr. Wulf explains how COPC chose Agilon Health as a partner to support its value journey in MA. 23:30 Commercial prepayments now also carry a risk component. 24:00 20-50% of COPC’s physician compensation is tied to value in some way. 24:45 Strategic partnership with advanced primary care provider Vera Whole Healthwhich recently merged with healthcare data company Castlight Health 26:00 Dr. Wulf explains COPC’s disruption-focused strategy in the large dysfunctional, self-insured employer healthcare space. 27:15 “Company CEOs don’t buy health; they buy insurance.  By partnering with an employer to impact TCOC spend, our practice can change the dynamic.” 28:00 Providing employers with onsite health clinics, health coaching, behavioral health services, and after-hours access to care. 29:00 Agilon Health has grown to over 250k Medicare Advantage members and over 90k attributed Direct Contracting beneficiaries (referencing Steve Sell podcast) 31:00 Dr. Wulf explains how partnership with Agilon’s technology, process standardization, and capital investment drives scale in global risk capitation models in Medicare Advantage. 32:30 “The challenge with CMMI value-based programs is that they are not long enough to recognize full value.” 32:45 Leveraging risk stratification to drive care delivery innovation for chronically ill, high need seniors. 33:45 Contracting expertise and passion are key ingredients to COPC’s partnership with agilon health. 34:45 Lower Hospital Admissions: 156 Admits per 1,000 (average Medicare ADK rate is 300+) 35:50 Lower Hospital Readmissions: 10-11% (average Medicare readmit rate is 18-19%) 35:00 “Because we are investing in the outcomes, we can provide a level of care that few can.” 36:00 COPC’s participation in the Comprehensive Primary Care Plus (CPC+) Advanced APM in the traditional Medicare program. 37:45 CPC+ prepayments (just like earlier experience with MA) led to investment in programs that led to better patient outcomes. 38:00 Dr. Wulf describes how the ER Care Coordination program allowed practice to send 400 patients home (instead of getting admitted). 39:00 Only 1 in 7 patients surveyed had attempted to call their PCP before going to ERà this led to nurses answering phones after hours! 40:00 Fall Risk Prevention and Smoking Cessation programs started with CPC+ funds. 41:00 COPC is now in the full-risk ACO REACH program in partnership with Agilon. 42:00 Starting with the ACO REACH program, CMS plans to be embed health equity into all payment models, with more focus on improving health outcomes in underserved populations. 43:30 COVID-19 brought health inequities to the forefront, and (finally) the new ACO REACH program has the potential to address it. 45:00 >40% of COPC clinics are located in underserved areas 45:15 “CMMI is taking us in the right direction to address health inequities through ACO REACH.” 46:00 COPC has been successful in expanding its integrated care network through skilled nursing, end of life, and 24/7 care to continue the population health journey. 47:30 How clinical integration can improve patient experience, eliminate care fragmentation, enhance information sharing, and ultimately improve patient outcomes. 48:45 Partnership with Leading Reach to digitize referrals and improve specialty referral management. 49:00 “We need to integrate specialists into value. Healthcare waste leads to unnecessary patient suffering.” 50:00 Dr. Wulf provides an example of how COPC used data to profile specialists by quality performance. 50:30 Partnerships to improve care in MSK and Oncology care. 51:00 COPC rapidly created and implemented a telemedicine program — within 1 week — during the pandemic. 53:30 The failure of HealthSpot and how COPC learned that patients are amenable to telehealth. 55:00 In primary care, telehealth is best utilized in a follow-up visit for a medication change. 56:00 “Telehealth, outside of a patient relationship and a longitudinal health record, is a low-level of care.” 57:30 Telehealth will continue to grow.  COPC is expecting 10-15% utilization in the long-term. 59:30 Dr. Wulf provides his parting thoughts on the movement to value-based care. 60:30 “If we just focused on waste, we could transform healthcare.”