The Race to Value Podcast

There is a need for hope and innovation in the delivery of value-based oncology care.  Cancer costs are on an alarming trajectory due to the aging and growth of our population. Oncology is currently the 3rd most expensive specialty, but it is growing 3X faster than the top 3 specialties. Unless we find a way to replicate and scale value-based oncology care, it will be soon be the #1 most expensive specialty!  Value-based transformation in oncology is especially needed due to the high variability in cancer costs from state-to-state, as we see a 2-3X cost differential multiple between regional markets, with no correlation between cost and quality.  Eliminating cancer care disparities would prevent 34% of all deaths and save $230 billion in direct medical costs and $1 trillion in indirect costs to society. Furthermore, we are seeing financial toxicity in cancer care that results in 1 in 4 patients declaring bankruptcy within 2 years of diagnosis. And on top of that, 1 in 3 Medicare patients are refusing to fill lifesaving prescriptions due to high out-of-pocket costs. This financial toxicity in cancer care is disproportionately impacting minority and low income communities, leading to increased mortality, decreased quality of life, and lower survival rates. To find hope and innovation amidst these grim statistics, look no further than The Oncology Institute of Hope and Innovation (TOI). Their highly specialized, value-based cancer care practice delivers cutting-edge, evidence-based cancer care to a population of approximately 1.6 million patients.  Oncology patients undergoing value-based care at TOI experience 40% fewer inpatient admissions, 75% fewer ER admissions, with patient satisfaction scores that are 14% higher than traditional oncology care.  Joining us in the Race to Value this week is Brad Hively (CEO) and Dr. Daniel Virnich (President) from TOI – the largest oncology practices in the US.  They discuss the importance of patient-centered high-quality, outcomes-based cancer care; emerging value-based oncology payment models; patient engagement and care coordination; clinical care pathways; physician compensation methodology; the importance of physician leadership in value transformation; and how to replicate growth at scale when delivery value-based oncology care. Episode Bookmarks: 01:30 Introduction to the Oncology Institute of Hope and Innovation (TOI), Brad Hively, and Dr. Dan Virnich 03:00 TOI is the first specialty value-based care company to go public (November 2021) and has become one of the largest oncology practices in the US 04:00 The unsustainable financial trajectory of American healthcare with annual costs of cancer care ballooning to $209 billion due to aging and growth of US population 06:00 “Oncology is the 3rd most expensive specialty in the senior population, but it is growing 3X faster than the top 3 specialties. It will soon be the #1 most expensive specialty.” 07:00 “From state-to-state, there can be a 2-3X multiple difference in oncology care costs, and there is no correlation between the cost and the quality.” 07:45 How do you replicate high value oncology markets across the country? (TOI is achieving 25% lower costs in oncology care.) 08:30 85%+ of oncology revenue comes from drugs (fee-for-service practices reimbursed at cost + 6% which creates a misalignment of financial incentives) 10:00 Medicare’s new value-based Enhancing Oncology Model (EOM) that is replacing the Oncology Care Model (OCM) 11:30 Brad explains why the voluntary Oncology Care Model has not generated as much savings as Medicare initially envisioned. 12:30 Brad discusses TOI’s participation outcomes in the OCM and how they are looking forward to EOM. 13:00 EOM will be slightly more limited (e.g. few cancer types included in the program, lower upfront care coordination payments). 14:00 The enhanced focus on health equity and patient navigation with the new EOM payment model. 15:00 An overview of the controversial mandatory Radiation Oncology (RO) Model 16:30 Dr. Dan provides context outlining the need for value-based radiation therapy 18:00 Suboptimal health literacy is an independent risk factor for poor health outcomes, including increased risk of hospitalization. 19:00 TOI has achieved 40% fewer inpatient admissions, 75% fewer ER admissions, with patient satisfaction scores that are 14% higher than traditional oncology care. 19:30 Cancer is unique in the amount of interdisciplinary care coordination that is required. 20:30 Coordinating cancer care between multiple specialists (e.g. surgeon, radiation oncologist, pain management specialist, PCP) 21:00 Additional support services are required in advanced cancer care (e.g. home health, palliative care, outpatient rehab) and how TOI’s high touch model 21:30 Dr. Dan explains the TOI high-value cancer care program that provides patient coaching, care coordination, and navigation assistance. 21:45 Benefits of care coordination (e.g. higher patient satisfaction, improved clinical outcomes, lower post-acute care utilization, and openness to advanced care planning discussions) 23:00 The importance of physician leadership and the opportunity to refocus attention on provider recognition, work-life balance to address physician burnout 24:00 Dr. Dan discusses the physician leadership model at TOI that elevates the clinical voice in making decisions for care delivery transformation 25:30 How TOI approaches the alignment of incentives with its physician compensation model 26:45 Do oncologists actually prefer a value-based compensation model? 27:30 Brad explains the importance of physician leadership in the governance of TOI. 28:30 Frontline practicing physicians are invited to meetings of the corporate Board of Directors to enhance communication, transparency, and collaboration. 29:00 Standardizing cancer care with clinical care pathways adopted from the National Comprehensive Care Network (NCCN) 30:00 Oncology clinical pathways align therapeutic decision-making with value-based care outcomes, e.g. the prescription of drugs to promote improved adherence. 31:30 Leveraging EHR optimization through order sets and advanced analytics to promote guideline-based therapy 33:00 The uses of telehealth in oncology and why the specialty is so well-suited for virtual care delivery 34:30 Brad discusses the tradeoffs between in-person and remote oncology care and how oncology is more heavily reliant on labs and pathology reports. 35:00 Dr. Dan on the impact that immunosuppression and second opinion seeking has in patient preference for telehealth consults. 37:30 Eliminating cancer care disparities would prevent 34% of all deaths and save $230 billion in direct medical costs and $1 trillion in indirect costs to society (report) 38:30 Dr. Dan provides an overview of TOI’s focus of health equity, focused on addressing high out-of-pocket costs for patients 40:00 Clinical trials often exclude non-English speaking patients which prevents underserved patients from accessing new innovative treatments 40:45 How TOI provides language proficiency and culturally competent care with its providers 41:30 The financial toxicity of cancer care (1 in 4 cancer patients go bankrupt within 2 years of diagnosis, 1 in 3 cancer patients go bankrupt within 5 years of diagnosis) 41:45 Lack of filled prescriptions due to cost (1 in 3 Medicare patients do not fill their prescriptions) 42:00 “Financial toxicity in cancer care disproportionately impacts minority and low income communities, leading to increased mortality, decreased quality of life, and lower survival rates.” 42:30 TOI now has 50 locations in 4 different states, serving 1.6 million lives under capitation. 43:30 “TOI represents a company where you can do well, while also doing good. Our vision is to be the leading value-based oncology group.” 44:45 Promoting replication at scale through practice pattern consistency

Primary Care in the United States is flawed, especially for our most complex patients in the Medicare program.  We have built this incredibly expensive primary care model around a fee-for-service system that is incredibly fragmented and uncoordinated.  There is now a need for a new model – one that yields a much better experience for patients and physicians.  We now stand at the threshold a great dawning. An era is ending, and we are at the core of creation in reimagining a more idealized, value-based model for primary care – one that untaps a massive reservoir of healing capacity. This vision for “A New Primary Care Model” will transform community health for our most clinically complex and vulnerable populations.  And it all starts with payment model innovation which, in turn, spawns care delivery innovation. Although we are in early days of full-risk Medicare Advantage and global capitation models in Medicare, there are leading indicators that show promise for the future of health. What exactly does a reimagined primary care model look like and how can it scale?  Look no further than agilon health – a company that partners with independent primary care practices that are leaders in their markets and helps them transition to value-based care success in the Medicare program. On the Race to Value this week, we are joined by Steve Sell, the Chief Executive Officer and a member of the board at agilon health.  Steve leads agilon health as an experienced, mission-based CEO known for transforming organizations through partnerships, product innovations and talented, collaborative teams. With over 25 years of experience in value-based care in the health plan environment, Steve Sell is building a new model of primary care for the future. Under Steve’s leadership and guidance, agilon health is transforming health care delivery through a technology enabled, full risk value-based care model that places the primary-care physician as the quarterback of patient care. And they are doing this at scale, in geographies that have operated in a fee-for-service environment. If you are want to know more about how we can transform primary care at scale, this week’s podcast episode is a must-listen! Episode Bookmarks: 01:30 Introduction to Steve Sell and agilon health 04:00 agilon’s growth to over 250k Medicare Advantage members and over 90k attributed Direct Contracting beneficiaries 06:30 “Primary Care in this country is really flawed. It’s been built around a FFS system that is incredibly fragmented and uncoordinated.” 07:00 The vision for “A New Primary Care Model” to transform community health that is empowered by payment model and care delivery innovation 08:00 Steve discusses the rapid growth of agilon health since its founding in 2016 (1% of all PCPs in the country, 23 communities in 12 states) and how PCP trust is built over time 09:00 Partnering with physicians to support scale and alignment in markets that have been historically dominated by FFS 09:45 “We believe that full-risk, value-based care is the best way to organize an entire community. PCPs can then move to the top of the overall delivery of care.” 10:15 The Speed of Transformation — agilon’s intensive 12-month implementation period 10:45 Win/Win/Win (Patients, Doctors, Communities) – transformed health outcomes, satisfied primary care providers, high industry-leading Net Promoter Scores 12:00 The consumer-centric innovation opportunity in fully-delegated, capitated Medicare Advantage plans 13:30 How changing demographics and an aging population fuels Medicare Advantage Growth 14:00 The economic challenges of a shifting payer mix in primary care, i.e. less concentration of commercial business when a population ages 14:45 “The reform of payment models are the key to starts the process of transformation in primary care practices.” 15:00 The early days of full-risk MA and global capitation models in Medicare as an indicator for future success 16:00 Recent study showing the association of full-risk value-based care and improved acute care utilization outcomes (e.g. 5-8% reduction in hospitalizations, 11-13% in ER visits per 1000) 18:00 Steve discusses agilon’s medical margin experience in impacting client success and primary care reinvestment 18:45 “This year, as a result of driving positive improvements in medical margin, agilon will reinvest over $100M into primary care in our communities.” 19:30 Creating a “flywheel effect” by capitalizing on the waste in the healthcare delivery system 20:00 Reestablishing a primary care visit cadence (i.e. frequency and regularity of visits) for the most complex patients 20:30 PCP visit within 48 hours of being discharged can reduce hospital readmission rates by >20% 21:00 The importance of medication adherence in high-touch, chronic care management 22:00 Amazon’s acquisition of One Medical for $3.9B — how will this impact the value-based, primary care landscape? 24:00 “There is need for a new primary care model – one that yields a much better experience for patients and physicians than what we’ve seen historically.” 25:00 Universal recognition of the broken nature of primary care as a driver of capital investment 26:00 Steve differentiates agilon’s primary care model with what we may see from Amazon Care/One Medical model 27:30 “The Amazon decision on One Medical is the latest indicator that a number of competitors have identified primary care as a place to invest.” 29:00 The scarcity of primary care physicians (only 200K nationwide): “We must treat them well.  Competition is a good thing.” 30:00 PCP Shortage: only 20% of young doctors are going into primary care, and the percentage of PCPs in the physician workforce has fallen to 32% 31:45 The need to slow the attrition rate of primary care doctors leaving the profession (and how value-based primary care can make this happen!) 34:00 “My dream is that we are going to look like the rest of the world, where adult primary care becomes one of the top 5 medical specialties in the next 5-10 years.” 34:30 Steve discusses the significance of primary care physician compensation models in realigning incentives to “do the right things” 36:30 “The elegance and simplicity of our compensation model is that it aligns with better outcomes for patients, and that allows our physicians to win.” 38:00 The agilon vision “to transform the future of health care in 100+ communities across the country by empowering patient-physician relationships.” 40:00 Driving success through scalability and how that enables agilon’s mission and vision 41:00 How a scalable partnership model and VBC support platform integrates with local health care markets to achieve success 45:00 Steve discusses the impact of the COVID-19 on the value movement and how it will reshape the primary care landscape 46:00 How telehealth innovation and amplified access further strengthened patient-provider relationships during the pandemic (with net promoter scores actually increasing!) 47:30 Partnering with practices to address staffing shortages in clinical care teams 48:30 “The macro effects of COVID-19 have pushed us more towards value.” 49:30 Eric provides brief overview of the new ACO REACH model 51:00 Steve discusses the important opportunity of ACO REACH with agilon’s physician partners 53:00 The scale and concentration benefits of ACO REACH as a tipping point for risk-based value transformation 54:00 Perspectives on how ACO REACH will impact health equity outcomes for agilon’s communities 56:00 Steve describes how agilon’s partner practices are taking upstream actions to address social determinants of health 58:30 Steve discusses agilon’s recent IPO and why a publicly traded primary care company should have a long-term focus on positively impacting health care 63:30 Learn more about agilon health through online resources (website, Twitter, LinkedIn, Instagram) and by talking to their existing partners

Democratization of value can only happen through the replication of full-risk APM adoption in primary care.  As a country, we must accelerate primary care progression towards fully-capitated risk by thoughtful health policy and payment model redesign.  Change is underway — primary care is already moving to a capitated model of reimbursement, and ACO REACH is our first real test of realigning financial incentives to improve care of patients living with chronic conditions.  Furthermore, this inflection point in the value movement is finally bringing much needed emphasis to those living in underserved communities facing health inequities.  So how do we operationalize primary care transformation at scale?  Is it possible to replicate a ‘clinical flywheel’ that provides RN care coordination, home-based care, embedded pharmacists, and floating health concierges to close care gaps and addressing health inequities? This week we are joined by two executives from UpStream, a billion-dollar, full-risk health services organization that embeds clinicians into participating doctors’ offices as an advanced, full-risk Medicare program for network physicians.  By focusing on patients living with chronic conditions, and physically embedding highly trained prescribing pharmacists and coordination nurses at each primary care physician office, UpStream partners with its client practices to create the right infrastructure and resources for the whole-person care experience. Their approach has been to fully invest in primary care delivery models accountable for Total Cost of Care, whereby reducing care fragmentation for chronically ill patients while also achieving the best clinical and financial outcomes. Dr. Sanjay Doddamani (CEO and Co-Founder of Upstream) and Valinda Rutledge (Chief Corporate Affairs Officer of Upstream) are two of the biggest thought leaders in the value movement. In this episode, they talk about the transformation opportunity of massively powerful primary care, the impact of COVID-19 on the value movement, technology innovation, health equity, capital investment in primary care infrastructure, collaborative care models, and the new ACO REACH payment model. Together they are leading one of the most innovative companies out there supporting primary care physicians in the Race to Value! Episode Bookmarks: 01:30 Upstream – the fastest-growing healthcare solution provider in the country 02:30 Introduction to Dr. Sanjay Doddamani and Valinda Rutledge 04:00 The transformation opportunity of massively powerful primary care within a value-based purchasing construct 05:00 Can we reach a “Win-Win-Win” for patients, primary care physicians, and patients? 06:00 Valinda on the impact of the pandemic on the value-based care movement and how it unleashed tech-enabled consumerism in primary care 08:00 Payment reforms and looming insolvency of Medicare and how it will impact the independent Primary Care landscape 09:00 The development of ACO REACH as a model for capitated primary care reimbursement 09:30 Sanjay speaks to the challenges of the post-pandemic environment and the ‘Great Resignation’ on physician networks 10:00 “Primary Care physicians influence 90% of all medical costs.” 11:00 PCP burnout and recent findings on how family medicine is one of the five most stressful specialties 13:00 “If you continue to practice in a fee-for-service environment, it is like being on a hamster wheel with no way to get off.” 13:30 Sanjay speaks about the need to reallocate investment dollars to build primary care infrastructure for the 21st century 15:00 Critical Success Factors: Pharmacy integration, home-based primary care, and advanced data science capabilities 16:00 Valinda speaks to the challenges of decreasing PCP panel size when there are access barriers in underserved communities 18:00 Population health infrastructure requirements as the table stakes needed to play the game of value-based care 19:00 How Upstream supports partner practices with the capital needed to move to fully-capitated risk 20:00 Valinda provides distinction between capital requirement needs in independent vs. health system-owned/employed PCP practices 21:30 An overview of the Upstream “Guaranteed Advanced Payments for Quality” (GAP-Q) advanced payments for quality performance 22:30 “As you shift off of the fee-for-service chassis, something needs to replace it.  And that to me is a floor incentive that is tied to quality.” 25:00 Sanjay’s previous work with Keystone ACO and Geisinger that built the health system’s first home-based care program 25:30 Recent McKinsey & Company study estimating that up to $265 billion worth of care in Medicare/MA (25 percent of the total cost of care) could shift to the home by 2025 26:00 Sanjay speaks about Upstream’s ‘clinical flywheel’ of home-based care and disease management for the chronically ill 29:00 The practice of forensic listening, behavioral psychology, and shared decision-making to engage patients in care management 31:00 Will collaborative care be more common than what we see now where pharmacists, physicians, and other clinicians address health disparities separately? 32:00 Valinda speaks about the importance of culture and interprofessional collegiality to build successful integrated team-based care models 33:00 Building partnerships with community benefit organizations to resolve health inequities in underserved communities 34:30 Sanjay provides clinical examples reaffirming the importance of workforce integration to build cohesive multidisciplinary team-based care models 37:30 Technology to implement specific individualized interventions to mitigate the risk of costly complications that have a significant impact on the quality of care 39:00 Sanjay speaks about the physician workflow challenges of the ‘measurement industrial complex’ 40:30 Valinda counters the technology transformation imperative by emphasizing the need for deep interpersonal patient-provider relationships 43:00 Sanjay on the use of Artificial Intelligence and Machine Learning in value-based primary care in partnership with ClosedLoop.ai 44:30 How will the move toward value-based care with prospective payment models upend the way we’ve historically defined primary care delivery? 47:00 Sanjay questions the feasibility of the CMS goal for 100% of Medicare beneficiaries in accountable care models since physicians are getting left behind 47:30 “We must bring all physicians along in value by enabling them to participate in risk models, indemnifying their downside, creating upside opportunities, and reallocating dollars to primary care.” 48:00 Valinda outlines the 3 Barriers to Value-Based Care adoption (i.e. Benchmarking methodology, Risk Adjustment, lack of Value-Based Care awareness with beneficiaries) 51:30 “We need to change the language of value-based care.” 53:00 Sanjay on how the current Administration is redefining the value movement through payment model redesign to include equity as a centerpiece 54:30 Valinda addresses the need for multistakeholder input to develop health policies that drive equity transformation 57:30 Valinda provides an comprehensive overview of the new ACO REACH payment model 61:00 Sanjay provides parting thoughts on the future of Upstream and how it will replicate its’ primary care model across the country

Community-based health transformation can be unleashed by uniting traditional allopathic medicine with lifestyle medicine.  To achieve a vision for population health, we will never change things by fighting the existing reality – we must instead innovate to render that old model obsolete.  On a mission to flatten the curve of healthcare costs, James Maskell has spent the past decade innovating at the cross section of functional medicine and community. To that end, he created the Functional Forum, the world’s largest integrative medicine conference with record-setting participation online and growing physician communities around the world. His organization and bestselling book of the same name, Evolution of Medicine, prepares health professionals for this new era of personalized, participatory medicine. His new project, HealCommunity, follows his second book “The Community Cure“, makes it easy for clinics and health systems to deliver lifestyle focused care effectively and frictionlessly. He is a high-demand speaker and impresario, being featured on TEDMED, HuffPostLive and TEDx, as well as lecturing internationally. In this episode, you will learn about the impact of social isolation on chronic disease, functional group medicine, the development of a community layer as a foundation to the population care pyramid, Empowerment Group models, Human Social Genomics and precision medicine, behavior health and psychedelic therapies, and the power of lifestyle-enabled value-based care. Tune in this week to hear from a leading population health economist on a mission to win the Race to Value! Episode Bookmarks: 01:30 Introduction to James Maskell (Community Builder and Healthcare Entrepreneur) 02:00 Books (Evolution of Medicine and The Community Cure) and theHealCommunity project 02:30 “Community is the most powerful force to transform health.  And Medicine has been slow to adapt to this reality…” 04:30 R. Buckminster Fuller: “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” 05:00 Blue Zone Regions and the Roseto Effect 06:00 Is Chronic Disease Reversible? 06:45 “The biggest driver of all-cause mortality is loneliness and social stress.” 08:00 “The combination of Lifestyle Medicine and Group Medicine are the potential foundation of the population care pyramid.” 08:30 How can insurance be restructured to rebuild the community layer? 09:30 Honoring our ancestry by resolving the isolation of modern living 09:45 The thesis by Raghuram Rahan that technology has ripped apart the fabric of traditional communities 12:00 Inspiration from Dr. Jeffrey Geller and his work with Empowerment Group Models, delivering care and providing social support to underserved populations 14:30 Innovation of medicine at the cross section community and health empowerment (the solution to loneliness) 16:15 Billing, reimbursement, and privacy challenges in implementing group visits 17:30 Value creation and the elegance of the empowerment group model 19:00 The social paradox: people’s willingness to share private information on Facebook rather than within a community health model 19:30 Development of skills and competencies for Group Medicine 21:00 The collective trauma of the pandemic has changed the way people engage together 22:30 Removing friction points in group medicine through virtual visits 23:30 The impact of human social genomics in precision medicine, disease prevention, and personalized care pathways 24:45 George Slavich, PhD and his work in Human Social Genomics 25:00 The cellular-level impact of stress and depression related to the loss of a social community 26:00 Is Group Medicine really the opposite of Precision Medicine? 27:30 The vision for Precision Public Health and the work of Dr. Christopher Mote 30:30 America’s Behavioral Health crisis and recent Mass Shootings 31:30 A comorbid behavioral health disorder makes a chronic disease cost 2-3 timesmore! 32:00 Emerging research in Psychedelic Medicine delivered in integrative mental health clinics (such as ketamine-assisted psychotherapy) 33:00 An economic perspective on the research related to Group Medicine and theBiopsychosocial Model 35:30 The promise of Psychedelic Therapy on PTSD and other major depressive disorders 36:45 Combining Psychedelic Therapy with Lifestyle Medicine delivered in groups 38:00 Functional Medicine and Knowledge Transfer (the doubling of medical knowledge every few months) 39:30 The hope for the future lies in the value-based care movement 40:00 Functional group medicine outperforms traditional hyper-individualized medicine in treating chronic disease (Cleveland Clinic Study) 42:00 Increased interest in functional medicine due to COVID-19 43:30 The competitive advantage and market economics of the community health model 46:00 Refocusing value-based payment reforms that emphasize clinical models for disease prevention and lifestyle medicine 47:45 Creating a “Lifestyle Medicine ACO” (e.g. Vytalize Health, self-funded employers) 49:30 The work of Dr. David Unwin in reversing Type 2 Diabetes and lowering healthcare costs 52:45 Leading advocates for Lifestyle Medicine (e.g. Dr. Dean Ornish, Dr. Mark Hyman, the ACLM, Mayor Eric Adams) 54:00 “Lifestyle Medicine is the future of Value-Based Care.” 55:00 How Governor DeSantis is focused on lifestyle medicine to address COVID-19 56:30 Lifestyle therapeutic interventions (e.g. plant-based eating, physical activity, restorative sleep, stress management, avoidance of risky substances, social connectivity) 58:45 What kinds of social determinants of health can effectively be addressed in the healthcare setting? 60:00 Digital transformation, Dr. Robert Pearl, and the benefits of telemedicine 61:00 Innovations in localized food growing and community-based group cooking 63:00 The threat of the Social Media Metaverse on mental health 67:45 More about James Maskell’s work in Value-Based Care and connecting with him on LinkedIn

The COVID pandemic has taken the lives of 1 million Americans in two years (more than twice the amount of Americans who lost their lives in WWII in four years).  This grim statistic came about because of a fundamentally broken, fragmented, expensive, inequitable, and occasionally unsafe healthcare system.  If the mission of our $4 trillion healthcare system is to improve health and prevent death from disease, we could look to no greater example of failure than the COVID-19 pandemic. Global pandemics are always horrific, but they also represent wonderful opportunities to learn by taking advantages of the crises invoked. The COVID crash of American healthcare is not unlike an airline crash.  Failure to learn and overcome our structural and cultural flaws will have calamitous results.  The airplane (American healthcare) will continue to crash again and again.  We would never tolerate these failures in aviation, but why do we accept them when it comes to healthcare?  The answer ultimately comes down to misalignment of financial incentives (fee-for-service medicine) and cultural headwinds related to structural racism, American exceptionalism, lack of trust, and tribalism. On this week’s episode of Race to Value, we interview Dr. David Nash about his new book co-written with Charles Wohlforth, “How COVID Crashed the System: A Guide to Fixing American Health Care.”  Dr. David Nash is among the world’s most respected experts on health care accountability, quality, and leadership. He is the founder of the Jefferson College of Population Health in Philadelphia and remains its founding dean emeritus.  In this interview, we do a deep dive on his new book explaining what went wrong as it relates to COVID and health care delivery.  This is a must-listen podcast as you will hear the unfiltered truth about the pandemic from the nation’s foremost prophet of population health.  This podcast will make you angry and sad, but it will also leave you with optimism for the future of value-based care and population health management.  We can get better and do better by those we serve – we can win this Race to Value. Episode Bookmarks: 01:30 The opportunity to learn and take advantage of the COVID-19 pandemic so we may heal a broken healthcare system 03:00 Introduction to Dr. David Nash, one of the world’s most respected experts on health care accountability and population health 05:00 America’s COVID crash and the realization of a broken, fragmented, expensive, inequitable, and occasionally unsafe healthcare system 07:00 Dr. Nash provides perspective on the 1 million American citizens that died 08:00 “Half a million Americans died fighting WWII over a period of 4 years, and it is mind boggling to see how COVID-19 killed twice as many in half the time.” 08:30 Recognition of the fragility of the healthcare system pre-pandemic 08:45 “If the mission of a $4 trillion a year healthcare system is to improve health, we are not doing such a good job.” 09:00 The Four Horses of the Pre-Pandemic Healthcare Apocalypse: 1) Depression, 2) Opioid Abuse, 3) Alcoholism, 4) Suicide Ideation 09:30 “The Baby Boomer Generation is going to end up living longer than the Millennial Generation if we don’t do something about our healthcare system.” 10:30 Investigating the COVID crash like we would an airplane crash 11:00 “The pandemic shined a spotlight on structural failures, social determinants of failures, and the failure of our healthcare system to have a clear mission to improve health.” 11:30 American exceptionalism and the hubris of political leadership 13:30 Failures of government: lack of communication, lack of understanding, and a lack of transparency 14:30 Early warnings from Italy in early December 2019 telling us that the pandemic was coming 15:00 President Trump’s pathetic goal to re-open the economy by Easter Sunday 2020 15:30 Failure at all levels of government (ex: White House, FDA, CDC, HHS) 16:00 “The Greatest Failure of Leadership in Our Time” (Referencing NEJM Editorial, Oct. 2020) 16:30 The passage of Medicare in 1965 led to a divergence of healthcare and public health due to economic incentives to overbuild hospitals and overutilize medical procedures 18:00 40-50 years of underfunding our Public Health infrastructure at the expense of a $4T healthcare industry 18:30 1/4th of all healthcare spending is wasteful and of no value (Referencing JAMA Article, Oct. 2019 from Will Shrank, et al.) 19:00 Reallocating wasteful healthcare spending to fund public health and community health workers? 19:30 The Power of Determinants of Health (i.e. Zip Code, Credit Score, Structural Racism, Inadequate Education, Gun Violence) 20:00 1-in-4 people in Philadelphia live in poverty (and half of them are in “deep poverty”) 21:00 African Americans have 7-8X higher mortality from COVID-19 than white populations 22:00 Fee-for-service medical practices that faced revenue disruption, laying off healthcare workers and facing bankruptcy 22:30 Hospital leaders that rallied together during the pandemic 23:30 Complex cases of cardiac disease, orthopedics, neurosurgery, and cancer keep hospitals in business 24:00 Dr. Nash’s shares the story of his physician daughter who wore a garbage bag to work because her hospital did not have an adequate PPE supply 24:30 “This airplane (healthcare) is going to crash again and again.  We would never tolerate this in aviation.” 25:00 The vulnerability that was created by American exceptionalism 27:00 Balancing patriotism and pro-capitalist views with the recognition of flawed aspects of our American culture 27:30 “Rugged individualism” and the lack of trust in government leadership 28:00 Social sciences research showing how other countries have stronger communities and trust their governments more (Referencing “Bowling Alone: The Collapse and Revival of American Community”) 29:00 State governors that refused mandates for masking and prior evidence of vaccination 29:30 Advocates for non-evidence based treatment (ex: Ivermectin) 30:00 “American culture led to a toxic witches brew of over-confidence.” 30:30 The invention of mRNA technology at Penn years ago led to COVID-19 vaccines by Moderna and Pfizer 31:00 Population health outcomes that are worst in the world juxtaposed to medical research that is the best in the world! 32:00 Life expectancy was already dropping in the U.S. in the time preceding the pandemic 32:30 The harmful culture of “hero worship” 33:00 Medical mistrust in the African American community stemming from the Tuskegee experiments 34:00 Lack of trust, deep racism, rugged individualism, and the over-reliance on science created a “cultural headwind” that prolonged suffering and cost American lives 35:00 The difficulties in understanding that mask wearing protects others (Why care about others in a tribal culture?) 36:00 Health inequities in African and Latin American communities 37:00 Dr. Nash reflect on his sadness for why safety net hospitals are even needed (“the only country in the western world without universal healthcare coverage and universal access to care.”) 38:00 Lack of primary care coupled with structural failures leading to poor healthcare outcomes in minority populations 39:00 “If you are poor in America, you are almost by definition ill health.” 40:00 Dr. Nash shares his optimism for the future of value-based care and population health management 42:00 Private sector innovation led by entrepreneurs (Referencing Dr. Stephen Klasko and “Health Assurance”) 44:00 Should we also be optimistic about public health? 45:00 “Public health saved your life today — you just don’t know it.” (referencing Dr. Leana Wen and her book, “Lifelines”) 46:00 Spending on public health = $400 per capita (compared to $11k per capita for the healthcare system!) 47:00 “We have to put public health on the same pedestal that we put sub-specialty medicine, requiring us to go deep into the medical training system.” 48:00 The misalignment of societal benefit and financial rewards leading to poor emphasis on public health infrastructure 50:00 “Reevaluating our mission may lead us to have a better appreciation for the power of Public Health.” 51:00 The financial stressors on fee-for-service healthcare during the pandemic leading to CARES Act relief payments 56:00 Dr. Nash provides perspective on “Bright Spots” in the healthcare industry (Payviders, disruptive primary care companies, bundled payment models) 58:00 “When we change economic incentives by aligning them towards health, we improve clinical outcomes, reduce waste, and improve patient satisfaction.” 58:30 “The pessimist sees difficulty in every opportunity. The optimist sees opportunity in every difficulty”. – Winston Churchill 61:00 Dr. Nash’s parting thoughts on applying lessons learned to find a path to healing 63:00 “When the dying stops, the forgetting begins — that is our culture.  How COVID Crashed the System is all about prolonging the conversation.” 64:00 Preorders now available for Dr. Nash’s new book at Rowman and Amazon with a release date planned for September 2022

While there have been meaningful improvements in healthcare delivery over the last decade, they have not catalyzed the transformation necessary to advance health value and equity. The promulgation of health policy and the implementation of new alternative payment models have created a landscape for experimentation in value-based care, yet the seismic shift needed to facilitate long-term and sustainable improvements has yet to occur. The key enabler for the future of our industry is workforce readiness to deliver on the promise of high-value, high-quality care that delivers equitable outcomes for all. This week on the Race to Value podcast, you are going to hear from a distinguished panel of industry experts on the importance of workforce development in value transformation.  Workforce development will drive success in value-based care by ensuring industry capability, and it will help underserved communities thrive through population health interventions that improve societal outcomes and reduce inequities. As you listen to this discussion with Dr. Jim Walton, Christina Severin, Dr. Joy Doll, and Dr. Richard Walker, think about how the scale and impact of workforce skill and knowledge is either a force multiplier or an impedance for change. If you want to learn more about affordable educational pathways for reskilling and upskilling in preparing for risk-based payment after hearing this discussion, please reach out to the Institute for Advancing Health Value – your partner in developing a competent workforce to win this Race to Value! Episode Bookmarks: 01:30 The key enabler for the future of our industry is workforce readiness to deliver on the promise of high-value, high-quality care that delivers equitable outcomes for all. 02:00 Workforce development will drive success in value-based care by ensuring industry capability, and it will help underserved communities thrive through population health interventions. 03:00 The Institute for Advancing Health Value – your partner in developing a competent workforce for the future of value-based care 03:30 Introduction to expert panelists:  Dr. Jim Walton, Christina Severin, Dr. Joy Doll, and Dr. Richard Walker 06:00 The imperative to ensure health equity and reduce disparities in our most vulnerable populations 07:00 Dr. Walker shares the vision to serve underserved populations through reengineered primary care 08:45 How TVP-Care access to care with both a “high touch” and “high tech” model that reaches patients in their homes 09:30 Dr. Doll on how CyncHealth addresses health equity through data democratization within a longitudinal health record and community-based SDOH support ecosystem 10:30 Dr. Walton speaks to the importance of building an engaged ecosystem and how GPG realizes that “equity is a valuable business model for the future of private practicing physicians” 11:00 The impact of burnout and moral injury and how that will become a “self-fulfilling prophecy” without a value-based business model and workforce strategy 12:00 “We must have an ROI attached to social interventions; otherwise, we are just tilting at windmills.” (Harnessing AI/ML for predictive risk stratification of the patient population) 13:00 Christina Severin on how C3 approaches team-based care, social interventions, behavioral health in its FQHC network 14:00 Establishing a diversity, equity, and racial justice committee and building a data infrastructure to drive health equity 16:00 How CMS is integrating health equity in every stage of payment model development, including the new ACO REACH program 17:30 Christina Severin discusses on ACO REACH is a great step forward in program redesign to have a more adequate benchmark that represents the complexity of the population 18:30 Taking the time to understand the legacy of white supremacy in this country and how it impacts healthcare delivery 20:00 Dr. Walker on the importance of developing trust with patients to overcome prior harms inflicted on minority populations 22:30 Dr. Walton discusses the intersection of the civil rights movement and the story of the American healthcare system 23:30 “To effectively upskill and reskill the workforce for the future, they must be grounded in the historical arc of racism in our country.” 24:00 How “Crossing the Quality Chasm” ignited a 20-year movement toward Patient Safety and why something similar is needed to elevate Health Equity 26:00 “It’s not about the patient who has lack of trust that needs to change. The system has to be more credible and trustworthy.” 27:00 “Workforce development requires exposing students to the history of inequities, giving them real-life experience in a value-based arrangement, and using technology to identify patients in need of intervention.” 27:30 Dr. Doll on empowering workforce transformation through resilience, challenging the status quo, and leaning in to uncomfortable conversations 31:00 Advancing the aims of value-based care through culturally competent care and how Higher Education can eliminate implicit biases in teaching and learning 32:30 Dr. Doll speaks about the need for scholarships to eliminate barriers to accessing education in minoritized populations 33:00 Referencing the work of Peter Cahn in interprofessional collaborative practiceand how to overcome structural racism in higher education in healthcare 34:30 Being more thoughtful with language and avoiding “trigger words” in the workforce (ex: midlevel providers) 36:00 “We have not trained health professions outside of silos. Education is still very new in the accreditation requirements for interprofessional learning.” 36:30 Dr. Walton on how “cultural competencies are table stakes in the workforce” and how he designed a student program to support health equity advancement in his ACO 38:30 “Health equity must have a pro-business strategy. You shouldn’t have to go to the nonprofit world to sacrifice to make a difference in the world.” 40:00 Dr. Walker on how WGU is leading the way in workforce development for the future of Value-Based Care and Population Health Equity 41:00 “Inequity is not having the tools or the capability to get what you need so that you can have the kinds of good outcomes that you expect. Disparity is bad outcomes based upon a population.” 42:00 Dr. Walker addresses the research about improved patient care outcomes with providers sharing the race and ethnicity of their patients (“It’s not about the fact that you look like me…it is trust.”) 43:00 How workforce training programs can be reoriented towards educating professionals on how to foster trusting patient relationships 44:00 Christina Severin: “We need to raise awareness of how white supremacy has created SDOH. Interprofessional programs can do this my making health equity a core focus in their curriculum.” 47:00 The disruption of Healthcare and Higher Education – the two most dysfunctional industries in America! 50:00 Dr. Walker on the need to integrate all interprofessional roles in healthcare education (CNAs are just as important as doctors!) 51:30 Dr. Doll on the current lack of innovation in education (ex. the gap between rigid academic requirements and what the industry really needs, time constraints in training, lack of interprofessional training) 53:00 Christina Severin speaks to the PCP shortage, how most patients don’t need MD level of care, and how her ACO uses telehealth navigators 55:30 The need for educational programs in peer specialists and recovery coaches to support team-based value-based care for SUD and behavioral health 56:00 Dr. Walton: “CMS has put the stake in the ground for health equity, and that can be the catalyst for how we prepare the workforce for the future.” 58:00 Creating a value-based care simulator to train the workforce for the future

It’s no secret that the Black community tops the list of groups afflicted by hypertension, stroke, diabetes, heart disease, kidney failure, and cancer. What the statistics do not show is the pain, misery, and despair that these conditions create—not only for the individual, but also for family and friends. As an African-American doctor, Dr. Richard Walker has studied these conditions among his patients for many years. Now, in his new book, “Black Health Matters”, Dr. Walker offers a number of commonsense ways to prevent, manage, and possibly eliminate these killers, turning the tide of African-American health. And he not only provides us with a construct for thought leadership in population health equity, he practices this type of care at his home-based primary care practice TVP-Care in Houston, Texas. Dr. Walker has spent considerable time in researching the health and healthcare journey of African captives into slavery and understands what current African Americans now to need to do to survive nutritionally and culturally. He is truly on a mission to overcome the chronic ill health and early death that is so pervasive in Black communities. Most importantly, however, Dr. Walker is a leader in the value movement that believes traditional medicine should be merged with lifestyle medicine. He understands that African Americans can turn their health around by understanding and incorporating better nutrition, nutritional supplements, exercise, and regular healthcare checkups into their lives. In this important podcast discussion, we you will learn from a leading clinician and entrepreneur how we should go about improving Population Health Equity within African American communities in this Race to Value! Episode Bookmarks: 01:30 Introduction to “Black Health Matters” and the work of Dr. Richard Walker in the health value movement 03:30 What does the use of the word “value” mean when it comes to community health? 05:00 Dr. Walker discusses his upbringing in Spanish Harlem and how that experience led him to become a physician leader seeking to advance health equity 07:00 The “mystery” of excessive hospitalizations due to sugar consumption and how that led to an epidemic of Type 2 Diabetes in the African American community 09:00 The misperception in the African American community that most common chronic diseases are genetic (instead of caused by environmental of lifestyle factors) 10:00 Dismantling the informational disadvantage that leads to a misunderstanding of Social Determinants of Health 12:00 The impact of the murder of George Floyd and the BLM social justice movement and how that inspired Dr. Walker to write “Black Health Matters” 14:30 How the collective experience of African Americans over the last 400+ years has been based on “waiting” (e.g. slavery, citizenship, civil rights) 16:00 “Taking care of your own life is all about taking charge of the environment by understanding the root causes that lead to disease.” 16:30 How poor nutrition in the African American community stems from the slavery era and persists to this day 17:30 The inadequate training of the healthcare workforce further exacerbates preexisting issues of poor health among African Americans 18:30 “Black Health Matters” is all about understanding the progenitors of chronic disease that are not genetic, and how to mitigate them in African American communities. 19:00 Environmental hazards and chemical toxicities are more common in underserved, minoritized communities 20:30 Research that confirms the presence of systemic issues in the healthcare industry related to institutional racism 22:00 “The concept of value-based care is transformational because it has the potential of changing the course in healthcare by recognizing the true value of the individual.” 23:30 Will value-based care bring us to the “Quintuple Aim” that includes health equity? 24:30 How the founding vision of Dr. Walker’s value-based, patient-centered medical practice has been informed by emerging payment models from CMS 27:20 Recent McKinsey & Company study estimating that up to $265 billion worth of care (representing up to 25 percent of the total cost of care) could shift to the home by 2025 28:30 Dr. Walker provides an overview of his MSO and primary care medical practice business model 31:30 Going upstream with patient-centered, reengineered primary care through an enabled access model that provides care in the home 32:30 Fostering trust and creating meaningful relationships between patients and providers through home-based care delivery 34:00 The enablement of remote patient monitoring, chronic care management, and telehealth to enhance home-based, primary care 34:30 Care coordination and chronic care management delivered by interdisciplinary teams supporting a primary care provider 35:30 “Smaller primary care patient panel sizes leads to better patient outcomes and providers with a better quality of life.” 36:30 “Micro” Social Determinants of Health that can be managed by the medical practice 39:30 Improving care for the 5% of the population driving healthcare expenditures is an economic opportunity for our country 41:00 Recent research showing significantly lower levels of telemedicine usage among Black patients, particularly those over age 65, as compared with white patients 42:00 “21st century care technologies – RPM, telehealth – are a gamechanger for primary care.” 44:00 The human-to-human relationship as the driving force of patient-centered, reimagined primary care (ex: the interaction of having tea with a patient in their home) 46:30 Dr. Walker describes the use of remote patient monitoring technology in his medical practice 47:30 The challenges of ethnogeriatric care focused on African Americans and the Aging Process can be overcome by addressing SDOH 50:00 The importance of workforce sufficiency and education to provide culturally-competent care 52:00 How concerns about implicit bias in care delivery may limit the progress of transformation (balancing the need to deliver the best care you can under the circumstances) 54:30 The role of the “Community Organizer” in bridging the gap in trust between patients and the healthcare system 56:30 The words of Dr. Martin Luther King, Jr: “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” 58:00 Functional medicine as a more holistic approach to delivering whole-person care to the individual 60:00 Healthcare providers must recognize the need for human connection, love, and trusting relationships to ensure equity in health 62:30 WGU and the Institute for Advancing Health Value as an example “as a lighthouse for the rest of the academic world and the healthcare industry”

A bright future for the nation depends on the health and prosperity of rural America, and unfortunately, we are at a moment in time where life is not ideal in the rural heartland.  Although most rural Americans are generally satisfied with the overall quality of life and see their communities as safe, we are reaching a crisis when it comes to financial insecurity, trouble accessing affordable, high quality health care, a lack of high-speed internet access, housing problems, and isolation/loneliness. When it comes to health care, even though most rural Americans have health insurance, about one-quarter say they lack adequate health care access, as they have not been able to get the care they needed at some point in the past few years. Consequently, potentially preventable deaths from the five leading causes are consistently higher in rural counties, especially with heart disease.  (Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.)  All of this has culminated into a mistrust of the traditional, fee-for-service dominated healthcare system and created a “shadow population” of underserved minorities and the socially isolated who are dealing with significant cardiovascular metabolic disease. The Arkansas Lincoln Project is an important population health program focused on improving cardiovascular health in highly underserved, under-resourced areas of the Arkansas Delta Region where economic and health disparities have life altering consequences for rural residents.  Joining us this week, we have two population health leaders sharing their insights about their work in deploying community-based cardiovascular health interventions led by community health workers. Chip Purcell is the director of cardiology research at the University of Arkansas Medical Sciences and the principal investigator of the Arkansas Lincoln Project.  Joining him is Dr. Jessica Barnes, the co-founder and CEO of 20Lighter, LLC – an award winning cardiometabolic health program, delivering dramatic reductions in inflammation and visceral fat.  Together they are winning the “Race to Value” by fighting cardiovascular metabolic disease in the Arkansas Delta, the worst region in the nation for healthcare quality and population health outcomes. Episode Bookmarks: 01:30 The challenges of obesity and cardiometabolic disease disparities in Rural America 02:00 Rural Americans facing financial insecurity, poor healthcare access and hospital closures, a lack of high-speed internet access, housing problems, and isolation/loneliness 02:45 “Nearly half of deaths from heart disease in rural counties are preventable, compared with 18% in large metropolitan areas.” 03:30 Introduction to Dr. Jessica Barnes (CEO of 20Lighter, LLC) and Chip Purcell (UAMS Cardiology Research and the principal investigator of the Arkansas Lincoln Project) 05:00 “Rural Americans tend to have higher rates of cigarette smoking, hypertension, and obesity, and report less leisure-time physical activity than their urban counterparts.” 06:20 The US News & World Report ranks Arkansas 50 out 50 states for overall healthcare quality with higher-than-average obesity rates and overall preventable hospital admissions 07:00 “Arkansas is the worst of the worst in health outcomes, and that is where we can make a difference.” 08:00 Mistrust of the healthcare system is pervasive in the Arkansas Delta Region 09:30 The exponential growth curve in building trust through improvement in individualized patient outcomes 10:00 Studying out-of-hospital, premature natural deaths as a proxy for determining population health needs in Eastern Arkansas (how the Lincoln Project began) 12:30 The use of geospatial mapping to identify the highest risk communities to target with cardiovascular health interventions led by community health workers 16:30 The economic challenges of Phillips County, Arkansas and the history of racial discrimination and conflict, including the Elaine Massacre of 1919 (the bloodiest racial conflict in history) 18:00 Implementation of the door-to-door novel intervention model to address cardiovascular health disparities 19:45 Guiding interventions to elicit behavioral change and the challenges of addressing multiple social determinants of health all at once 20:30 “Women are a very fast growing subset of the population that is struggling with cardiovascular disease.” 21:00 Lower income and higher poverty with women in rural areas creates another layer of challenges (e.g.  “inequities in the inequities”) 22:00 “Ultimately our vision is to introduce practical community-centered interventions that improve rural health.” 23:30 “Community Health Workers (CHWs) are the most under-utilized resource we have in healthcare right now.  They should be the face of healthcare to overcome patient mistrust of the system.” 26:00 How the Lincoln Project trains CHWs to navigate the medical and social resources available to improve population health outcomes 28:30 Ensuring patient compliance to support the behavioral changes needed to improve community health 29:30 Referencing recent study showing how Massachusetts General Hospital was able to reduce 30-day readmissions among ACO patients supported by trained community health workers 30:30 “Changing cardiovascular disease outcomes is a longer-term goal but utilization and compliance measures are interim measures of success in the short-term.” 31:30 “Community Health Workers actually come from the local, underserved community and really care about the community members they are helping.” 33:00 How 20Lighter (a unique, comprehensive cardiometabolic telehealth program)engaged African American women in a pilot program aimed at improving risk and burden of cardiovascular disease 38:30 The 20Lighter strategy to dramatically reduce inflammation and visceral fat in hypertensive and diabetic community members 44:00 Utilizing telehealth interventions to support precision medicine programs for rural patients at high cardiovascular risk 45:00 How COVID-19 enhanced the value of telehealth by healthcare consumers and patients 46:30 Tech + Touch = Scalability and Personalization 48:00 How a CHW holistic model of community outreach can help providers better communicate with patients and improve health literacy 49:45 Facilitating health literacy in Phillips County whose community members, on average, have a 4th Grade reading level 52:30 “Fee-for-service created a shadow population — usually underserved minorities and the socially isolated — who are unable or unwilling to involve themselves in healthcare.” 53:45 Why capitation will eventually transform the health of the rural South 54:30 Changing the way people think about wellness by overcoming the failed fads of the weight loss and employee wellness industries

The arc of the future bends in the direction of person-centered care. While payment reform is critical, our nation must also deliver whole-person care models that are exquisitely attuned to both medical and non-medical needs and intentional about addressing unique problems facing racial and ethnic minorities. The entrenched interests perpetuating the status quo of the fee-for-service, medical-industrial complex are immense; however, the pandemic is a catalyst for consumer-driven, value-based payment reform. In this week’s episode of Race to Value, you will hear from Dr. Mark McClellan, former CMS Administrator and current Director of the Duke Margolis Center for Health Policy.  As one of the leading physician economists and health policy leaders in our country, he discusses the future of health reform and value-based care. We cover such topics as health policy and alternative payment models, COVID-19 impacts on healthcare, advanced primary care that goes upstream in the detection and treatment of chronic disease, technology-enabled care delivery transformation, health equity and social determinants of health, specialist integration in person-centered care models, and the path forward to comprehensive value-based care in our country. Episode Bookmarks: 01:30 Introduction to Dr. Mark McClellan 03:00 Launching Medicare Part D, Medicare Advantage, and the ACLC (now the Institute for Advancing Health Value) 04:00 “While payment reform is critical, there are other essential steps that go along with it.” 05:30 “In this journey to value that we need to bring all patients along. That means explicit and intentional attention to equity and the special problems facing racial and ethnic minorities.” 06:00 Achieving a whole-person approach to health reform through patient engagement and “going upstream” 07:30 Upstream opportunities to address the prevention and management of cardiovascular disease 09:00 The impact of the COVID-19 pandemic on Value-Based Care and the recent advancements in biotechnology and clinical treatment 12:00 The parallel transformation in care delivery and organizational culture that happens in value-based payment reform 14:00 How innovation in through emerging medical technologies and virtual care technologies will delivery value (even if costs increase) 15:00 Digital apps, home based care, and community-based care to address upstream non-medical factors that the social drivers of poor health 16:00 The limitation of current reimbursement models in addressing the social factors that influence health 16:40 “Payment reform remains an important component of making faster progress in achieving value and achieving equity in our health care system.” 17:00 The work that Drs. McClellan and Mark Harrison from Intermountain are doing as co-chairs of the Health Care Payment Learning Action Network (HCP-LAN) 18:30 The current pace of the value movement and how “accountability for results and value at the person level is really the core theme behind payment reform” 19:20 “The arc of the future for medical care bends in the direction of person-centered care.” 20:00 Perspective on value-based reform success between Medicare, Medicaid, and Commercial plans 20:45 The importance of measuring race and ethnicity reliably and then incorporating a focus on equity for traditionally underserved populations 21:30 Healthcare revenue disruptions during the pandemic as a recognition for the need of value-based payment reforms 23:30 How organizations that were further along in adopting advanced payment reforms experienced less financial disruption during COVID-19 24:30 The newfound appreciation that the American public has for convenient, virtually-enabled, person-centered care models 26:20 Referencing the Duke Margolis Center for Health Policy report, “Value-Based Care in the COVID-19 Era” 27:30 The new CMMI Strategy Refresh that focuses on both Accountable Care and Health Equity and the 2030 Goal for Payment Transformation 29:30 Health Policy focus on areas like workforce, behavioral health, and integration of specialists in value-based comprehensive care 31:00 The new ACO REACH program as an accelerated pathway to value and equity 32:20 Referencing the success of Medicaid transformation in North Carolina 33:00 “Medicare Advantage is the health care payer segment that has the highest rate of alternative payment models.” 33:30 The importance of payer-provider partnerships to advance accountable care models in MA, Medicaid managed care, and commercial plans 34:30 Employer-provider partnerships supporting payment reform and advanced primary care (e.g. JPMorgan and Vera Whole Health, CalPERS and PBGH) 36:00 Multi-purchaser initiatives to foster regional directional alignment on data sharing, quality measures, and specific measurable value and equity goals 38:45 The need for more optimal Risk Adjustment methodology to ensure better patient outcomes (and the associated challenges with upcoding) 44:30 The integration of specialty care within value-based purchasing and accountable care (“We haven’t done enough.”) 46:30 PCPs obtaining data from CMS on specialists are performing in supporting longitudinal care pathways 49:00 Person-centered specialty care and Bundled Payment innovation (referring the work of Dr. Kevin Bozic and his musculoskeletal care management program at Dell Med) 51:00 Incorporating quality performance into the system-based bundle and PMPM payment to the specialist 52:00 Other value-based policy reforms (e.g. transparency, Medicare incentives to shift into advanced APMs, MIPS reforms) 55:00 The path forward to comprehensive value-based care in our country 57:30 “The fundamentals here are in the direction of value and people are in this country are just not going to tolerate having to get care at a hospital when they can get at home.”

As we talk about the current zeitgeist moving us towards value and equity, we also have to think about how polarized our country is politically. Democrats and Republicans live in separate worlds, or “echo chambers,” with each side prone to bias or “motivated reasoning.” This has created an existential threat of tribalism where partisanship has turned Americans against one another.  The term that best describes our strife is “political sectarianism,” or the tendency of political groups to align on the basis of moralized identities rather than shared ideas or policy preferences.  However, the promise of value-based care is something that we should all agree on in a bipartisan way.  The Race to Value is both an economic and a moral imperative, and it can be actualized through relationship-based care, collaborative health models, and the power of advanced analytics. In this week’s episode, we interview Michael L. Millenson, an internationally recognized expert on making American health care better, safer and more patient-centered. As a leading expert on health policy, quality improvement, and patient-centered care, he provides a deeply informed and unfiltered perspective on how to defeat political sectarianism to achieve analytics-based value innovation.  This intellectual conversation leaves nothing unsaid and will provide you with an enhanced understanding of the political challenges of value transformation and how analytics will drive collaborative health in the Information Age. Episode Bookmarks: 01:30 Introduction to Michael Millenson 03:30 The “Race to Value” — is this a revolution? 06:00 “Value-based care is the ethically right thing to do.” 06:45 Confusion about value in health. (Public perception equates the term “value-based care” to fast food.) 07:30 Referencing Walter McClure, Ph.D and the ‘Buy Right’ strategy of health care reform 08:00 “Value-based care is the most important transformation of American medicine in our lifetimes.” 10:30 The dilemma of VBC (you must first recognize that poor quality exists currently to realize the potential for value) 12:00 Political sectarianism – how tribalism and entrenched interests hinder health policy 13:30 Winners and Losers in health policy reform and how “motivated losers” fight back! 15:30 How social media and suspicion stifles value-based payment innovation and the promise of bipartisan reform 16:30 Authentic healthcare leaders realize the need for value (there is hope!) 18:30 How do you engage providers to root out clinical variation and unnecessary care? 20:00 The need for Patient Safety and Quality Improvement in Healthcare 21:00 Referencing Michael’s book, “Demanding Medical Excellence: Doctors and Accountability for the Information Age” 22:00 “Hospitals often do not do what it takes to be as safe as possible because there is no return on investment.” 24:30 Referencing Michael’s article “Why We Still Kill Patients: Invisibility, Inertia, and Income” 26:00 The moral challenges of bureaucratic medicine and misaligned economics and how it creates preventable harm 29:00 The disconnect between Cost and Quality 31:00 The ethics of value-based care and the travesty of physicians not speaking up (Referencing Michael’s article “The Silence”) 33:30 The promise of “Analytics” in the future of healthcare (and the similarities to the “Plastics” scene in The Graduate) 34:30 Enhancing clinical outcomes through semantic interoperability, AI, and predictive analytics 37:30 The misperception that population health analytics will impinge on clinical autonomy 39:30 Smart phone technologies and “proactive benefits” to engage patients in getting well 41:15 “Analytics is the key to the Information Age of Medicine.” 43:00 The limitations of human cognition in healthcare and how unleashing analytics can foster empathy and compassion in medicine 44:30 How open APIs and the FHIR interoperability standard will empower personalized care delivery 47:00 The National Academy of Medicine estimates that moving “upstream” could cut health care expenditures by 20% and save $800 billion a year! 48:00 Building deeply contextualized algorithms with consumer, behavioral, psychosocial, and biometric data 51:00 Understanding the research on SDOH and Lifestyle Medicine and applying analytics to drive clinical innovation and patient activation 55:00 “Collaborative health” to for shared accountability that goes beyond patient-centered care 59:00 Overcoming information asymmetry to actualize the collaborative health model 62:00 Focusing on relationships and trust will help us overcome the issues of cost and quality