Relentless Health Value

Karen Root discusses the importance of customer-centricity and innovation at large organizations, emphasizing the role of change management. The podcast explores key considerations for leading transformations and innovation, driving change in a large organization, improving the call center experience, and choosing the right innovation for a customer-centric experience.

Entrepreneur Mark Cuban and Ferrin Williams, PharmD, MBA, discuss the importance of CEOs and CFOs getting involved in healthcare benefits. Topics include hospital prices, cost plus drugs, CEO and CFO engagement, subscription revenue for healthcare financing, challenges of inflated drug prices, indirect funding of communities, and optimizing healthcare benefits for mid-market companies.

Dan Mendelson, industry expert in self-insured employer healthcare strategies, discusses actionable tips for CEOs to improve employee health, the importance of outcomes data for self-insured employers, and the role of accountable care in achieving health equity. The podcast also explores the role of primary care providers in coordinating care and introduces Morgan House as a platform for optimal patient outcomes.

Exploring Effective Payer-Provider Collaborations: Insights and Key Strategies To read the full article and show notes with links mentioned as well as a full transcript, click here. In episode 417 of Relentless Health Value, Stacey Richter engages in a detailed discussion with Josh Berlin from Rule of Three consulting firm about the dynamics and strategies behind successful provider and payer collaborations in the healthcare industry. They delve into the historically adversarial relationship between these entities and explore five distinct types of collaborations, ranging from data sharing to risk-bearing partnerships. Berlin outlines five crucial 'must-haves' for these collaborations to succeed, including scalability, sustainability, flexibility, effective collaboration, and compatible risk profiles. They further examine real-world examples of both successful and failed healthcare collaborations, emphasizing the importance of mutual goals and adaptive strategies to enhance patient outcomes and improve market competitiveness. The conversation offers practical insights for healthcare executives aiming to foster stronger, more innovative partnerships in a complex and evolving industry. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 06:06 Why should payers want to collaborate with providers? 09:46 “Collaboration … is bilateral. … Both sides, plan and provider, should be equally as interactive with the individual populations they work with.” 12:37 What are the must-haves for collaboration between providers and payers? 13:10 What are the five different types of collaboration? 16:03 What are the five characteristics you want to be focused on in partnership? 21:35 EP359 with Dan O’Neill. 22:16 In order to collaborate, do you have to be collaborative? 26:11 Ochsner as a great example of collaboration. 27:46 Episodes with David Carmouche, MD, and Eric Gallagher. 28:51 A collaboration failure in Haven.

Dr. Adam Brown discusses the importance of teaching the business of medicine in medical schools. He emphasizes the changing role of physicians, the expectation mismatch, and the need for doctors to advocate for themselves and patients. The podcast also explores the impact of teaching the business of medicine on healthcare costs and patient outcomes, as well as the importance of physician involvement in healthcare leadership and decision-making processes.

Improving Healthcare Outcomes and Reducing Costs: Insights from Rob Andrews of HTA To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 415, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA), about how jumbo employers are achieving better healthcare outcomes while saving on total care costs. The discussion highlights the significant positive impact of targeted healthcare strategies on reducing readmissions and overall costs, particularly related to maternal health. Andrews elucidates how addressing root causes, negotiating data-driven contracts, and holding intermediaries accountable can create win-win scenarios for both employers and employees. The episode underscores the importance of using data to drive healthcare improvements and the role of self-insured employers in transforming healthcare delivery. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 07:29 How did Rob get to his current role? 09:11 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this. 10:36 Why economic consequences move the needle, and why sometimes they don’t. 12:36 Why the best way to address costs isn’t to re-shift costs but to address them directly. 14:34 Why compensation that isn’t dependent on outcomes is a problem. 18:09 “Strategy’s not what people say; it’s what they do.” 21:40 How do you operationalize saving money with better outcomes? 29:46 How do employers turn conflict into collaboration? 31:41 What is the win-win-win structure among employers, payers, and providers in Rob’s eyes? 34:13 To whom should the task of risk adjustment fall? 38:03 “Better contracts do improve outcomes.”

Delivering Better Care and Getting Paid: A Value-Based Healthcare Guide with Justina Lehman To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 414 of 'Relentless Health Value,' host Stacey Richter interviews Justina Lehman to explore practical strategies for healthcare practices to provide coordinated, high-value care while achieving financial growth. The discussion covers the detailed steps for developing and implementing value-based care models, including assembling a committed team, defining ideal care pathways, navigating payer relationships, and engaging with self-insured employers. Lehman emphasizes the importance of close collaboration between physicians, clinicians, and payers to enhance patient outcomes and reduce costs. The episode provides actionable insights for healthcare professionals aiming to transition from fee-for-service to value-based care. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 07:35 What has Justina been up to, and why is it relevant to this conversation? 08:23 What is high-value care, and how do we figure out what it is in reality? 08:59 EP412 with Robert Pearl, MD, on the art and science of medicine. 10:08 “What is the clinical design of … high-value care?” 10:21 Care as usual vs ideal care. 11:11 Summer Shorts 8 with Larry Bauer. 12:23 How does Justina figure out what the benchmark is for high-value care? 12:36 Meeting patients where they are at, not where we want them to be. 17:42 EP402 with Amy Scanlan, MD. 18:28 “What is the story as a group to the payer? What is the story as a group to the self-funded employer?” 19:19 How do you align business operations and the financials? 20:16 What are the four avenues for getting paid for high-value care? 21:58 What are highly engaged payers most intrigued by in high-value care? 24:11 What are the different ways a practice can get compensated? 28:52 Are there programs that have advanced without payers leading the way? 29:37 What’s the “hook” for payers? 31:12 What’s a winning message to payers and employers? 33:04 Summer Shorts 4 with Eric Gallagher. 34:13 “Not everyone needs to participate.” 38:24 Can a program be successful even if a physician is a passive participant in the program?

Reducing Healthcare Waste: Aligning Incentives and Empowering Primary Care Physicians To read the full article and show notes with links mentioned as well as a full transcript, click here. In Episode 413 of 'Relentless Health Value,' Stacey Richter interviews Dr. Will Schrank on the intersection of healthcare waste, value-based care, and the rising influence of primary care physicians (PCPs). Dr. Schrank's extensive background includes roles at CMMI, CVS Health, UPMC, and Humana, and he is currently a venture partner at Andreessen Horowitz. The discussion delves into a study estimating nearly a trillion dollars of annual waste in U.S. healthcare, categorized into administrative failures (fraud, complexity, pricing) and clinical failures (care coordination, delivery, low-value care). Solutions like aligning financial incentives with higher quality care and primary care-driven models are explored. The episode also highlights challenges in shifting away from fee-for-service models, the potential evolving power of banded PCP groups, and the imperative for health systems to adopt value-based approaches. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 05:56 Can we cut healthcare waste while improving patient care? 06:35 What does “healthcare waste” consist of? 06:48 What are the six categories of “healthcare waste”? 09:25 EP363 with David Scheinker, PhD. 09:39 How much money does Dr. Shrank estimate is wasted each year in healthcare? 12:11 Where is that healthcare waste going, and why does it happen? 19:09 Uncaring by Robert Pearl, MD. 20:20 “We’ve built a backbone of extraordinary waste on a fee-for-service chassis.” 21:18 EP409 with Larry Bauer, MSW, MEd. 23:26 EP359 with Dan O’Neill. 25:04 Dr. Shrank’s warning to providers out there. 29:04 Summer Shorts 2 with Scott Conard, MD. 30:43 Why there might be a generational shift among younger providers looking to work with different models.

The following episode covers my intro to the episode and thoughts on the topic of new innovations used in hospitals as part of procedure including bloodstream infections and dialysis. Oh, hey, some unexpected news. This interview is unavailable at this time. One of these days we may be able to make it available, and if so, this will be announced in our weekly email. So please subscribe by going over to our website at RelentlessHealthValue.com. The episode emphasizes the remarkable progress made by the Relentless Tribe in improving outcomes for chronic kidney disease (CKD) patients and highlights the obstacles hospitals face in adopting expensive new technologies under the DRG payment model. The discussion also covers the significant impact of hospital-acquired infections, particularly those leading to sepsis, and explores the role of Medicare's NTAP (new technology add-on payment) in incentivizing the use of innovative treatments. The episode underscores the complex balance between cost and patient outcomes in healthcare. 00:00 Introduction to Episode 411 00:36 Acknowledging the Relentless Tribe 02:30 Interview with Secretary David Shulkin and Erin Mistry 03:53 The Issue of Bloodstream Infections 04:52 Understanding DRG and Hospital Economics 06:19 Medicare's NTAP and Hospital Payments 07:44 Guest Backgrounds and Acknowledgements 08:43 Acronym Alerts and NTAP Recap 09:54 Conclusion and Subscription Information

The Reality of Closing Care Gaps: A Conversation with Dr. Carly Eckert To read the full article and show notes with links mentioned as well as a full transcript, click here. In this encore episode titled 'The Gap In Closing Care Gaps,' host Stacey Richter interviews Dr. Carly Eckert, exploring the pervasive issue of care gaps in the U.S. healthcare system.  Care gaps arise from fragmented medical transitions and tend to recurred if root societal causes are left unaddressed. The conversation reveals the shortcomings of reactive care gap mitigation strategies, likening them to a futile game of 'whack-a-mole.' Dr. Eckert highlights the importance of proactive solutions, such as population health models and community-based interventions. The podcast emphasizes the need for a systemic shift towards holistic and continuous patient care, integrating social determinants of health and enhancing provider-patient relationships. Love the show? Please consider signing up for our weekly newsletter. We'll send you an article covering the latest episode with show notes, mentioned links and a transcribed intro. Join the RHV Tribe. 05:31 What is the true goal in making population health successful? 05:58 How does the clinical pathway need to manifest in population health? 06:29 How do we get a nonfragmented state of care? 06:54 What is the best model of care? 08:37 “Identifying and addressing care gaps is an important element of population health.” 11:30 Closing care gaps vs creating a nonfragmented system of care. 15:38 “I think you have to take small steps with people.” 16:45 “There’s a lot of power in peer support.” 17:18 Why should provider organizations connect with peer groups? 19:05 “The key is that it’s not going to be the same for everybody.” 23:09 Why is diversity of the workforce key to closing care gaps? 23:33 EP322 with Monica Lypson, MD, MHPE. 23:37 EP347 with Ian Tong, MD. 28:36 Where can providers improve transparency to help close care gaps?