Relentless Health Value

You know back in the olden days when a foot of measurement was actually the measure of your own foot? So, I might measure something and it’s, like, 19 feet. And then you measure the same exact thing and it’s 38 feet because you have tiny feet. This is the analogy that kept running through my mind as I was talking with Anna Kaltenboeck in this health care podcast about QALYs to measure the value of drugs. In this metaphor, QALYs are the ruler so that 1 foot of drug value is the same for everybody and all drugs. It’s very civilized as a concept if you think about it. QALY stands for quality-adjusted life year. The goal of a QALY is to figure out how much any given drug is worth to a society so that we, as a society, have a benchmark to evaluate the price of pharmaceutical products. QALYs are an apples to apples or a foot to foot way to compare the value of drugs for we the people. I mean, is this drug amazing and we should all pay a lot for it? Or is the drug more expensive than the current standard of treatment and it doesn’t confer any added benefit to patients? It’d be good to know that as a patient and as a payer and, frankly, as a pharma company. QALYs offer a framework for levelheaded discussions. It’s complicated. I’m gonna take the risk of oversimplifying, but here’s how I’d explain the three parts in a QALY measurement, which combines measure pharmaceutical value. The first part is, if relevant, how much additional survival can be expected with this drug? So, if it’s an oncology drug, for example, how much longer will the patient live? The second part of a QALY is, how does the drug make the patient feel? So, in an ideal world, survival is long and the patient feels super great. So, some economists and scientists get together and they do some math and they come up with the sum of these first two factors. Then the third part of a QALY calculation is the cold hard cash. How much is society willing to pay for this improvement in survival, in quality of life? This last part will depend based on the society (ie, the country) and also the condition. We’re willing to pay a lot for a drug that helps blind people see. We might be not so willing to pay a whole lot for a drug that lowers blood pressure marginally, for example. My guest in this health care podcast is Anna Kaltenboeck. She is a health economist and program director for the Drug Pricing Lab at Memorial Sloan Kettering. She knows a lot about QALYs. One last thing: ICER is the Institute for Clinical and Economic Review. It is an independent and nonprofit organization who creates a lot of these QALY assessments. Whether they succeed or not is something that is sometimes questioned, but the team over at ICER prides themselves in not working for Pharma and not working for payers in an effort to be as impartial as possible.   You can learn more at drugpricinglab.org.   Anna Kaltenboeck is the senior health economist and program director for the Center for Health Policy and Outcomes and the Drug Pricing Lab at Memorial Sloan Kettering Cancer Center (MSKCC). She focuses on the development and application of reimbursement methods for prescription drugs that reduce distortionary incentives in the supply chain and encourage pricing of treatments based on their value. Her work centers on developing an unbiased evidence base that characterizes the effect of federal policies on coverage and reimbursement decisions for branded specialty drugs and cell and gene therapies and identifying opportunities for policy changes that encourage affordability and access while maintaining incentives for innovation. Her current research interests include global comparisons of reimbursement policy and supply chain regulation, game theory in innovation decisions, and the effect of market concentration on pricing decisions. Ms. Kaltenboeck’s research and policy work is informed by her experience as a consultant for pharmaceutical clients. Prior to joining MSKCC, Ms. Kaltenboeck spent 10 years working for Analysis Group and IMS Consulting Group, where she conducted health economics and outcomes research and developed pricing and market access strategies for pharmaceutical and diagnostic products. She has published numerous articles in peer-reviewed journals and other press, including JAMA and Morning Consult, and speaks frequently on the topics of value-based pricing, economics of the supply chain, and reimbursement models. Ms. Kaltenboeck holds bachelor’s and master’s degrees in economics from Tufts University. 3:56 What is a QALY? 05:28 “You don’t get marks; it’s the treatment that gets the marks.” 09:13 What is willingness to pay? 10:52 “What we pay for drugs should be reflected in societal preference.” 12:29 Does Pharma fear the QALY? 15:38 “At the end of the day, the ideal here is simply to be able to quantify ‘This is what we’re going to pay for this additional benefit that we’re going to provide for patients.’” 17:09 “When you meet that price, patients should be getting access to that product.” 19:27 What are the significant advances being seen with QALYs and drug development? 21:23 “The challenge is when the price is so much higher than those benchmarks.” 22:27 How do we use the QALY as a tool? 25:56 Where does value-based pricing fall in the world of QALYs? You can learn more at drugpricinglab.org.   @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue What is a #QALY? @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue “You don’t get marks; it’s the treatment that gets the marks.” @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue What is willingness to pay? @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue “What we pay for drugs should be reflected in societal preference.” @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue Does Pharma fear the QALY? @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue “At the end of the day, the ideal here is simply to be able to quantify ‘This is what we’re going to pay for this additional benefit that we’re going to provide for patients.’” @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue “When you meet that price, patients should be getting access to that product.” @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue How do we use the QALY as a tool? @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue Where does value-based pricing fall in the world of QALYs? @a_kaltenboeck discusses #drugpricing and #patientadvocacy in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #healthvalue #drugvalue

Sometimes when I overhear a conversation/argument about telehealth, it occurs to me that there’s a lot of fighting words about some things and very, very little about other things which I’d regard as equally, or maybe even more, important. Some of the sparring tends to jump immediately to tactics and UX (user experience), absent of strategy and CX (customer experience). In my experience, you can’t talk about a user interface until you talk about the overall customer experience and journey and what your goal is. So, here’s what I mean: Let’s take urgent care as an analog. Say a patient goes to urgent care with symptoms consistent of allergic asthma. The NP (nurse practitioner) gives the patient strict instructions to take an antihistamine and Flonase and Flovent. She tells the patient to be sure to make a follow-up with their PCP (primary care provider) to evaluate how it’s going. If the patient doesn’t make a follow-up visit, do we suggest it’s because the live in-person visit should have been telehealth? Or if the patient is nonadherent and winds up in the hospital with a full-blown asthma attack, do we suggest that live in-person visits diminish adherence? Let me respectfully suggest that it’d be a solid no on that. This is exactly why, whenever I listen to a diatribe about how telehealth did not work out for a patient, I find it interesting to ask a couple of questions. The question that I tend to ask when someone starts talking about some telehealth fail is “How did it fail?” How did it not work out? And the answer to this question tends to be similar to the above allergic asthma example: that the patient needed lab work or imaging or a follow-up visit, and that couldn’t be done via telehealth. There was no resolution to the patient concern, in other words. Okay … so, first of all, most practices don’t have immediate on-premises lab work or imaging, so the patient would have had to have gone somewhere else to get it anyway. But even if they did, as far as I know, you can’t have a follow-up visit at the same time that you have the first visit. Not to be cheeky, but that’s why they call it a follow-up visit. Then the next logical question is, if the patient doesn’t show up for a follow-up, if the patient were in person, what’s the greater likelihood that they would have gone for the lab test and/or come back for the follow-up? This is when you start to realize that the setting of care (ie, virtual or in person) may be a little bit less important than the agency of the provider involved. And it may be a little less important than the structure of the organization sitting around that patient encounter. Said another way, strategically, what are we doing here? What are we trying to accomplish? What’s our road map to get the patient from where they are now to wherever that goal is? A patient visit is a tactic. It’s one point in time. And that’s true regardless of whether it’s a remote visit or an in-person one, synchronous or asynchronous. A patient visit or interaction is not a care pathway. It is rarely, if ever, a magic bullet one and done. But that doesn’t stop us from thinking about patient encounters, one encounter at a time, which may be exactly why we wound up with a fragmented health care system that doesn’t work very well. But I digress. So, from what I can see, some of the flaws that some people attribute to telehealth might be more properly construed as flaws to the ecosystem in which the telehealth is being deployed. For example, how much agency or data or infrastructure does the provider behind the camera have to see where the patient is in their treatment journey and make sure that they get to that next milestone? Because in cases where the doctor behind the camera or the telephone or the text message has agency and the telehealth visit is part of a defined patient journey, telehealth results are strikingly comparable to not telehealth results, if not better. If we’re contemplating a patient journey or a treatment journey, writ large, the site of care at any moment in time is a secondary or tertiary factor—certainly not a primary one. Here’s what I want to know about telehealth. How do you best use it, not as a point solution but as part of a larger whole? How do you optimize a telehealth encounter so it pulls its weight in helping patients get a resolution to their chief complaint or manage their chronic conditions? Christian Milaster has written about this in his Telehealth Tuesday newsletter, which is great, by the way. Christian wrote that the delivery of care, when viewed through the eyes of a systems engineer (which he is), becomes a quite simple four-step process. These are the four steps that Christian says. He says, the first step is assessment, which leads to a diagnosis, which is step two. Step three is the development of a treatment plan. And then step four is the implementation of that treatment plan.   Amongst other sidebars, I talk about these four steps in this health care podcast with Blake McKinney, MD. Dr. McKinney is an ER doc as well as the cofounder and CMO over at CirrusMD. In our conversation, Dr. McKinney actually comes up with one more step to add to the four-step process. It’s kind of a pre-step, where the patient decides that he or she needs care to begin with. You can learn more at cirrusmd.com.   Blake McKinney, MD, cofounder of CirrusMD, had a vision: to enable every person to have a better experience accessing health care services. Blake observed the barriers his patients were up against in seeking care and, at the same time, saw that his friends and family were able to reach out to him directly for guidance, most often via text. CirrusMD was created so everyone seeking care could immediately connect and communicate with a real doctor in this way. Partnering with Andy Altorfer in 2012, Blake and the CirrusMD team have built a platform to achieve this vision of an improved health care experience. Through the years, this path has been guided by Blake’s clinical insight and ongoing, practice-based understanding of the needs of both patients and doctors. Dr. McKinney completed his internship and residency at the University of California Davis after graduating from the University of Texas Medical School in Houston. Prior to medical school, he served 4 years as a communications intelligence officer in the United States Marine Corps. 06:53 “Regardless of the availability of convenient options, there is one force more powerful than convenience, and that is familiarity.” 09:01 “Telemedicine that is continuity based is going to be better medicine fundamentally.” 13:21 “The fundamentals of medicine are the same, and the standard of care is the same, whether the care is in person or in clinic.” 15:16 What’s the underlying determinant of patient success? 16:08 “When it comes to the ‘What’s next,’ doctors love resources.” 16:52 How is telemedicine lacking in resources? 18:42 “Implementation to me is, first and foremost, about follow-up.” 23:10 “There’s a place for automations. My prime directive … is to build trust.” 25:13 “The best adaptive interview that you can create is human to human.” You can learn more at cirrusmd.com.   @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “Regardless of the availability of convenient options, there is one force more powerful than convenience, and that is familiarity.” @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “#Telemedicine that is continuity based is going to be better medicine fundamentally.” @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “The fundamentals of medicine are the same, and the standard of care is the same, whether the care is in person or in clinic.” @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech What’s the underlying determinant of patient success? @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “When it comes to the ‘What’s next,’ doctors love resources.” @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech How is telemedicine lacking in resources? @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “Implementation to me is, first and foremost, about follow-up.” @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “The best adaptive interview that you can create is human to human.” @BlakeMcKinneyMD of @CirrusMD discusses #telehealth in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

There’s lots going on these days with transparency. Three cost transparency rules, as a matter of fact, just came out of CMS, for example. These rules demand that hospitals and payers make available cost information so patients can shop and employers can also shop. That last part there, about employers and/or payers being able to shop … that might wind up actually being the part of these transparency rules that has the most impact.   It all goes back to kind of a first-principle assumption that many made—including me, by the way—which is turning out to be arguable. It’s the great hope for consumerism through high-deductible health plans. The thought originally was that by pushing the burden onto patients/employees to find high-quality care at a fair price, we assumed that health care delivery would level up. We assumed that prices would come down, driven by the weight of consumer demands. But anybody seeking to validate this hypothesis would be pretty hard pressed to claim any sort of broad-stroke success beyond cost shifting by brute force. The vast majority of patients don’t have medical degrees. This is why they went to a doctor to begin with. So, it’s unsurprising to learn that providers wield a lot of influence. If a doctor tells a patient to go here for an MRI or there for surgery, patients have a tendency to go, without questioning. So, logically, if we want to create a high-value health care system and high-value health care—high quality at a fair price—we need to contemplate the recommendations that providers are making. These recommendations especially matter because a patient’s entry point into the health system—where they go first—can make all the difference. This is also a particularly relevant point these days with all the discussion about digital front doors. Earlier, I spoke with Ashok Subramanian, CEO and founder over at Centivo. Centivo is a novel self-funded health plan centered around robust primary care. And I thought this episode had particular relevance given what is going on in the health care industry today. You can learn more at centivo.com. Ashok Subramanian founded Centivo in 2017 after observing the inefficiency in the health care system and the pain that has resulted for employers and employees.

Three transparency rules have come out of CMS in the past months. My guest in this health care podcast, Jeff Leibach, calls these three rules three steps on a ladder. They build on each other. The first rule was announced last year, and it was for hospitals to post their chargemasters. You could consider this a baseline step. It’s not really all that useful in practice as many discovered. The next step on the ladder (which is coming out on 1/1/21): Providers (hospitals) for all services have to post a machine-readable file—all of their negotiated rates for all service categories. They also have to post a shoppable service file and/or some kind of patient estimator tool so patients can estimate the cost of the most shopped services. Then there’s the payer rule. This is more comprehensive than the provider rule, and the payers have some extra time—actually, they have an extra year (till 1/1/22). But basically, payers have to comply at a higher level. They have to allow price shopping across all sites of care. My guest in this health care podcast, Jeff Leibach, is a director with Guidehouse in the Healthcare Practice. He focuses on how health care services are priced and paid for, working with a lot of payers and providers. Thus, he is the perfect person to discuss these transparency rules with because of his deep knowledge of payers and provider contracting and also how pricing impacts patients, employers, and stakeholders across the industry. Jeff and I get into these three transparency rules and their likely impact and also kind of their philosophical underpinnings. We also talk about what might happen with them under a Biden administration. After our conversation, I started to think about these transparency rules in the broader context of what’s going on in the health care marketplace. There’s kind of a constellation of market factors, and these market factors increasingly seem to be necessitating hospitals and ambulatory practices to really differentiate themselves in ways that employers and patients/consumers care about. I mean, these CMS transparency rules for payers and hospitals are but one thing that is going on. But these rules ultimately mean that it’s easier for patients and employers to price shop. It also makes it easier for employers to narrow their networks and exclude providers. Consider this impact and then think about how that fits with the ONC TEFCA (Office of the National Coordinator for Health Information Technology Trusted Exchange Framework and Common Agreement) rule. So, that ONC TEFCA rule means that it’s gonna be a less effective tactic to prevent network leakage by hoarding patient data. So, if patient data is portable, patients can seek out the best care provider without the friction of some kind of PHI (protected health information) transfer. Okay … so now prices are available because of the transparency rule, and patients can walk more easily because of the TEFCA rule. So, these two together could be a forceful combination. We also have the rise of consumerism. I just saw a study the other day kind of validating that consumers are voting with their feet if a provider does not meet the quality of care, the supportive patient experience that they believe could be found elsewhere. And add to that the at-risk PCPs (primary care providers) cropping up in various concentrations across the country. But then also, you’ve got payers buying PCPs. And what that means is that you get these PCPs who control the referral flow, and they’re taking an active interest in the downstream costs and population outcomes of specialists in their referral networks. So, you’ve got specialists who maybe lack processes to minimize inappropriate care or who do not deliver consistently high patient experiences and outcomes. They could easily get excluded from those referral flows. So, you take all these things together—the transparency, the ONC TEFCA rule, consumerism, and the disruption of certain referral flows—and, if you ask me, I think all of this together means that providers who are more commodity and less brand may need to consider ramping up their Triple Aim endeavors. You can contact Jeff at jeff.leibach@guidehouse.com. You can also connect with him on LinkedIn and Twitter.   Jeff Leibach, MBA, is a director with Guidehouse’s Healthcare Practice. Over the last decade, Jeff’s main area of expertise has been in developing and implementing managed care solutions for payers and providers. These solutions include development of several analytic solutions, alignment of clinical and financial models, and negotiation training and preparation. Jeff has significant experience building and leading teams to deliver complex analytical tools to quantify opportunities into business strategies for clients. Jeff currently leads Navigant’s Strategic Pricing and Revenue Rebalancing Solutions for Navigant. Prior to his consulting career, Jeff led national nonprofit Camp Kesem, a summer camp for children affected by a parent’s cancer. Additional information: Price Transparency White Paper and 2019 Massachusetts Attorney General Report 05:31 What are the two pieces to the new transparency rule going into effect on January 1, 2021? 06:58 “Any negotiated rate … is required to be disclosed.” 07:43 What’s the payer rule, and how does it differ from the hospital rules? 10:24 Where are direct comparisons going to come in most useful with transparency rules? 11:16 How does CMS intend these rules to be used? 14:34 “I anticipate employers having a newfound power here.” 17:27 Why is there opposition to transparency in health care? 18:27 “The administrative burden is real.” 21:03 “I think commoditized is a word we’re going to hear a lot more.” 22:55 Where is CMS headed under a Biden administration? 26:22 What barriers can tech help break down, and what other opportunities are there for tech right now? 28:49 What should payers be preparing for right now? You can contact Jeff at jeff.leibach@guidehouse.com. You can also connect with him on LinkedIn and Twitter. @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency What are the two pieces to the new transparency rule going into effect on January 1, 2021? @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “Any negotiated rate … is required to be disclosed.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency How does CMS intend these rules to be used? @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “I anticipate employers having a newfound power here.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “The administrative burden is real.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency “I think commoditized is a word we’re going to hear a lot more.” @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency Where is CMS headed under a Biden administration? @jeffleibach of @GuidehouseHC discusses #hospital and #payer #transparencyrules. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcaretransparency #healthtransparency

Wow! It’s episode 300. That’s a milestone. Because of you, we’ve grown to be one of the largest podcasts for health care executives—so, thank you to every one of you who has recommended the show to your friends and colleagues, which is really the highest compliment. Thanks also to all the listeners of this show who have written reviews, LinkedIn posts, and sent emails. The team over here at Relentless Health Value really appreciates your kind words. They’re super motivating. The emails we love to get are the ones where one of you talks about a success story, like an example where you’ve taken something you heard and made it actionable—how you helped patients get better care to lower cost or how you were able to collaborate with fellow stakeholders in a meaningful way. That’s really why we’re here and why it’s so motivating to hear stories like this, which brings me to a really important point. We’re in this together. All of you health care decision maker/stakeholder types out there, you who can directly effect change, it’s really you who deserve the biggest round of applause, if I do say so. We appreciate the opportunity to kick off the activity or the decision making, but it’s you all who pick up the ball and run with it. And for that, we—as both professionals and patients—thank you. Moving on to today’s episode 300, my guest in this health care podcast, Bruce Rector, MD, is an expert on drug affordability; and he has extensively studied how to make sure we get the right drugs developed by considering innovation incentives among other things. He’s done a lot of work with Doctors for America and the Center for American Progress. He also teaches medical students, pharmaceutical policy, and has worked with drug companies on drug development promotion. So, I felt like that was a pretty rounded perspective of the issues that I wanted to get into here. Let me tell you why I started to think about this. Any one of those stories where somebody dies of an infection that was resistant to antibiotics, they’re always ghastly tales that seem so unnecessary. And every time I hear one of them, I wonder why pharma companies aren’t in the antibiotic business. Clearly, there’s a need. Well, it turns out antibiotics are a great case study of what happens when drug companies don’t have the incentive to develop drugs that are a huge need to society—which brings me to the big hairy challenge I’m talking with Bruce Rector about in this podcast. How do you ensure that pharmaceutical manufacturers are fairly incented and compensated to develop the drugs that are of the most value to society? Orphan drugs, by the way, are a great example of what happens when incentives are put in place to develop drugs. At last count, half the drugs developed in the past decades have been for rare diseases—because of the 1983 Orphan Drug Act that made it quite profitable to develop for rare diseases. So, in this health care podcast, we dig in to two—arguably three—categories of incentives that are typically offered or available to pharma companies in this country today and which are, frankly, used in that Orphan Drug Act. The first two are push incentives, and then there’s pull incentives. Push incentives are when the government, generally, offers incentives to reduce industries’ costs during the R&D (Research & Development) stages, like they give grants or tax credits for clinical research—things like this. Pull incentives, on the other hand, are ways to guarantee demand after the drug is developed or to help the pharma company make more money on the drug, for example, by extending patent exclusivity—like if you, Pharma, develop this drug, we’ll promise to buy millions of doses right up front and/or we’ll bar any generics for two extra years so you get the two extra years of revenue. (You might be thinking about what’s going on with COVID right now. Just sayin’.) So, we have push incentives, we’ve got pull incentives, and then this last one, which is more of a market condition than really anything paid up front or deliberately engineered on the back end. It’s that drugs aren’t like new desk chairs or some other product that, if the price goes too high, your employer just doesn’t buy it. If someone is suffering from a deadly disease and there’s one drug for it with no competition, there’s nothing and nobody in the US marketplace that really has the power to hinder the pharma company from basically charging whatever they want for it. Dr. Vincent Rajkumar talks about this in EP296 if you want to go back and listen to that one for more info. But wait … there’s more I talk with Dr. Rector about in this health care podcast. He brings up two different ways to contemplate paying for drugs. First is the fire extinguisher model, which is really applicable to antibiotics—and we talk about a couple of things I had never thought about relative to antibiotics. And then secondly, we have the subscription model—definitely food for thought for any of you innovative health plan types or policy makers out there. You can learn more by following Dr. Rector on Twitter and LinkedIn. Bruce Rector, MD, is physician whose work spans many important areas of the health care landscape: biopharmaceutical policy advisor, health policy lecturer, life science company consultant, and physician advocate. He focuses on policies to ensure that the right drugs get developed to meet society’s needs and that they are value based and equitably priced. Dr. Rector coauthored an article on value-based pricing, “Grounding Value-Based Drug Pricing in Population Health,” which is published in Clinical Pharmacology & Therapeutics. 05:58 What’s the issue with innovation in the pharmaceutical space? 06:47 “The problem … everyone talks about is antibiotics.” 07:38 What are pharmaceutical companies launching to drive value instead of antibiotics? 08:21 What are orphan drugs? And why is development incentivized for those drugs? 11:56 What are the differences between push incentives and pull incentives? 14:37 “The pharma company is all about how much money [the drug] can make once it hits the market.” 16:28 “These contracts, they know once they hit the market, there’s billions just waiting for them.” 17:17 What are the biggest pull and push incentives in Pharma? 17:40 What are the push and pull incentives with antibiotics? 24:39 What’s the fire extinguisher theory in Pharma? You can learn more by following Dr. Rector on Twitter and LinkedIn. @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What’s the issue with #innovation in the #pharmaceutical space? @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “The problem … everyone talks about is #antibiotics.” @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What are pharmaceutical companies launching to drive value instead of antibiotics? @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What are #orphandrugs? And why is development incentivized for those drugs? @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What are the differences between #pushincentives and #pullincentives? @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “The pharma company is all about how much money [the drug] can make once it hits the market.” @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “These contracts, they know once they hit the market, there’s billions just waiting for them.” @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What are the biggest pull and push incentives in Pharma? @BERector discusses #drugdevelopment and affordability in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

If you are a forward-thinking specialist right now, alarm bells may be going off, given COVID and/or the prospect of another COVID-style pandemic. Also, all of the capitated and advanced PCP (primary care provider) practices popping up. Also, virtual care models. FFS is a cushy status quo revenue model until it isn’t. One underappreciated point might be that FFS is not only a revenue/payment model. It’s also a business model. And as a business model, FFS very much drives how practices structure themselves to realize that FFS revenue. Consider that to earn a fee for a service, someone (a human person) has to physically do the service. So, all FFS-style businesses have an inherent incentive to add labor and not use technology in any way that actually reduces the amount of billable human hours involved in providing care to patients. But if that top-line revenue line goes down—wow!—you’ll find yourself as many did with way too many employees. An FFS business model has zero flexibility when it comes to revenue that isn’t consistently going up or, at a minimum, a flat line. If revenue plummets and payroll is big—big so as to power a way higher revenue number than is possible for whatever reason—you have a major financial problem on the quick. That is what I talk about in this health care podcast with Alan Kaplan, MD, MBA. Dr. Kaplan is assistant professor of urology at Georgetown University, and he is a practicing urologist. He recently cowrote a paper with Dan O’Neill in the publication NEJM Catalyst Innovations in Care Delivery. The article discusses COVID-19 and health care’s “productivity shock,” as they call it. Dan O’Neill, by the way, was on the show. Also, he was on EP287 and part of EP292. But in the article that Dr. Kaplan and Dan O’Neill wrote, they give some advice to specialists and hospitals who are looking to evolve with the changing marketplace. Spoiler alert: Conceptually, it’s a shock to move from a place where, every year, you can count on your billings going up and up and move to a model instead that assumes that this is not the case. So, yeah, there’s a little talk for sure about the joys and challenges of transitioning to value or a value-based payment model. But that’s only the very first consideration. It’s also about reconsidering the operating model and the strategic use of digital technologies. We talk about all of the above in this health care podcast. Quick sidebar: My interview with Dr. Steve Schutzer (EP294) might be a good follow-on for a very actionable work plan for specialists to implement some of the advice that Dr. Kaplan gives in this podcast.   You can learn more by contacting Dr. Kaplan via LinkedIn. Alan L. Kaplan, MD, MBA, is a practicing surgeon, innovator, and health services researcher. After finishing his urology residency, a health care administration fellowship, and an MBA, all at UCLA, Alan helped build a multispecialty medical group in a highly underserved area of South Los Angeles. Alan is currently an assistant professor of urology at Georgetown University; an attending physician at the Washington, DC, VA Medical Center; and a physician advisor at IDEO, a human-centered design firm. Alan’s work over the past 10 years has centered on value-based care redesign, aiming to transition to a more just, equitable, and sustainable health care system for all Americans. 03:51 Who are we actually discussing when we use the term specialist? 05:58 How does the PCP taking on more risk affect the specialists’ path to value-based care (VBC)? 09:42 “Technology leads to … a reduction in labor burden … but in health care, that really hasn’t been the case.” 11:36 “Technology … in health care … has never really been about making the bottom line more efficient. It’s been about expanding the top line.” 13:39 What do specialists need to be considering if they want to stay relevant in the next 5 years? 14:27 EP292 with Brian Klepper, PhD. 16:53 Is there a future where specialists can transition from FFS to VBC while skipping the messy middle of a transition? 18:37 “The way we always did things is not the way that we have to always do things in the future.” 25:20 “When all is said and done, the relationship between [PCPs] and the specialists that they refer … those relationships are really, really important.” 26:14 EP219 with Arshad Rahim, MD, MBA, FACP. 28:13 What’s going to be a big driver for providers to become more independent in the next 5 to 10 years? You can learn more by contacting Dr. Kaplan via LinkedIn. @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #ffs Who are we actually discussing when we use the term “specialist”? @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs How does the PCP taking on more risk affect the specialists’ path to value-based care? @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs “Technology leads to … a reduction in labor burden … but in health care, that really hasn’t been the case.” @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs “Technology … in health care … has never really been about making the bottom line more efficient. It’s been about expanding the top line.” @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs What do specialists need to be considering if they want to stay relevant in the next 5 years? @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs Is there a future where specialists can transition from FFS to VBC while skipping the messy middle of a transition? @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs “The way we always did things is not the way that we have to always do things in the future.” @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs “When all is said and done, the relationship between [PCPs] and the specialists that they refer … those relationships are really, really important.” @ALKaplan_MD of @DCVAMC discusses #valuebasedcare and #feeforservice models. #healthcarepodcast #healthcare #podcast #digitalhealth #vbc #ffs

Dr. Don Fowls discusses value-based payments in behavioral health and the rise of telepsychiatry. They debunk misconceptions about telehealth and address the epidemic of loneliness. The podcast explores the advantages of telehealth integration in mental health services, data-driven approaches to improve patient outcomes, and the impact of value-based initiatives on healthcare outcomes.

Here’s something I never really understood: how physicians and nurses more often than not get to be responsible for the entire patient journey, including, start to finish, patient satisfaction. But if you just take one look at any random poorly rated physician’s reviews, they’re usually littered with complaints about the front desk in the practice. Negative reviews, of course, are not limited to front desk diatribes; but there’s often a lot of front desk commentary in them. It has always seemed to me to be a common and strange phenomenon in health care provider practices where the front desk is like a totally separate little fiefdom with a different mission statement and goals from the health care providers in the same exact office. Isn’t that odd when you think about it? I mean, first, the front desk is literally physically separated from everybody else. No matter which direction you approach from, there’s at a minimum a half-wall barrier surrounding them. Sometimes, in directions most likely to receive an attack, I suppose, there’s been added a big glass barrier. Liliana Petrova pointed this out in EP236 of the Relentless Health Value podcast, and it was really the first time that I had thought about it at all and also thought about the implicit message this sends not only to patients but also to clinicians. That whole physicality of the setup, it just screams, “We over here have nothing to do with the mission or vision of anyone else in this place. We have our own thing going on over here, and to do it, we need to be protected from you all and all of your chicanery and untoward goings-on, you doctors and nurses and patients!”   I was really inspired the first time I heard Jerry Durham from The Client Experience Company talking. His message, as I understood it, was that a practice really on board with helping patients achieve the best patient outcomes and, nothing for nothing, erode clinician burnout includes the front desk in their thinking. Jerry has said that there’s four phases in the patient life cycle, as he calls it, which is sort of a synonym for the patient journey: Marketing The moment that a patient/person engages with the clinic or office Provider interactions The post course of care So, all of these phases—all four of them—are critical to both patient outcomes and experience but also, really, to business success. So, you kind of almost have to do well by doing good. The front desk is mostly responsible for that phase two: what happens when that person/patient engages with your office or clinic. In this health care podcast, as mentioned, I’m talking with Jerry Durham. He’s a former physical therapist and practice owner who has worked with a whole lot of PT (physical therapy) practices and also other MSK (musculoskeletal) specialties among other clients. His message transcends the specialty, however. In this health care podcast, we get into a lot of aspects in terms of how a front desk can work for or against patient experience and outcomes. One of them is how a front desk can help secure a patient’s relationship with a practice. Trust follows from a relationship. Lately, maybe even earlier than lately, study after study is coming out—including some that Rebecca Etz, PhD, talks about in EP295—which shows that, without a relationship and trust, patient outcomes are meh at best. (You can always count on me for scientific terminology.) But a lack of trust is a big hairy factor behind disparities in outcomes among different ethnic groups, for example, as one point to ponder.   You can learn more at clientexperiencecompany.com or by emailing Jerry at jerry@jerrydurhampt.com.   Jerry Durham is a physical therapist with over 25 years of experience and 20+ years of business ownership. Jerry’s singular passion is leveraging the entire practice team toward improved patient outcomes while boosting the practice bottom line. Jerry has spent significant time on the front line, answering patient calls and learning why patients think and act the way they do when interacting with the front desk. Jerry now leads The Client Experience Company, focused on improving both client outcomes and practice profitability through the leveraging of the patient life cycle by the front desk. 04:31 What is the patient life cycle? 05:33 What are the milestones of the patient life cycle? When does it start? 08:51 “This isn’t a business solution; this is a patient-driven solution.” 09:08 “What is best for the patient is best for business.” 12:45 “The takeaway there is that your team members are all driving toward the same goal.” 13:54 How does the front desk impact health outcomes? 16:00 What is the objective of a front desk to reduce provider burden? 20:38 “There’s actually three roles at the front desk.” 29:57 EP228 with Julie Rish, PhD, from the Cleveland Clinic.   You can learn more at clientexperiencecompany.com or by emailing Jerry at jerry@jerrydurhampt.com.   @Jerry_DurhamPT discusses #patienttrust and #healthoutcomes in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech What is the patient life cycle? @Jerry_DurhamPT discusses #patienttrust and #healthoutcomes in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “This isn’t a business solution; this is a patient-driven solution.” @Jerry_DurhamPT discusses #patienttrust and #healthoutcomes in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “What is best for the patient is best for business.” @Jerry_DurhamPT discusses #patienttrust and #healthoutcomes in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “The takeaway there is that your team members are all driving toward the same goal.” @Jerry_DurhamPT discusses #patienttrust and #healthoutcomes in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech How does the front desk impact health outcomes? @Jerry_DurhamPT discusses #patienttrust and #healthoutcomes in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech “There’s actually three roles at the front desk.” @Jerry_DurhamPT discusses #patienttrust and #healthoutcomes in this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech

My guest in this health care podcast is Vincent Rajkumar, MD. Dr. Rajkumar is a professor of medicine at Mayo Clinic, Rochester. He’s also a practicing hematologist at the Mayo Clinic with a focus on multiple myeloma. Dr. Rajkumar does research and conducts clinical trials. He’s a well-known thought leader in questions about the cost of drugs in this country versus other countries. So, let me tell you what happened with this episode: I mentioned to a few people I would be speaking with Dr. Rajkumar, and every single person I mentioned it to sent me questions to ask him. So, that happened. I wound up with way too many questions; thus, I spent my Thursday evening organizing said questions into some semblance of a logical order. In this health care podcast, we talk about telehealth in oncology. We talk about standardizing treatment pathways in oncology amidst the growing complexity of said treatments and how this could potentially help community oncologists and generalists. We wrap things up with Dr. Rajkumar’s insights on the high price of oncology and other drugs. You can learn more by reading Dr. Rajkumar’s papers about the high cost of insulin, the high cost of prescription drugs, and cost-effective therapy of multiple myeloma.   You can also watch his presentation on the high cost of prescription drugs.  S. Vincent Rajkumar, MD, is the editor in chief of Blood Cancer Journal and the Edward W. and Betty Knight Scripps Professor of Medicine, Mayo Clinic, Rochester, Minnesota. His academic career was profiled by The Lancet (November 26, 2011). He is co-chair of the International Myeloma Working Group (IMWG) and chair of the Eastern Cooperative Oncology Group (ECOG) myeloma committee. He also serves as the associate editor for Mayo Clinic Proceedings, Leukemia, and European Journal of Hematology. Dr. Rajkumar has received several awards, including the Giants of Cancer Care Award (2019) from OncLive and the Robert A. Kyle Lifetime Achievement Award, an honor given by the International Myeloma Foundation (IMF). He has also received the Relentless for a Cure Award from the Leukemia and Lymphoma Society (2010), the John Ultmann Lecture and Award (2011), and the Janet Davison Rowley Patient Impact Research Award from Cures Within Reach Foundation (2015). He was named Mayo Clinic Distinguished Investigator in 2018. He serves on the board of directors for the IMF and is a member of the National Institutes of Health’s Multiple Myeloma Steering Committee. Dr. Rajkumar has over 600 publications, including over 350 peer-reviewed original research papers and over 200 reviews and book chapters. 01:45 What is the perspective on telehealth and its impact on oncology? 03:50 “Cancer has become extraordinarily complex.” 05:32 Is it possible to still have community oncologists in the advent of technology? 08:39 What’s the viability for flat-fee reimbursement in oncology? 14:31 “The pathways should be designed and developed by people who don’t have a financial stake [or] conflict.” 18:34 “Part of the problem for physicians is, you want to deliver the best care.” 21:23 “There are no allies in this fight for lower prescription drug costs.” 23:18 “This is not like a television or a car where you can say you can live without it.” 24:33 “It’s absolutely not a free market.” 25:35 “Each drug is a monopoly.” 30:22 “When you do value-based pricing, you’re not putting a price on anybody’s life. You’re only putting a price on what [a] drug is worth.” You can learn more by reading Dr. Rajkumar’s papers about the high cost of insulin, the high cost of prescription drugs, and cost-effective therapy of multiple myeloma.   You can also watch his presentation on the high cost of prescription drugs.  @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech What is the perspective on telehealth and its impact on oncology? @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “Cancer has become extraordinarily complex.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech Is it possible to still have community oncologists in the advent of technology? @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “The pathways should be designed and developed by people who don’t have a financial stake [or] conflict.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “Part of the problem for physicians is, you want to deliver the best care.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “There are no allies in this fight for lower prescription drug costs.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “It’s absolutely not a free market.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech “Each drug is a monopoly.” @VincentRK of @MayoMyeloma discusses #oncology #FAQs on this week’s #healthcarepodcast. #healthcare #digitalhealth #healthtech

PCPs (primary care providers) are really important to population health. Primary care is the foundation of any well-functioning health system, I am sure many listening to this podcast know well. For the Triple Aim to happen, patients really need access to robust primary care. This has been affirmed by almost anyone who looks into it. And yet, in this country, our system sort of anemically supports our primary care colleagues. As a general statement, poking and prodding and procedures are compensated at a far higher rate than anything requiring cognitive services. What a PCP or a pediatrician mainly does all day is really cognitive. It’s listening and thinking and counseling and coordinating. But here is maybe an underappreciated point: If we’re going to measure PCP performance, then we need the right measures to measure that performance. You might be doing this measurement as a basis for incentives or maybe for continuous improvement programs. Either way, if you don’t have the right measures, then maybe great primary care is under-rewarded or your continuous improvement process is counterproductive—you’re incenting the wrong things, you get the wrong activity. And to add to that, PCPs (ie, practices) can spend upwards of $40,000 a year of uncompensated time trying to add and subtract and tote up the difference in all these varied and potentially inapplicable measurement standards coming at them from all manner of directions. My guest in this health care podcast is Rebecca Etz, PhD. Dr. Etz and the team over at The Larry A. Green Center have worked hard to create a set of 11 performance measures for primary care. These measures went through the wringer as far as their creation and validation. These 11 measures take into account what patients want, what primary care clinicians (including pediatricians, nurse practitioners, and others) think is most important and possible to provide, and what payers want to pay for. These 11 measures are aligned across the three stakeholders, and they are actionable. Neither of these descriptors is anything to take for granted. Rebecca Etz, PhD, is associate professor of family medicine and codirector of The Larry A. Green Center, which is in Richmond, Virginia, at the Virginia Commonwealth University. You can learn more at green-center.org. Rebecca S. Etz, PhD, is an associate professor of family medicine and population health at Virginia Commonwealth University (VCU) and codirector of The Larry A. Green Center—Advancing Primary Health Care for the Public Good. Dr. Etz has deep expertise in qualitative research methods and design, primary care measures, practice transformation, and engaging stakeholders. Her career has been dedicated to learning the heart and soul of primary care through three main lines of inquiry: (1) bridging the gap between the business of medicine and the lived experience of the human condition, (2) making visible the principles and mechanisms upon which the unique strength of primary care is based, and (3) exposing the unintended, often damaging consequences of policy and transformation efforts applied to primary care but not informed by primary care concepts. As a member of the VCU Department of Family Medicine and Population Health and previous codirector of the ACORN practice-based research network, Dr. Etz has been the principal investigator of several federal and foundation grants, contracts, and pilots, all directed toward making the pursuit of health a humane experience. Recent research activities have included studies in primary care measures, behavioral health, simulation modeling, care team models, and adaptive use of health technologies. Dr. Etz currently leads the fielding of a weekly survey regarding the response to and impact of COVID-19 on US primary care practices. She also serves on the National Academies of Medicine consensus study, “Implementing High-Quality Primary Care.” 03:41 Why is primary care one of the “best-kept secrets” of better health outcomes? 08:38 “Measures are a form of communication.” 08:51 “If the way that you are assessed does not actually match up with the work you do or what you find to be important, it’s pretty demoralizing.” 11:41 “It is the outcome of health care, but it is not the same thing as quality.” 16:31 “It creates a financial incentive to hit a target by any means necessary.” 18:06 “We incentivize people to have good outcomes, and what that means is that electronic medical records are no longer simply databases that tell us what the health of the population is. They are databases that tell us what is the optimal picture that a clinician is able to paint of their patients.” 21:07 “Primary care is a relational field.” 22:14 “How does this relate to cost and utilization?” 26:43 “I think we all know that fee for service is death.” 27:11 How has the measure of PCPs in the time of COVID held up? 27:32 What measure performs worse in the time of COVID? 28:17 “Primary care is the place that everybody goes.” 31:16 EP270 with Dave Chase and EP272 with Guy Culpepper, MD.  You can learn more at green-center.org. Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “Measures are a form of communication.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “If the way that you are assessed does not actually match up with the work you do or what you find to be important, it’s pretty demoralizing.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “It is the outcome of health care, but it is not the same thing as quality.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “It creates a financial incentive to hit a target by any means necessary.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “Primary care is a relational field.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp “I think we all know that fee for service is death.” Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp How has the measure of PCPs in the time of COVID held up? Rebecca Etz of @GreenCenterOrg discusses #primarycare performance on this week’s #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #pcp