Relentless Health Value

John Rodis, MD, MBA, is an OB/GYN specializing in high-risk pregnancies. He’s been a board examiner and a department chairman. He’s been a COO and a CEO of a 600-bed Level 1 trauma center. He’s also an author working on a book to help consumers make better choices. Dr. Rodis has said he feels an inflection point is coming in the transition to value. First, we have the pressure of large employers. Second, we’ve got doctors themselves who are being crushed by the current environment and who may also have realized that FFS (fee for service) is kinda risky in the middle of a pandemic. The third force toward the inflection point is the new breed of fee-only transparent brokers. And then fourth, we’ve got the government, particularly state governments who are struggling fiscally coming out of this pandemic and also realizing that the current health care system is pretty rigged to profit on the backs of taxpayers and firefighters and teachers. In the face of this transition, health systems who aren’t keeping up with the times are at increasing risk. Given that Dr. Rodis has held pretty much every job in health care at this point, he’s probably the perfect person to ask how to quantify that risk, number one, and then what health system leaders should be doing in the face of it. You can learn more by emailing Dr. Rodis at john@aristahealth.com.  John F. Rodis, MD, MBA, is a high-risk obstetrician by training and has had a long and illustrious career as a renowned health care leader. Most recently, he was the president of Saint Francis Hospital and Medical Center in Hartford, Connecticut. Dr. Rodis had two stints at Saint Francis, starting there early in his career as a maternal-fetal medicine fellow in 1985. In between, he was head of obstetrics and gynecology at Stamford Hospital, served as its chief medical officer, was a faculty member at the UConn School of Medicine, and became chair of OB/GYN at Saint Francis in 2011. Dr. Rodis took the helm at Saint Francis as a recent state provider tax was quickly expanding into a huge fiscal burden on Connecticut’s acute care hospitals. In December 2015, he was named its eighth president. Dr. Rodis was the first physician to be appointed president in Saint Francis’s 118-year-history. He guided the hospital through an era of consolidation and rising state taxes. His last challenge arrived in spring 2020 as he oversaw an expansion of temporary facilities as the hospital faced the crush of the coronavirus pandemic. Also, during his tenure as president, Dr. Rodis ushered the Saint Francis team through significant change and transformation, much of which has been recognized at the national and regional level. Those transformations led them to achieve an “A” Safety Grade from Leapfrog seven of the last eight grading cycles. Saint Francis was also named Best Regional Hospital in 2019 by US News & World Report and was the only hospital in Connecticut named one of the nation’s 100 Top Hospitals by IBM Watson Health. Dr. Rodis’s passion is patient safety and, in particular, providing consumers (patients) with reliable data to make informed health care decisions. He departed his post as president of Saint Francis in May 2020. Dr. Rodis has now started his own consulting firm, Arista Health, and is finishing a book entitled You Put Your Life in Their Hands. 02:16 How the scales are starting to rebalance. 02:44 “There’s going to be a day of reckoning.” 04:18 The risk a health system is taking by not adjusting to the market. 05:20 Where are the nominal dollars coming from, and where might they come from in the future. 08:04 EP279 with Peter Hayes.08:15 EP281 with Rob Austin.08:56 The difference in today’s market when it comes to cost setting. 10:02 Why the conversation is shifting from cost comparisons to value comparisons. 11:34 Value is quality over cost. 11:55 The four domains that go into value. 12:32 EP242 with Dr. Marty Makary.14:01 “The problem in this market: It’s not that free.” 16:48 Who is best equipped to be an arbiter of value in this new market system? 18:49 “I think that trust is starting to erode.” 20:30 How payers are leading the charge on this market change. 21:37 Dr. Rodis’s advice to hospital and health system executives to get ahead of this market change. 24:45 EP257 with Karl Bilimoria, MD.26:53 “I think you have to take ownership.” 28:08 “There’s no real Four Seasons business [model] in health care.” 28:30 “Look at the entire episode of cost.” 29:51 Where bundling falls into this equation. 31:45 Dr. Rodis’s upcoming book. You can learn more by emailing Dr. Rodis at john@aristahealth.com.  Check out our newest #healthcarepodcast with John Rodis, MD, MBA, as he discusses #healthsystems, #consumerism, and #valuebasedcontracts. #healthcare #podcast #digitalhealth #vbc #valuebasedcare How are the scales of the market starting to rebalance? John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare “There’s going to be a day of reckoning.” John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare What’s the risk a health system is taking by not adjusting to the market? John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare What’s the difference in today’s market when it comes to cost setting? John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare Why is the conversation shifting from cost to value comparisons? John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare Value is quality over cost. John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare “The problem in this market: It’s not that free.” John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare Who is best equipped to be an arbiter of value in this new market system? John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare “I think that trust is starting to erode.” John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare “I think you have to take ownership.” John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare “There’s no real Four Seasons business [model] in health care.” John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare “Look at the entire episode of cost.” John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare Where does bundling fall into this equation? John Rodis, MD, MBA, discusses #healthsystems, #consumerism, and #valuebasedcontracts on our #healthcarepodcast. #healthcare #podcast #digitalhealth #vbc #valuebasedcare

I’m going to summarize some points that Dr. Marty Makary made in his manifesto for why he wrote his most recent book. The Price We Pay is its name. You can hear this manifesto in his own words—in Dr. Makary’s own words—on Relentless Health Value episode 242, but here’s his point: He said that the 2007 banking crisis, writ large, resulted from complexity that kept onlookers confused. So, when people questioned the banks being overleveraged and selling mortgages to, you know, those who couldn’t afford them, experts responded by saying, “You know, it’s very complicated. Leave it to us.” But on the ground, it was clear there was a problem. And in hindsight, there obviously was a problem.  Here’s the point that Dr. Makary was making, which I think is super valid: Many of the entrenched stakeholders in medicine fend off criticism by claiming that these are highly complex systems that should be left to experts. They say, “You wouldn’t understand. Leave it to us.” And just like the experts in the banking industry got us into the calamitous Great Recession in 2007-2008, the experts that we’re leaving it to in health care have driven ever-higher prices for care that I’m gonna say that most in the health care industry who actually care about patients are certainly not proud of. In this health care podcast, I’m speaking with Dawn Cornelis, cofounder and director of transparency at ClaimInformatics. We get into what sounds so simple: self-insured employers having their medical bills paid by a third party who specializes in paying medical bills. Maybe these third parties even say that they give all the bills the once-over before they pay them—except when a company like ClaimInformatics reviews the same bills, they find savings in the double digits from paying bills that are wrong at some level or just flat-out fraud. Considering that by some estimates there’s like a trillion dollars lost in this country to some level of fraud, waste, and abuse, this is pretty much the opposite of poking around in the couch cushions looking for change. While there’s certainly a lot of details, it’s not really that complicated. You can learn more at claiminformatics.com or by emailing Dawn at d.cornelis@claiminformatics.com.  Dawn Cornelis is cofounder of ClaimInformatics and serves as its chief transparency officer. With 25 years of experience in health care claim review and cost containment, Dawn brings a personal passion for rooting out fraud, waste, and abuse. Dawn’s work includes building strong national alliance partnerships with major insurance companies and health systems such as AIG World Investigative Resources, Global Options, Mutual of Omaha, Principal Financial Group, Deloitte, PHCS/Multiplan, Jefferson Health System, and Seton Health System. Dawn has identified and recovered hundreds of millions of dollars of improper payments through pre- and post-payment cost containment programs while navigating the payment systems of all of the national health carriers. In 1993, Dawn cofounded Claim Recovery Services, the industry’s first audit and recovery firm, and served for 17 years as its chief operating officer, assisting several Fortune 100 companies. She then spent 3 years as the chief operating officer of ClaimReturn. Dawn has been an expert speaker at national forums such as The Institute for HealthCare Consumerism on various health care audit topics and participates in roundtable sessions on federal and state regulations. 02:54 The story in the data. 03:32 Who’s submitting these claims? 04:10 The three problems with the data. 07:19 The varying factor between carrier systems to stop fraud, waste, and abuse. 07:59 Why carriers don’t push for better systems to stop inappropriate dollars. 10:07 The difference between fraud, waste, and abuse. 11:46 “When it becomes the norm, that’s what’s very bothering.” 12:13 The barriers or hurdles in the marketplace. 15:35 What we don’t know about but could do better at when looking at the data. 18:01 “It’s not so much the health system and what they are charging. It’s about … what the contracted rate is agreed to. That’s what drives our costs.” 19:02 “Data’s fixed for itself.” 22:09 Identifying and eliminating fraud. 22:14 Unbundling and the lack of enforcement behind preventing illegal billing. 28:59 How providers ensure they aren’t inadvertently harming employers and patients through billing. You can learn more at claiminformatics.com or by emailing Dawn at d.cornelis@claiminformatics.com.  Check out our latest #healthcarepodcast with Dawn Cornelis of @claiminformati1 as she discusses saving billions through health care billing. #healthcare #podcast #digitalhealth #healthtech #healthcarebilling The story in the #data. Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata Who’s submitting these claims? Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata The three problems with the data. Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata What’s the varying factor between carriers? Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata Why don’t carriers push for better systems to stop inappropriate dollars? Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata What’s the difference between fraud, waste, and abuse? Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata “When it becomes the norm, that’s what’s very bothering.” Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata The barriers or hurdles in the marketplace. Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata “It’s not so much the health system and what they are charging. It’s about … what the contracted rate is agreed to. That’s what drives our costs.” Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata “Data’s fixed for itself.” Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata Identifying and eliminating fraud. Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata How are providers ensuring they aren’t inadvertently harming employers and patients through billing? Dawn Cornelis of @claiminformati1 discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #healthdata

There is a transparency zeitgeist kicking off right about now. In June was the biggie, the one where health systems now have to divulge their contracted rates with insurance carriers starting January 1, 2021. But this zeitgeist is flowing into drug prices as well. Surescripts just released their real-time prescription price transparency tool. This price transparency tool allows detailed cost and alternative drug information to be seen in real-time. Surescripts, by the way, is owned by several large PBMs (pharmacy benefit managers). Can the prescriber see how much drugs will cost the patient as they are writing the prescription? The answer is yes if that prescriber is using a tool to display the prices in their EHR (electronic health record) or e-prescribing system. That is pretty cool and could save a whole lot of rigamarole and time for both the prescriber and the patient who doesn’t now have to go the whole way over to the pharmacy to figure out the drug price is unaffordable. I just want to bring up one point to be aware of: Surescripts is, as aforementioned, owned by some PBMs. PBMs are not exactly non-profits. They do a great job for their shareholders collecting middle-man dollars from pharma and pharmacies and patients alike. The copay amount a patient pays is a decision that is made, in many cases, by a PBM. So, showing the PBM-set patient price at the point of care to doctors increases PBM leverage in conversations with at least pharma. You see what I mean? Maybe that’s good if the PBM actually takes the dollars it shakes out of pharma and gives it to employers or the patients, the government or pays pharmacies they don’t own fairly. Maybe it’s bad if the PBM uses its additional leverage to, I don’t know, start its own GPO (group purchasing organization). In Switzerland. Wait, what?! Yeah, that happened. All I’m saying is, this is a tangled web we weave with implications for pharma, pharma's PBM negotiations, pharmacies and patients as patients and also patients as members of plans. Here’s a really important point that I need to make. Nobody in the health care industry is conflict free. Not PBMs, not IDNs (integrated delivery networks), not you, not me. I love transparency and I love sparing doctors and clinicians administrative burden. If I were a provider organization, I would definitely use this tool. But here’s what I need to say… in addition to transparency showing the copay of a drug and the best pharmacy to get it at, these systems also make transparent the underlying levers of the system itself if you look at them in a kind of pattern-wise way. So, if I’m a doctor and I find it weird that the lowest price is always at the pharmacy owned by a PBM, for example. Yeah, it’s up to you to start asking questions. My hope is that everyone sticks with the spirit of the endeavor and gets to the heart and the potential of transparency and chooses the path that benefits the patient the most. To that end, I am speaking in this health care podcast with Carm Huntress, who is the CEO and cofounder of RxRevu. We talk a lot today about how showing prescribers how much drugs cost can really help patients avoid financial toxicity and/or a whole lot of running around getting prescriptions changed to drugs that are on-formulary. You can learn more at RXrevu.com. You can also connect with Carm Huntress on Twitter at @carmhuntress. Carm Huntress is CEO and cofounder of RxRevu. As CEO, Carm has successfully taken prescription decision support from a concept to a reality for physicians, payers, health systems, and patients. At the core of this work is to transform the value of health care through better prescribing decisions. At a national level, Carm has played a key role in supporting interoperability and patient access to data through the development of the Fast Healthcare Interoperability Resources (FHIR) standards and other projects with the Office of the National Coordinator (ONC). 04:25 The protracted way doctors prescribe drugs right now. 06:15 “What is the macro thing we want to have happen here?" 08:10 Where we are today. 08:38 Value-based contracts. 10:10 Who is hurt by higher-cost alternatives. 12:50 The number one thing doctors get out of drug cost transparency. 13:20 The second thing doctors get out of drug cost transparency: patient satisfaction. 13:55 The downside to drug cost transparency. 14:40 “We gotta back up and just say, ‘What do we want?’” 16:30 How real-world evidence is going to affect drug pricing and rationalization. 17:43 “They’re waking up to the new world.” 20:20 How copays play into this. 20:45 “What’s the total cost, what’s the patient cost, and what are the alternatives?” 22:00 The history of formulary and benefit. 26:41 The problem with specialty drugs. 29:30 “Can we just start with first principles here?” 29:40 “We don’t really think about socio-economic factors.” 29:43 “What can you really pay?” 31:00 Why do IDNs care about drug pricing transparency? You can learn more at RXrevu.com. You can also connect with Carm Huntress on Twitter at @carmhuntress. Check out our newest #healthcarepodcast with @carmhuntress of @RxRevu as he discusses patient cost for prescription drugs to the point of care. #digitalhealthcare #healthcare #podcast #digitalhealth The protracted way doctors prescribe drugs right now. @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth “What the macro thing we want to have happen here?” @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth Value-based contracts. @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth Who is hurt by higher-cost alternatives? @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth The number one thing doctors get out of drug cost transparency. @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare  #healthcare #podcast #digitalhealth Patient satisfaction with drug cost transparency. @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth Is there a downside to drug cost transparency? @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth “We gotta back up and just say, ‘What do we want?’.” @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth How is real-world evidence going to affect drug pricing and rationalization? @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast  #digitalhealthcare #healthcare #podcast #digitalhealth “They’re waking up to the new world.” @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth How will copays play into drug cost transparency? @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth “What’s the total cost, what’s the patient cost, and what are the alternatives?” @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast  #digitalhealthcare #healthcare #podcast #digitalhealth “Can we just start with first principles here?” @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth “We don’t really think about socio-economic factors.” @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth Why do IDNs care about drug pricing transparency? @carmhuntress of @RxRevu discusses patient cost for prescription drugs to the point of care. #healthcarepodcast #digitalhealthcare #healthcare #podcast #digitalhealth

At the end of the day, health care should be about helping patients find their way to health while doctors, nurses, and other clinicians don’t burn out in the process. It’s becoming increasingly indisputable that the way to get to this North Star efficiently is through human-centered health care. Human-centered health care is a term coined by Dr. Sylvia Romm, and it’s a play on the term customer-centered design. How do we innovate? How do we use technology to intensify the human experience for both provider and patient? How do we rid ourselves of friction points and create a continuum of care that is sticky and makes getting healthy as enjoyable as Instagram? In this health care podcast, I speak with Sylvia Romm. She’s an MD and an MPH with a background as a researcher and a telemedicine entrepreneur prior to coming to Atlantic Health System as their chief innovation officer. We talk in this podcast about human-centered health care—what this means, what the success factors are, and how to make it happen. We also take into account the assorted challenges to overcome on the way there. This interview was recorded moments before COVID-19, and I say that as a good thing. Dr. Romm brings up telehealth as, let’s just say, a first step toward actuating human-centered design in health care. Clearly in the past, that was quite a hurdle. No longer. So, those health systems or you other stakeholders in the mix who have gotten the telehealth thing nailed, listen on for ways that you can leverage your success. And for those of you who haven’t, well, here’s a little extra motivation. You can learn more by connecting with Dr. Romm on Twitter at @sylvia_romm.  Sylvia Romm, MD, MPH, is driven by a passion for transforming health care delivery to patients and communities. She brings her background and expertise as a clinician and an entrepreneur to her role as chief innovation officer for Atlantic Health System. Firmly believing that a patient-centered focus is vital to health care innovation, Dr. Romm works with Atlantic Health System’s team members and physicians to find new ways to improve access to high-quality, affordable care. She also forges relationships with local and national innovation partners and works to expand the organization’s research profile. Dr. Romm is an avid author and speaker in the areas of health care, technology, and health information technology (IT) policy. She has written articles for various publications—including NEJM Catalyst, Forbes, KevinMD, and the Huffington Post—and was named one of Fierce Healthcare’s 8 Influential Women Reshaping Health IT and Becker’s Women in Health IT to Watch in 2020. A board-certified pediatrician, Dr. Romm has served in a variety of clinical leadership roles throughout her residency and as a hospitalist. Before joining Atlantic Health System, she was vice president of clinical transformation for American Well, the largest video-based telemedicine company in the United States. In addition, she was the founder of MilkOnTap, the nation’s first telehealth company focused on the needs of nursing mothers and lactation support. Dr. Romm earned her Master of Public Health in global health from Harvard TH Chan School of Public Health. She holds a medical degree from the University of Arizona College of Medicine and completed her residency in pediatrics at Massachusetts General Hospital. 02:18 How Dr. Romm’s background in research, public policy, and being a pediatric hospitalist intertwine to create great innovation strategies. 03:22 “How do we look at populations?” 03:31 “It’s really about affecting the system in its entirety.” 04:33 What human-centered health care means. 06:36 “You’re only as effective as the rapport that you build with [this] person.” 08:05 “What do people really need … but also, what do they find valuable?” 09:42 How data are folded into human-centered health care. 11:55 “The endgame is to figure out … how to have a better experience.” 12:39 How this fits into the quadruple aim. 17:19 “We are going to have to earn and learn agility.” 19:38 What has the most promise in deepening the connection between patients and providers. 20:32 “Is this about you, and how do we know … how people outside feel about creating a relationship?” 23:29 Is there a best practice for furthering the patient/doctor relationship from afar? 24:24 The need for a variety of approaches to patient/doctor connections. 27:30 What innovation initiatives need to be successful. 28:07 “People have to understand the ‘why.’” 29:38 The classic tenets of change management. 30:02 A challenge Dr. Romm is proud of having solved. 31:56 Secret weapon: collaboration. You can learn more by connecting with Dr. Romm on Twitter at @sylvia_romm. Check out our newest #healthcarepodcast with @sylvia_romm of @SonderHealth and @AtlanticHealth as she discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation “How do we look at populations?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “It’s really about affecting the system in its entirety.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast What does human-centered #healthcare mean? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “You’re only as effective as the rapport that you build with [this] person.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “What do people really need … but also, what do they find valuable?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast How are data folded into human-centered #healthcare? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “The endgame is to figure out … how to have a better experience.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “We are going to have to earn and learn agility.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “Is this about you, and how do we know … how people outside feel about creating a relationship?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast What do innovation initiatives need to be successful? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast “People have to understand the ‘why.’” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast What are the classic tenets of change management? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast Why collaboration is the secret weapon to innovation in health care. @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast

This past March, I was looking forward to giving a keynote at the Arizona Technology Council. Unfortunately, that didn’t happen. COVID happened. But in the process of figuring out what I was going to talk about during my keynote, I came up with an idea and I wanted to share it. It’s the idea of how to measure value in health care delivery, because might as well go big or go home, right? The metrics that we use to measure value is critical, and not just because what gets measured gets managed. It’s because American health care is the biggest most impressive display of game theory anyone anywhere has ever seen. I am not easily impressed, and I have to say that I am unfailingly and frequently more than impressed by the cognitive prowess and sheer determination among some parties to game the system and reach as much profit as possible at the expense of patients and taxpayers. So, coming up with the right metrics is paramount. The metrics have to be unimpeachable; they have to be immune to those who have every intention of twisting them against their spirit. For more information, go to aventriahealth.com.  When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient.   01:28 Health care profiteering and the halo effect. 02:16 Dr. Robert Pearl’s book, Mistreated.02:27 “If there’s money on the table, it’s really hard to not take it.” 02:42 How Stacey came up with her first metric. 04:31 The impact of caring for the patient on patient outcomes. 06:09 The quadruple aim. 06:50 “An endgame of nouns” vs “the verbs which are going to get us there.” 07:19 How are we helping patients and providers? 09:02 Making the touchstone “helping physicians help patients.” 09:50 Gary Price, MD, on the Healthcare Strategies podcast from Xtelligent Media.10:36 Danielle Ofri, MD, at danielleofri.com.12:04 Eric Topol, MD, and “the gift of time.” 12:36 The first metric: optimizing time for patients. 14:31 Financial toxicity in health care. 15:24 Marty Makary, MD, MPH, author of The Price We Pay.17:11 Two metrics: optimal time with patients and reduction of cost for patients. For more information, go to aventriahealth.com. Check out our latest #healthcarepodcast with our host, Stacey, as she discusses two metrics to measure the value of #caredelivered. #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery #Healthcareprofiteering and the #haloeffect. Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery “If there’s money on the table, it’s really hard to not take it.” Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery The impact of caring for the patient on patient outcomes. Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery The quadruple aim. Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery “An endgame of nouns” vs “the verbs which are going to get us there.” Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery How are we helping patients and providers? Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery The first metric: optimizing time for patients. Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery #Financialtoxicity in health care. Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery Two metrics: optimal time with patients and reduction of cost for patients. Our host, Stacey, discusses two metrics to measure the value of #caredelivered. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #valuebasedcare #caredelivery  

In the April issue of Value-Based Cancer Care (that’s a journal), there’s an article talking about a keynote presentation and a study highlighting a big problem for patients with cancer: toxicity. It’s a fact that some chemo agents are pretty toxic, but in this health care podcast I am talking about financial toxicity. The financial burden of cancer care has a seriously negative influence on patients’ quality of life. This keynote speaker quoted in the Value-Based Cancer Care article implored his fellow oncologists: “Think twice before ordering costly interventions that may have little impact on the clinical course,” he said. This might be difficult for a number of reasons, and one of them is that oncology centers make money, a whole lot of money, sometimes the most money, from infusing cancer medications. It’s this little payment paradigm called “buy and bill.” The cancer center buys the meds and then gets paid an additional fee to infuse the drug. This fee is a percentage of the drug cost. It ranges from 4.5% to about 20% of the cost of the drug. You’ve probably heard a lot lately about the skyrocketing costs of some of these cancer agents. Add 4.5% to 20% onto those costs and realize that if you’re an oncology center, the higher the drug costs, the higher your revenue. Now consider the patient suffering under the weight of increased cost sharing and employers and taxpayers who are funding this strange payment model. In this health care podcast, I dig into this so-called “buy and bill” payment model with Aaron Mitchell, MD, MPH. Dr. Mitchell is an oncologist and health services researcher over at Memorial Sloan Kettering. He seeks to understand how changes to current reimbursement models for oncology services may be used to achieve better patient outcomes and reduce low-value care. You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.  Aaron Mitchell, MD, MPH, is a practicing medical oncologist and health services researcher. He is an assistant attending at Memorial Sloan Kettering Cancer Center in the department of epidemiology and biostatistics. His research focuses on understanding how the financial incentives in the health care system affect physician practice patterns and care delivery to cancer patients. He cares for patients with prostate and bladder cancer.   03:00 Following the drug and following the dollar. 03:28 The “buy and bill” system. 04:15 The perverse and problematic incentives of the system. 07:24 “It creates the incentive for us to gravitate toward the more expensive drug.” 07:28 The hesitancy to address the financial toxicity of drugs for patients. 08:40 Why the only person losing in this situation is the patient. 09:40 The financial impact from the patient perspective. 13:07 Are patients realizing this impact? 13:53 Solving the problem of oncology drug choice. 16:06 Reimbursement reform. 17:49 Capitated systems and incrementalist impacts to reimbursement reform, and what these look like. 23:04 Are we at a tipping point? 23:27 “The current system … works too well for too many people.” 24:47 Who isn’t well served by the current system. 26:27 Who has to lead the charge for change. 29:54 Large oncology providers vs small oncology providers in the buy and bill system. You can learn more at drugpricinglab.org. You can also connect with Dr. Mitchell on Twitter at @TheWonkologist.  Check out our #healthcarepodcast with @TheWonkologist of @sloan_kettering as he discusses #oncology #drugpricing and #reimbursement. #healthcare #podcast #digitalhealth Following the drug and following the dollar. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth The “buy and bill” system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth The perverse and problematic incentives of the system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth “It creates the incentive for us to gravitate toward the more expensive drug.” @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Why is there hesitancy to address the financial toxicity of drug pricing for patients? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Why the patient is the only one that loses. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth What’s the financial impact from the patient perspective? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Are patients realizing this financial impact? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Solving the problem of oncology drug choice. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth What should reimbursement reform look like? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth “The current system … works too well for too many people.” @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Who has to lead the charge for change? @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth Large oncology providers vs small oncology providers in the buy and bill system. @TheWonkologist of @sloan_kettering discusses #oncology #drugpricing and #reimbursement. #healthcarepodcast #healthcare #podcast #digitalhealth

You know what the second biggest cost line item is on most health systems’ profit and loss report: supplies—buying things like artificial knees, stents, service contracts. It’s estimated that an average hospital can save more than $12 million a year if they manage their supply chain better. And interestingly, oftentimes care actually improves as a result. For context, that wasted $12 million could pay for 165 more nurses or 50 more PCPs. It’s the cost of 3100 knee replacements. (All this, by the way, is according to Navigant.) Does it bother you that so many people in this country can’t afford care and nurses and PCPs aren’t getting raises and some of it is because leadership at many hospitals is not adequately managing their costs of goods? Maybe I’m an idealist, but the human consequences of this inadequacy certainly bother me. In this health care podcast, I am talking with Rob Austin. Rob is director of health systems at Guidehouse. He works a ton on supply chains at hospitals, health systems, and physician practices. Quick industry news flash: Guidehouse is a new entity comprised of legacy PWC (PricewaterhouseCoopers) government business which has combined with Navigant. You can learn more at guidehouse.com. You can also connect with Rob on LinkedIn.  Rob Austin is director of health systems at Guidehouse. He works closely with health systems to help reduce the cost and improve the quality of health care in the United States. As part of Guidehouse’s Healthcare Performance Excellence practice, Rob assists hospitals and systems to achieve rapid financial, clinical, and operational improvement, simultaneously reducing cost and improving quality. He previously worked at Allegheny Health Network, a seven-hospital system based in Pittsburgh, serving as director of supply chain and business development. Rob helped grow Provider Supply Chain Partners, a regionally focused group purchasing organization, from 12 hospital members to 74 and $1.3 billion in spend over three years. He also held various delivery, sales, and leadership roles at SAP Ariba. Rob writes and speaks frequently on topics relating to health system operating margin improvement, particularly around optimizing the supply chain and enhancing shared services functions within systems. 02:04 Why the pandemic is actually a good time to get a handle on hospital supply chains. 03:21 “Supply costs, nonlabor costs, are the second largest costs any health system has.” 04:08 The $24 billion opportunity for hospital systems. 04:35 How efficient supply chains help patients at large. 06:18 The hospitals that would benefit the most from streamlining supply chains. 07:05 The case of the haves and have nots in the supply chain. 07:36 EP279 with Peter Hayes.09:46 “The most efficient supply chains … are also more clinically effective.” 11:45 Standardizing supplies vs nonstandardization. 14:15 The biggest problems with a mismanaged supply chain. 15:50 Purchase services. 15:58 Areas of opportunity with supply chains. 19:27 The structural issues that add to the supply chain problem. 20:20 “To make an impact on your nonlabor costs … it needs to be driven initially from the C-suite.” 22:10 The steps to focus on to improve your supply chain. 29:32 Value-based care in the supply chain. 31:16 How smaller organizations can get a handle on their supply chains. 31:47 “Focus on people, process, and data.” 32:59 Amazon’s role in the health care supply chain. You can learn more at guidehouse.com. You can also connect with Rob on LinkedIn.  Check out our newest #healthcarepodcast with Rob Austin, director of #healthsystems at @Guidehouse. #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain Why is the #pandemic a good time to get a handle on your #hospital supply chain? Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain “Supply costs, nonlabor costs, are the second largest costs any health system has.” Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain The $24 billion opportunity for hospital systems. Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain How do efficient supply chains help patients? Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain What hospitals would benefit the most from streamlining supply chains? Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain “The most efficient supply chains … are also more clinically effective.” Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain What are the biggest problems with a mismanaged supply chain? Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain What are purchase services? Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain Where are there areas of opportunities within supply chains? Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain What structural issues add to the supply chain problems? Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain “To make an impact on your nonlabor costs … it needs to be driven initially from the C-suite.” Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain “Focus on people, process, and data.” Rob Austin, director of #healthsystems at @Guidehouse, discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #supplychain #hospitalsupplychain

In this health care podcast, I am talking with Yauheni Solad, MD. Dr. Solad is one of the top minds in data and data exchange. He’s medical director of digital health and telemedicine at Yale New Haven Health, and he has a mission to lead digital transformation toward accessible and affordable high-quality care that’s enabled by technology. Dr. Solad also does a lot of work with NODE—the Network of Digital Evidence. In the conversation we’re about to have, Dr. Solad represents the provider point of view. The show also features the one and only Rahul Dubey, hero to peaceable protesters. You can search for Rahul Dubey protesters to see what I mean. And also, he is the founder of Percynal Health Innovations. Rahul is the former chief innovation officer over at AHIP—that is, America’s Health Insurance Plans. In this conversation, Rahul represents the payer point of view. Here’s what we’re talking about, and I’m gonna keep this brief: It has been postulated that technology will be a catalyst for health care transformation. By technology, I mean the leaps many systems of care have made in their technological capabilities to deal with the realities of C-19. Dr. Solad, Rahul Dubey, and I talk about whether and how greater digital capability—which often means greater ability to care for populations vis-à-vis remote monitoring and telehealth—but whether, you know, the tail can wag the dog, so to speak, because so much investment has been made in these technology capes that we’re gonna want to use them. And when we use them, we transform care delivery. You can learn more by connecting with Dr. Solad on Twitter at @ysolad or on LinkedIn. You can also connect with Rahul via email or LinkedIn. Yauheni Solad, MD, MHS, is the medical director of digital health and telemedicine at Yale New Haven Health System. He is a practicing physician, clinical informaticist, and entrepreneur with a strong hands-on experience in software and data standards development with a particular focus on enabling the next wave of value-based care innovation. Yauheni received his medical degree summa cum laude from Belarusian State Medical University and a Master of Health Science from Yale School of Public Health. He is currently completing his executive MBA at Yale School of Management. Rahul Dubey is CEO of Percynal Health Innovations and the founder of America’s Health Insurance Plans (AHIP) Innovation Lab. Rahul is currently responsible for collaborating with C-level executives at his health plan. Prior to joining AHIP and launching Percynal Health Innovations, Rahul held a leadership role as a founding employee of a successful digital health care start-up based in Washington, DC. Along with the company’s cofounders, Rahul was instrumental in developing a multifaceted consumer tool as well as leading the company’s “go-to-market strategy,” resulting in successful market penetration and revenue growth for the industry’s first consumer-led shared decision making and treatment selection platform. Rahul was recognized with the Smart Health’s 2018 Excellence in Healthcare Transformation award, was named the American Journal of Health Promotion’s 2017 Innovators and Game Changers, and is featured in Accenture Perspectives: Minds Driving the Future of Business. In 2017, Frost & Sullivan presented Rahul with one of their highest honors, their Global Visionary Innovation Leadership Award. He is a graduate of the University of Michigan–Ross School of Business and lives in Washington, DC, with his son. He invites you to contact him directly—that is, if you’re willing to roll up your sleeves and drive transformation through inflective collaborative. 03:56 How COVID-19 affects interoperability. 07:06 “It’s not only the data exchange; it’s your ability as a health care system to innovate.”—Dr. Solad 09:11 How close are we to adopting more innovative and better technologies? 11:32 “Make docs happy. That is a very foreign concept for … people that are not delivering care to think about.”—Rahul 11:47 “We want to be able to enable the primary care physician to deliver care.”—Rahul 12:03 Working doctors rather than “dictating upon them.” 13:16 “I can’t sell burnout … I can sell value of care and outcomes of less cost.”—Rahul 18:44 “There might be an increase in overconsumption of care.”—Rahul 19:14 The possible increase in utilization of care and the potential for lower cost sharing. 19:57 Unlimited primary care and the benefits this might offer. 22:59 Does this pose risks to health systems? 25:22 “Everything you do for the patient should have a clear value to them.”—Dr. Solad 26:35 “What type of technology can provide this missing link for your particular health care system?”—Dr. Solad 28:18 Reimbursement as the new HIPAA. 29:15 “We need more evidence in data around the delivery of this technology-enabled service.”—Dr. Solad 32:20 What payers and providers should be doing today. 35:16 Care management vs consumerism. You can learn more by connecting with Dr. Solad on Twitter at @ysolad or on LinkedIn. You can also connect with Rahul via email or LinkedIn. Check out our newest #healthcarepodcast with @ysolad and Rahul Dubey as they discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #podcast #digitalhealth #covid19 #pandemic How does #COVID affect #interoperability? @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “It’s not only the data exchange; it’s your ability as a health care system to innovate.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic How close are we to adopting new and better technology and innovation? @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “Make docs happy. That is a very foreign concept for … people that are not delivering care to think about.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “We want to be able to enable the primary care physician to deliver care.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic Working doctors rather than “dictating upon them.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “I can’t sell burnout … I can sell value of care and outcomes of less cost.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “There might be an increase in overconsumption of care.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic What benefits might unlimited primary care offer? @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “Everything you do for the patient should have a clear value to them.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “What type of technology can provide this missing link for your particular health care system?” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic “We need more evidence in data around the delivery of this technology-enabled service.” @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic Care management vs consumerism. @ysolad and Rahul Dubey discuss #healthcare delivery and reimbursement from the #payer and #provider perspectives. #healthcarepodcast #podcast #digitalhealth #covid19 #pandemic

Let me explicitly state an implicit theme that’s been running through a bunch of the latest Relentless Health Value podcasts talking about if and how the COVID-19 pandemic could possibly serve as a flash point in the health care industry—a flash point where egregious and self-interested financial pursuits take such a toll that politicians notice. Why do these legislators notice? Because the patients (also known as voters), the ones that we all serve, begin to break under the weight of a system that inappropriately enriches some of its purveyors. In this health care podcast, I speak with Peter Hayes, who is president and CEO at the Healthcare Purchaser Alliance of Maine and a national presence in health care strategy/innovation and frequent keynote speaker. One thing, among many, that Peter said during our conversation struck me. He said it will take a village to fix what ails the health care system in this country. There’s just too many interdependencies. Take, for example, some of the biggest, most powerful health systems in this country. Most are, by almost every account, pretty darn inefficient in how they purchase supplies, how they pay their CEO millions of dollars, and how they put a waterfall in the lobby and don’t pay any taxes. Look, here’s my point—and it’s both an uncomfortable time and a great time to make it. I want the doctors and the nurses and others who actually provide care to be heroes and fairly compensated for their hard and dangerous work. But that should not, and maybe even cannot, happen within the context of a larger system that is anything but fair to patients. So, this whole upcoming conversation that I have with Peter pertains to the business decisions that many huge health systems are making and have made. It does not pertain to the “scrubs,” for the most part, who are doing the best they can and should be exalted—except to urge you guys to organize, please. But why should health systems change their often wildly inflated and secretive billing practices if employers just pay whatever the bill is no fuss, no muss? Short answer: They won’t. It’s not like no one in the health system noticed that the CEO is getting paid, like, 10x what the average worker makes. It’s not like no one noticed what has been sacrificed in patient care or infection control or technology to spring for that kind of green. Health systems operate the way they operate because someone wants them to operate that way. Follow the money and you can figure out who. So, it’s going to be up to someone else in the village to make it untenable for them to continue to do these things. It’s going to be up to another party to slow that roll. You can learn more at purchaseralliance.org. You can also connect with Peter on LinkedIn. Peter Hayes is president and CEO of the Healthcare Purchaser Alliance of Maine and formerly a principal of Healthcare Solutions and director of associate health and wellness at Hannaford Supermarkets. He has been in innovative, strategic benefit design for the past 20+ years. During the past several years, Hannaford has received numerous national awards in recognition of the company’s commitment to working collaboratively with health care providers and vendors in delivering health benefits that are focused on value (high-quality efficient care). Hannaford Supermarkets has been successful in this arena by focusing on innovative solutions for patient advocacy, chronic disease management, and health promotion programs. Hannaford was recognized by receiving the National Business Group on Health Platinum Award for the health promotion and wellness programs three years in a row. These programs, along with health care delivery strategies, contributed to a flat trend line over five years. Peter has also been involved in health care reform leadership roles on both the national and regional levels with organizations like the Center for Health Innovation, Care Focused Purchasing, and Leapfrog. He’s also cofounder of the Maine Health Management Coalition (now Healthcare Purchaser Alliance of Maine) and has been appointed by two different Maine Governors to serve on Health Care Reform Commissions to recommend public policies to improve the access and affordability of health care for Maine citizens. 03:36 Why employers are spotting the margin from commercial pay. 05:20 Public pay vs commercial pay, and why profit for a hospital has to come from commercial payers. 05:51 Inefficient costs in health systems. 07:22 How the health care system evolved this way. 09:12 “If you’re a business, a manufacturer, you actually do cost accounting. … Hospitals don’t use cost accounting. They really don’t know.” 12:00 The amount that taxpayers are actually subsidizing hospital systems. 12:24 Cost shifting and how this is affecting employers and employees. 14:45 How a hospital could increase its employer prices by such a large magnitude. 17:19 The perverse incentives that have made health plan premiums what they are today. 22:11 The case for the bundled payment program. 23:35 How purchasers shopping around for benefit designs can transform health pricing and make hospitals more willing to move from fee-for-service to bundled payments. 24:54 EP257 with Karl Bilimoria, MD.25:46 Employers outside of the health care industry vs the health care industry, and how this plays out in state and federal legislature. 27:26 What else employers can be doing. 29:09 “Instead of being market takers, [it’s time] to be market makers.” 29:47 What employers can be doing at the local level. 34:30 Employers can find a transparent health broker by checking out Health Rosetta and Validation Institute. 35:17 “If we don’t do something to have the market work, it’s going to be done to us.” You can learn more at purchaseralliance.org. You can also connect with Peter on LinkedIn. Check out our newest #healthcarepodcast with Peter Hayes of @HPAofMaine as he discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice #Publicpay vs #commercialpay. Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice Inefficient costs in #healthcaresystems. Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice “If you’re a business, a manufacturer, you actually do cost accounting. … Hospitals don’t use cost accounting. They really don’t know.” Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice How much are taxpayers subsidizing #hospitalsystems? Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice How does cost shifting affect #employers? Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice Perverse incentives in #healthcarepremiums. Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice How #bundledpayments could change things. Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice “Instead of being market takers, [it’s time] to be market makers.” Peter Hayes of @HPAofMaine on our #healthcarepodcast discusses inflated #healthcarepricing among #healthsystems and #employers. #healthcare #podcast #digitalhealth #hospitalpricing #feeforservice

In this health care podcast, I’m speaking with Maura Calsyn from the Center for American Progress—or CAP—and we’re talking about value-based drug pricing and the impact that COVID-19 may have on its definition, operationalism, and broad adoption. I remember a situation (kind of years ago, actually) where a pharma company decided to lower its price on an infused product. Normal supply and demand would dictate that if you lower your price, you will get more overall business, which will result potentially in more overall revenue—the old supply-and-demand curve at work. In this case, though, that pharmaceutical brand’s business plummeted. The Pharma had to raise their price again to capture the market share that they wound up losing by lowering their price. Why? Because doctors get paid a percentage of the drug cost to administer the product. So, the lower the drug price, the less a physician gets paid. Provider organizations have a big incentive to prescribe the highest-priced product—so, you know, the opposite of whatever you learned in Economics 101. On the other hand, and possibly more often, we have Pharma pricing products based on what they think the market will bear. And historically, that has meant a really high price point because the market will bear, it turns out, quite a lot. There’s this perception that our national and employer pocketbooks are unlimited when it comes to health care spending. And I can see how the health care industry would get that idea, because it pretty much has always been a true statement. Despite a lot of grousing and complaining, the bill gets paid. But pain causes change. It is very possible that this pandemic will not only change how medical care is delivered, which we’ve been talking a lot about in the past few episodes; but also it will have an impact on how pharmaceutical drugs are priced and patented. If you think about it, and I started to think about it after this conversation with Maura, the optimal price for a pharmaceutical product would be an amount that enables everyone in a population who needs the drug to be able to get it. What a tragedy it is when there is a drug, when science has produced a drug that can help someone who is suffering but they can’t get it. Maybe this is because a health care middleman is trying to game the system for as much profit as possible, or maybe it’s because the manufacturer set their price high to earn as much money as they can from those who can pay, but at a sacrifice of those who cannot. Maura and I talk about the emerging “Netflix Model” or the “Australian Model” of paying for drugs in this health care podcast also, which is pretty interesting. Prior to her role at the Center for American Progress, my guest Maura Calsyn worked at HHS in the general counsel’s office and was lead attorney and/or worked on a number of Medicaid initiatives, including the Medicaid rebate program. You can learn more at americanprogress.org. You can also connect with Maura on Twitter at @maura_calsyn.  Maura Calsyn is the managing director of health policy at the Center for American Progress. In this capacity, she plays a leading role in American Progress’s health policy development and advocacy efforts. She has authored and coauthored work published in The New England Journal of Medicine, JAMA Internal Medicine, US News & World Report, and The Hill. Her work covers a range of topics, including Medicare and Medicaid payment reform, health care transparency, and trends in employer-sponsored insurance. She has also testified before Congress. Prior to joining American Progress, Calsyn was an attorney with the US Department of Health and Human Services Office of the General Counsel. During her time there, she served as the department’s lead attorney for several Medicare programs and advised the department on implementation of the Affordable Care Act. Before joining the Office of the General Counsel, Calsyn worked as a health care attorney at two international law firms and represented a wide variety of health care payers, providers, and manufacturers. Calsyn first worked in health policy as a health care legislative assistant for Rep. Anna Eshoo (D-CA) before attending law school. Calsyn graduated cum laude from Harvard Law School and received her bachelor’s degree summa cum laude from Hamilton College. 03:48 The value of pharmaceutical products. 06:58 “We’re dealing with what might seem like an infinite amount of resources, but it’s really not.” 07:03 The “Netflix” or “Australian” payment models vs value-based pricing. 09:35 “You need a transparent and really replicable process.” 10:41 Considerations of equity and affordability. 11:10 “Everybody wants people to get the drugs that they need … I think the question really is just, ‘Who is paying for it?’” 11:44 What value-based pricing really means in the pharma industry. 13:22 “We’re confusing what is actually a value-based price with some of the tools that are used to try to get closer to that.” 14:03 Why extracting prices by future impact holds implications for the health industry on the whole. 15:44 “Value-based pricing is a tool to be able to lower health care prices across the board.” 16:15 The problem with shifting costs. 17:20 Generic pricing and the patent system. 18:30 Leveraging fear. 20:40 “There’s the ability for extraordinary amounts of money to be made here in a way that really does not advance the health of the country.” 21:33 Next steps for value-based pricing in Pharma. 23:08 “How are you going to justify those prices?” 23:28 “If you keep pressing and pressing and pressing, there’s going to become a breaking point.” 24:42 “We need to preserve a way to make sure that those products are developed.” 26:26 “Are there other ways that we need to finance and bring to market drugs?” 27:43 The call to action for value-based pricing in Pharma. You can learn more at americanprogress.org. You can also connect with Maura on Twitter at @maura_calsyn.  Check out our newest #healthcarepodcast with @maura_calsyn of @amprog as she discusses #valuebasedpricing in #pharma. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic The value of pharmaceutical products. @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “We’re dealing with what might seem like an infinite amount of resources, but it’s really not.” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic The “Netflix” or “Australian” payment models vs value-based pricing. @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “You need a transparent and really replicable process.” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “Everybody wants people to get the drugs that they need … I think the question really is just, ‘Who is paying for it?’” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “We’re confusing what is actually a value-based price with some of the tools that are used to try to get closer to that.” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “Value-based pricing is a tool to be able to lower health care prices across the board.” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic What’s the problem with shifting costs? @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic Generic pricing and the patent system. @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “There’s the ability for extraordinary amounts of money to be made here in a way that really does not advance the health of the country.” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “If you keep pressing and pressing and pressing, there’s going to become a breaking point.” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “We need to preserve a way to make sure that those products are developed.” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic “Are there other ways that we need to finance and bring to market drugs?” @maura_calsyn of @amprog discusses #valuebasedpricing in #pharma on #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #covid19 #pandemic