Relentless Health Value

Look, bottom line, value-based care has to be the future of health care delivery in this country. That’s just inarguable at this point. Nobody disagrees except for health care industry stakeholders trying to reap as much reward as possible while the going is good. And they’ve been really successful with their reaping thus far. Here’s the thing, though: There’s speculation that health insurance premiums may go up, like, 4% to 40% next year if the status quo remains the status quo. Is this the moment when we all start to get real about value-based care? Not because it would be a nice thing to get up and running, but because we have to. Health care costs are already too high in this country. You can’t just add 40% and think that somebody’s gonna find that kind of change in the bottom of their pocket, which has already been turned inside out. But also because on the provider side of the equation, it’s less risky. Here’s what I mean by less risky: All of those health systems struggling right now because of the decrease in elective procedures—if they had all had a significant portion of their revenue derived from value-based agreements where they were contracted to take care of populations, they’d all still be getting paid their global/capitated payments right now and actually able to take care of patients who need care instead of sitting on the sidelines watching their bank accounts dwindle. In this health care podcast, I speak with Eric Weaver, who is the newly minted executive director of the Accountable Care Learning Collaborative based in Utah. We talk about how life could have been a lot different for PCPs and also specialists, by the way, and health systems had we lived in a value-based world instead of an FFS (fee-for-service) one. Considering that this pandemic might consist of waves that extend for months if not years, this might be a call to action for providers to get meetings set up with payers, like, right now to switch up payment terms into value. But it’s also a call to action for purchasers of health care like employers and commercial carriers. When I was talking to Guy Culpepper, a PCP, in episode 272, he really wants value-based contracts; but he can’t get them alone. Purchasers and payers have to be willing to come to the table and offer them.  So come on, everybody! Let’s belly up to the conference room table—or your little Zoom Brady Bunch box, as the case may be. Now’s the time to really flip the switch to payment models that work for patients and enable physicians at the same time to provide the kind of care that’s in alignment with their values. One acronym heads-up in this conversation that I have with Eric Weaver coming up: APM stands for advanced payment model, which is, at its simplest level, a kind of value-based payment model. You can learn more at accountablecarelc.org. You can also connect with Eric on Twitter at @Eric_S_Weaver or on LinkedIn. Eric Weaver, DHA, MHA, is nationally recognized for his work in payment and delivery transformation. He is the recently appointed executive director of the Accountable Care Learning Collaborative (ACLC), a nonprofit organization founded by former Secretary of Health and Human Services Mike Leavitt and former Administrator of the Centers for Medicare and Medicaid Services Dr. Mark McClellan. With a mission to accelerate the readiness of health care organizations transitioning to value-based payment, the ACLC has defined the standards for high-value organizations and the workforce skills and competencies needed to advance value-based care. Dr. Weaver has been recognized for his contribution to the health care industry by receiving the ACHE Robert S. Hudgens Award for Young Healthcare Executive of the Year and the Modern Healthcare “Up & Comers” Award in 2016. Prior to assuming his new leadership role with the ACLC earlier this month, Dr. Weaver was a senior vice president for Innovista Health Solutions, a population health MSO, and was the president and CEO of Austin, Texas–based Integrated ACO—one of the more successful physician-led accountable care organizations in the country. For more information on Dr. Weaver and his vision for the future of the ACLC, you may access this video. If you are a provider organization looking to succeed in value-based care, you can obtain a free membership to the ACLC at accountablecarelc.org/join-us.  03:23 Is this pandemic an inflection point for value-based care? 04:10 “If United Kingdom built their National Health System post-World War II, why can’t we rebuild ours?” 04:40 “If it’s ever gonna happen, it’s gonna happen now. I just think we need to wake up.” 05:04 Do volume decreases equal payment decreases? 06:10 Where value-based care plays into specialty care vs primary care. 06:21 “There just hasn’t been a value on cognitive services as there has been on procedural volume-based care.” 06:55 “I really think that independents have to be in the driver’s seat here.” 06:59 The possible silver lining in this pandemic. 08:07 Why it’s mostly about economic incentive … with a couple of caveats. 12:21 More or less hospitals when this shakes out? 14:01 “There has to be some standard of measurement for quality, and we all know that.” 17:00 Where the patient experience plays into the value-based care equation. 21:54 “We have to be thinking about the consumer and the patient.” 22:25 Where employers land in this equation. 25:14 What happens to the value-based care measures that were in place and aren’t anymore? 27:20 How carriers buying providers impacts value-based care. 29:54 “I really think we’re … [looking at] a new normal.” 30:49 “We have to go all in.” You can learn more at accountablecarelc.org. You can also connect with Eric on Twitter at @Eric_S_Weaver or on LinkedIn.  Check out our newest #healthcarepodcast with @Eric_S_Weaver of @The_ACLC as he discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs Is this pandemic an inflection point for value-based care? @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “If United Kingdom built their National Health System post-World War II, why can’t we rebuild ours?” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “If it’s ever gonna happen, it’s gonna happen now. I just think we need to wake up.” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs Do volume decreases equal payment decreases? @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs Where value-based care plays into specialty care vs primary care. @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “There just hasn’t been a value on cognitive services as there has been on procedural volume-based care.” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “I really think that independents have to be in the driver’s seat here.” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs Why it’s mostly about economic incentive … with a couple of caveats. @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “There has to be some standard of measurement for quality, and we all know that.” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs Where the patient experience plays into the value-based care equation. @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “We have to be thinking about the consumer and the patient.” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs Where do #employers land in this equation? @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “I really think we’re … [looking at] a new normal.” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs “We have to go all in.” @Eric_S_Weaver of @The_ACLC discusses transitioning from #feeforservice to #valuebasedcare during #covid19. #healthcare #podcast #digitalhealth #ffs

In this health care podcast, I talk with Brian Scott. Brian has a background which is perfect for the question of “Will employer health care costs go up or will they go down as a result of this pandemic?” First, Brian was an underwriter at United. Then he was in a dedicated complex claims group for Lockton that managed self-funded plans. And now he’s at Point6 Healthcare, where he works to put together the best-value plan for employers, including getting stop-loss. Brian works with TPAs (third-party administrators) across the country to this end. So, this conversation that I had with Brian is a two-part affair: The first episode (episode 275) was mostly about the specific additions as a result of this pandemic used in cost models and also what some self-insured employers are doing or considering doing to address the underlying risk factors that might help drive up costs in a plan. This, however, is episode 276; and it includes Brian’s advice for self-insured employers, as well as a look into the fully insured market. Why there have been those estimates that costs will go up 4% to 40% when premiums are re-upped, Brian has some thoughts.  You should definitely listen to both episodes (275 and 276), although you probably don’t need to listen to them in order if you just happened to hit on this show first. You can learn more at point6healthcare.com and brian.scott@point6healthcare.com. You can also connect with Brian on LinkedIn.  Brian Scott is an assistant vice president at Point6 Healthcare. He joined the team in 2019 to implement and lead a new type of ICU related to self-funded employers focused on implementation, consulting, and underwriting strategies on behalf of self-funded benefits plan sponsors. Point6 is an authority on employer-sponsored self-funded health care financing and risk transfer strategies in the United States and maximizes the value of interactions between those providing, receiving, and financing health care. Brian has also worked as the strategic consultant for a major consulting firm specializing in employer stop-loss and cost-containment strategies, where he managed administrator and carrier relationships and opportunities, risk transfer strategies, and self-funding overall, while growing a team to ultimately handle stop-loss placements nationwide. Prior to that, Brian worked as a senior underwriting consultant for a BUCA managing stop-loss negotiation and placement, administration, and pharmacy pricing for large and complex self-funded, fully insured, and HMO cases. Brian works to maximize employer strategies for managing high-cost claimant risk, focusing on opportunities to enhance plan designs, administrator-specific gap avoidance, and cost-containment processes. Brian has assisted with the formation of medical stop-loss captives, merger and acquisition risk coverage strategies, fully insured to self-funded conversion strategies, and reference-based pricing and alternative funding concerns as well. 02:48 What health care costs and revenue look like further out—2021. 06:13 Can and will employers meaningfully impact the price of care? 07:59 “A lot of it has to do with, ‘Who do I receive direction from?’” 10:54 The fully insured market vs the self-insured market. 14:15 The cost of care for COVID-19 cases and the cost of care for cases that turn out not to be COVID-19. 14:41 “Provider billing behavior is going to be impacted well beyond COVID.” 16:02 Covered California in the time of COVID-19. 17:15 Does a fully insured carrier have the incentive to cut costs? 17:40 What will happen to fully insured carriers who can no longer raise premium costs to cover COVID-19 costs. 19:13 What self-insured employers shouldn’t be doing right now. 20:07 Examining cost vs value of care. 23:42 “How can you create the best chance that you’re not going to have really big outlier costs on your plan?” 24:35 Where the name Point6 Healthcare came from. You can learn more at point6healthcare.com and brian.scott@point6healthcare.com. You can also connect with Brian on LinkedIn.  Check out our newest #healthcarepodcast with Brian Scott of Point6 #Healthcare as he discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing What health care costs and revenue look like further out—2021. Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing Can and will employers meaningfully impact the price of care? Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing “A lot of it has to do with, ‘Who do I receive direction from?’” Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing The fully insured market vs the self-insured market. Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing “Provider billing behavior is going to be impacted well beyond COVID.” Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing Does a fully insured carrier have the incentive to cut costs? Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing What shouldn’t self-insured #employers be doing right now? Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing Examining cost vs value of care. Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing “How can you create the best chance that you’re not going to have really big outlier costs on your plan?” Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing What’s the cost of care like for cases that aren’t COVID-19? Brian Scott of Point6 #Healthcare discusses premium increases in the fully insured market during #covid19. #digitalhealth #predatorypricing

I have the same burning question that I think many of you have: If I am a self-funded employer, as a result of this pandemic, will my health care costs go up? This question boils down to an equation that has two parts: the additions and then the subtractions. In the Additions column, how much will an employer spend on COVID-19 treatments—you know, both the ICU visits but also employees who haven’t been to the doctor in 15 years, get a cough, go to the doctor, and get diagnosed with some underlying condition (maybe after a lot of lab work and a few CT scans), and potentially wind up, for example, on some expensive therapy? Back to our equation: In the Subtractions column, we have shelter in place, whether by mandate or fear based. Everyone who is forgoing or has forwent elective surgery or follow-up visits or anything else in a fee-for-service world results in less costs for an employer. Doctor visits are down 35% to 80%, depending on the specialty. And, nothing for nothing, health care industry revenue is an employer's cost. If we disregard payer mix for a sec, this could mean that employer costs are down the same percentage as any given doctor’s revenue. In this health care podcast, I talk with Brian Scott. Brian has a background which is perfect for the question of “Will employer health care costs go up or down?” First, he was an underwriter at United. Then he was in a dedicated complex claims group for Lockton that managed self-funded plans. And now he’s at Point6 Healthcare, where he works to put together best-value plans for employers, including getting stop-loss. Brian works with TPAs (third-party administrators) across the country to this end. So, this conversation with Brian has two parts: This first episode (episode 275) is mostly about the specific additions used in a lot of the cost models that are being floated relative to whether costs will go up or down for self-funded employers and also what some self-insured employers are doing or considering to address the underlying risk factors that might drive up costs in a plan and help reduce them. Episode 276, which is the next one after this one, includes Brian’s advice for self-insured employers, as well as a look into the fully insured market. We explore why estimates in the fully insured markets show that costs could go up anywhere from 4% to 40% when premiums are re-upped. You can learn more at point6healthcare.com and brian.scott@point6healthcare.com. You can also connect with Brian on LinkedIn.  Brian Scott is an assistant vice president at Point6 Healthcare. He joined the team in 2019 to implement and lead a new type of ICU related to self-funded employers focused on implementation, consulting, and underwriting strategies on behalf of self-funded benefits plan sponsors. Point6 is an authority on employer-sponsored self-funded health care financing and risk transfer strategies in the United States and maximizes the value of interactions between those providing, receiving, and financing health care. Brian has also worked as the strategic consultant for a major consulting firm specializing in employer stop-loss and cost-containment strategies, where he managed administrator and carrier relationships and opportunities, risk transfer strategies, and self-funding overall, while growing a team to ultimately handle stop-loss placements nationwide. Prior to that, Brian worked as a senior underwriting consultant for a BUCA managing stop-loss negotiation and placement, administration, and pharmacy pricing for large and complex self-funded, fully insured, and HMO cases. Brian works to maximize employer strategies for managing high-cost claimant risk, focusing on opportunities to enhance plan designs, administrator-specific gap avoidance, and cost-containment processes. Brian has assisted with the formation of medical stop-loss captives, merger and acquisition risk coverage strategies, fully insured to self-funded conversion strategies, and reference-based pricing and alternative funding concerns as well. 03:27 Contemplating the additional costs an average employer might incur relative to employees and COVID-19. 04:34 “People want to interact differently with the health care system moving forward than they have in the past.” 06:55 “It’s not necessarily intuitive.” 07:03 The biggest point of care that’s probably going to be utilized post-COVID: telemedicine. 09:19 EP273 and EP274 with Jonathan Thierman, MD, PhD.09:34 The health care shifts we’re likely to see moving forward. 13:00 Some of the negative consequences of COVID-19. 15:25 What a health care model without a pharmacy benefits manager (PBM) might look like moving forward. 17:22 “Their solution might be, ‘Change the formulary.’” 19:39 EP264 with Ron Wince.21:02 “Finding ways to really dig into … these individual concerns … are not necessarily top of mind.” 22:37 COVID creating a flash point for change. 23:04 “I don’t know if it’s best to call it an opportunity.” 24:52 The different health model changes being discussed. 27:28 The incentive carriers have to make this COVID analysis. 28:51 “Costs have to come down.” You can learn more at point6healthcare.com and brian.scott@point6healthcare.com. You can also connect with Brian on LinkedIn.  Check out our newest #healthcarepodcast with Brian Scott of Point6 #Healthcare as he discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing “People want to interact differently with the health care system moving forward than they have in the past.” Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing “It’s not necessarily intuitive.” Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing #Telemedicine as a big point of care coming out of the #pandemic. Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing What are the health care shifts we’re likely to see moving forward? Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing What are some of the negative consequences of the #pandemic on #healthsystems? Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing What might a #healthmodel without a #PBM look like post-#pandemic? Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing “Their solution might be, ‘Change the formulary.’” Brian Scott of Point6 #Healthcare as he discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing “Finding ways to really dig into … these individual concerns … are not necessarily top of mind.” Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing “I don’t know if it’s best to call it an opportunity.” Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing “Costs have to come down.” Brian Scott of Point6 #Healthcare discusses #selfinsured #employer costs post-#covid19. #digitalhealth #predatorypricing

Everybody’s talking about the surge in telehealth usage. I wanted to talk to someone who has been ramping up their telehealth capabilities for a while to get a sense of what it takes to do it well. And, as has been said by many, doing telehealth isn’t just about technology. It’s about training clinicians, patients, and accounts receivable and other staff. It’s about rearranging workflows and processes. So, I was super pleased to have had the opportunity to speak with Jonathan Thierman, MD, PhD. Dr. Thierman is an ER doctor. He’s also the chief medical information officer for LifeBridge Health systems and medical director of the LifeBridge Health Virtual Hospital. This show has two parts. This is the second part—episode 274. In this health care podcast, we’ll get into some of the operational aspects of telehealth, like what EHR integration actually means and looks like. We talk about whether laws governing telehealth that were relaxed get stringent again. We talk about natural language processing and artificial intelligence and how they fold into the telehealth answer. I also ask Dr. Thierman for his advice to those potentially more new at the telehealth thing—what lessons he’s learned, what critical success factors might be. One last point: In episode 273 (and you probably don’t need to listen to these in order), which is the first part of this two-part series, Dr. Thierman and I discuss what telehealth can accomplish, maybe better than a face-to-face patient encounter, and what it’s not so good at. One thing that dawned on me as we were talking is that technology isn’t just a video system. There’s apps, there’s AI, there’s minivans full of lab equipment … there are other innovations that expand the capacity of a remote patient visit.  You can learn more at lifebridgehealth.org. You can also follow Dr. Thierman on Twitter at @techie_doc or connect with him on LinkedIn.  Jonathan Thierman, MD, PhD, is physician executive in the LifeBridge Health system and president of the medical staff at Northwest Hospital. He started his career as an engineer and inventor, earning his PhD at MIT and then training in emergency medicine at Harvard Medical School and Johns Hopkins Hospital. In the past, he has worked to bring real-world clinical experience to the engineering and design of medical devices. Currently, he is the chief medical information officer for the LifeBridge Health system in Baltimore, where he leads a team of physician informaticists to interface between the 180+-person IT department and the 3000+ affiliated physicians across five hospitals and in community practices on matters of the EMR, CPOE, and other health IT systems. Dr. Thierman is passionate about applying technology to improve health and outcomes. To this end, he helped to establish the LifeBridge Health Virtual Hospital, with affiliated clinical call centers in Jerusalem and the Philippines, to provide telemedicine services across the continuum. He also created the LifeBridge Techbar to offer in-person IS assistance to LifeBridge providers. In addition, he developed a patient “Digital Front Door” to help direct patients to the right care center with the least wait time, improving patient experience and load-balancing the emergency departments and urgent care centers in the LifeBridge Health system. 03:15 The net effect of adopting telemedicine during the pandemic. 06:42 “Data is key.” 09:20 “There’s a lot more communication going on now between health care providers and their patients than there was before.” 09:40 “Even now, we’re still scratching the surface of what insights we can gain from the data.” 12:42 EP251 with Dr. Kimberly Noel and training doctors in webside manner.13:00 How telehealth and EHR systems align. 14:02 The telehealth value points that are coming. 17:23 The necessity of training for clinicians embarking on this telehealth adaptation. 18:50 “Jump in, because it’s … here to stay.” 19:30 “It doesn’t have to be as expensive as you think.” You can learn more at lifebridgehealth.org. You can also follow Dr. Thierman on Twitter at @techie_doc or connect with him on LinkedIn.

Everybody’s been talking about the surge in telehealth usage—how it would have taken, like, ten years to get as far as we’ve gotten in the past ten days. I wanted to talk to somebody who has been ramping up their telehealth capabilities for a while to get a sense of what it takes to do it well. As has been said by many, doing telehealth isn’t just about technology. It’s about training—clinicians and patients and accounts receivable and other staff. It’s about rearranging workflows and processes. So, super pleased to have had the opportunity to talk with Jonathan Thierman, MD, PhD. Dr. Thierman is an ER doc. He’s also the chief medical information officer for LifeBridge Health systems and the medical director of the LifeBridge virtual hospital. So, this show has two parts: episode 273 that you’re listening to; but the second part, episode 274, is where we’re going to get into some of the operational aspects of telehealth, like what EHR integration actually means and what it looks like. In this health care podcast (episode 273), however, Dr. Thierman and I discuss what telehealth can accomplish, maybe better than a face-to-face patient encounter, and what it’s not so good at. One thing that dawned on me as we were talking is that the technology isn’t just, you know, a video system. There’s apps, there’s AI, there’s minivans full of lab equipment … there are other innovations that expand the capability of a remote patient visit. Here’s another point to ponder that Dr. Thierman and I explore a little bit. What is the impact of telehealth in a value-based care environment but also in an FFS (fee-for-service) reimbursement model? It’s likely, if you think about it, there will be more patient visits because the barrier to getting care has diminished. And that might be a good thing if we’re talking about chronic care, if we’re talking about ensuring follow-up after a surgical procedure. There’s any number of examples where patients getting help prior to some sort of acute event would be considered a good thing by most. But does improving access to care increase a patient’s chances of getting inappropriate care? You know, 25+% of care is some variation of waste, fraud, and abuse; and additional services rendered always have the risk of negative consequences. Or do we figure that bad actors are doing a pretty good job behaving badly anyway, so the net positive for the rest of us is worth it? You can learn more at lifebridgehealth.org. You can also follow Dr. Thierman on Twitter at @techie_doc or connect with him on LinkedIn.  Jonathan Thierman, MD, PhD, is physician executive in the LifeBridge Health system and president of the medical staff at Northwest Hospital. He started his career as an engineer and inventor, earning his PhD at MIT and then training in emergency medicine at Harvard Medical School and Johns Hopkins Hospital. In the past, he has worked to bring real-world clinical experience to the engineering and design of medical devices. Currently, he is the chief medical information officer for the LifeBridge Health system in Baltimore, where he leads a team of physician informaticists to interface between the 180+-person IT department and the 3000+ affiliated physicians across five hospitals and in community practices on matters of the EMR, CPOE, and other health IT systems. Dr. Thierman is passionate about applying technology to improve health and outcomes. To this end, he helped to establish the LifeBridge Health Virtual Hospital, with affiliated clinical call centers in Jerusalem and the Philippines, to provide telemedicine services across the continuum. He also created the LifeBridge Techbar to offer in-person IS assistance to LifeBridge providers. In addition, he developed a patient “Digital Front Door” to help direct patients to the right care center with the least wait time, improving patient experience and load-balancing the emergency departments and urgent care centers in the LifeBridge Health system. 03:26 What was happening with telehealth pre-COVID-19. 04:50 What’s happened to telehealth and primary care practices post-COVID-19. 06:28 How quickly telehealth medicine appointments are growing. 07:30 What percentage of patients are doctors able to see via telemedicine? 08:24 Are patients getting adequately cared for? 10:20 “The vast majority of medicine, except for surgical services, really is a mental game.” 14:15 “If you have a window into the home, you probably have a better view of the social determinants of health.” 14:25 How AI plays into telemedicine right now. 16:52 Where telehealth visits will land after the pandemic. 18:40 “When you improve access, you also improve demand.” 19:22 Is telehealth consumer driven? 20:48 “For the most part, patients are most connected to their actual physician.” 21:37 Why more frequent touch points via telehealth will benefit health care quality and costs in the future. 28:20 “It’s about the patient, and it’s about really keeping them well.” You can learn more at lifebridgehealth.org. You can also follow Dr. Thierman on Twitter at @techie_doc or connect with him on LinkedIn.  Check out our #healthcarepodcast with @techie_doc as he discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 What was happening with telehealth pre-COVID-19? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast What’s happened to telehealth and #primarycare practices post-COVID-19? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast How quickly is #telemedicine growing right now? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast How many patients can a doctor see via #telemedicine? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast Are patients receiving adequate care from #telemedicine? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast “The vast majority of medicine, except for surgical services, really is a mental game.” @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast “If you have a window into the home, you probably have a better view of the social determinants of health.” @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast How is #AI playing into #telemedicine? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast Where will #telemedicine visits land after the pandemic is over? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast “When you improve access, you also improve demand.” @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast Is #telemedicine consumer driven? @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast “For the most part, patients are most connected to their actual physician.” @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast “It’s about the patient, and it’s about really keeping them well.” @techie_doc discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast

A lot of people are wondering why independent PCPs are furloughing nurses and talking about shuttering their practices in the middle of a pandemic. Conventional wisdom would assume that PCPs would be just fine if they stand up telehealth and can take some sort of majority of their patient visits virtually. After all, it would make a lot of sense that a lot of patients are calling their doctor right now. In this health care podcast, I interview Guy Culpepper, MD. Dr. Culpepper sets us straight about what is actually going on day to day for PCPs right now. He also suggests that, right now, this pandemic is a flash point. It’s a game changer. It’s the trigger for an abrupt and transformational change in the business of providing patients with primary care. Just a couple of vocab words to keep us straight here: DPC stands for direct primary care. This is when a doctor bills a patient directly—no insurance in the picture. So, the doctor sends a bill for, say, $70 a month to the patient and the doctor will then take care of that patient no matter how many questions they ask or texts they send or office visits they require or don’t require. Direct to employer means that the doctor contracts directly with an employer—usually a self-insured employer, again without insurance. So, the employer pays the doctor usually some capitated lump sum per month or per year for primary care. Goodbye, fee for service (FFS). Dr. Culpepper is a founder and CEO of an independent physician group in North Texas with 550 providers. He served in that role for 25 years, but as he says, his day job is being a board-certified family doctor. You can learn more at benttreemd.com. You can also connect with Dr. Culpepper on Twitter at @DrCulpepper.  Guy L. Culpepper, MD, founded Bent Tree Family Physicians in 1987. His enthusiasm for health care and his focus on each patient as an individual has been rewarded by numerous recognitions as one of America’s premier family physicians. Disease prevention is the primary goal of his work. He has expertise in diabetes, cholesterol management, and osteoporosis; however, caring for children is his greatest joy. Dr. Culpepper’s leadership has been seen at every stage of his career. During training, he served as both chief resident in family medicine and as the president of the medical/surgical house staff of St. Paul Medical Center. He was the founding chairman of the department of family medicine at Texas Health Resources Presbyterian Hospital of Plano, where he was honored to serve as the president of the medical staff. His dedication to primary care continues to be seen in his leadership of the Jefferson Physician Group, an organization of more than 230 internists, pediatricians, and family physicians improving North Texas health care since 1995. A Dallas native, Dr. Culpepper lives in Frisco with his three sons, whose support has made his work possible and his leisure time joyful. He enjoys reading, writing, movies, sports, and collecting medical antiques and is a lifelong fan of the Dallas Cowboys. 02:22 What a PCP’s average day looks like during the pandemic. 03:48 How likely is it that PCPs can transition easily to telehealth? 06:00 Why the pandemic is a flash point game changer for telehealth and PCP reimbursement. 08:54 “It’s like a perfect storm of multiple tragedies coming together.” 10:47 How primary care is going to alter after this. 13:24 “We need to totally change the way that our country pays us.” 14:29 What is the incentive for health plans and hospitals to change financial models in all of this? 16:26 “The ones who are going to change are the ones who need to change.” 18:13 Why the employers will be demanding this change in financial model. 19:12 Why being independent vs being part of an accountable care organization matters during this pandemic. 21:07 “If we don’t save the independent doctors, there’s nothing to break this chain of abuse.” 24:34 “Higher income doesn’t always mean more happiness; it often means less sense of freedom.” 25:53 “There’s a point where a little bit more money and a loss of freedom are no longer properly balanced.” 27:53 Untangling the FFS reimbursement. 30:00 Why right now is a flash point for PCP reimbursement. 30:38 “No one else can do what we can do in effective primary care. No one … in this market.” 31:49 What payers should be doing right now. 33:27 EP270 with Dave Chase of Health Rosetta.33:39 Dr. Culpepper’s message to Medicare. You can learn more at benttreemd.com. You can also connect with Dr. Culpepper on Twitter at @DrCulpepper.  Check out our #healthcarepodcast with @DrCulpepper as he discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs What does a #primarycarephysician’s typical day look like during this #pandemic? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcarepodcast #healthcare #podcast #digitalhealth #reimbursement #ffs How likely will #primarycarephysicians find the transition to #telehealth? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic Why is #coronavirus a flash point for #telehealth and #PCPreimbursement? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic “It’s like a perfect storm of multiple tragedies coming together.” @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic How will #primarycare alter after this? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic “We need to totally change the way that our country pays us.” @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic What incentive do health plans and #hospitals have for changing their financial models? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic “The ones who are going to change are the ones who need to change.” @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic Why will employers be demanding a financial model change? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic Why do #independentPCPs matter in all of this? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic “If we don’t save the independent doctors, there’s nothing to break this chain of abuse.” @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic “Higher income doesn’t always mean more happiness; it often means less sense of freedom.” @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic “There’s a point where a little bit more money and a loss of freedom are no longer properly balanced.” @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic Untangling the #ffsreimbursement. @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic “No one else can do what we can do in effective primary care. No one … in this market.” @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic What should #payers be doing right now? @DrCulpepper discusses what #covid19 means for #PCPs, #employers, and #healthplans. #healthcare #podcast #digitalhealth #reimbursement #ffs #pandemic

In this health care podcast, I’m talking to Al Lewis from Quizzify. This episode also guest stars Rachel Miner from Thrive Benefits, David Contorno from E Powered Benefits, and Doug Aldeen, a health care attorney in Texas. This episode started out being about surprise billing in the emergency room (ER) and a potential defense strategy that patients and employees can use to protect themselves from egregious billing practices. Surprise bills are when a patient gets “balance billed” for a sum above what their insurance carrier will pay. Usually this transpires when an out-of-network provider somehow or another gets involved in their care. Usually the patient has no idea this happens until after the bill comes—the big bill, in many cases, thus the surprise. But here’s where surprise billing and COVID-19 connect. You might not have thought of this because you might know that patients who present in the ER with COVID-19 and then test positive are protected from surprise bills, for the most part, by the CARES Act. But there’s a couple of wrinkles. What if the patient does not actually have COVID-19? Then whatever treatment they wind up getting in the notoriously expensive ER is business as usual. Here’s another wrinkle: The cost of treatment for COVID-19 is not like it’s capped. So even if an employee doesn’t get a surprise bill, the self-insured employer or health plan might. And the CARES Act explicitly states that the employer or plan is on the hook to pay for it. And one last wrinkle: Dealing with this pandemic among other things leaves about 0.0 chance that the national surprise billing legislation is gonna happen this year. But it’s not like kids have stopped running into the side of the pull-out couch and needing stitches, or drug overdoses or heart attacks have suddenly vanished. There was a news article just the other day about a private equity–run ER in the Midwest continuing to dish out nasty surprise bills to their community of taxpayers at the exact same time that they were lobbying to get a piece of the federal bailout paid by taxpayers. Al Lewis and his team over at Quizzify created this handy wallet card that patients or employees can use when they have the unfortunate experience of going to the ER themselves or with a loved one. It protects them from egregious surprise bills, thus its moniker, the surprise billing defense strategy. But nothing for nothing, this wallet card, this surprise billing defense strategy, also protects employers and health plans from these large bills in the age of COVID-19.  Al Lewis and I start our conversation talking about a New York Times article (also available here for those who don’t subscribe to the New York Times) that came out recently featuring Al as well as myself and chronicles my visit to an emergency room wherein I deployed the surprise billing defense strategy/wallet card.  You can learn more at quizzify.com or connect with Al on LinkedIn. You can also connect with Al on Twitter at @quizzify and @whynobodybeliev.   You can also connect with Rachel and David on LinkedIn and with Doug on Twitter at @AldeenDoug and on LinkedIn.  Al Lewis wears multiple hats, both professionally and also to cover his bald spot. Hat #1: Employee Health Literacy. He is the founder and “quizmeister-in-chief” of Quizzify, whose mission is to help companies teach their employees to utilize health care services appropriately, using a format best described as “Jeopardy meets health benefit education meets Comedy Central.” Quizzify is the only vendor authorized to display the Harvard Medical School “Veritas” shield and has received excellent reviews from users.  Quizzify is best known today for its employee coronaquizzes (now exceeding 100,000 plays!) and its surprise billing “Prevent Consent” solution, which was recently featured in the New York Times. It can be taped to an insurance card, used as a stand-alone card, or downloaded into your Apple Wallet.  His quiz-specific background includes authorship of the best-selling Newsweek Presents the Ultimate Trivia Game, which Games magazine lauded as having the best questions of any trivia game; hosting two quiz shows on Boston network affiliates; and appearing on Jeopardy. Hat #2: Outcomes Measurement. As an author, his critically acclaimed category best-selling book on outcomes measurement, Why Nobody Believes the Numbers, chronicling and exposing the innumeracy of the health management field, was named digital health book of the year in Forbes. Cracking Health Costs, written in conjunction with Walmart alum Tom Emerick, was also a trade best seller. Surviving Workplace Wellness has also received great accolades, and excerpts appeared in Harvard Business Review and elsewhere.  He was the cofounder of the World Health Care Congress’s Validation Institute.  His expertise in outcomes measurement got him named one of the unsung heroes changing health care forever.  He graduated Phi Beta Kappa with honors from Harvard, where he taught economics as well. He also graduated from Harvard Law School, albeit with no honors that time—other than winning their annual trivia contest, of course. David Contorno is founder of E Powered Benefits. As a native of New York, David began his career in the insurance industry at the age of 14 and has since become a leading expert in the realm of employee benefits over the last 22 years. Most recently, David was Benefits Selling magazine’s 2015 Broker of the Year; and in March 2016, Forbes deemed him “One of America’s Most Innovative Benefits Leaders.” David is a member of the board of directors for both the Charlotte Association of Health Underwriters and HealthReach Community Clinic. He served on the NC Insurance Commissioners Life and Health Agent Advisory Committee, as well as participated in the Technical Advisory Group that helped with the market reforms required under the Affordable Care Act in North Carolina. He is a longtime member of the Lake Norman and South Iredell Chambers of Commerce as well as the National, North Carolina, New York, and Long Island Associations of Health Underwriters. David contributes to numerous publications, including Forbes, Benefits Selling magazine, Business Leader magazine, and Insurance Thought Leadership. David is committed to giving back to his community and actively participates in the membership drive for the United Way, assisting the local chapter of Habitat for Humanity, and supporting The Dove House Child Advocacy Center. When he is not working, he enjoys boating, traveling, and being with his wife, Heather, and their two children, Hannah and Ethan. Rachel Miner became engaged with the health care system seven years ago as her son, Jackson, was consistently ill. Her frustration with the complexity of the health care system and expensive bills made her think about how helpless employees must feel. So, she set out to find a benefits firm that helped employees understand how to be educated consumers of health care year-round—and she didn’t find one. Thus, Thrive Benefits was born. Her mission is twofold: to help employers and employees. Rachel understands that companies need to have good benefits to attract and retain employees and makes it her mission to help employers save money so they can offer good benefits year over year. In addition, she helps employees to navigate the health care system so that they can have the highest quality of care at the lowest possible cost. Rachel says that her true passion is helping people and her purpose is to challenge the mindset of others so that they can overcome adversity, take risks, and achieve their goals. Health care is confusing, but it doesn’t have to be. For organizations to thrive, employees must thrive, too. Doug Aldeen is an Austin, Texas–based health care and Employee Retirement Income Security Act (ERISA) attorney who recently served as ERISA counsel on behalf of the Berkeley Research Group in New York City to the $7.7 billion May 2016 acquisition of Multiplan and its medical bill repricing product Data iSight by the private equity firm Hellman and Friedman. Since 1997, he has represented reference base pricing organizations, a bundled payment software platform, PPO networks, medium to small self-funded plans, third-party administrators, and provider-sponsored health maintenance organizations in various capacities, including Herdrich v. Pegram, which was argued before the US Supreme Court in 2001. Moreover, he serves as a resource to national news organizations regarding issues on health care and as a consultant with the Governmental Relations Committee at the Self-Insurance Institute of America in Washington, DC, and as an adviser to RIP Medical Debt, which has abolished over $1.2 billion in medical debt. Doug received his JD from the University of Illinois. 04:26 What is the likelihood of a surprise bill in the time of coronavirus? 07:41 What the surprise billing wallet card looks like and what it does when you use it.09:55 Rachel Miner’s experience with the Quizzify surprise billing wallet card. 14:42 EP249 with Dale Folwell.15:33 Should employers be advocating for the use of the Quizzify wallet card? 16:22 How an employer should get the wallet card out to their employees. 17:29 David Contorno explains the inspiration behind the Quizzify wallet card. 19:29 “Because of that federal law, you do not need to sign that financial consent.”—David 19:42 “Don’t obligate yourself financially to some unknown amount.”—David 19:56 The legal standard: a battlefield consent. 21:18 Negotiating vs not negotiating. 22:38 Why employers should care about surprise billing. 22:58 Best practices for employers educating employees on why this wallet card is important. 24:19 “This is not something your employer is doing to you; this is something your employer is doing for you.”—David 24:25 EP186 with David Contorno.27:19 Doug Aldeen on what happens after using the wallet card and then gets the balance bill. 30:47 What happens after you sign the financial contract after editing. 32:01 Asking for the director of revenue cycle management after getting your surprise bill. 36:36 “It’s not as daunting as people think.”—Doug 36:56 “The general rule … is that the more you do in advance, the better.”—Al 37:49 Why 2x Medicare is the sweet spot for reasonable price. 38:38 What employers should be doing right now to distribute these Quizzify wallet cards. You can learn more at quizzify.com or connect with Al on LinkedIn. You can also connect with Al on Twitter at @quizzify and @whynobodybeliev.   You can also connect with Rachel and David on LinkedIn and with Doug on Twitter at @AldeenDoug and on LinkedIn. Check out our #healthcarepodcast with @whynobodybeliev of @quizzify and featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling What is the likelihood of a #surprisebill in the time of #coronavirus? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling What does the #surprisebill #walletcard look like and what does it do? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling Should #employers be advocating for the use of the Quizzify wallet card? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling How should an #employer distribute the wallet card to his/her #employees? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling What was the inspiration behind the Quizzify wallet card? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling “Because of that federal law, you do not need to sign that financial consent.” @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling “Don’t obligate yourself financially to some unknown amount.” @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling What is battlefield consent? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling Negotiating vs not negotiating surprise bills. @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling Why should employers care about surprise bills? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling “This is not something your employer is doing to you; this is something your employer is doing for you.” @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling What happens when you use the Quizzify wallet card? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling “It’s not as daunting as people think.” @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling “The general rule … is that the more you do in advance, the better.” @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling Why is 2x the Medicare rate the sweet spot for reasonable price? @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling What employers should be doing right now. @whynobodybeliev of @quizzify discusses on our #healthcarepodcast featuring Rachel Miner of @BenefitsThrive, @dcontorno, and @AldeenDoug. #healthcare #podcast #digitalhealth #covid19 #surprisebilling

Let’s talk today specifically about primary care physicians (PCPs) and family medicine doctors. Data was reported in USA Today, saying that an estimated 60,000 family practices will close and 800,000 of their employees will lose their jobs by the end of June. It’s hard for any practice to just snap its fingers and transfer patients over to telemedicine regardless of the reimbursement rate and/or how many payers are actually paying any reimbursement for telemedicine or remote patient monitoring. It’s a thing to go virtual. It requires new processes, different staffing training, different workflows. Plus, a lot of what a PCP does (ie, fielding phone calls with quick questions, for example) aren’t reimbursable; and if they were, no one’s gonna, like, spend half an hour trying to send a bill for $12. What are the consequences of all, let’s just say, independent PCPs going out of business? Well … first, logically, all patients served by these doctors and their teams now no longer have a place to go to get care, right in the middle of a pandemic. Second, let’s just say in a thought experiment that a lot of independent physicians do go out of business and do wind up going to work in an employed model. That might very well happen. Private equity and payers like Humana and Optum have been buying up PCP practices all over the place. Why? So they can have captive populations. Patients come in the door at their PCP, and everywhere they go from there can be controlled by the vertically integrated entity. This has been stated openly. It’s also pretty clear at this point that that model increases costs for any ultimate purchaser of health care like, for example, an employer. There’s also other, let’s just say, more unseemly motivations if you start to think about what a company who owns patient relationships with their PCPs can manage to perpetuate. It’s great if you’re a shareholder. It might be less great if you’re a citizen of this country. In this health care podcast, I speak with Dave Chase, cofounder and CEO of Health Rosetta. Health Rosetta empowers community-owned health plans like, for example, employers and states’ and town governments. Dave talks about Health Rosetta’s Marshall Plan, which is an action plan right now to minimize the negative impact of COVID-19 by ensuring that family and primary care practices can stay in business. The Marshall Plan is a call to action for self-insured employers and commercial health plans. You can learn more about the Marshall Plan at healthrosetta.org/marshallplan. You can also connect with Dave on Twitter at @chasedave and follow Health Rosetta at @HealthRosetta.  Dave Chase leads the vision for Health Rosetta, which is to empower community-owned health plans. Health Rosetta’s blueprint and platform power the health plans of your dreams: high-quality, trustworthy, local, affordable care—that you thought had disappeared forever—from caregivers we know and trust. They free up compassionate, well-trained, community-based caregivers to rediscover love in medicine so they can do what they have always been called to do: serve their patients not just in disease but toward their fullest health. A trusted and sacred caregiver-patient bond is built through transparency and openness that equips and empowers patients wherever they can best achieve their unique health goals—at home or any setting best optimizing their well-being. By avoiding the 50% wasted health care spending, we can ensure our caregivers have the independence and resources to address the psychosocial and medical issues their patients face. Human-centered health plans restore health, hope, and well-being. Through best-selling books and The Resident (on FOX), where Dave serves as a consultant, collateral damage from the Extractive Era of health care is highlighted as well as the tremendous successes and opportunities with Health Rosetta–type health plans. The books, writing for various media outlets, TED Talk, and TV/film have reached over 10 million people, with the goal of informing, enraging, empowering, and activating a broad grassroots movement designed to restore hope, health, and well-being to our communities. Dave proudly received the Health Value Awards’ Lifetime Achievement for Health Benefits Innovation at the 2020 World Health Care Congress. Dave cofounded Avado, which was acquired by and integrated into WebMD/Medscape, and founded Microsoft’s $2 billion, 28,000-partner health care ecosystem. Outside of work, Dave Chase is an oxygen-fueled mountain athlete and volunteer high school track and cross-country coach. Once upon a time, Dave was a PAC-12 800 meter and 4x400 competitor. Most importantly, his devotion to faith, family, and friends underpins a desire to be a servant leader to the four million lives (and growing) stewarded through the Health Rosetta community. 03:15 The state of independent fee-for-service PCPs during COVID-19. 03:57 CMS and telehealth, and why these aren’t really aiding PCP revenue. 05:52 Worst-case scenario of where COVID-19 is going to leave our PCPs. 06:58 Looking to Optum’s PCPs and what’s happening there. 08:46 “There’s a biological virus that’s running rampant in our country, but there’s been a metaphorical virus running through our health care system.” 09:33 The incredibly fast transition to digital health because of COVID-19. 10:56 CMS’s prospective payment model. 14:43 “In my view, we are not returning to normal.” 15:21 Dave’s call to action for saving PCPs during COVID-19. 22:07 Dave’s advice for what PCPs should be doing right now. 24:01 “Here’s the egg; crack it open.” You can learn more about the Marshall Plan at healthrosetta.org/marshallplan. You can also connect with Dave on Twitter at @chasedave and follow Health Rosetta at @HealthRosetta.  Check out our newest #healthcarepodcast with @chasedave of @HealthRosetta. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus What is the state of independent fee-for-service #PCPs right now? @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #ffs #PCP #covid19 #coronavirus Why isn’t #telehealth really aiding revenue for #PCPs? @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus What is the worst-case scenario of where this #pandemic is leading our #PCPs? @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus “There’s a biological virus that’s running rampant in our country, but there’s been a metaphorical virus running through our health care system.” @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus What is the fast transition to digital health looking like for #PCPs? @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus #CMS’s prospective payment model, and what this means for #PCPs. @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus “In my view, we are not returning to normal.” @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus What should #PCPs be doing right now? @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus “Here’s the egg; crack it open.” @chasedave of @HealthRosetta discusses on our #healthcarepodcast. #healthcare #podcast #digitalhealth #PCP #covid19 #coronavirus

The first wave of this COVID-19 pandemic has been totally reactionary. Don’t get me wrong: That does not detract from the Herculean effort made by hospitals and clinicians who have thrown everything they have at this—and more. But I don’t think that anyone would disagree that if we had enough PPE (personal protective equipment) and ventilators—you know, like, proactively—we’d be in better shape. So let’s stay ahead of the second wave of this pandemic, which is going to happen when, as Marty Makary put it in episode 267, the backlog of patients who were scared to or unable to get care for a few months creep out of their homes. What happens when patients who should have gotten a tumor removed or had a colonoscopy because of GI bleeding or felt the symptoms of a heart attack but did not get timely care?  In this health care podcast, I am speaking with Eric Bricker, MD, from AHealthcareZ; and we’re talking about how the post-COVID-19 new normal may shape up. One way to conceive of what health care will be moving forward is to look at how stakeholders are impacted by the pandemic right now and what action steps they’re taking right now, because to a nontrivial degree, the moves made now will have an outsized impact on their success trajectory in the near term and long term in the months and years to come. I was super thrilled to have the chance to speak with Dr. Bricker. If you haven’t watched his videos on LinkedIn or at AHealthcareZ.com, you should definitely go and check them out.  You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn.  Eric Bricker, MD, is an internal medicine physician and former cofounder and chief medical officer of Compass Professional Health Services. Compass is a health care navigation service that grew to 2000+ clients, including T-Mobile, Southwest Airlines, and Chili's/Maggiano's restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000-person employee benefits and HR outsourcing company that separated from Aon in 2017. Dr. Bricker has since started AHealthcareZ.com, with 170+ health care finance videos with approximately 90,000 views per month across all platforms. He is also the author of Healthcare Money Campfire Stories.  02:48 How COVID-19 is impacting insurance carriers and payers. 06:16 How COVID-19 is going to affect payers with self-insured employers. 07:59 “The carrier’s revenue is going to go down because of layoffs.” 09:05 Other helpful or harmful COVID-19 factors to insurance carriers. 12:37 The risk to pharmacy benefit manager (PBM) revenue. 13:14 The financial stability of recent health system mergers. 14:03 The potential “cash crunch” for health systems because of COVID-19. 17:01 The issue with telehealth revenue right now. 20:57 EP251 with Dr. Kimberly Noel. 21:32 “In health care, you add technology and the price tends to go up.”—Stacey 22:02 “Telemedicine allows for geographic competition.” 22:19 How COVID-19 will affect specialty from a revenue perspective. 24:31 “An economic truism … one person’s spending is another person’s income.” 27:06 “Pain causes change.” 28:01 Do population health outcomes go up or down after COVID-19? 29:15 The high number of moves from high-deductible plans to Medicaid and how that will affect patient outcomes. 32:38 EP267 and EP268 with Dr. Marty Makary.33:02 Coming out of this peak, what hospitals need to be thinking about. You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn.  Check out our newest #healthcarepodcast with @DrEricB. #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare How is #covid19 impacting #insurancecarriers and #healthpayers? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19billing #covid19healthcare How will #covid19 affect #healthpayers with #selfinsured #employers? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19billing #covid19healthcare “The carrier’s revenue is going to go down because of layoffs.” @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare What’s the risk to #PBM revenue? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare What’s the issue with #telehealth revenue right now? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare “In health care, you add technology and the price tends to go up.” @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare “Telemedicine allows for geographic competition.” @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare How will #specialtyhealth revenue be affected by #covid19? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19billing #covid19healthcare “An economic truism … one person’s spending is another person’s income.” @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare “Pain causes change.” @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19 #covid19billing #covid19healthcare How will #populationhealthoutcomes be affected by #covid19? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #populationhealth #pophealth #covid19billing #covid19healthcare Coming out of this #covid19 peak, what should #hospitals be thinking about? @DrEricB discusses. #healthcarepodcast #healthcare #podcast #digitalhealth #healthtech #healthcarebilling #billing #covid19billing #covid19healthcare

On Friday, March 27, President Trump signed into law the Coronavirus Aid, Relief, and Economic Security Act—otherwise known as CARES. This CARES Act covers the whole $2 trillion megillah stimulus package, but in this health care podcast episode, we’re talking quickly about a provision in that Act. I speak first with Doug Aldeen, an attorney specializing in helping employers settle hospital bills. Doug works with clients across the country. And then at the end of the episode, you will also hear from Al Lewis, who is a founder over at Quizzify. Al Lewis, as many of you may or may not know—but if you don’t know, you should—created a “surprise billing wallet card” that is actually super relevant to this discussion as you will see. There’s actually going to be a whole surprise billing episode coming up soon where we discuss this wallet card, so you can consider Al’s short commentary today as kind of a coming attraction. The provision that we’re going to talk about in this episode is the No Cost Sharing for COVID-19 Testing and Vaccines provision. This is where insurers are required to cover testing for COVID-19 without cost sharing to their enrollees, and they must pay for the tests based on contracts or the posted pricing of labs. So, the thing is, hospitals and diagnostic testing companies can essentially basically name their price on COVID-19 tests; and employers and insurers will be required to pay for it. This is in Section 3202, the Price of Diagnostic Testing, in that CARES Act. The plot thickens this week as health insurers—including Aetna, Cigna, and Humana—are now waiving patient cost sharing on all treatment for coronavirus, not just the testing, including hospitalizations and ambulance transfers. And they’re doing this for their insured members and employer plans at their in-network health systems—emphasis intended on the “in-network” part. So, you might be thinking, “Great … no costs to anybody!” But I did emphasize that last part for a reason. If you think for a minute about this, just because patients are not paying co-pays for COVID treatments first of all doesn’t mean that while they’re in the hospital that their diabetes won’t flare up … or their MS or their RA. COVID-19 is just one thing, and the US has a patient population that has, let’s just say, no shortage of chronic conditions—otherwise known as underlying conditions, otherwise known as the people most likely to be in the ICU. My concern is that there’s nothing to say that co-pays and coinsurance for treatment of other things while being treated for COVID are going to suddenly vanish, too, even if it’s an in-network health system. Furthermore, there is that problem of a patient going to a hospital that’s not contracted with the employer plan or the patient’s insurance carrier. At that point, I’m not seeing anything that would suggest that patients with COVID-19 are going to get any different treatment billing-wise than patients with anything else. We’ve seen COVID-19 bills that are, for uninsured patients, $34,000 and $73,000 in the press. What if the patient doesn’t have out-of-network coverage, for example? What if the patient’s out-of-network deductible is tens of thousands of dollars like some of them are? I don’t see anything in this bill to suggest that those are suddenly going to go away. And, oh, by the way, exactly as the bill pretty much states explicitly, regardless of what the patient pays, the employer’s on the hook to pay for whatever the hospital chooses to charge—at least as far as testing goes. You can connect with Doug on Twitter at @AldeenDoug and on LinkedIn.  You can learn more at quizzify.com or connect with Al on LinkedIn. You can also connect with Al on Twitter at @quizzify and @whynobodybeliev.   Doug Aldeen is an Austin, Texas–based health care and Employee Retirement Income Security Act (ERISA) attorney who recently served as ERISA counsel on behalf of the Berkeley Research Group in New York City to the $7.7 billion May 2016 acquisition of Multiplan and its medical bill repricing product Data iSight by the private equity firm Hellman and Friedman. Since 1997, he has represented reference base pricing organizations, a bundled payment software platform, PPO networks, medium to small self-funded plans, third-party administrators, and provider-sponsored health maintenance organizations in various capacities, including Herdrich v. Pegram, which was argued before the US Supreme Court in 2001. Moreover, he serves as a resource to national news organizations regarding issues on health care and as a consultant with the Governmental Relations Committee at the Self-Insurance Institute of America in Washington, DC, and as an adviser to RIP Medical Debt, which has abolished over $1.2 billion in medical debt. Doug received his JD from the University of Illinois. Al Lewis wears multiple hats, both professionally and also to cover his bald spot. Hat #1: Employee Health Literacy. He is the founder and “quizmeister-in-chief” of Quizzify, whose mission is to help companies teach their employees to utilize healthcare services appropriately, using a format best described as “Jeopardy meets health benefit education meets Comedy Central.” Quizzify is the only vendor authorized to display the Harvard Medical School “Veritas” shield and has received excellent reviews from users.  Quizzify is best known today for its employee coronaquizzes (now exceeding 100,000 plays!) and its surprise billing “Prevent Consent” solution, which was recently featured in the New York Times. It can be taped to an insurance card, used as a stand-alone card, or downloaded into your Apple Wallet. His quiz-specific background includes authorship of the best-selling Newsweek Presents the Ultimate Trivia Game, which Games magazine lauded as having the best questions of any trivia game; hosting two quiz shows on Boston network affiliates; and appearing on Jeopardy. Hat #2: Outcomes Measurement. As an author, his critically acclaimed category best-selling book on outcomes measurement, Why Nobody Believes the Numbers, chronicling and exposing the innumeracy of the health management field, was named digital health book of the year in Forbes. Cracking Health Costs, written in conjunction with Walmart alum Tom Emerick, was also a trade best seller. Surviving Workplace Wellness has also received great accolades, and excerpts appeared in Harvard Business Review and elsewhere.  He was the cofounder of the World Health Care Congress’s Validation Institute.  His expertise in outcomes measurement got him named one of the unsung heroes changing health care forever.  He graduated Phi Beta Kappa with honors from Harvard, where he taught economics as well. He also graduated from Harvard Law School, albeit with no honors that time—other than winning their annual trivia contest, of course. 04:12 Hospital billing as it relates to COVID-19. 05:45 Who is “on the hook” for paying these COVID-19 bills. 08:17 “Reasonable payment” in the case of COVID-19. 08:45 Is COVID-19 different than every other billing situation? 10:12 What’s going to come out of the out-of-network COVID-19 costs? 11:29 What employers should be doing right now. 12:50 The takeaway for everyone “bankrolling” COVID-19. 13:26 “This whole thing is tilting towards, ‘Who’s going to pay for all this stuff?’” 13:53 Connecting the dots with COVID-19 billing. 15:25 Using the Quizzify wallet card, and how this can help avoid COVID-19 surprise billing. 16:17 Download the wallet card at quizzify.com.  You can connect with Doug on Twitter at @AldeenDoug and on LinkedIn.  You can learn more at quizzify.com or connect with Al on LinkedIn. You can also connect with Al on Twitter at @quizzify and @whynobodybeliev.   Check out our newest #AnExpertExplains #healthcarepodcast with @AldeenDoug and @whynobodybeliev of @quizzify as they discuss #hospitalbilling in the age of #covid19. #healthcare #podcast #digitalhealth #billing #healthcarebilling Who is on the hook for #coronavirus billing? @AldeenDoug and @whynobodybeliev of @quizzify discuss #hospitalbilling in the age of #covid19. #healthcare #podcast #digitalhealth #billing #healthcarebilling #healthcarepodcast What is #reasonablepayment in the age of #coronavirus? @AldeenDoug and @whynobodybeliev of @quizzify discuss #hospitalbilling in the age of #covid19. #healthcare #podcast #digitalhealth #billing #healthcarebilling #healthcarepodcast Is billing for #coronavirus different than all other billing? @AldeenDoug and @whynobodybeliev of @quizzify discuss #hospitalbilling in the age of #covid19. #healthcare #podcast #digitalhealth #billing #healthcarebilling #healthcarepodcast What’s going to come out of the out-of-network COVID-19 costs? @AldeenDoug and @whynobodybeliev of @quizzify discuss #hospitalbilling in the age of #covid19. #healthcare #podcast #digitalhealth #billing #healthcarebilling #healthcarepodcast “This whole thing is tilting towards, ‘Who’s going to pay for all this stuff?’” @AldeenDoug and @whynobodybeliev of @quizzify discuss #hospitalbilling in the age of #covid19. #healthcare #podcast #digitalhealth #billing #healthcarebilling #healthcarepodcast Connecting the dots with #covid19billing. @AldeenDoug and @whynobodybeliev of @quizzify discuss #hospitalbilling in the age of #covid19. #healthcare #podcast #digitalhealth #billing #healthcarebilling #healthcarepodcast