Relentless Health Value

The reaction of some hospitals and health care systems to the COVID-19 pandemic has been truly breathtaking. Doctors, nurses, first responders, other staff at hospitals and elsewhere have worked hard—so hard—to support the national effort. The same can be said to some tech entrepreneurs and other businesses who have snapped into action in order to provide PPE (personal protective equipment) and artificial intelligence to the frontline health care workers. In this health care podcast, I’m talking again with Marty Makary, MD, MPH. Dr. Makary is a surgeon at Johns Hopkins, professor of surgery and health policy and management at Johns Hopkins University, and the author of The Price We Pay and Unaccountable. So, this is episode 268. In this particular episode, Dr. Makary and I discuss the situation that will likely play out after the “reactive” phase of this COVID-19 pandemic (ie, March, April, May).  After about June, the pandemic, according to Dr. Makary, will start to wind down a bit; and at that juncture, there’s going to be a backlog of patients who had their elective surgeries postponed and their care journeys potentially interrupted if they required an in-person visit or a lab test or an imaging study that did not happen. There will be a need to prioritize them, something that we have never really done in this country before. This is what we’re going to talk about in this episode: this second phase. Potential point of interest: Episode 267 (the one right before this episode) is about the here and now, prior to the peak, if you want to go back and listen to that when you have time.  You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary.  Martin “Marty” Makary, MD, MPH, is an American surgeon, New York Times best-selling author, and Johns Hopkins health policy expert. He has written for The Wall Street Journal, USA Today, Time, Newsweek, and CNN and appears on NBC and Fox News. He has written extensively on organizational culture, the science of measuring quality in medicine, and health care reform. Dr. Makary is the author of two best-selling books: Mama Maggie, a book about a Nobel Prize nominee, and Unaccountable, a book about health care transparency. He also recently released The Price We Pay: What Broke American Health Care—and How to Fix It. This book offers a road map for everyday Americans and business leaders to get a better deal on their health care and profiles the disruptors who are innovating medical care. Dr. Makary is principal investigator of a Robert Wood Foundation grant to lower health care costs in the United States by creating physician-endorsed measures of appropriate medical care and directs the national “Improving Wisely” project to reduce waste in medicine. He speaks nationally on disruptive innovation in health care. Dr. Makary is a frequent medical commentator of NBC and Fox News, commenting on the health care cost crisis, the impact of new technology, and interpreting the latest medical research for everyday consumers. Dr. Makary is director of the Center for Opioid Research and Education and founder of solvethecrisis.org, a Web site that shares expert opioid prescribing recommendations for common medical procedures for clinicians and patients.  At Johns Hopkins, he has served as the endowed chair of gastrointestinal surgery, director of surgical quality and safety, and founding director of the Johns Hopkins Center for Surgical Outcomes Research and Clinical Trials. Dr. Makary is a surgical oncologist specializing in minimally invasive surgery and teaches health policy and management at the Johns Hopkins University School of Medicine. He currently serves as the chief of the Johns Hopkins Center for Islet Transplantation and director of the appropriateness in medicine project. 02:23 What “normal” will look like in June. 03:46 Why people who need basic medical care right now aren’t getting that care. 06:13 “For the first time, we’ve got to think now about prioritizing which patients need to get in line first.” 07:51 “We see gaming of the system.” 08:05 “We don’t do a good job of prioritizing.” 10:07 Why teamwork and team building are a problem in medicine. 12:57 The incredible heritage of the medical profession. 13:52 Will there be a decrease in outcomes? 14:33 Why lowering insurance deductibles will be key in making successful strides on the other side of this pandemic. 17:23 The great things to come out of the pandemic. 21:41 “Everybody’s right … [they’re just] looking at it from their point of view.” 21:56 What’s in store for pharmacies coming out of this pandemic. 24:53 What hospital executives should be doing, looking and planning months out from now. 25:48 “We’ve never asked ourselves, ‘What would take priority?’” You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary.  Keeping up with #covid19 news, check out our second-part episode with @MartyMakary as he talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech What will “normal” look like come June? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 Why aren’t people getting basic #medicalcare right now? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “For the first time, we’ve got to think now about prioritizing which patients need to get in line first.” @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “We see gaming of the system.” @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “We don’t do a good job of prioritizing.” @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 Why are teamwork and team building a problem in health care? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What is the incredible heritage of the #medical profession? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 Will there be a decrease in #healthoutcomes come June? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 Why will lowering insurance deductibles help ease the coming months? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What positive changes might be coming after #covid19? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech “Everybody’s right … [they’re just] looking at it from their point of view.” @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What’s in store for #pharma coming out of #covid19? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech What should hospital execs be planning for in the upcoming months? @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “We’ve never asked ourselves, ‘What would take priority?’” @MartyMakary talks #healthcare, #hospitals, and #coronavirus in the upcoming months. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19

Marty Makary, MD, MPH, is a surgeon at Johns Hopkins. He’s a professor of surgery and health policy and management at Johns Hopkins University. And he’s also the author of The Price We Pay and Unaccountable. I had the honor of speaking with Dr. Makary last week, and I learned a lot. For one, the worst is between now and June. For two, it’s all about ramping up capacity as fast as possible in our hospitals. We talk a lot, Dr. Makary and I, about what that looks like and what other stakeholders like employers and Pharma can be doing right now in this very, very reactionary phase. Spoiler alert: On Thursday this week, a second episode with Dr. Makary will be out. In this second show, Dr. Makary discusses the next phase of this pandemic when all of the pent-up demand becomes a backlog of patients who need care for everything else besides COVID over the summer. You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary.  Martin “Marty” Makary, MD, MPH, is an American surgeon, New York Times best-selling author, and Johns Hopkins health policy expert. He has written for The Wall Street Journal, USA Today, Time, Newsweek, and CNN and appears on NBC and Fox News. He has written extensively on organizational culture, the science of measuring quality in medicine, and health care reform. Dr. Makary is the author of two best-selling books: Mama Maggie, a book about a Nobel Prize nominee, and Unaccountable, a book about health care transparency. He also recently released The Price We Pay: What Broke American Health Care—and How to Fix It. This book offers a road map for everyday Americans and business leaders to get a better deal on their health care and profiles the disruptors who are innovating medical care.  Dr. Makary is principal investigator of a Robert Wood Foundation grant to lower health care costs in the United States by creating physician-endorsed measures of appropriate medical care and directs the national “Improving Wisely” project to reduce waste in medicine. He speaks nationally on disruptive innovation in health care. Dr. Makary is a frequent medical commentator of NBC and Fox News, commenting on the health care cost crisis, the impact of new technology, and interpreting the latest medical research for everyday consumers. Dr. Makary is director of the Center for Opioid Research and Education and founder of solvethecrisis.org, a Web site that shares expert opioid prescribing recommendations for common medical procedures for clinicians and patients.  At Johns Hopkins, he has served as the endowed chair of gastrointestinal surgery, director of surgical quality and safety, and founding director of the Johns Hopkins Center for Surgical Outcomes Research and Clinical Trials. Dr. Makary is a surgical oncologist specializing in minimally invasive surgery and teaches health policy and management at the Johns Hopkins University School of Medicine. He currently serves as the chief of the Johns Hopkins Center for Islet Transplantation and director of the appropriateness in medicine project. 01:38 What happened that made Marty Makary sound the alarm bells on COVID-19. 03:12 Paul Kennedy’s The Rise and Fall of the Great Powers.04:21 “Everyone has an opinion, but no one’s listening.” 06:00 What the next 4-6 weeks will look like. 08:22 What we should do to support our highest-risk patients: health care workers. 09:16 How long will this initial phase last? 13:10 What business leaders should be doing right now. 16:11 “Critical care generally pays very well.” 17:15 Marty’s concern for rural hospitals. 17:30 “If we’re going to overfund [something], I’d like it to be our hospitals.” 20:54 “I think the pharma industry has also gotten a wake-up call … Maybe we should start working on viruses.” 24:04 “We’re at war with COVID-19 right now.” 25:32 “We need to help researchers that are working specifically on lowering deaths from COVID-19.” 28:23 “Anything that can wait 3 months must wait 3 months.” 30:37 “We need everybody.” 31:38 “Hospitals need to be focused on building capacity, number one.” You can learn more at martymd.com or connect with Dr. Makary on Twitter at @MartyMakary.  In light of COVID-19 news, check out our specially released episode with @MartyMakary, as he talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What made @MartyMakary sound the alarm on COVID-19? Listen to our episode where he talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “Everyone has an opinion, but no one’s listening.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What will the next 4-6 weeks look like? @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 How can we support #healthcareworkers, who are at highest risk for contracting COVID-19? @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 How long will this initial phase last? @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 What should business leaders be doing right now? @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “Critical care generally pays very well.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “If we’re going to overfund [something], I’d like it to be our hospitals.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 The concern for #ruralhospitals. @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “I think the pharma industry has gotten a wake-up call … Maybe we should start working on viruses.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “We’re at war with COVID-19 right now.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “We need to help researchers that are working specifically on lowering deaths from COVID-19.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “Anything that can wait 3 months must wait 3 months.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “We need everybody.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19 “Hospitals need to be focused on building capacity, number one.” @MartyMakary talks #healthcare and #hospital #coronavirus action steps. #healthcarepodcast #podcast #digitalhealth #healthtech #covid19  

This episode was recorded prior to COVID-19 hitting our shores. Irrespectively, it is incredibly relevant. Right now, more than ever, we need physician leadership and we need partnership across organizations and within organizations so that good decisions can be made as fast as possible. Look, we don’t have time to mess around right now. We need to be making good decisions—and fast. And these decisions on digital health solutions and other technologies and processes and workflows need to really be made by those who are participating in the care of patients directly. Or by the patients themselves. Or, best case, by both together working as partners, if you will. It doesn’t go well for all kinds of reasons when decisions about what patient care is going to look like at a macro level are made by the suits and people or departments or companies who are “over there” as opposed to here in the exam rooms. In this health care podcast, I speak with Matt Anderson, MD, MBA. Matt is the innovation lead over at Banner Health. He talks about the importance of physician leadership a lot. And, by that, he means doctors and nurses and other clinicians demanding to be heard and demanding that their point of view be a decision-making criterion in how a care delivery system operates. But as we dug deeper, Dr. Anderson and I, a theme emerged. Along with multiple mentions of the Shkreli Awards and my conversation with Shannon Brownlee and Vikas Saini (which is episode 260 if you want to look back and listen to that), the theme that emerged in the conversation you’re going to hear was the importance not just of physicians in leadership roles but of the scrubs partnering with the suits in almost every leadership decision. Doctors and nurses and administrators really have to work together so that the business is sustainable, for sure, but while patients continue to get the best care—also for sure. One cannot sacrifice the other without consequence. You can learn more at bannerhealth.com and drmatthewanderson.com. You can also connect with Dr. Anderson on Twitter at @DrAnderson19 and on LinkedIn. Matthew Anderson, MD, MBA, is a father, husband, and family physician living in Arizona. He serves as innovation lead and division medical director for Banner Health. Since joining Banner Health in 2018, Matthew has been an active member of the AZBio Government Affairs Committee. By providing primary care medical services to his patients in Arizona, Matthew has seen many of the inefficiencies and difficulties within their health care system. His training at Mayo Clinic taught him what it means to put the patient first, and that focus has stayed with him for every patient encounter. Recently, Matthew completed an MBA program at Arizona State University’s WP Carey School of Business. His goal is to take the foundation he has in good-quality medical care and combine that with an understanding of the economics of health care to use technology to create a better, safer, and healthier medical system. 02:30 Distinguishing between billing technology and technology improving bonds between clinicians. 04:03 “The scribe is literally just there to take the burden of the EMR off the physician.” 04:41 “If all of your goals begin and end with patients, you’re not gonna go wrong.” 06:07 “We gotta get a little bit tribal in medicine.” 06:27 “Physicians have to be leaders in this space.” 07:21 Suits vs scrubs. 08:47 Why low-revenue care is sometimes better than high-revenue care. 13:49 EP260 with Shannon Brownlee and Vikas Saini, MD, from the Lown Institute.16:11 “There’s a role to play for all of our clinical partners in the leadership of our health care systems.” 16:38 “You have to be able to be curious.” 18:35 The movement to humanize medicine with technology, led by Eric Topol. 20:45 Creating a culture where it’s okay to fail. 22:31 Starting the educational process on the business of health care earlier. 25:48 Technology as top-down vs physicians as bottom-up. You can learn more at bannerhealth.com and drmatthewanderson.com. You can also connect with Dr. Anderson on Twitter at @DrAnderson19 and on LinkedIn. Check out our #healthcarepodcast with @DrAnderson19. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Billing #technology vs technology that improves clinician work. @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals “The scribe is literally just there to take the burden of the EMR off the physician.” @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals “If all of your goals begin and end with patients, you’re not gonna go wrong.” @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals “We gotta get a little bit tribal in medicine.” @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals “Physicians have to be leaders in this space.” @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Suits vs scrubs. @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Why is low-revenue care sometimes better than high-revenue care? @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals “There’s a role to play for all of our clinical partners in the leadership of our health care systems.” @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals “You have to be able to be curious.” @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Humanizing #medicine with #technology. @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Creating a culture where it’s okay to fail. @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Educating on the business of health care. @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals Technology as top-down vs physicians as bottom-up. @DrAnderson19 discusses in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #physicians #clinicians #healthsystems #hospitals

There is a lot going on with digital health tools these days. Which ones are the good ones and which ones are nothing burgers packaged up in beautiful marketing? That’s a good question, and it would be nice to have a go-to source for such information. Some parties — mainly PBMs [pharmacy benefit managers] and to some extent payers and providers — recognize that this actually would be nice, and they see that creating digital formularies could be an opportunity to grow revenue for their shareholders by meeting a market need potentially and offering additional services to the marketplace. But the term formulary implies more than just some kind of health technology assessment. It implies, at least at some level, the promise of reimbursement. But given how local health care tends to be, especially when considering patient populations and the “bottom-up” nature of the doctor-patient relationship, here’s the question I have for you: Is it even possible for a third party, disconnected from the care setting and the patient, to “top-down” select the technology which will be used and reimbursed … especially in the age of consumerism? For more on the intersection of patients and provider digital tool selections, listen to episode 250 with Vicky Tiase from NewYork-Presbyterian.  In this health care podcast, I am speaking with Randy Vogenberg, PhD. Randy suggests that a more crowdsourced approach to digital health tool selection might be in order here. He says that those who are using the tools really need to have a seat at the table. He says that possibly the “formulary” within any given organization should be more of a consensus among stakeholders and less of a mandate from on high. But there are a lot of wrinkles … like, lots of wrinkles. Randy Vogenberg is board chairperson at the Employer-Provider Interface Council. He is principal over at the Institute for Integrated Healthcare. You can learn more at iih-online.com, epicouncil.org, and hope.rutgers.edu.  Randy Vogenberg, PhD, is principal at the Institute for Integrated Healthcare, co-leader for the National Employer Initiative on Specialty Pharmacy, and cofounder of the National Institute of Collaborative Healthcare (NICH). He is a health care expert on health system delivery and economics as well as health-related solution innovation research. Most recently he partnered with the Hospital Quality Foundation in developing the Employer-Provider Interface Council (EPIC). His broad hospital and managed care expertise includes current or future trends around financing, market excellence, and benefit management or design. A leader and highly requested speaker on applied health systems research, he has authored programs or books on self-funded health benefits, managed markets, hospitals, and integrated medical-pharmacy benefit management. His academic relationships include Rutgers HOPE Center and former senior fellow at the Jefferson School of Population Health. Currently, he is an adjunct professor at the University of Rhode Island College of Pharmacy and Presbyterian College School of Pharmacy as well as the University of Illinois College of Pharmacy. 02:51 What a digital formulary is. 03:52 PBMs and digital formularies. 04:41 The changing landscape of PBMs and digital health. 06:00 The intersection of PBMs and digital health tools. 10:18 “Arbitrage, full on.”—Mark Blum, from America’s Agenda. 12:21 The inherent differences between a health plan and a PBM. 15:58 The original purpose of a pharmacy/therapeutics committee. 16:58 “There’s a lot of change happening, is the bottom line.” 18:18 The risk assessment behind medical software. 18:29 Harm vs digital therapeutics and digital medicine. 18:52 Cybersecurity in digital therapeutics. 19:08 Reimbursement in digital therapeutics. 19:43 The question of “how” in reimbursement. 20:37 “How do we reset health care in just one state, let alone the whole country?” 22:13 Taxpayers, patients, and employers vs the health care industry. 22:56 The slow move away from fee for service, and why. 24:13 The timeline for incorporating digital tools into the health care system. 24:33 “It’s a real problem for the consumer side.” 25:09 “What’s really going to be worthy of reimbursement?” 25:50 “There’s only two major payers in the health care system … that’s the government, and it’s the private sector employers and state programs or unions.” You can learn more at iih-online.com, epicouncil.org, and hope.rutgers.edu.

It’s kind of a vicious cycle. Payers don’t trust providers to do the right thing and provide appropriate care. And OK, there’s some logic there considering that 25-ish% of health care delivered is low-value or unnecessary. On the other hand, some patients actually need the care and now it’s painstaking for them to get it—and that painstaking part of the sentence is borne by providers, at least logistically. So then the providers learn how to expedite getting their patients care by copying and pasting, and now they’re gaming the system. Then more arduous processes get put in place, and now good physicians get caught in the same net as the less good ones and they begin to spiral toward moral injury and burnout. Let’s get to the bottom of this. In this health care podcast, I speak with Ron Wince, CEO of Myndshft. You can learn more at myndshft.com or follow Ron on Twitter at @RWince.  Ron Wince is founder and CEO of Myndshft Technologies in Mesa, Arizona. An engineer by training, he has two decades of experience automating and optimizing time-consuming health care administrative tasks and has held executive positions at leading financial, manufacturing, outsourcing, and customer experience companies. Ron created Myndshft with a singular but ambitious goal: to fix the “administrative plumbing” that keeps health care stuck in the past. They are working at the intersection of blockchain and artificial intelligence (AI). Through CognitiveBus, a first-of-its-kind cognitive blockchain platform, Myndshft Technologies is simplifying enterprise-grade AI and unlocking the insights hidden in the massive and growing data universe. 01:29 What is a prior authorization? 02:45 The three reasons payers put prior authorization in place. 02:49 Cost, medical necessity, and compliance. 04:24 EP200 with Stacey Worthy.05:15 “Clinicians are really managing clinicians in a lot of ways.” 05:41 Why the prior authorizations system sometimes fails patients and payers. 08:13 Surprise care—can it be avoided? 09:53 The impact on providers. 14:52 The impact on patients. 16:46 Specialty pharmacy and prior authorizations. 18:43 Shkreli Awards (EP260).19:25 The most complex prior authorizations. 21:03 E-prior authorizations. 24:19 Gold carding and what that is within prior authorizations. 28:08 The “chasm of trust.” 29:11 Myndshft and its goal to solve prior authorization issues. You can learn more at myndshft.com or follow Ron on Twitter at @RWince.

Here’s the thing: All the top-performing Medicare Advantage plans are using, today, right now, some form of advanced analytics and artificial intelligence (AI) to risk-stratify their populations and predict which members will, without intervention, become high cost in the near term. The idea is then to intervene to mitigate risk and stop bad things from happening—bad things that stink if you’re the patient and also cost a lot if you’re the plan. That’s what population health management is all about, after all. Others using AI, right now, to do the kind of predictive analytics that you need to excel at pop health include PCP groups and other providers, mainly those at risk to manage populations or readmissions. In this health care podcast, I talk with Andrew Eye about AI. Andrew is CEO over at ClosedLoop. I get to ask Andrew some of the hard questions that have been bothering me about all the AI hype, and he set me straight a couple of times. Love it when that happens. You can learn more at closedloop.ai or by following Andrew (@andreweye) on Twitter.  Andrew Eye’s executive and entrepreneurial experience spans over 20 years in business to consumer and business to business for start-ups and Fortune 500 companies. Andrew founded and sold three technology companies and today is the CEO and founder of ClosedLoop.ai. In 2017, Andrew founded his fourth technology company, ClosedLoop.ai. ClosedLoop.ai is a next-generation predictive analytics platform provider leveraging the latest in artificial intelligence and machine learning technologies to rapidly create predictive models from diverse sources of raw, messy, real-world health care data. Prior to founding ClosedLoop, Andrew cofounded the mobile software company Boxer. Boxer developed mobile productivity software for individuals and large corporations. Boxer’s flagship email product was downloaded by millions of users and received significant industry praise for its exceptional user interface, including a 2015 Webby nomination as one of the top 5 productivity applications in the world. Boxer was purchased by VMWare (one of the top 10 largest software companies in the world) in 2015. Prior to Boxer, Andrew cofounded the cybersecurity firm Ciphent in 2007. Ciphent grew to nearly 100 employees with 1000 customers by 2010 before being acquired by Accuvant (now Optiv). With a three-year growth rate of 8900%, Ciphent was recognized by Inc. magazine as the 16th fastest-growing private company in the United States. During his tenure as SVP of services at Accuvant, Andrew oversaw a $50-million, 200-person organization and was responsible for doubling revenues in 18 months. Andrew also served as CEO of Bodkin Consulting Group, where he worked with Fortune 500 brands and technology companies to define their interactive marketing strategies. Andrew began his career as a software architect working with NASA, i2 technologies, and the US Marine Corps. Andrew graduated summa cum laude from Virginia Tech with a degree in management information technology. Andrew lives in Austin, Texas, with his two daughters and champion “Dock Dog” Sophie. 01:50 Artificial intelligence in health care, and the different things that this means to the health care community. 02:06 Image analysis, also known as replacing doctors with robots. 02:25 Chatbots for health care. 02:43 Predictive analytics. 04:39 “What they really care about is, How can this impact our business? How can this improve patient lives?” 04:51 “For us, this is all just better math.” 08:13 What exactly predictive analytics is. 08:40 The use cases of predictive analytics value. 11:33 The oversimplification of how people think about risk. 13:13 “Did you have an impact or not?” 13:27 The public scorecard for predictive analytics. 18:16 “Explainability is a real hot topic in artificial intelligence, specifically in health care.” 19:46 Data shaming—what’s wrong with it, and why incomplete data are still important. 21:53 The possibilities that machine learning allows for in patient care in health care. 28:08 “Our health care system can’t afford for that level of inefficiency.” 29:21 “It’s not a question of if; it’s a question of when.” 30:37 The diminishing returns of interoperability and more data for machine learning. 33:54 “You’re running your business today, and whatever data you’re using to run your business … you can use it to provide better patient care.” 34:34 Andrew’s advice: Get started now. You can learn more at closedloop.ai or by following Andrew (@andreweye) on Twitter.

The World Bank had a revelation a few years back. Some very smart people working there realized that countries that were easy to do business with thrived. Within these countries’ business ecosystem, the best and the brightest entrepreneurs and investors grew not only their own businesses but also positively influenced other businesses and the community around them. Brian Van Winkle and Rishab Shah, both executives at Johns Hopkins, had their own revelation: Health systems who are easy to do business with attract and enable the best and the brightest start-ups or other entrepreneurs who are able to do great work within their walls, with their patients, and with their clinicians. It’s becoming fairly axiomatic at this juncture that provider organizations—along with payers, by the way—cannot be good at inventing and innovating absolutely everything that’s possible to conceive of and develop. It is impossible for any group, no matter how dynamic and forward thinking and awesome, to be better than everybody else at everything. For this reason, the idea of health systems and payers becoming great aggregators of amazing tech and services is definitely gaining traction. This would include internally developed as well as externally sourced technology and services. Listen to Rahul Dubey in episode 259 for more info on this evolution in the payer space. But back to Brian and Rishab. They spotted this trend in its early days and also saw the issues that health systems face and will face as the ease of doing business becomes more and more of a rate critical of success. Thus was born the Ease of Doing Business Initiative, health care–style, based on the World Bank’s Ease of Doing Business model. In a nutshell, what the World Bank did in their Ease of Doing Business Initiative is they came up with a set of measures and hived those measures into categories and then they ranked countries against those measures. Brian and Rishab decided to do the same thing. They created a list of questions for health systems to self-rank (at least initially) themselves on how well they did within these seven categories of measures. Twelve to fifteen of the leading health systems agreed to participate. Most are members of NODE.Health, where Brian is the former executive director. And this Ease of Doing Business Initiative is under the NODE.Health umbrella.  In this health care podcast, Brian and Rishab speak only for themselves during this interview. They do not speak for their employer or anybody else. (Note: I also interviewed Brian and Rishab at the NODE.Health Digital Medicine Conference.) You can learn more at the Sibley Innovation Hub (@SibleyHub) on Twitter or by connecting with Brian and Rishab on LinkedIn. Brian Van Winkle, MBA, is the executive director of innovation at the Sibley Innovation Hub. His focus is on transforming the health care system by being a conduit between passionate clinicians and some of the most advanced solutions emerging around the world. Brian brings more than 10 years of experience helping some of the most complex health care systems in the world with transformation, process improvement, and strategy design. Brian has a dual degree in economics and English from the University of Virginia and earned his MBA at Fuqua School of Business at Duke University. Rishab Shah, MHS, is the head of digital innovation and strategic partnerships at the Sibley Innovation Hub. He leads the Hub’s charge in development, implementation, and oversight on driving innovation through strategic partnerships with emerging technologies around the world as senior manager of tech innovations. Rishab is a strategist inspired to innovate while empowered to create. He has helped companies around the world with corporate strategy, business operations optimizations, and large-scale technology transformations—primarily within the health care and life sciences industries. Rishab has a bachelor’s degree in biomedical engineering from Virginia Commonwealth University and a Master of Health Science from Johns Hopkins University. 03:46 Focusing on “outside-in” innovation. 04:09 The downside to hospitals and health systems not being easy to work with. 05:17 “You have to acknowledge that we’re in a crisis state.”—Brian 06:56 “Are we putting ourselves at a disadvantage by not … being easy to interface with?”—Rishab 08:25 Why hospitals might not be so easy to work with right now. 09:11 The correlation between a partnership strategy and health outcomes and metrics that matter. 09:42 The gap between health care players’ workload and collaboration. 12:04 “Who is putting the focus on the requirements?”—Rishab 12:44 What the Ease of Doing Business Initiative is. 14:56 The opportunity for entrepreneurs to be involved in this process. 16:07 Ecosystem-based work groups. 17:22 “What box do you exist in?”—Brian 18:29 The seven success factors an organization needs to be good at to improve their ease of business. 18:53 Customer support and governance. 19:02 Contracting and legal. 19:11 Patient safety and clinical research. 19:21 Integration and technology. 19:27 Data security and availability. 19:32 Commercialization support. 19:39 Industry perceptions. 21:04 How health care systems view their own ease of doing business. 25:20 The intent of the Ease of Doing Business Initiative. 28:39 Outside innovation vs comprehensive innovation strategies. You can learn more at the Sibley Innovation Hub (@SibleyHub) on Twitter or by connecting with Brian and Rishab on LinkedIn.

Fred Goldstein, President and Founder of Accountable Health, LLC, discusses the steps to achieve population health, including the importance of precision medicine, meaningful questions for patient surveys, stratification and interventions, addressing healthcare issues, and the role of providers in population health and value-based care.

In this health care podcast, Josh LaRosa from the Wynne Health Group is back to give us an update on the snowball of drug pricing initiatives zigzagging their way around Washington right now. For the details, listen to episode 243. That’s where we really drill into the details. This conversation is more of a status report. (Note: This episode was recorded on February 6.)  You can learn more at wynnehealth.com or reach out to Josh at josh@wynnehealth.com. Josh LaRosa, MPP, is a policy director at Wynne Health Group, focusing primarily on regulatory affairs with a focus on the US Food & Drug Administration (FDA) and Centers for Medicare & Medicaid Services (CMS). His interests lie in delivery reform and innovations in payment and care delivery models. Josh also supports the firm’s Public Option Institute, which studies the emergence of public option programs at the state level. Prior to Wynne Health Group, Josh consulted for the CMS Innovation Center, where he worked to implement, monitor, and spread learning garnered from the center’s high-profile demonstration projects, most recently including the national primary care redesign effort, Comprehensive Primary Care Plus (CPC+). Josh holds a Master of Public Policy from the University of Virginia’s Frank Batten School of Leadership and Public Policy. He also completed his undergraduate studies at the University of Virginia, graduating cum laude with a BA in political philosophy, policy, and law. 01:01 Updates on the drug pricing front on the national level. 01:44 The three major updates on national drug pricing. 01:48 Part D redesign legislation. 02:54 Giving private industry more stake in the game of keeping costs lower. 03:01 Check out EP243 for more info on drug pricing deals.05:18 The legislative deadline for any of these drug pricing bills to take place. 06:39 The International Pricing Index Model. 08:49 The administration’s importation plan. 10:13 The end of the comment period and how long stakeholders have to give their input on the importation plan. 12:29 Updates on 340B hospitals and Health & Human Services (HHS). You can learn more at wynnehealth.com or reach out to Josh at josh@wynnehealth.com.