Relentless Health Value

Last week I was invited to attend and present at a Rare Disease Roundtable hosted by Health Catalyst and McDermott Will & Emery in Boston. A colleague from Aventria Health Group and I were there to talk about ways to enlist stakeholder collaboration throughout the rare disease patient journey. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders and, most of all, the patient. 00:43 The rare disease patient journey. 02:03 The burden to stay on top of clinical developments falls on patients. 02:14 The major problem with patients tracking clinical developments in rare disease. 03:42 Stacey’s personal journey with a rare disease. 06:19 These stories aren’t unique; there’s a hard reality around rare disease management and treatment. 06:37 “Rare disease management takes stakeholder collaboration.” 07:00 “Payers … need to pay for evidence-based approaches.” 08:04 Rare disease management requires coordination between points of care. 08:57 The tough ask behind improving rare disease management. 09:41 Why Pharma is primed to affect organizational change. 10:50 “It is less about an individual patient … and more about a population of patients.” 11:34 The effort required to collaborate to treat rare diseases has to be less than or equal to the perceived reward. 12:06 “What Pharma needs to offer up is more than a molecule.” 12:47 Account managers, go to aventriahealth.com for blog posts on helping account managers develop the skill set to create collaborative relationships. 13:28 It is best to include clinical trial endpoints in the package insert that reflect institutional and/or payer needs.  

The Society for Integrative Oncology recently completed a systematic evaluation of peer-reviewed randomized clinical trials for patients with breast cancer. The researchers assigned letter grades to therapies based on the strength of the evidence. Meditation got an A; it had the strongest evidence supporting its use. Music therapy, yoga, and massage received a B grade. Hypnosis got a C. By the way, the letter grade varied depending on the symptoms that were involved. You can go on the website of the Society for Integrative Oncology if you want to look up the trial itself. So, here’s my question: Are insurance carriers paying for music therapy, meditation, and yoga? How about cooking classes? Some are, generally if it’s part of the services provided by the cancer center. It’s striking, though, that every single insurance carrier will pay for the downstream costs of unfettered anxiety, stress, poor nutrition … you get the idea—things that an integrative oncology focus would aim to attenuate. Do employers know about integrative oncology? I think I’d rather have an employee on a cocktail of music therapy and yoga than a cocktail of pretty much anything else. I’m thinking about this because if these therapies are not covered benefits, then I’m going to doubt that the middle-of-the-bell-curve employees or patients can afford them. Who’s going to “splurge” on meditation classes when GoFundMe has a whole section to help people pay for their traditional cancer care? Today I speak with Glenn Sabin, an integrative oncology consultant at FON Consulting. Glenn is a nationally recognized thought leader with a reputation for successfully positioning integrative health organizations for sustainable growth. You can learn more at fonconsulting.com and glennsabin.com. Glenn Sabin is director of FON Consulting, a leading strategy and business development consultancy specializing in the integrative health and medicine sector. FON’s clients span from medical practices, hospitals, and health systems to nutraceutical, pharmaceutical, and media companies. Glenn brings economic and moral clarity to the misnomer that health creation and promotion cannot align with profitability. 

It is pretty much inarguable that happy customers are a prerequisite for business success. And that’s true in health care as much as it’s true in every other industry—although in health care, sometimes the customer is also called a patient. Provider organizations like Cleveland Clinic are really walking the walk when it comes to creating amazing patient/customer experiences; so are other leading provider organizations. But in other segments of the health care industry, maybe they haven’t quite connected the dots between the idea of satisfying customer needs in the abstract and then what that actually looks like relative to a strategic approach. Let me give you an example—certainly not all pharmaceutical manufacturers: Here’s where key performance indicators, or KPIs, come in. Everything we do should really be derived from what customers need and expect. This could be considered our North Star. And that’s why creating KPIs that focus on how well we are doing delivering on great customer experiences over the long run delivers superior market returns and patient outcomes and patient satisfaction. My guest today on the podcast is Jon Skinner, who is an executive vice president at The Verde Group. Jon’s message is that your KPIs—if they are done right, in any case—should tell you if you are delivering on a set of customer expectations that are going to lead you to your vision of what success looks like. The Verde Group is a market research firm that specializes in quantifying the customer experience, in case you have not heard of them. I met Jon, by the way, at the PanAgora Pharma CX conference this past spring. You can learn more at verdegroup.com. Jon Skinner is executive vice president with The Verde Group, a customer experience (CX) research consultancy focusing on the financial quantification of customer experiences. Jon works with market leaders across the pharmaceutical and health care space to help them identify the specific customer experiences most consequential to revenue and share growth, and then to develop CX improvements that sustainably grow customer value, build brand equity, and develop customer-centric cultures. 

Will the Health and Human Services (HHS) proposal materially impact Pharma’s ability to “pay to play” on pharmacy benefit manager (PBM) formularies? We have that HHS proposal that is now at the stage where they’re trying to figure out how to implement it. What’s at stake right now is that implementation flowchart and who exactly is involved in adjudicating the something like $186 billion in potential charge-backs. Since any middleman who gets himself involved in any flowchart of this sort takes a buck, there is a massive land-grab opportunity that all these heretofore hidden players are battling over. My guest today, AJ Loiacono, CEO at Capital Rx, can shed light on the hidden complexity of what goes on in the dark middle of a pharma drug transaction and contracting—and that is very relevant right now. Anthony J. “AJ” Loiacono is a successful entrepreneur, with over 20 years of experience in pharmacy benefits, finance, and software development. As the CEO of Capital Rx, his mission is to change the way pharmacy benefits are priced and administrated in the United States. Prior to Capital Rx, AJ was a co-founder of Truveris, where he served for 8 years as CEO, chief innovation officer, and board member, leading the company to record growth. 

Today I’m talking with John Lynn, founder of Healthcare Scene as well as two conferences, Expo.Health and HITMC. If I was going to frame out an overarching theme, I would suggest that it is this: Organizational culture eats strategy for breakfast, lunch, and dinner. Let’s consider the scope of this statement: Ambulatory patients spend about 84 minutes on average in clinic. Of those, 7-12 minutes are with a physician. Inpatient, I imagine, has probably an even greater ratio. So those 7-12 minutes are hypercritical, of course. I would never suggest anything that minimized the doctor-patient relationship. But how many times has a doctor’s patient grade gone down because of someone nasty at the front desk? All of the other individuals that a patient meets in the non-doctor portion of their visit, all of the moments that happen in that time frame, all of the care coordination that does or does not happen ... all these things have a significant and meaningful impact on not only the patient experience but also patient outcomes. So, how do you get the front desk and the back office and the middle office and anyone on the phone to recognize the importance to the mission of attaining the quadruple aim of health care? How do you get the janitorial staff to see their role as crucial in the prevention of health care–associated infections (HAIs)? The IT team to feel proud that they have helped with physician burnout by making the tech help doctors instead of slow them down? Or the finance team to consider the financial toxicity of their actions? Or the medical assistants to enter the correct blood pressure or whatever data so our predictive analytics actually work? The answer to all of these questions points back to strong leadership. It’s building a culture of love, as John Lynn puts it. He means aligning around a mission to do right by patients and give them the best care and outcomes that we can. Consider this, though: A culture of love can be within one organization, but it can also be cross-organizations. Peers come together and share their experiences and their best practices for the purpose of improving patient care. Then they can take their enthusiasm and passion back to their own organizations. Doing this disperses a culture; it promotes a way of thinking that connects day-to-day drudgery with an endpoint that we all can be proud of. I don’t think it’s controversial to say that establishing a real culture of love is the best way to achieve patient health in health care, a better patient experience, fewer burned out doctors and nurses, as well as other business results. If you’re interested in how all this connects to patient experience, by the way, listen to EP228 with Julie Rish. John Lynn is the founder of the HealthcareScene.com network, which currently consists of 10 blogs containing over 11,000 articles, with John having written over half of the articles himself. These electronic medical record– and health care IT–related articles have been viewed over 18 million times. John also manages HealthcareITCentral.com and HealthcareITToday.com, the leading career health IT job board and blog. He also organized the first-of-its-kind conference and community focused on marketing to health care: HealthITMarketingConference.com. Plus, he launched Health IT Expo, a conference focused on practical health care IT innovation. John is an adviser to multiple health care IT companies and a highly sought-after keynote speaker. John is deeply involved in social media and, in addition to his blogs, can be found on Twitter at @techguy and @ehrandhit.

No one denies that it’s a tough world out there for health start-ups. Finding a customer is tough, financial models are tough to figure out, operationalizing is tough. But the same is true for those other health care stakeholders attempting to purchase and implement the innovations start-ups are creating. Here’s another unassailable truth: Everything is just easier within a supportive community. You gain feedback, mentorship, networking opportunities, and maybe just a venue to sob into your beers together. Today I speak with Alex Fair, managing partner at MedStartr Ventures and CEO of MedStartr. MedStartr is a community for health tech entrepreneurs that also provides venture capital to crowdsourced contest winners. And spoiler alert, the one core skill all successful start-up teams possess is listening. The ability to listen. You can learn more at medstartr.vc, medstartr.com, and medstartr.nyc, or call Medstartr at 530-MedStartr. Alex Fair is the founder and CEO of MedStartr. He originally trained as a scientist, working in physics, then cancer, and finally in heart disease research. In the 1990s he had an idea for a company that took off, so he finished off his last paper and came into the world of business. MedStartr is his seventh start-up. 

Let’s talk about the opioid crisis for a moment. When we say the words “opioids crisis,” as a general broad stroke, many people immediately picture somebody who lives under a bridge. But that actually wouldn’t be your average profile of someone with a substance misuse/opioid problem. The average profile of someone with an opioid/substance misuse profile looks exactly like an employee. In fact, 75% of adults up to the age of 64 with a misuse issue are in the workforce. And the cost to an employer of someone addicted to a long-acting opioid such as oxycontin is $117,000, on average, if you count the medical spend and loss of productivity. My name is Stacey Richter. I am the host of the Relentless Health Value podcast and co-president of a cause-driven organization called QC-Health®. We started QC-Health® to do what we can to improve the state of health care in this country today, which is, by the way, the mission of this podcast as well. You can learn more at QC-MyMeds.org. When not hosting the show, Stacey is co-president of Aventria Health Group, a marketing agency and consultancy. Aventria specializes in helping pharmaceutical, employer, pharmacy, and health system clients improve patient outcomes by creating and leveraging collaborations with other health care organizations. For more than 20 years, Stacey has innovated better-coordinated health solutions benefiting all stakeholders, and, most of all, the patient. 01:46 One of the programs QC-Health® is sponsoring—QC-MyMeds™. 02:10 SinfoníaRx—one of the most well-respected medication therapy management (MTM) providers in the country. 02:23 What QC-MyMeds™ essentially is. 02:55 Why QC-Health® thought it was important to take a proven program to even the smallest employer. 03:57 How QC-Health® aims to helper smaller employers. 04:08 The QC-MyMeds™ approach. 05:51 “This program does not aim to boil the ocean.” 06:02 “The problem with opioids is that they change your brain chemistry.” 06:29 Connecting the dots between service programs and employees who need them. 07:01 Eliminating barriers for small employers. 08:49 Stacey presented QC-MyMeds™ at the World Health Care Conference. You can learn more at QC-MyMeds.org.

There’s a great video of Steve Jobs responding to an audience question that is, at a minimum, let’s just say strident. Jobs kind of ignores the aggressive nature of the query and offers a thoughtful response which is super relevant to health care. He says, “One of the things I’ve always found is that you’ve got to start with the customer experience and work backwards to the technology. You can’t start with the technology and try to figure out where you’re going to try to sell it.” I don’t know about you, but I find this quote over-the-top relevant in health care. In health care, when we contemplate changing the workflow or integrating some technology or building some technology or whatever else we’re up to, how many times are we starting from the perspective of the patient or member? How often is the patient the “why” behind “why are we prioritizing this?” I wonder, in the health care industry, how many meetings go on about what patients want with no patients in the meetings and no real consideration to that end. As a data point, probably twice a week I hear of a new program, product, service, device, digital something or other that has zero or only a few patients using it because only after development did anyone check with patients what they think about the thing. And then sometimes the patient gets blamed and labeled nonadherent to something they didn’t want in the first place. I met Julie, by the way, at the PanAgora CX conference this past March. You can connect with Julie on Twitter at @julie_rish. Julie Rish, PhD, is a clinical psychologist for the Bariatric and Metabolic Institute at the Cleveland Clinic. 

If you don’t know the nuts and bolts of the current Health and Human Services (HHS) proposal to nix Pharma’s ability to pay pharmacy benefit manager (PBM) rebates, then it’s possible you might want to listen to EP216 with Chris Sloan first. In this episode, we don’t talk much about the impact of the HHS proposal on patient premiums or drug costs. That’s EP216. What we do talk about today is the impact on pharmaceutical companies. We also discuss the drug-buying transaction. Kuo Tong is my guest today. Kuo is a managing director in the life sciences practice of Navigant, focusing on how pharma companies interact with insurance companies and get reimbursement for their drugs. And that’s actually the burning question we aim to answer today: Will Pharma’s interactions with and reimbursement from insurance companies change after this proposed HHS rule goes into effect, assuming it goes into effect? We also talk about what Pharma could and should be doing right now to improve the odds of a smooth transition into a new contracting model. You can learn more at navigant.com, connect with Kuo on Twitter at @NavigantHealth, or email him at kuo.tong@navigant.com. Kuo Tong is a managing director in the life sciences practice of Navigant and oversees its US Market Access Center of Excellence. He joined the firm in November 2017 to lead a team focused on health economics, pricing, and market access engagements. 

Today I speak with Devon Herrick, PhD, who is an expert in surprise billing. Devon is a health care economist and public policy analyst who has authored many articles on surprise billing. You’ll find some links in the show notes. Devon is also an adviser to the Heartland Institute, which is a free-market think tank. I find it incredibly thought provoking that a free-market think tank, for reasons we discuss in this podcast, finds unfettered market-driven surprise billing as egregious as the most progressive socialists do. Handshaking across aisles everywhere. If you’re a hospital or insurance carrier executive, what are you doing right now in light of all this public attention and legislation? I hope your response includes actions to protect your patients—and not just an industry-centric lobbying effort. You can learn more and connect with Devon on Twitter at @DevonHerrick or on Facebook at Devon Herrick.   Devon M. Herrick, PhD, is a health economist and former hospital accountant. He is currently a health policy adviser for the Chicago-based Heartland Institute. Dr. Herrick worked for the Dallas-based National Center for Policy Analysis (NCPA) for 21 years until it ceased operations in 2017. He also served two terms as chair of the Health Economics Roundtable of the National Association for Business Economics (NABE). Dr. Herrick focuses on health insurance issues, including state health care regulations, federal health reform, managed care, Medicare, Medicaid, and the uninsured. He also researches issues such as consumer-driven health care, telemedicine, medical tourism, pharmaceutical economics, and emerging trends in retail medicine.