Relentless Health Value

It turns out, patient-centric care that produces outcomes patients care about is usually less expensive than care that is not. The Patient-Centered Outcomes Research Institute (PCORI), an independent nonprofit, nongovernmental organization in Washington, DC, was authorized by Congress in 2010. PCORI was established to fund research that can help patients make better-informed decisions, guided by clinicians, payers, and others. In other words, help nudge health care into a patient-centric place, for the good of everyone involved in a quadruple aim sort of way. Since December 2012, PCORI has funded hundreds of studies that compare health care options to learn which work best, given patients’ circumstances and preferences. Today I speak with Dr. Joe Selby, executive director of PCORI. You can learn more at PCORI.org. Joe V. Selby, MD, MPH, is the executive director of the Patient-Centered Outcomes Research Institute (PCORI). A family physician, clinical epidemiologist, and health services researcher, Dr. Selby has more than 35 years of experience in patient care, research, and administration. He is responsible for identifying strategic issues and opportunities for PCORI and implementing and administering programs authorized by the PCORI Board of Governors.

“Those who say it cannot be done are usually interrupted by others doing it.” That’s a James Baldwin quote to keep in mind while considering employers ginning up real change in the health care industry. Generally speaking, employers who still don’t believe they could have an impact helping their employees get better health care at lower prices, don’t listen to this podcast. But if they did, I’d suggest this James Baldwin quote is apropos. It’s probably also apropos for providers, carriers, Pharma … anyone who isn’t paying a whole lot of attention to the success of organizations like Catalyst for Payment Reform. Americans, meaning employees, can no longer afford their health care. Deductibles are higher than savings, basically meaning that employees have health plans they can’t even afford to use; and it costs as much as a midsize sedan—a new one every single year. Furthermore, we have employer health care spend chewing up raises. Employers and their CFOs are increasingly in a position where they have to act. It’s no longer an option. I speak today with Suzanne Delbanco, PhD, executive director of Catalyst for Payment Reform. In one of her past lives, Suzanne was the founding CEO of The Leapfrog Group. You can learn more at catalyze.org. In addition, for a curriculum of podcasts to get you up to speed on what’s happening in the employer space, check out this blog post. Suzanne Delbanco, PhD, is the executive director of Catalyst for Payment Reform (CPR), an independent, nonprofit corporation working to catalyze employers, public purchasers, and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. In addition to her duties at CPR, Suzanne serves on the advisory board of The Source on Healthcare Price & Competition at the University of California–Hastings and the Blue Cross Blue Shield Institute. Previously, she was the founding CEO of The Leapfrog Group. Suzanne holds a PhD in public policy from the Goldman School of Public Policy and an MPH from the School of Public Health at the University of California–Berkeley.  

Last time I looked this up online, there were more than 5000 companies offering digital medicine tools. Which ones worked? Which ones are less good than others? Which ones have not been tested? How were they tested: apples to apples or a whole fruit basket of standards? If you’re a clinician or the head of population health or an insurance carrier and you’re trying to figure out whether a digital tool could help solve a problem your patients are having … at this juncture, may the force be with you and I hope you know how to use Excel. The Digital Therapeutics Alliance (DTA) aims to put definitions and standards around what can be legitimately called a digital therapeutic and how these tools are best deployed so that patients are best equipped to get the best possible outcomes. Today I speak with Megan Coder, executive director of the Digital Therapeutics Alliance. You can learn more at dtxalliance.org. Megan Coder, PharmD, MBA, is executive director of the Digital Therapeutics Alliance (DTA), whose mission is to broaden the understanding, adoption, and integration of clinically validated digital therapeutic solutions into mainstream health care through education, advocacy, and research. With more than a decade of experience in the health care industry, Megan’s expertise extends from strategic growth and partnership development within the digital health sector to the direct delivery of patient care.

Say you’re a provider, an insurance carrier, a pharma company … and you’ve realized that you need to innovate to reduce costs and deliver better care. Or hedge against an upstart showing up on the scene and disrupting your good thing. Or ensure that your risk-based contracts go well. It’s one thing to cerebrally decide to be innovative and another thing to get your organization to actually do innovation and, arguably just as importantly, cross the “o-gap” or the “operationalization gap,” as my guest today, Naomi Fried, puts it. Naomi is the CEO of Health Innovation Strategies, which she founded after a storied career with innovative greats such as Kaiser Permanente, Boston Children’s Hospital, and Biogen. You can learn more at healthinnovationstrategies.com. Naomi Fried, PhD, is an innovative and digital health thought leader and founder and CEO of the boutique advisory firm, Health Innovation Strategies, which focuses on innovation program design and digital health strategy. Naomi was the first vice president of innovation and external partnerships at Biogen, the first chief innovation officer at Boston Children’s Hospital, and vice president of innovation and advanced technology at Kaiser Permanente. She served on the board of directors of the American Telemedicine Association and the Governor of Massachusetts’ Innovation Council.

“Dr. Google” has a bad rap in some health care circles. If you doubt my words, go on Instagram and do a search for “Doing battle with Dr. Google.” But let me give you a tip: Pretending Dr. Google doesn’t exist or telling patients to quit it with the internet—these are tactics that are always followed by #doomed. The best way to help your health care brand, organization, and clinicians and patients is to ensure that patients can find credible, accurate content on the internet, which they will be searching whether you like it or not. Another way to help your health care brand, organization, and clinicians and patients is to help patients and their families better process and use the information that they do find on the internet. Today I speak with Chris Cullmann, head of innovation and engagement at Guidemark Health. Chris offers up some key insights and practical advice to help you help patients and clinicians. Chris also curates a great Twitter and LinkedIn feed. You can learn more at guidemarkhealth.com, or find Chris on Twitter at @cullmann and LinkedIn at Cullmann. Chris Cullmann is the head of innovation and engagement at Guidemark Health, a leading marketing agency. Chris is a veteran in digital marketing with more than 2 decades of experience. Health care has been a focus of his career, technology a passion, and strategy a craft. A career in professional communication has allowed Chris to explore emerging platforms, channels, and data to create industry-leading customer experiences. Chris is actively involved in the health care innovation space and is an evangelist for the adoption of digital in health care.

Today we’re talking episodes of care payment models, otherwise known as bundled payments. Just to catch you up if you’re unfamiliar, this type of payment model means that a health care provider packaging together all the services needed during an episode and charges a guaranteed price for guaranteed quality of care. If we’re talking about government payments, about 50% of, for example, knee surgeries are paid for right now in an episode of care fashion. In the private pay landscape, that number is lower but growing. Bundles have advantages to purchasers (ie, employers or taxpayers who are the ultimate payers) because it’s possible to predict and compare the target price they’ll pay. But it’s also important for consumers who are partial payers in most cases. Bundles make health care prices transparent in a way that fee for service (FFS) can never manage. Today I speak with François de Brantes, senior vice president at Remedy Partners and a noted expert in episodes of care and bundled payment initiatives. François also actively supported the launch of the Leapfrog Group, created Bridges to Excellence, and led the development and implementation of PROMETHEUS Payment. You can learn more at remedypartners.com. François de Brantes is senior vice president of commercial business development at Remedy Partners. He has spent nearly 20 years advocating for, and working to transform, the US health care system by improving incentives for providers and consumers to encourage value-based decisions. Prior to joining Remedy Partners, he was executive director of the Health Care Incentives Improvement Institute (HCI3), a not-for-profit company that designed programs to motivate physicians and hospitals to improve the quality and affordability of health care delivery. Early in his career at General Electric, he was involved in many strategic programs that rewarded providers for better performance. He has written extensively about the topic, including his 2013 book, The Incentive Cure: The Real Relief for Health Care.

Arshad Rahim, MD, MBA, FACP, is a practicing physician and a health economist at his core. He enjoys a track record of building innovative health care businesses, including Mount Sinai Health Partners, Healthgrades, and Sg2. As the senior medical director for population health at Mount Sinai Health System, Dr. Rahim is responsible for driving physician performance for 3000 physicians within the Mount Sinai Clinically Integrated Network, focusing on key utilization, cost, and quality metrics. Dr. Rahim has a bachelor’s degree in economics from Duke University, an MD from the University of North Carolina, and an MBA from Emory University. He completed his internal medicine residency at Yale University and Northwestern University and is an actively practicing hospitalist at the Mount Sinai Hospital.

Ram Raju, MD, brings vast executive leadership experience and a keen understanding of New York’s health care delivery system to Northwell Health. As senior vice president and community health investment officer, he evaluates the needs of Northwell’s most vulnerable communities and provides solutions for them by collaborating with community-based organizations. He’s responsible for promoting, sustaining, and advancing an environment that supports equity and diversity, and helping the health system eliminate health disparities. Prior to Northwell, Dr. Raju served as president and CEO of NYC Health + Hospitals from January 2014 to November 2016. Dr. Raju also served as CEO for the Cook County Health and Hospitals System in Chicago, the nation’s third-largest public health system, where he improved cash flow by more than $100 million and changed the system’s financial health during his tenure from 2011 to 2014. Dr. Raju served as vice-chair of the Greater New York Hospital Association and currently sits on the boards of numerous city, state, and national health care organizations, including the American Hospital Association, the New York Academy of Medicine, and the Asian Health Care Leaders Association. Dr. Raju earned a medical diploma and Master of Surgery from Madras Medical College in India. He underwent further training in England, where he was elected as a Fellow of the Royal College of Surgeons. He later received an MBA from the University of Tennessee and CPE from the American College of Physician Executives.

Steve Watson, CPA, SHRM-SCPAs a CFO/CHRO, Steve was frustrated each year with rising health care costs for his employer and employees. In 2012, he decided to make a change. First, he decided to fix the misaligned incentive that he had with his broker. Then he and his broker moved on to fixing the way his insurance was purchased from the insurance carriers. Now Steve is sharing this process with other employers through his consulting company Summit Path Group, whose mission is to lower employee benefit costs by sharing best practices from around the country with local employers and advisers. For more information on direct primary care, listen to EP184 with Alex Lickerman, EP198 with Eric Parmenter, and EP215 with Caroline Znaniec.

Chris Sloan is an associate principal at Avalere Health, a Washington, DC–based nonpartisan consulting firm. He advises a number of clients—including pharmaceutical manufacturers, health plans, providers, and patient groups—on key policy issues facing the health care industry. His particular areas of expertise include drug pricing, the Affordable Care Act, generics, and biosimilars. Additionally, Chris is a recognized expert in the health care policy issues facing people living with HIV/AIDS and multiple sclerosis. Chris’s economic analyses of key policy proposals and issues, including drug pricing and the repeal and replace efforts around the Affordable Care Act, have been featured in a wide range of publications such as the Wall Street Journal, the New York Times, Politico, Vox, and others. He has a BBA degree in economics and marketing from the College of William and Mary.