Relentless Health Value

Today’s episode features the following guests: Ross Bjella, MBA, is the founder and CEO of Alithias, a patient advocacy and population health analytics company serving self-insured employers, insurance companies, networks, and third-party administrators. (EP163) 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 EMR and health care IT-related articles have been viewed over 18 million times. (EP124/171) Gary Frazier is a disrupter and founder of OM Healthcare, Inc., a health care technology start-up established in 2015. He has over 18 years of business development experience and over 13 years of executive-level hospital and health system strategy expertise. (EP168) David Smith is from Avia and founder of Third Horizon Solutions. He is chief development officer, where he is responsible for expanding the firm’s influence in the health care market. (EP135) Alex Jung is global strategist at Ernst and Young. She is a partner/managing director in Parthenon-EY, where she works primarily on growth strategy projects. (EP189) Joe Murad is president and CEO at Pokitdoc. He most recently served as managing director and head of individual exchange solutions for Willis Towers Watson, where he was responsible for the largest private health insurance exchange. (EP183) Frazer Buntin is president of value-based services from Evolent Health. He has worked in strategic and operations leadership positions for the past 17 years. He is responsible for managing the operational performance of Evolent Health’s partners. (EP202) A.G. Breitenstein is a partner at Optum Ventures. She was most recently the co-founder and chief product officer at Humedica, one of the earliest big-data analytics companies in health care. (EP207) 02:21 Ross Bjella’s short list—5 action items—for employers to get the most for their money out of the health care system. 03:05 Take control of employer health care costs by gaining access to their health care data. 03:18 Offer an incentive-based plan design. 03:32 Create virtual narrow networks. 03:46 Offer live care navigators. 04:10 The importance of controlling health care costs. 04:43 The emotional component behind what an employer must do to maximize the value of their health care. 05:10 Disruptive vs incremental change, and what’s really happening in health care. 06:17 John Lynn of HealthcareScene.com, and why it’s so tough for disrupters to break into the health care system. 07:26 The weird dynamic of the false market that is health care. 08:46 Health care regulations making it difficult to disrupt the market. 13:15 Gary Frazier’s opinion on connecting value-based care and empowered patients. 15:20 What value-based care is really about. 16:17 David Smith elaborates on the problem with assuming empowered patients change health care. 18:21 Rational decision making and how that isn’t always present in health care. 19:19 Alex Jung and the “messy middle” of the economic side of health care. 19:44 How the economic model, not the business model, of health care is broken. 21:36 “Is [this] necessary?” 22:13 Joe Murad and the “messy middle” in medical services pricing. 23:11 Frazier Buntin and where we are in the transition from fee for service to value-based care. 24:09 Is this change driven from the health system or major employers? 25:00 A.G. Breitenstein and the power of consumers en masse to move markets.

Eric Weaver, DHA, MHA, is nationally recognized for his work in primary care transformation and value-based care. As a corporate vice president for Innovista Health Solutions, he oversees enterprise strategy and technology adoption for a fast-growing population health management services organization. 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 joining the Innovista leadership team in 2015, he was the president and CEO of Austin, Texas–based Integrated ACO—one of the more successful physician-led accountable care organizations in the country.

A.G. is a partner at Optum Ventures. She was most recently the co-founder and chief product officer at Humedica, one of the earliest big-data analytics companies in health care. Following its acquisition by Optum, she became chief product officer at Optum Analytics. She began her career as an attorney, founding a non-profit aimed at helping homeless youth at high-risk for HIV infection. A.G. expanded her mission by obtaining a degree in public health from Harvard. She is a mission-driven leader focused on transforming the health care system into a health system.

Ashok founded Centivo in 2017 after observing the inefficiency in the health care system and the pain that has resulted for employers and employees. Prior to Centivo, Ashok co-founded Liazon, operator of the nation’s industry-leading private benefits exchange for active employees. Liazon was acquired by Willis Towers Watson in 2013, and after the acquisition, Ashok served as managing director for Willis Towers Watson’s Group Exchange business. Prior to Liazon, Ashok was an associate principal at McKinsey and Co., where he served as a leader in the firm’s health care and private equity practices. ​In addition to his role at Centivo, Ashok serves as an independent Board director at Artemis Health as well as a senior adviser to Silversmith Capital, a growth equity firm. Ashok received his undergraduate degree from Princeton University, a master’s degree from Stanford University, and an MBA from the Stanford Graduate School of Business.

TJ is a designer at heart and a pharmacist by training. He started his career at his family’s long-term care pharmacy in 2004 and has worked at Target pharmacy, a local community pharmacy, and Massive Health (acquired by Jawbone). He holds a doctor of pharmacy (PharmD) degree from Massachusetts College of Pharmacy and Health Sciences. In 2015, Forbes named TJ to its 30 under 30 List in Healthcare. In 2018, PillPack was acquired by Amazon.   02:20 TJ talks about his origin story with PillPack. 04:16 TJ explains what PillPack is and how it works as a full-service pharmacy. 06:57 One of the biggest challenges is getting across to patients that there is a better option to approaching their health. 10:06 How the customer experience is different between PillPack and a retail pharmacy, and how PillPack is working toward eliminating the frustration that comes with a normal retail pharmacy. 11:13 PillPack’s average customer age is 49. 12:42 How PillPack addresses the issue of customer loyalty and the personalized experience that might be offered by retail pharmacies. 15:01 Providers and prescribers often spend somewhere around 30% of their time prescribing medication, when a more efficient solution can be to implement a start and end order. 20:16 The illogic behind using expirations on prescriptions to entice patients to remain accountable at doctor visits. 22:47 How PillPack steps in to be the medication coordinator for individuals. 26:32 The complicated issue of nonadherence and what this means. 27:57 How PillPack reminds the patient about being proactive about refilling prescriptions. 33:29 How patients pay to use PillPack. (Hint: It’s the same cost as going to a traditional pharmacy.)

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. Dave is a 30-year veteran of managed-markets marketing. After working in consumer marketing with AT&T and health care publishing with Elsevier, Dave made the move to medical advertising and communications at KI Lipton, Inc. Subsequently, he became a cofounder of Pinnacle Health Communications. Dave is an accomplished strategist, providing innovative customer marketing, access, quality, and health intervention solutions for large clients and has directed the development of numerous industry-leading campaigns in primary care and specialty markets. He has supported clients in disease areas that include oncology (Bristol Myers Squibb [BMS], Novartis, Eisai), virology (BMS, Merck & Co.), pharmacy (American Pharmacists Association, Merck, Novartis), and blood disorders (Novo Nordisk), to name a few. Dave has helped more than 15 clients achieve top rankings in their respective categories. He is also an active member of the Pharmacy Quality Alliance. 00:30 Collaborating with “large organized customer groups” aka IDNs and health care stakeholders. 01:36 Pharmaceutical companies working with IDNs. 04:58 “Historically, Pharma trained ... their representatives on the brand; secondly ... on [their] selling skills.” 05:17 “What they don’t do well ... is training them on understanding customer objectives and needs.” 05:56 “What a customer wants to buy is impact.” 07:57 “It’s basically Pharma meeting on a level playing field with peers.” 08:42 The more stakeholders take on risk, the more they will demand seeing outcomes from Pharma. 09:09 “Pharma can’t ... prove its value in the absence of having collaborative relationships.” 09:30 One of the most important roles that Pharma can play. 10:42 The barrier with market share. 13:13 Enabling a brand to be successful. 13:39 Solving the customer's problems. 13:50 Creating a near-term and a long-term plan. 16:00 How Pharma can be a collaborative partner throughout the entire patient journey. 16:58 Pharma’s barrier in not striving for the ideal. 22:39 Barriers in pharma collaboration with IDNs. 24:28 “Consider these plans a living document.” 24:45 “It’s a commitment to invest the time, invest the energy.” 27:24 “The much more valuable brands are [the ones] that build upon their successes.” 29:44 “How can we work together to find a solution that is approvable?” 31:03 How Aventria might be able to help mitigate some of these challenges.

Maya Dusenbery is a journalist, editor, and the author of Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick. She is editorial director of Feministing.com and has previously been a fellow at Mother Jones magazine and a columnist at Pacific Standard. Her work has appeared in publications like Slate, Cosmopolitan.com, HuffPost, TheAtlantic.com, Popular Science, and Teen Vogue, among others.

Virginia Gurley, MD, MPH, is the senior vice president and chief medical officer at AxisPoint Health, responsible for leading all clinical content development and analytics activities for the company, as well as providing strategic clinical oversight for delivery of population health management services. Dr. Gurley brings with her more than 30 years of experience in preventive medicine, clinical programs and systems design, analytics, and health education. Prior to this role, Dr. Gurley held leadership positions at managed care organizations and care management vendors, including Healthways, Blue Cross Blue Shield of Michigan, McKesson, and Henry Ford Health System. Dr. Gurley earned her MD from the University of California at Davis School of Medicine and completed her residency training at George Washington University and Johns Hopkins University, where she also completed her MPH in epidemiology.

Gregory Makoul, PhD, MS Greg is founder and CEO of PatientWisdom, Inc. He is internationally recognized for expertise in physician-patient communication and shared decision making as well as a radical commonsense, person-centered approach to health care innovation. He started PatientWisdom because professional and personal experience made it clear that listening to patients—individually and at scale—is the real key to improving health and care.

Frazer Buntin has worked in strategic and operations leadership positions for the past 17 years and currently serves as the president of value-based services for Evolent Health. Evolent Health partners with leading provider organizations to achieve superior clinical and financial results in value-based care, actively managing care across Medicare, Medicaid, and commercial and self-funded adult and pediatric populations. Frazer is responsible for managing the operational performance of Evolent Health’s partners. Prior to Evolent, Frazer served as CEO for WhiteGlove Health, a population health management firm providing primary health care services to self-insured employers and health plans. Previously, Frazer was co-founder, president, and CEO for Silvercare Solutions, one of the largest providers of primary care and health care management services to the senior population in the United States. Prior to Silvercare, he served in several senior-level roles for Healthways Inc. and Dollar General Corporation. Frazer currently serves on the board of Leadership Health Care and holds an MBA from Vanderbilt University and a BS degree from The University of the South.