Relentless Health Value

Cora Opsahl, Director of the 32BJ Health Fund, plays a pivotal role in serving over 200,000 members by negotiating cost savings and improved healthcare benefits. In their conversation, they delve into the challenges of fiduciary duties and the entrenched status quo in healthcare. Opsahl shares how data analysis reshaped their benefit design and enabled significant savings by kicking a major hospital out of their network. The discussion highlights the importance of collaboration between employers and unions to tackle escalating healthcare costs and enhance member welfare.

In this Spotlight Episode host Stacey Richter discusses the management of oncology side effects with Dan Nardi, CEO of Reimagine Care. Highlighting the challenges cancer patients face, especially following chemotherapy which often leads to nausea and readmissions, the conversation delves into how Reimagine Care facilitates at-home integrative cancer care. Their services focus on proactive and reactive support via AI-driven tools like 'Remy' to assist patients outside of clinical environments. This approach aims to reduce emergency visits and improve patient outcomes while easing the workload on healthcare providers. The discussion underscores the role of patient reported outcomes and the integration of technology with human care to improve the quality of oncology treatment pathways. Note from Stacey Richter: Pulling off a show like this one is not cheap, and my Aventria business partner Dave Dierk and I are happy to fund the vast majority of it. But yeah, breath of fresh air, and thanks much to the team over at Reimagine Care for their sponsorship. My one disclaimer is that I have not personally vetted the solution, but there is a white paper (link in show notes) available where you will also find some insights from Reimagine Care's work with Memorial Hermann Health System. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Spotlight1 🔗 Healthcare Industry Acronyms and Terms https://relentlesshealthvalue.com/healthcare-acronymns ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 03:38 Why is it really important to keep track of oncology patients and their side effects? 04:27 Why is cancer treatment such a complex care journey? 05:57 Are there outcome and financial issues that compound when an oncology patient is left to navigate their care journey on their own? 08:53 What is difficult in navigating cancer treatment care pathways, and what does Reimagine Care tackle within that? 09:55 EP157 with Ethan Basch, MD. 10:17 How does Reimagine Care proactively check in with oncology patients to help them navigate their care pathways? 12:41 How does Reimagine Care measure their performance, and how did their work affect patient outcomes? 13:28 The Reimagine Care white paper. 14:57 How do providers feel about Reimagine Care services? 17:37 Where can technology really make a difference in cancer care?

In Episode 451 of Relentless Health Value, host Stacey Richter converses with Dr. Spencer Dorn about the implications of AI in healthcare, referencing lessons learned from EHR implementations. They discuss Kranzberg's first law of technology, which advises against labeling a technology as inherently good, bad, or neutral, emphasizing instead the importance of its application, configuration, and the human decisions surrounding its use. Dorn and Richter explore both the potential benefits and drawbacks of AI, drawing parallels with past experiences in healthcare digitization. The first takeaway from this short show focused on artificial intelligence is gonna be the same, really, as it was in episode 446 about EHRs. Do not ascribe any given technology a label of, as good, bad, or even neutral. That is Kranzberg's First Law of Technology; and it applies here, too. Second major takeaway—and again, this is the same as in that earlier show about EHRs, but today we're talking about AI—if you're thinking about the ultimate impact of the people and the processes that have some technology in their midst (technology, again, such as AI, artificial intelligence), the ultimate impact will not be a black-and-white binary. We talk about some of these nuanced not binaries in the 10 minutes that follow, but for more, I've put some links in the show notes on our epsiode page for some newsletters et cetera to check out. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP451 🔗 Healthcare Industry Acronyms and Terms https://relentlesshealthvalue.com/healthcare-acronymns ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 05:23 What could happen with AI in healthcare if we aren't thinking about how we're deploying it? 05:58 How could the lessons from digitizing healthcare help us with employing AI? 08:25 How could artificial intelligence make things better and simultaneously worse? 10:55 Why is it important to look beyond the hype and pessimism and make a clear-eyed assessment?

Marilyn Bartlett, a renowned CPA with a track record of transforming healthcare financials, shares her incredible journey of turning a $9 million deficit into a $112 million surplus for Montana's employee health plan. She discusses the critical steps taken to identify inefficiencies and the importance of a dedicated team in navigating challenges. Marilyn elaborates on strategic contract negotiations and the need for transparent communication with stakeholders. Listeners will walk away with actionable insights on effective change management and financial strategies in healthcare.

So, I had a chance to read Dr. Marty Makary's new book, which is called Blind Spots; and here's why I wanted to get him to come back on Relentless Health Value and talk to you, people of the healthcare industry. It's because of something that he said on page 127 and which I've been mulling over for probably years, actually. It's this idea of what is appropriate care and how good are we at ensuring that patients/members get said appropriate care. Lots of people are of the same minds because appropriate care has come up in the show with Ben Schwartz, MD, MBA (EP434); John Lee, MD (EP438); Spencer Dorn, MD, MPH, MHA (EP446); Tom Lee, MD (EP445). I mean, an estimated 21% of all medical care is potentially unnecessary. And unnecessary is, of course, one category of things that are not appropriate. This is according to a national survey of physicians: 25% of diagnostic tests, 22% of all medications, and 11% of all procedures are unnecessary/inappropriate. This is billions of wasted dollars doing stuff that shouldn't be done, and it's not appropriate care. But think about this: How many visions for how to fix healthcare and how to reduce waste depend upon a broad-stroke assumption that we will materially ensure that patients are getting best-practice (ie, appropriate) care? That we cut down on over-medicalization and surgeries on the back end and add appropriate preventative stuff and optimal medical therapy to the front end? Dr. Makary and I delve into the challenges of ensuring patients receive appropriate care, touching on medical dogma, financial, business, and legal incentives, and the importance of measuring practice patterns. Dr. Makary provides practical advice for clinical leaders, payers, and plan sponsors on promoting transparency, improving health literacy, and steering members towards higher performing providers. === LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP449 🔗 Healthcare Industry Acronyms and Terms https://relentlesshealthvalue.com/healthcare-acronymns ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe 🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe 📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue 🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1 🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b === CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/ 07:32 What is appropriate care? 10:19 Why what we think might be appropriate care might not be appropriate care. 10:34 Why is medical dogma damaging to appropriate care? 12:45 Why we need less absolutism in medical practice. 13:37 How is groupthink prevalent in medicine? 14:02 Why do we resist new ideas? 17:43 How do providers figure out what to believe and what not to believe? 20:59 "If you leave it to the medical profession to fix itself … so far, it's not going well." 22:33 How does supporting health literacy affect appropriate care? 30:23 "People need to find their care based on quality and price." 34:28 What proportion of medical care is deemed unnecessary right now?

In this conversation, Shawn Gremminger, a 340B program expert, shares why employers should pay attention to this crucial healthcare initiative. He explains how the program, designed for low-income Americans, unexpectedly impacts drug pricing for employers, leading to lost rebates and higher costs. Shawn dives into studies revealing market distortions caused by 340B entities and questions its effectiveness in assisting underserved communities. This episode emphasizes the need for employers to understand the financial risks associated with the 340B program.

Shawn Gremminger, a specialist in the 340B program, dives into its origins and evolution since its inception in 1992. He discusses the initial intentions of the program to help underserved communities, contrasting them with current outcomes. Gremminger raises critical questions about transparency and effectiveness, particularly regarding its impact on safety-net providers. The conversation highlights the financial strain on hospitals and the growing need for reform to ensure that 340B genuinely benefits those it was designed to help.

Elizabeth Mitchell, President and CEO of the Purchaser Business Group on Health, dives into the complexities of value-based care. She discusses how the ideal intentions can be sidetracked by middlemen, causing inflated costs without delivering real value. Elizabeth advocates for transparent payment models that include prospective and bundled payments, urging cooperation among employers, employees, and primary care providers. Given the affordability crisis, she emphasizes the urgent need for innovative solutions to ensure genuine care that meets the needs of everyday Americans.

Will Shrank, MD, a venture partner at Andreessen Horowitz and former chief medical officer at CVS Health and Humana, discusses the shocking one trillion dollars wasted annually in U.S. healthcare. He highlights the need to align incentives with patient outcomes and the rising potential of primary care providers to combat this waste. The conversation delves into the evolution of value-based care, the challenges of the fee-for-service model, and innovative strategies to improve healthcare delivery and efficiency.

Dr. Amy Scanlan, a physician dedicated to integrating care, shares insights on the evolving landscape of healthcare. She highlights the financial and operational pressures facing doctors today and the necessity for strong teamwork in value-based care. Dr. Scanlan emphasizes the shift from traditional practices to collaborative care, discussing the importance of communication and real-time data in overcoming healthcare challenges. Her perspective reinforces the vital role physicians play in enhancing patient outcomes while adapting to a demanding environment.