Friends, I’ve heard back from a few of you recently about some of the episodes we’ve had around employer health insurance & benefits. In fact, I was just speaking this past week with a physician colleague who listened to episode #125 with David Contorno, and he literally said that it blew his mind.  Well, I think you’ll find this episode illuminating and mind-blowing. The system of employee health benefits is one of the most opaque and confusing legacy constructs we have in healthcare. Payment, financial incentives and business models are not aligned with the best interests of healthcare consumers. This is an incredibly timely and relevant topic.  In fact, I just read a piece on ACO’s in Health Affairs (Jan 24, 2022) by Michael Chernew discussing ‘why payment reform remains necessary’. We’ve had numerous expert guests who have commented on the problem in employee-based healthcare and the need for major reform, including episode #121 with Glen Tullman, CEO of Transcarent; episode #119 with Steven Nelson, CEO of Contigo; episode #114 with Zack Cooper, a Yale economist; episode #113 with Harris Rosen, CEO of RosenCare; and episode #111 with Dave Chase, just to name a few. In this episode, we have the privilege of hearing from Francois de Brantes. Francois has spent two decades working to transform the U.S. healthcare system by improving incentives for providers and consumers, in order to encourage value-based decisions. He brings the perspective of an economist, but also has hands-on experience deploying numerous real-life programs. François de Brantes serves as Senior Vice President of ‘Episodes of Care’ at Signify Health. He leads customer development of the Medicare Advantage, Self-Insured Employer, and Commercial Payer markets.  From 2006 to 2016, 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 healthcare delivery. This organization was responsible for the Bridges to Excellence® (BTE) and PROMETHEUS Payment® programs, which compensate and reward clinicians that focus on ‘episodes of care’ and ‘performance measures’. François holds a master’s degree in Economics & Finance from the University of Paris IX-Dauphine and a MBA from the Tuck School of Business Administration at Dartmouth College. In this episode, we’ll discover: The amazing journey that Francois has been on for the past couple of decades, starting with his being in corporate benefits at GE. The perverse financial incentives and disincentives built into the fee-for-service, employee health benefits contracts that drive payers, providers and patients away from healthful decisions & behaviors. The principles and tactics required for a shift to value-based employee health benefits. Specific examples of programs demonstrating the benefits of shifting to business and clinical models that focus on profits generated through value rather than volume. How ‘episodes of care’ and ‘bundled payments’ make sense from an individual consumer perspective as well as from a clinical and risk perspective. Every once in a while, a leader comes along stating the piercing truths that capture the core challenges of an era. Francois de Brantes makes such a statement, “There is no real competition for value [in the American healthcare system]. There’s competition for revenue, competition for market share, and competition for billboards, but not for value.” He further distills the fatal flaw in our healthcare system, “Fundamentally fee-for-service does not distinguish between high value care, low value care, or even harmful care for that matter”. Pushing the point even more, he shares that physicians and provider groups, for years, have shared with him the appalling reality that they are not paid to improve or optimize chronic conditions, better manage patient care, or reduce harm.  In fee-for-service, providers are simply paid for each incremental service offered, regardless of its intrinsic value to patients. Just pause for a moment and let all that sink in. Payment in American healthcare does not incent providers to do the right thing on behalf of patient care, and in many ways, disincents them. And far from blaming clinicians, Francois understands the challenges and hurdles from an economic perspective, “Clinicians are really hit with an onslaught of incentives [throughout their daily practice]… that drives them away from their professional mission…” Given that reality, Francois shares, “…the ingredients for creating competition for value are known, tested and validated: (1) transparent information on price and quality; (2) risk contracts to reduce volume incentives; and (3) benefits design that encourages steerage to value providers and reduces demand for low-value care.” Francois and his colleagues have manifested these three principles, combining them with alternative value-based payment models around episodes of care and conditions. This is a major lesson I gleaned from this interview.  Focusing on “packaged” episodes of care or conditions vs. total costs of care makes sense from a consumer-centric perspective since consumers deal with specific episodes and conditions.  It also enables providers to construct viable clinical and business models, and to take more defined risks that they have more control over. I came away from this dialogue, as I have from many of these other interviews, with the reaffirmed belief that the fundamental problem and key solution are bound to a shift toward value-based payment, and toward value-based business and care delivery redesign. The real challenge is the transition – creating the catalytic energy to overcome the entrenched incentives within which legacy stakeholders are mired. There are many other critically important improvements we can make in healthcare delivery.  But, in my opinion, without that value-based payment keystone, employee health and American public health will not improve. And, as Francois points out, this is not a threat to the free market.  Quite the opposite. The private sector is actually protected and the free market is expanded by enhancing competition for value. And most importantly, there is the human suffering and economic toll that continues to be created by legacy stakeholders clinging to FFS payment and non-value-based competition. Francois eloquently captures the call to action, “I never stop thinking about the individual consumers of care – the tens and tens of millions of people in this country… who struggle every single day with making decisions around paying for care and medicines vs. paying for food and housing. By reforming payment and benefits design, we can give those consumers what they need in order to have access to care that is good and doesn’t cost them a fortune. The moment you stop thinking about the average person and the choices they have to make that they shouldn’t have to make, you lose your sense of purpose.” Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, The focus of this interview is an approach to primary care that is divergent from the mainstream approach. It’s different in a number of ways and it’s creating outstanding outcomes for patients, payers, and providers. Our guest today, Dr. Chris Crow, has a compelling story to tell. He is an inspiring leader and a bold reframer of healthcare. I’ve had the privilege of speaking with him a number of times, and am impressed by his personal story, as well as what he and his colleagues have accomplished. Christopher Crow M.D. is the CEO and Founder of the Catalyst Health Network.  He is a nationally recognized healthcare innovator with numerous recognitions & awards; but more importantly he has spent the past 20 plus years focused on helping communities thrive through improving the delivery of healthcare. In this episode, we’ll discover: Some of the underlying problems that greatly sub-optimize the performance of our healthcare system. The three major stakeholders in healthcare, which Chris and his colleagues have built their approach around. The “extended care team” approach that Chris and his colleagues have taken to create an ‘Advanced Primary Care’. The critical distinction between ‘Direct Primary Care’ and ‘Advanced Primary Care’. How Chris is organizing a sustainable financial model that can support this enhanced model of primary care. Early on in our discussion Chris points out that although American consumers demand outstanding customer service, convenience and quality in every other facet of their lives; when it comes to healthcare they have been gripped by what he terms “the tyranny of low expectations”. He goes on to state that the underlying problem is the status quo and inertia of legacy stakeholders, whom he describes as having turned the American health system into a ‘wealth system’ – that is, a system that creates wealth for the few at the expense of the majority of Americans who can not easily access or afford healthcare. One of the major root cause problems is the strong pull to maintain Fee-For-Service payment, which incentivizes volume (visits, procedures, tests, imaging & hospitalizations) over preventive care. Another is the preferential payment afforded to subspecialty and acute-based care over primary care. Chris has been, admittedly, frustrated with the American healthcare system because, as he bluntly states, we know the solution. The “prescription for America” as Chris puts it, is “advanced primary care” – primary care that is accessible, affordable, effective, equitable, and sustainable for both patients and providers. The mechanism behind advanced primary care is through a tech-enabled, virtual, “extended care team” of pharmacists, care managers, social workers and care coordinators. This extended care team is particularly focused on more complex conditions and situations. Some of the services they offer include: (1) medication management and adherence programs; (2) managing formulary-specific medication changes; (3) a referral management and tracking system that maintains network integrity and helps patients and providers navigate to higher value specialists and surgeons; and (4) addressing social determinants of health. In this advanced primary care model, patients derive tremendous benefit in terms of greater connectivity and continuity of care, as well as more preventive care and improved outcomes.  Providers derive benefit through the additional support and the reduced administrative burden, as well as the support they receive in improving clinical quality. Payers derive benefit through more cost effective care and the reduction in total costs of care. There are numerous metrics and stats that demonstrate the outcomes Chris and his colleagues have achieved. One example that Chris shared is around access. The Healthcare Catalyst Network has reduced average waiting times to see a specialist from approximately 28 days down to 4 days. Chris also shares some of the massive cost reductions his network has achieved. The approach that Chris and his colleagues are taking is incredibly mission driven. They consider healthcare to be critical for communities to thrive; and they believe that a value-based, prospective-payment model of primary care is critical in delivering the health outcomes that patients, providers and payers all want. As Chris states, “We’re trying to leave the world a better place and we believe that ‘advanced primary care for all’ in America is the prescription.” Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Our topic this week is employer-based healthcare, which accounts for nearly 50% of all the healthcare spend in the US. We’ll kick off the episode dispelling some surprising misconceptions about how healthcare insurance actually works; which explains, in large part, how the costs of care continue to rise way beyond other costs of living.  Our guest today, David Contorno is a nationally recognized expert in employee benefits. After nearly 20 years consulting to large national employers, David created E Powered Benefits: a benefits consulting firm whose mission is to deliver fully transparent, value-based benefit services. David has won numerous recognitions & awards, and has been a major contributor to the work and publications that Dave Chase has produced out of Health Rosetta, and the nationally recognized publications of Dr. Marty Makary. He mentors other benefits managers from across the country to transform their business models as well. In this episode, we’ll discover: Some surprising insights into how healthcare insurance companies, insurance brokers and benefits managers are incentivized and bonused – and the conflict-of-interest that is built into the system. The radically different and transparent approach David Contorno takes in creating healthcare benefits programs for employers and employees. How his business model has produced average one-year savings of over 50%, along with substantially reduced out-of-pocket costs for employees – all while improving quality and experience of care. The specific approaches and tactics that David uses, targeted to decrease unnecessary healthcare costs. A real-life example of how David and his colleagues have reduced the costs of a 500 person company by $35 million over the past 5 years. The complexity and lack of transparency in our employer-based healthcare payment and insurance system make it incredibly challenging to understand or do much about – even for the expert employer-based HR benefits managers, whose job is to manage the costs and quality of care for their employees. In an attempt to provide some clarity, I’ll summarize three significant take-home messages I gleaned during this interview: (I) the healthcare stakeholders that employers and employees rely on to manage quality & costs are not, for the most part, financially incentivized to lower costs, raise quality or improve outcomes of care. (II) The majority of healthcare insurance costs are actually medical costs; so the way to fix rising healthcare insurance costs is to address the detailed medical costs.. (III) The specific tactics that David focuses on include: (1) finding surgeons and surgical centers with higher quality outcomes and lower costs – centers that offer fixed-price bundled payments. (2) finding imaging centers that deliver state-of-the-art service at a fraction of the cost of high-priced centers. (3) purchasing medications outside of the traditional pharmacy benefits management (PBM) system – thus avoiding huge mark-ups. (4) providing value-based ‘direct primary care’ for chronic diseases and preventive services. These models allow a physician to spend more time with their patients rather than be driven by Fee-For-Service, RVU-based, high-volume care. (5) Employers passing the savings onto their employees rather than the more typical employer approach of pass-through cost-shifting. What I truly admire about David Contorno is that he’s adopted a radically different approach to the way that he and his company get paid. His compensation and bonus structure are based on lowering costs while assuring high quality care. And, his revenue is completely aligned with employers’ and employees’ best interests, not with those of corporate shareholders. Healthcare insurance and medical costs are a crippling problem for a significant and growing percentage of American employees and their families. The goal here is not to lay blame on legacy stakeholders in healthcare. Rather, it’s to lay out for all to see that the fundamental payment structure and incentives in the system are misaligned and grossly maladapted for the purported purpose of healthcare – that is, of keeping employees and their families healthy. David sums it up in this way, “Every entity that an employer trusts to manage healthcare costs benefits [financially] from healthcare costs going up.”  And so, as many have stated, our healthcare system isn’t broken, it’s perfectly designed to deliver the results it delivers. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, This episode is about a domain of healthcare delivery that will undergo a fundamental transformation over the next 3 – 5 years. It is the most precarious and fragmented stage of care – post-hospital discharge and post-acute care transitions. It is a side of healthcare that is ripe for disruption, with the potential to greatly reduce readmissions, reduce total costs of care, and dramatically reduce preventable pain and suffering for patients and their families. Our guest today, Yoni Shtein, is a serial entrepreneur who started his journey as a software engineer at Microsoft. Having completed his MBA at Harvard, Yoni joined RPX Corp as a founding member of the insurance business. After RPX went public, Yoni left to co-found and merge a tech fund into Fortress Investment Group, where he spent six years as an investor. Yoni then moved to Israel and launched Laguna Health, a ‘digital recovery assurance company’, with his longtime friend and colleague from Microsoft, Yael Peled Adam. They also have recently brought Dr. Alan Spiro on as their President and Chief Medical Officer. In this episode, we’ll discover: Why Yoni states that “recovery is everyone’s problem and no one’s job”, and how Laguna is making it their job! Why and how Laguna is focused on the behavioral and contextual aspects of care, even more than the clinical signs and symptoms. The three platforms that Laguna has created to engage patients and guide providers in optimizing transitions of care: their patient-facing app, the Harmony Case/Care Management Platform, and their Clinical Care Engine How Laguna is customizing care through a “choose your own adventure” approach. The tremendous outcomes Laguna is achieving in readmission reduction. During the interview Yoni states his fundamental thesis: “Laguna is reframing healthcare in changing the dialogue from readmissions and provider penalties to member ‘recovery journeys’ and payer cost drivers.” He points out that the most fundamental problem in transitions of care is the misalignment of incentives. Let’s unpack his statement. The reality is that healthcare systems and provider groups are not financially incentivized to optimize patients’ health after discharge. While there has been an increased focus over the past few years on reducing readmission rates (driven in large part by CMS readmission penalties); the fact is that hospitals’ financials are not aligned to post-hospital care. And, just to be clear, this is not to blame hospital systems. Instead, it’s a commentary on how care is paid for in our country. Given that reality, Yoni and his colleagues are targeting their efforts at entities whose business models are aligned with improving post-discharge care: (1) self-insured employers; (2) Medicare Advantage Health Plans; and (3) payers or healthcare systems that are taking financial risk for their populations’ total cost of care. A second reframe that Laguna is introducing is instead of focusing on a metric (i.e. 30-day readmission rate); they are focused on the patient’s “recovery journey”. They’re using decades of published research to identify “recovery barriers”, and are designing their products and services to mitigate and eliminate those barriers. A third reframe that Laguna has introduced is that they have designed their care model to address the behavioral and contextual aspects of care.  They’re identifying and solving for the daily barriers that people face in engaging with healthcare and optimizing their health. According to Yoni, over 50% of all readmissions are preventable. That means that the American healthcare system is failing patients and their families one out of every two readmissions. It’s been said that our healthcare system is perfectly designed to deliver the results it delivers. But if we understand how wrong those results are, why aren’t we changing the system more intentionally and more immediately? Why aren’t more healthcare leaders not pushing to create a new healthcare? Far from being discouraged, these questions only strengthen my resolve to seek avenues to create a new and more humanistic healthcare system. And, it also strengthens my belief that we need more leaders like those in Laguna, who are reframing healthcare to be what patients, their families, as well as providers need it to be, and not what ‘the system’ dictates it be. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, There are numerous critical healthcare reframes in this week’s episode. First, what Dr. Silverstein makes abundantly clear is that the senior leadership team at ChristianaCare is fully comitted to accelerating the shift to value based payment. Second, they are committed to greatly expanding the use of virtual care as a  primary mode of care. Third, they are focused on health outcomes vs healthcare delivery. Underlying these three patient-centered goals is another profound reframe, the notion that in order to achieve the quadruple aim, provider organizations must form vertical integrations and create complementary collaborations with other types of stakeholders in healthcare – such as payers and retailers. Our guest today, Ken Silverstein, is the Chief Physician Executive at ChristianaCare. He previously served as chair of ChristianaCare’s Department of Anesthesiology, Medical Director of Perioperative Services and as Chief Medical Officer. He received his undergraduate degree from Brown University, his medical degree from New York University School of Medicine and his MBA from the University of Delaware. Dr. Silverstein was a resident and a fellow in anesthesiology at the Brigham and Women’s Hospital in Boston. He completed his clinical fellowship in anesthesiology at Harvard Medical School. In this episode, we’ll learn about: The 10 year value-based collaborative agreement that ChristianaCare and Highmark have launched together. The 5 major “vehicles” that ChristianaCare & Highmark are planning to deploy within their collaboration. The guiding “partnership principles” that are being used to create a relationship-centered approach to this synergistic collaboration. The fascinating independent spin-off virtual primary care practice that ChristianaCare is building out with Highmark, that greatly improves the efficiency and effectiveness of care. At the beginning of our conversation, Ken states, “we created a new company and the intent is to completely transform healthcare.”  That bold remark speaks volumes about the visionary leadership at ChristianaCare. Another statement which gripped me was the fact that the ChristianaCare leadership team is discussing Clayton Christenen’s ‘dilemma zone’’, which the folks at ChristianaCare have relabelled as the “commitment zone”. The point of the concept is that in order to transition to a value paradigm and realize a long-term gain, leadership must accept a short-term loss. It’s amazing to see hospital leadership thinking and acting in this way. But even more amazing is the fact that their Chief Financial Officer was the one who introduced this concept to the leadership team. In our correspondence prior to the interview, Ken wrote that American healthcare is “facing an apocalyptic forecast…”.  It’s a disconcerting pronouncement from a seasoned physician executive.  But, what was concerning for me was that I had heard this very same comment from two other physician executives in the prior week. During our interview, I asked Ken what he meant by this statement. He went on to discuss issues such as the worsening unaffordability of healthcare, fragmentation of care, and inappropriate overutilization. He also passionately talked about the unacceptable inequities and disparities in healthcare, using Delaware as an example.  In Wilmington, the difference in life expectancy – what Ken referred to as the “death gap” – between white communities and black communities only 2 miles apart is 16 years! He punctuated this statistic by asking how that is acceptable to anyone. The situation may seem dire but I have to say that I have never been more hopeful, more inspired and more encouraged about the future of healthcare than I am today. The reason stems from listening to leaders like those at ChristianaCare who are not just speaking the rhetoric of reframing, but are taking the very concrete steps necessary to create a new and better healthcare. They are making the painful trade-offs required, and are investing in a better future. They are, as Simon Sinek would put it, playing the generative “long game”. ChristianaCare is making a demonstrable commitment to creating a value-based future. They are aligning their resources with their rhetoric. They are doing this not because it’s easy or safe. They are doing it, as Ken states, “because it’s the right thing to do, period.” Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, With the onslaught of the Covid-19 pandemic, numerous hospital systems across the country rapidly adopted the hospital at home model in an effort to deal with overcapacity.  Many systems are planning to continue this service – even after the pandemic. The reasoning is simple. It’s a much lower-cost alternative. It’s much more personal and customized care. It’s a lot more convenient and comfortable for patients and their families. And, it’s going to be a major clinical delivery approach in the future; a major source of revenue, as well as a source for patient growth and retention. Our guest today, Raphael Rakowski, is one of the most significant entrepreneurial leaders in this rapidly advancing and transformative trend in healthcare delivery.  In 2010, years before most of us even heard of it, Raphael Rakowski led a team of engineers and clinicians in the creation of Clinically Home, the first commercially scalable model to enable safe hospitalization at home. In 2017, Raphael and his team created a next-gen version called Medically Home and joined forces with Atrius Health (a large multi-specialty medical group in eastern MA) to bring the program to market.  In 2020, after his role as CEO & Founder, Raphael was named Executive Chairman of Medically Home Group, Inc.  Medically Home operates in over 15 states at the time of this interview with a large number of strategic partners, and has most recently partnered with the Mayo Clinic & Kaiser Permanente. In this episode, we’ll learn about: Why – according to Raphael – the financial and business model for facility-based hospital care is misguided, misaligned and maladapted to the needs and safety of patients and their families. Why the shift to decentralized healthcare is necessary if we are to have a sustainable system, and how it’s consistent with the path that other industries, such as banking and retail have taken. The four operational pillars that allow Medically Home to deliver a much higher acuity level of care in the home than other ‘hospital at home’ models. The superior outcomes that Medically Home is achieving compared to traditional facility-based hospital care. How Medically Home is addressing some of the challenges in delivering high acuity care in the home setting. According to Raphael, the reason facility-based hospital care is suboptimal is that it has been fashioned like an industrial factory. He backs up his statements with powerful observations, compelling data and intelligent reasoning. For example – according to Raphael, 65% of hospital costs are due to the fixed costs of their bricks and mortar infrastructure. This overhead creates a “tax on care”, leaving only 35% for medical care. On the other hand, the cost savings Medically Home is achieving are about 25%.  Patient satisfaction is at or above hospital levels. Mortality and morbidity reductions are 10%, and fall rates and infection rates are dramatically better than facility-based hospitals. Raphael also reframes our notion of acute care and post acute care.  As he puts it, “The point of the Medically Home model is that you’re reliably integrating three things that should never have been siloed – acute care, post-acute care,and population health… There is no such thing as post-acute care. It was invented as an artifact of reimbursement. You should be cared for by the same care team until you’re not sick anymore.  This is one of the reasons for the high readmission rates we see in hospitals across the country…  We combine these together in a single episode called “stay with the patient until they’re well and you understand what it will take for them to stay well…”   At the present moment, the home-based care market in the US is approximately $140B in revenue, and predicted to grow to over $200B within the next 4 to 5 years. One can view this rapidly emerging home-based care market as a threat to hospital systems – or, as an opportunity.  For those hospital systems willing and capable enough to be early entrants – it is a huge opportunity to diversify their business models and revenue stream, and to de-risk the unprecedented market disruption that is almost certain to occur this decade. From a mission-based perspective, it is an opportunity for our healthcare systems to do what we need them to do: improve care and care outcomes, lower costs, and provide a more compassionate and convenient care experience. Until Next Time, Be Well. Zeev Neuwirth, MD

Glen Tullman, former CEO of Livongo Health and current Executive Chairman & CEO of Transcarent, discusses the lack of alignment between payers, healthcare systems, and employers. He also explores the impact of digital healthcare companies on healthcare delivery. Tullman emphasizes the importance of empowering individuals and transforming the healthcare system. The chapter also introduces Transcarent, a healthcare consumer experience company, and discusses the concept of Transcaring and the key components of their offering. They also discuss the benefits of technology in rehab and physical therapy, lowering pharmacy costs, and creating a curated package and ecosystem for healthcare solutions.

Friends, Welcome back to the first episode of the 2021 Fall season.  We are embarking upon the 5th year of the ‘Creating a New Healthcare’ podcast – and we have an amazing line-up of courageous, bold, entrepreneurial individuals that we’ll be hearing from this season. In this episode, we have the privilege of speaking with Michellene Davis. The theme of this interview, which was recorded on Aug 4th 2021, is centered on eliminating the racial disparities & inequities in the healthcare profession, as well as addressing the gross disparities in healthcare delivery and outcomes in the US. Ms. Davis is the new President and Chief Executive Officer of National Medical Fellowships, Inc.  Prior to her current role, Ms Davis served as the Executive Vice President & Chief Corporate Affairs Officer at RWJ Barnabas Health, the largest academic medical center system in New Jersey. Michellene has been named among the Top 25 Most Influential Minority Leaders in Healthcare by Modern Healthcare Magazine. Prior to joining RWJBarnabas Health, Ms. Davis served as Chief Policy Counsel to former New Jersey Governor Jon Corzine, where she was the first African American to serve in this position. She was the first African American and only the second woman to serve as Acting New Jersey State Treasurer, responsible for a state budget of over $30 billion dollars. She began her legal career as a trial litigator. In this episode, we’ll learn about: The National Medical Fellowship Inc – the only private organization solely dedicated to providing scholarships to medical and health professions students underrepresented in healthcare. The tens of thousands of professional alum that have been supported by the NMF since its inception in 1946, including 2 surgeon generals. The leadership development programs and the unique community of support that the NMF offers medical students and fellows. How the NMF directly addresses the elimination of the disparities & inequities in American healthcare through an evidence-based approach. Michellene’s articulation of the purpose and value of the National Medical Fellowship Inc is enlightening. It’s goal, as I now understand it, is three-fold.  First, to break the cycle of inequity in medical education by providing medical students, residents and subspecialty fellows with financial support. The second goal is to not only increase the percentage of doctors who are Black, LatinX and other under-represented ethnicities in medicine; but also to support these students and trainees in advancing as leaders. The third goal is to eliminate the disparities in healthcare delivery and outcomes in our country. Toward the end of the interview, I ask Michellene why she upended her career to make this recent professional shift. Her response – “At the height of the pandemic I watched no less than 30 of my colleagues perish. And when you look at who perished and who are the most vulnerable in our communities… after that I just realized that I am done dying. I am done watching colleagues and communities suffer and die, at the expense of what others would just consider an inconvenience…  And I just am tired of watching the same community members suffer the same reality, when those who are in power are blind to the entire equation… And for me, what shifted was that on this side of Covid, with whatever amount of time I might have left on this planet…  I needed every second of it to truly matter, to address this one ill, to save even one life, and to change the face of medicine. As a result of that, I came to NMF…” Michellene Davis is a leader of rare integrity, honesty and courage. Michellene’s discernment is a litmus of the insidious fundamental wrongs that need to be righted within our healthcare system. Her professional actions and her career trajectory demonstrate a commitment to doing something about it – not talking about doing something – but actually doing something. In my 30 years in healthcare, I have heard countless mission statements & purpose statements – multiple pronouncements about a new day in healthcare. But I have never heard anything as authentic, as meaningful, as resilient, and as full of selfless conviction and integrity as Michellene’s statement of purpose. Her words will ring in my ears and resonate in my soul for years to come. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, Our guest this week, Steve Nelson, takes us on a journey into a new category of company that is curating the collaboration between employers and providers. It’s an incredibly exciting adventure – actually a leap into the world of value-based care. The insights that he shares provides a lens into where healthcare is going – empowering patients & payers to navigate to healthcare that is appropriate, high quality and reliable. Into this mix are enabling technologies that contribute to the value proposition. It’s an incredibly enlightening dialogue – not one you’ll want to miss. Steven Nelson leads the Contigo Health team as President. He was one of the leaders who initiated Contigo within Premier, a leading hospital supply chain company. Before joining Premier, he served as Vice President of Strategy and Planning and COO of Anthem’s diversified business group. Prior to joining Anthem, Nelson led strategy, product and marketing at Highmark Blue Cross Blue Shield and helped to build Allegheny Health Network, a provider entity consisting of seven hospitals, 2,000 doctors and various other facilities. In this episode, we’ll discover: The challenge that employers face in understanding and dealing with the staggering costs of healthcare, and how they’re responding. How the ‘Centers of Excellence’ program and network management – which are foundational to employer-based healthcare – are evolving. The use of ‘2nd opinion’ interventions in maintaining high standards of quality in employer healthcare navigation offerings. How Contigo is convening local collaborations between employers, healthcare systems & health plans – and creating vertical ecosystems with numerous other enabling partners. One of the revealing insights that Steve shares during the interview is that the purpose of Centers of Excellence (COE) is not necessarily to drive costs down; but instead, to drive value up!  For years, I’ve heard the concern that bundled payments are a ‘race-to-the-bottom’. Steve reframes them as a ‘race-to-the-top’. The value of these COE’s is NOT that they provide a lower unit price for heart surgery or joint replacement. The value is that they don’t perform unnecessary procedures. They provide an overall bundle of care that is of higher quality, safety and legitimacy. I underscore this because we know that a significant percentage of procedures and surgeries performed in this country are unnecessary, thereby subjecting the American public & employees to unnecessary harm & costs. In fact, the Lown Institute just published a report demonstrating that over 60% of hysterectomies and nearly 25% of cardiac arterial stenting procedures were unnecessary. This was a 2-year Medicare study of 3100 hospitals which discovered that older Americans were subjected to over 1,000,000 unnecessary tests & procedures. Within that were 200,000 cardiac stent procedures that fell into the category of ‘overuse’. Core to Contigo’s approach is that they convene and coordinate local collaborations between employers and healthcare systems. Not only are they convening, but they are optimizing care through: (1) standardized, high reliability, bundled pathways in specialty areas; (2) providing physicians with clinical decision support tools, best practice alerts and patient benefits information; (3) assisting employees in navigating to and accessing high quality care; and (4) using both clinical data, claims data, and advanced analytics to identify patients at risk. Contigo is also bringing health plans into this ecosystem, as well as in numerous enabling technology vendors. What I find encouraging is that Contigo is not alone in creating a more integrated, seamless value-based system of care. While many healthcare systems across the country are hedging their bets and responding as if fundamental transformation is not around the corner, this movement of direct-to-employer curators & navigators is leading and catalyzing the transformation to assure that patients receive the right care. In 2020, over two-thirds of large employers were steering, or planning to steer, their employees to Centers of Excellence. There is little doubt that employers will continue to play an increasing role as a major market force pulling us toward value-based payment & care. As healthcare becomes less affordable for the majority of Americans, we are rapidly reaching a tipping point, or perhaps more like a boiling point. This does not seem like the type of bet any healthcare stakeholder should be hedging. Until Next Time, Be Well. Zeev Neuwirth, MD

Friends, In this episode, Dr. Shantanu Nundy shares with us his thoughtful reframing of healthcare. His book, Care After Covid, is a practical exposé on the misalignment of healthcare – offering a guideline for how to reframe the healthcare system moving forward. What you’re going to love about this interview (and his book) are the stories that he shares – transporting us from an inner city clinic in Washington DC, to the plains of Africa with community health workers in villages, to the university hospital where he discovered the power of caring relationships. Dr. Shantanu Nundy MD, MBA, is a primary care physician, engineer, technologist, and business leader who serves as Chief Medical Officer for Accolade, which delivers personalized navigation and population health services to companies. Previously, Dr. Nundy served as a senior health specialist at the World Bank Group where he advised developing countries on health innovation & technology. Prior to that, he was Director of the Human Diagnosis Project, a healthcare artificial intelligence startup which he successfully built into a medical project spanning 80 countries. He is also co-inventor of SMS-DMCare, an automated text messaging software for individuals with diabetes, one of the first mobile health interventions to be adopted by the World Health Organization. He attended MIT for undergrad, the Yale School of Medicine & completed his residency in Internal Medicine at the University of Chicago, where he also obtained a MBA. In this episode, we’ll discover: The maladaptive aspects of our healthcare system that the pandemic has exposed and magnified. The 3D model – distributed, digitally-enabled & decentralized – that Dr. Nundy believes can transform healthcare How Dr. Nundy views ‘connected care’ as being ‘beyond technology’, but also how digitally-enabled care can create greater access, more personalized care, and greater patient engagement. The largely untapped opportunity we have to include patients as part of the healthcare team, and the tremendous potential that has to transform care. Real life stories that demonstrate how providers’ professionalism, empathy and overall value proposition are being constrained by our system. Dr. Nundy’s ability to leverage divergent perspectives is remarkable. He shares a story of conducting research on automated reminders for improving medication taking. What he discovered in interviewing patients was that it wasn’t the digital reminder that motivated them to take their pills. Instead, it was the caring research coordinator, Marla, and the relationship that patients had formed with her, that compelled them to take their medications. Plainly put, they didn’t want to let Marla down. The lesson – caring relationships are not just more empathetic care, they’re also more effective care. Another example of Dr. Nundy’s ability to balance divergent perspectives is his notion of decentralized care – that healthcare decisions are best modulated as close to patient care as possible. He shares a poignant story of a patient with heart failure. His patient kept on being admitted to the hospital because she didn’t have a scale to weigh herself. (People with heart failure are susceptible to water retention, which causes their lungs to fail. Having a scale allows them to detect fluid retention and take appropriate medications to reverse it). During one post-hospital visit, Dr. Nundy realized that his patient did not own a scale because she couldn’t afford one. So, he handed her twenty dollars to buy one. She bought the scale and did not have any further hospital admissions after that. It’s important to note that Dr. Nundy was actually breaking rules and regulations in giving her the money to purchase that scale. He did not, as a primary care doctor, have the decentralized decision-making or authority to personalize care and do what was right for his patient. Dr. Nundy’s goal in authoring this book is to create a mindset shift in healthcare delivery. As he states in our dialogue, ‘words create worlds’. So, I’ll conclude by sharing some of his profound words. One phrase that struck me was, “Digitalizing poor care isn’t enough. We need to reinvent care”.  Another, “We need to do population health one patient at a time”. Dr. Nundy envisions a world in which both providers and patients are much more empowered and connected by the healthcare system. I believe that words do create worlds, and I hope this is the case with the words that Dr. Nundy has shared with us. Until next time, be well. Zeev Neuwirth, MD