Healthcare Rethink

Population health, public health, social determinants of health, healthcare equity, and other terms are often used in the healthcare realm but may be confusing to those unfamiliar with health terms. Population health and public health can be especially easy to confuse. Public health, as the CDC explains, prioritizes bettering community health via policies, education, outreach, and research. The CDC differentiates this from population health because population health is centered around healthcare entities collaborating to improve community health outcomes. What does that definition of population health actually look like in today’s American healthcare system, and how is it evolving to become increasingly important?On today’s episode of Healthcare Rethink, Host Brian Urban speaks with Dr. David Nash, Founding Dean Emeritus, Jefferson College of Population Health, to provide context on who Banner Health is and how they are involved in the payer-provider relationship in healthcare.Urban and Dr. Nash also discussed…Dr. Nash’s journey from an Economics major to medical school to his current leadership roles in medicine How analytics, population health, and other topics can be prioritized in healthcareTransformative health leaders and how they have influenced healthcare’s approach to population healthDr. Nash explained how there is much improvement that can be made in medical education, but why there is such a barrier. “There’s a lot we can learn from, ‘Are we training the right doctor, nurse, pharmacist, social worker for the future?’ I would argue there’s a long way to go here, a lot of opportunity for improvement. Let’s start with quality and safety, human factors engineering, epidemiology, understanding the social determinants, all that stuff…here’s the model: American medical education, nursing education, all the rest—it’s like a barge in the river. And medical education is weighted down by lots of stuff, and you can’t put more stuff on the barge unless you take stuff off the barge. So, I don’t believe in that description, but that is the reality.”Dr. David Nash is Founding Dean Emeritus of Jefferson College of Population Health and Dr. Raymond C. and Doris N. Grandon Professor of Medicine at Thomas Jefferson University. He earned his BA in Economics from Vassar College, his MD from the University of Rochester School of Medicine and Dentistry, and his MBA from The Wharton School. Dr. Nash is a board-certified internist, has held a variety of governance positions, and has earned a variety of accolades including the Philadelphia Business Journal Healthcare Heroes Award and honorary distinguished fellow of the American College of Physician Executives.

Face to face time with a primary care physician is invaluable. However, it isn’t always easy to get - that’s where pharmacists come in. During the height of the pandemic, pharmacists provided care that acted as the first line of defense. Pharmacists are more accessible, and while they’re not here to replace primary care providers, they can support your healthcare needs. So how is one company utilizing their pharmacists’ skills to provide more localized community care? On today’s episode of the Healthcare ReThink podcast, host Brian Urban chats with Walgreens’ own Falguni Shah, Director of Health Corners Product and Clinical Services, and Adam Samson, Head of Clinical Delivery Operations, to explore community health and clinical trial diversity. The three examine… How Walgreens is re-imagining community, localized healthcare in the United States through health corner clinical trials The areas in which Walgreens is exploring expansion, particularly in offerings of health services How pharmacies are changing the game when it comes to building diversity in clinical trials “We need to be much more thoughtful and the FDA is really starting to increase their vigilance; there’s new guidance and even some policy…that says…you need a diversity plan and I think that’s where Walgreens is, you know, really uniquely positioned,” said Samson. “We’re not here to replace primary care. We’re here to support the primary care and be a partner with the primary care physician,” explained Shah. Shah has over seven years’ tenure with Walgreens, where she has served in multiple directorial roles. Prior to this, Shah worked with Rush University Medical Center as a manager for over a decade. She is a graduate of The Ohio State University with a Bachelor of Pharmacy degree and earned her MBA in Health/Healthcare Management from Loyola University Chicago. Samson joins Walgreens having designed and conducted multiple clinical trials across a diverse array of therapeutic areas, including academia, tech, and pharma. Prior to this, Samson served as Adjunct Faculty at George Washington University and was the VP of Clinical Operations for Curebase. Samson earned a BS in Dietetics and Nutrition from Florida International University and a MS in Clinical Research Administration from George Washington University.

Healthcare revenue cycle management is essential to keeping a business up and running, and it’s one beast of a topic. The Healthcare Financial Management Association lists the following components of the patient-centric revenue cycle roadmap: an 1) engaged consumer who has ease of access, improved customer service, and improved quality; an 2) engaged patient with coordination of care, coordinated financial and clinical care, and compliant clinical documentation; and a 3) satisfied customer with appropriate payment, effective and efficient account resolution, and decreased cost to collect. And that’s just the tip of the iceberg, because you have to consider all the actual components under each of these such as, claim processing, case management, third-party follow-up, and so much more. So, how do companies make sure patients and healthcare companies are fully satisfied with all components of the patient-centric revenue cycle when there is so much to think about? On today’s episode of Healthcare Rethink, host Jonathan Wiik speaks with Brad Tinnermon, VP RCM, Banner Health, to provide context on who Banner Health is and how they are involved in the payer-provider relationship in healthcare. Wilk and Tinnermon also discussed… What Banner Health is, their strategy and philosophy, and how their revenue management ties in Why payer-provider collaboration is important Advice for healthcare entities to manage their revenue cycles in tighter financial times Tinnermon explained how Banner Health is trying to bridge the healthcare financial literacy gap, “A few innovative things we’ve done—we have an app that’s called a patient concierge app so when you get your bill, you can fire up this app and it brings an avatar out that walks you through your bill. Literally, it’s standing on top of your bill, and you can touch different parts of the bill and the avatar will talk to you about the bill. We created explainer videos for more of the more complicated parts of revenue cycle and healthcare that give you little 60-minute animated shorts that kind of take a complicated topic and help you understand, ‘What’s a copay, what’s coinsurance, why might your estimate not match the final bill?’ stuff like that.” Brad Tinnermon has 25 years of healthcare revenue cycle operations, tech, outsourcing, and consulting experience and is Vice President Revenue Cycle and Revenue Integrity at Banner Health. He has worked in Revenue Cycle at Conifer Health Solutions, Optum360, and Eclipsys, which is now Allscripts. Tinnermon attended the University of Tennessee and the UCLA Anderson School of Management.

Physician rating sites are a common starting point for patients after a new diagnosis or referral. Unfortunately, many of them miss out on the whole-patient journey and focus on isolated stats. Embold Health uses sophisticated attribution models that allow them to start at the beginning of a patient’s journey. While evaluating physician performance is necessary and interesting, the basic standards are insufficient. Host Brian Urban talks to Embold Health’s CCO, Brad Kimler, about expectations and ways of rating healthcare providers, focusing on local data.● The technology and data behind Embold Health.● Changing the healthcare economy and improving performance for providers.● How to transform healthcare in the US.Kimler uses the example of arthroscopic surgery in the knee to describe Embold’s Approach. “It’s really important to understand who does it disproportionately relative to others in the marketplace. Meaning have you tried more conservative treatment methodologies? Are you doing other things to help coach the other person through? In order to do that, you need to go upstream to the initial point of diagnosis and find out who’s been involved all the way through. It’s a fairly sophisticated model.” Brad Kimler came out of retirement to join the Embold Health team as Chief Commercial Officer. Before his retirement, he worked at Fidelity. He also advised large employers on managing costs and delivering employee benefits. Kimler is a graduate of Brown University.

Healthcare in the U.S. is a big business, and due to that, significant factors result in the type of healthcare the everyday American will receive. But in regard to Social Determinants of Health, better known as SDOH, plays a crucial role in overall healthcare. Investment in SDOH is equally vital to its improvement. Per Health Care Transformation Task Force, SDOH makes up 75 percent of the health outcomes people have access to.Investing in SDOH is of utmost importance in making the best and most significant changes to healthcare. From an investor standpoint, what does that look like?On the latest "Healthcare Rethink" podcast, host Brian Urban talked to John Gorman, an SDOH investor, about the effects that costs and money have on healthcare. But more importantly, how equity and return on investments are achievable.Urban and Gorman talked about:1. Gorman’s background in healthcare and investment2. Some of the issues that prevent eliminating poor healthcare3. The types of solutions and programs Gorman implemented to address SDOH"Let me just say from the outset, Brian, I freaking hate that phrase [SDOH]. It's just four fancy words for poverty and racism… I wanted to find a way to help make a business imperative out of investments in alleviating poverty and racism in healthcare. Because what wasn't lost on me was that 60 to 80 percent of what we spend on healthcare in this country is attributable to poverty," said Gorman.John Gorman is an SDOH investor who worked for the Health Care Financing Administration (HCFA) before it was renamed Centers for Medicare and Medicaid Services (CMS). He attended Oberlin College and created the first-ever SDOH venture capitalist group, Nightingale Partners.

The concept of healthcare in the world has seen some of the most rapid and ultra modern improvements over the centuries. In the U.S. in particular, healthcare is not only business, it is one of the most advanced and important areas in the average American’s life. In essence, for adequate services, a lot of money goes into healthcare and that means finances play an extremely critical role in its function. While providing healthcare was not intentionally meant to be a business per se, but in the U.S., it most definitely is. However, the conversation about improving healthcare becomes counterproductive when finance is also at the very crux. Can both improve simultaneously? In the latest FinThrive podcast, host Brian Urban talked to Dr. Eric Bricker, an Internal Medical Doctor and the Medical Director at SimplePay Health, about the effects that costs and money has on healthcare. In the episode Urban and Dr. Bricker talked about: Dr. Bricker entering the finance field within healthcare How finances ultimately affect healthcare services, hospitals, and patients The role insurances play in healthcare finance “Money dramatically impacts the care. I'm not interested in money for the sake of money — I'm interested in money for the sake that it impacts the care,” said Dr. Bricker. Dr. Eric Bricker is an Internal Medical Doctor and the Medical Director at SimplePay Health. He also founded AHealthcareZ, where he teaches videos on financial healthcare.

Washington Health System is a small to medium-sized non-profit healthcare system twenty-five miles south of Pittsburgh, PA. Brook Ward, President & CEO of Washington Health System, joined FinThrive’s Jonathan Wiik to discuss the importance a regional health system brings to local communities.During the past decade, Washington Health System transformed its healthcare model to focus on value-based care. “If we can provide great satisfaction, high-quality, lower utilization, and lower costs, then we share in that savings,” Ward said. “And so, like many organizations, we have those gain-sharing programs with payers, but we’re also in an ACO with three other community non-profit healthcare organizations called Bridges Health Partners for six years.”Collaboration with payers is essential to making a value-based health system work. “From our perspective, they’re all integral to our future and success,” Ward said. “We can’t afford to take an antagonistic perspective towards them, so we try to work with all of them.” Ward said Washington Health System looks for gaps in care and coding to create efficiencies that improve the provider-payer relationship and mutual success. Controlling health care utilization doesn’t mean cutting costs and services to satisfy budget constraints; it’s a strategy of keeping people healthy, so they don’t wind up in the ED unless it is a real emergency. “There are lots of patients who show up at every emergency department across the country that could be done through telemedicine, a primary care office, a follow-up discharge appointment, or with some social work/care coordination,” Ward said. Washington Health System provides resources and medical support to underserved community areas, like homeless shelters, to care for those who need it and reduce the amount of ED visits.

The world of U.S. healthcare may be slow in advancing health equity, but the movement is gaining popularity. Social determinants of health (SDOH) are more than a trending concept these days; providers are putting it into practice and seeing results. Geoffrey M. Roche, SVP, National Health Care Practice & Workforce Partnerships with Core Education PBC, joined host Brian Urban to share his thoughts on SDOH and how it can provide many benefits for community health. CMS (The Centers for Medicare & Medicaid Services) is keen to take on this approach, but Roche said there’s a lot of work to meet today’s needs. Still, states like Pennsylvania are adopting SDOH at a much faster pace. “In the Commonwealth of Pennsylvania, we’ve been fortunate in the current administration to have taken many steps forward regarding social determinants of health and health equity,” Roche said. “In Pennsylvania, we do not have by statute an office of health equity in the Pennsylvania Department of Health, but we do by executive order.” Roche said a tremendous effort through the PA Department of Human Services brings this approach to the Medicaid managed care population. “And we’ve seen the department of health do a lot of work with hospitals and health systems to think about what we do to address social determinants of health, and do it in a manner that advances health equity.” Pennsylvania developed a health equity action team during the pandemic that now provides boots-on-the-ground reliable data and information to the department of health to aid in those equity efforts. This data helps drive new programs that address the needs of communities. “When Pennsylvania drilled into the data, what was really telling was we still saw significant health equity issues, particularly in social determinants of health, in areas of the Commonwealth that were redlined.”

Twill, formally Happify Health, combines technology with humanity to create digital-first solutions for condition-focused care communities. Dakota Donovan, Director of Product Marketing at Twill, and Bobby Murphy, Vice President of Payor Sales at Twill, joined Brian Urban to share how Twill helps deliver better care tools, to more people, at a lower cost.For most of its ten-year existence, Twill was Happify Health. Behind the scenes, Twill’s been hard at work transforming its solutions toward intelligent healing. “We’ve seen an epidemic of point solutions happening in the healthcare space,” Murphy said. “Part of this has been because of the Covid-19 pandemic where everything suddenly moved virtual, and now healthcare partners needed a digital product for smoking cessation, weight management, or mental health. That point solutions epidemic got us thinking about how we should evolve as a company.”Today, Twill delivers sequences that comprise four distinct elements: digital therapeutics, care communities, digital-first coaching & telebehavioral health, and third-party integrations. In addition, Twill focuses on four therapeutic areas: mental health, psoriasis, MS, and the pregnancy journey. “Within each of those, we contextualize it for senior populations, a commercial population, or a Medicaid population,” Murphy said.Donovan said that community is a broad definition, but it’s ultimately about connecting a group of people and making them feel that they’re part of something special. “It’s a safe place. It’s a supportive place. People should be comfortable expressing themselves in a community, asking questions, and seeking answers through whatever highs or lows they’re going through, and we’ve seen such a need. Humans are innately social creatures.” Digital communities provide the type of interaction and support needed today.At the heart of these communities is a need for accurate health advice to support patients through their journeys. “To that end, we take the idea of moderation and managing the community so that it’s safe, appropriate, and people are getting trusted advice, and they know that they can rely on what they’re learning inside of Twill Care,” Murphy said.

Just before the pandemic, in December 2019, UPMC started its Center for Social Impact. Since then, the team has grown from two to twelve. The Center for Social Impact aims to address health on a holistic scale. UPMC has launched many programs in collaboration with partners. The motivation behind The Center for Social Impact was to collaborate, “We thought it would be useful to organize this into a more coherent framework, rather than a one off,” said John Lovelace, President of UPMC For You. “As we think of how to influence healthcare, we consider ‘How does food impact healthcare?’, ‘How does housing impact healthcare?’, ‘How does poverty impact healthcare?’, those are much bigger questions that if you don’t think about them in an organized way, you are just spending money on healthcare without getting as much of an outcome as you could be getting,” said Lovelace. The goal is to broaden the scope and intersect healthcare with other funding sources. The collaboration will, in turn, create a more robust, synergistic approach. And ideally, the sum will be greater than the individual parts. “There are many things we can’t do,” said Lovelace. But the program's foundation works to include existing frameworks and connections that people already have. It builds on what already exists and it makes the entire program more impactful. The program recently partnered with a massive database in the county. “Data is a large part of everything we do. It helps us make more informed decisions about what we can do for people. We’ve developed a data sharing, HIPAA-compliant data sharing agreement with the county,” explained Lovelace. The data helps the program remain evidence-based and better support the community.